Between You and Your Doctor

I find it just wonderful that conservatives are still pulling out the “A government bureaucrat between you and your doctor” canard in their fight against health care reform. I guess I can see that argument working during the Clinton years, when things weren’t quite as bleak as they are now (although, being a teenage dependent with two well-off parents, I never had to worry about health insurance during the Clinton years, so what do I know?). But relying on it again now? Balls, folks: that takes some.

For a little under twenty years, I’ve been dealing with chronic pain. (No, not my back problems. I’m going to refrain from discussing my specific condition itself in order to keep the focus on the politics.) Because this condition is hard to diagnose and often misunderstood, I’ve gone without treatment for most of my life. In fact, the only two times I’ve had regular treatment for it were in college and grad school, when I had the twin luxuries of student health insurance and autonomy from my parents. In college, the doctor I found was well-meaning, but ineffective. In grad school I had a great doctor, and together we started to make progress. But then I finished grad school.

For about a year, I went untreated again until a flare-up made me realize that I needed to find a doctor despite the cost. My husband and I did some budgeting – I currently subscribe to Blue Shield’s cheapest plan, which only covers basic exams and major disasters – and found a doctor who charged a sliding scale. She was awful. For a few months, I went untreated again, and had another flare-up. It turned out that a friend of mine has a similar condition, and she gave me the name of her specialist.

Here’s where the story gets interesting.

I made an appointment with the specialist – and loved her. Within ten minutes of our first appointment, she’d described my condition with eerie accuracy and outlined what sounded like an effective treatment plan, with options that I’d barely even known about. Her bedside manner and level of expertise were terrific; she put even my grad school doctor to shame. At the end of the appointment we talked money. My current insurance didn’t cover regular office visits, so I’d be paying completely out of pocket. I gulped at her office visit fee – even paying for that first appointment was going to be interesting. I talked to my husband and we agreed that I’d have to get a new insurance plan. If we ditched the cable, the Netflix subscription, and a couple other amenities here and there, we could pay more for something better.

I looked at other Blue Shield plans while my husband looked at Kaiser. I figured that while I was getting a new plan, I might as well search for something that covered maternity. I looked at plans going up to $200, $250 a month – nope, nope, nope. Blue Shield doesn’t like its members having babies.

Meanwhile, my husband found a Kaiser PPO (at least, we thought it was a PPO, but I guess that’s kind of rare for Kaiser) just barely within our price range. It was $139 a month – yikes, but okay. It had a fairly good maternity plan. We called their office to find out if this doctor was in their network. They didn’t know. They gave us a regional number to call. We called. No, this doctor was not in their network.

Next we tried Blue Cross. I don’t even remember what plan we eventually found, because the whole website was so labyrinthine. We didn’t bother calling them before we filled out the form because, hey, everyone takes Blue Cross, right? The application took all morning – and we even left off in the middle because I needed to dig up some old information.

Later that day, I talked to the doctor to reschedule our next appointment, since it was taking so long to find a new plan. I asked if she took Blue Cross (just to be absolutely sure – because everyone takes Blue Cross!). “Uh, some of their plans,” she said. “I don’t know, some but not others. It’s all very strange. I don’t even handle that part of it.”

We called Blue Cross. No, the plan we’d selected didn’t cover her. Were there any plans in our price range that did? Tappa tappa tap, pause. No, there were not.

So we went back and called Blue Shield, told them I was already a member. We asked for any plans at all that covered this one doctor. Damn the cost! We’d use our savings! We’d move into a smaller apartment! We’d rob a bank if we had to! What was the doctor’s name again? We spelled it. Nope, they said. Blue Shield of California does not cover this doctor at all.

We called the doctor again, canceled the appointment, told her we just couldn’t afford her. I still owe her for our first (now useless) meeting – $150 down the drain. I cried, I was so disappointed. All that work, all that hope, for nothing.

I’ll probably never know why no insurance plan would touch her. She wasn’t some bizarre, esoteric practitioner or anything; my best guess is that only employer-paid plans cover her. But when I hear conservatives trotting out the specter of “a government bureaucrat between you and your doctor,” I have to laugh. Because right now, at this moment, I am gritting my teeth through 20-year-old pain while the doctor who could have treated me goes about her business 2 miles from my apartment. Bureaucrats are standing between me and my doctor.

On the one hand, if conservatives are going to try to block affordable health care, the least they could do is come up with a less insulting argument. On the other, I guess it’s to my advantage that they’re making themselves look like total idiots.

We’ll go ahead and give Pacificare and Aetna a call, but I think my course of action now is to go for the original Kaiser plan we found and hope that there’s a doctor as good as this one in their network. (Of course, the maternity coverage raises some troubling questions. Does Kaiser have midwives? Doulas? Birthing centers? Will I have to give birth on my back? But I’m not pregnant, so I can cross that bridge when I come to it.) If we ever get a national health plan in place, then sign me up – but I’m not holding my breath. My one wish for those who oppose it is that they someday experience health insurance that is comparable to mine.

(A note on comments: because I know what types of comments posts like these tend to receive, I am declaring myself Queen Tyrant on this thread and will delete offensive comments without warnings or justification.)

(Cross-posted at Alas, A Blog.)

Self-Sufficiency Sundays: Stack Your Functions!

In Permaculture lingo, “stacking functions” refers to building redundancies into a sustainable garden. In a forest, a tree doesn’t just do one thing; instead, it performs multiple jobs, like regulating climate, sequestering carbon, holding soil together, providing habitat, and giving food, just to name a few. One of the problems with industrialized society is that almost every aspect of our lives is specialized – there are shockingly few things we do or have that that perform more than one or two functions. This is especially true in our food and habitat (for most of us, houses and apartments), and it leads to an incredible amount of waste. Imagine if forests needed a separate organism to do each and every single job that one tree can easily perform.

Take, for example, a lawn. The lawn is pretty much the epitome of wasted space. Most of the time, it performs one single function: looking nice (if you like the way lawns look, something I personally can’t wrap my head around). Sometimes – sometimes – it also serves as a recreational area, so that’s two functions, which wouldn’t be so bad if lawn wasn’t the single largest crop in the United States. If you add a hedge to the edge of it to make it look nicer, you again have a plant that probably only serves one function – and notice that they don’t help each other out very much. If you find it impossible to keep your lawn healthy, this wasted space and lack of relationships is the reason why. Lawn is a monoculture, and there’s a reason monocultures never occur in nature.

To build a truly ecological garden, you need to make sure that all your plants are performing multiple tasks (and that all tasks are being done by multiple plants – more on that in a minute). For example, if you’re a fan of flowers, don’t just get a variety that looks nice. Try to find a flowering vegetable or perennial herb, or a creeping vine that acts as mulch or shades a window, or an edible flower like nasturtiums, or a flower that feeds and creates habitat for beneficial insects and spiders. If you’re growing vegetables, go for natural configurations that help the plants help each other. The most often cited example is the Three Sisters garden, in which squash, corn, and beans help keep each other healthy through mutually beneficial relationships. The corn provides a stalk for the beans, the beans fix nitrogen in the soil, and the squash acts as mulch. See The Urban Homestead or Gaia’s Garden to learn how to do it, or check out Kai Chang’s blog for updates on his garden. Another way to stack functions is through a polycultural bed, in which seeds are scattered so that vegetables come up in no particular pattern. The random placement of beans means that you don’t need to rotate your crops to amend the soil, and the close proximity of plants shades the ground so that the temperature is regulated and moisture is preserved. Again, see Urban Homestead or Gaia’s Garden.

Think about stacking functions in terms of landscaping, too. Why plant some anonymous hedge when a rosemary bush is edible and produces adorable flowers? If you’re looking for border plants, why not plant strawberries or chives, both of which also flower? If you never use your lawn, why have one at all? Edible landscaping, polycultural beds, or a fruit or nut tree can look just as nice (better, in my opinion) as grass. And if you take your climate into consideration when you’re planting, it’ll take much less work to care for your garden.

It’s also important to make sure that multiple plants are meeting a particular need, in case something happens to one of them. If you want to grow food, don’t just grow one plant or type of crop – if it gets a disease, then there goes all your work for the season. If you live in a dry climate, don’t rely on just one source of water – use multiple irrigation and conservation methods, like a soaker hose, thick mulch, a cistern, and berms and swales.

To reduce waste, try to stack functions in the rest of your life, too. One example from my own life is transportation. When I drive my car unnecessarily, I’m wasting both gas and time; notice that the car is only performing one function. If, however, I ride my bike, now I’m getting exercise while I travel. If I ride the bus, I can read or grade papers. If my destination is close enough to walk to, then I can listen to a Yiddish tape while I exercise and travel. Note that since most people reading this blog probably live in a car culture, the car makes sense, for now, if you’re in a hurry or if you need to carry a lot of stuff. However, since the earth doesn’t contain enough resources to sustain car cultures indefinitely, consider the virtues of animal transportation – a horse will give you fertilizer and companionship in addition to healthy transportation. (Horseback riding is a workout, right? It looks like it, at least.) Also note that this form of stacking functions shouldn’t turn into an addiction to multitasking. If you’re doing more than you can comfortably concentrate on, or if it’s stressing you out, then you are canceling out the good effects of your functions.

Conversely, living in a place that gives me the option of walking, biking, taking public transportation, or driving is an excellent system of redundancies. If my car or bike is in the shop, or I’m temporarily disabled, or I don’t have time for the bus, I still have plenty of options. I’ll never be completely stranded as long as I’m traveling within my city.

Another area of your life in which you should stack functions is food. Over the past century, we’ve developed a bizarre system in which, generally speaking, pleasure and nutrition are separated from each other. We eat fast food and chips and then buy vitamin supplements. We choke down iceburg lettuce and then crave cookies and soda. The whole reason we have a sense of taste is because a good taste, absent artificial ingredients, signals good nutritional content. If the food you’re eating isn’t both pleasurable and nutritious, then there’s a problem. It’s probably not your fault, especially if you’re low-income, but it’s a problem nonetheless. Western culture needs to drastically change its food system.

Finally, think about stacking functions in terms of space and garbage. If you have one room in your house for the guest bed, one room for each child, one room for eating, one room for watching TV, one room for entertaining guests, and one room for working on the computer, then you have too many rooms. (Full disclosure: I myself currently live in an apartment with too many rooms.) Like the lawn, all this wasted space creates a lot of unnecessary work. Can you put your desk in the guest room? Do you need both a living room and a den? Similarly, if you use a disposable cup once, for fifteen minutes, and then throw it away, that cup has only performed one function in its entire lifetime. Use a glass instead – or, at the very least, compost the disposable one and feed it to your plants. If the cup isn’t compostable because it’s plastic or has wax or poisonous dyes or whatever, then that’s a bad system.

Of course, the idea of cutting down on garbage is hardly revolutionary – but in practice, it can be maddeningly hard to pull off. This is why the best way to really start stacking your functions isn’t to simply pat yourself on the back for using canvas bags at the grocery store or travel mugs at the coffee shop, but to honestly evaluate every single object you use. If it only performs one function – or if it’s not reusable or even biodegradable – then it’s wasting space and resources. Once you realize that, you can begin figuring out what to do about it.

my garden

Image description: close-up of a calendula blossom in a basket hanging from a rail.

About My Body

(Note: soon after I started writing this this morning, I realized that it’s heavily influenced by BFP and Jess’s (Re)Thinking Walking series at Flip Flopping Joy. I’ve had a troubled relationship with walking for a few years, but their essays helped me crystallize a lot of thoughts that were amorphous, and I doubt I would have come to this essay without them.)

About five years ago, I worked as a computer services aide at a public library. Most of my job consisted of running around the main branch fixing problems and installing software. Sometimes the running around was virtual – we had a program called VNC, which allowed us to freak out librarians by manipulating their computers remotely – but more often than not, it was physical. I’d run around. Well, walk. I loved this job because it allowed me to move, exercise, be active, interact with people, hide out occasionally in the stacks with a book as software installed or there was a lull in demand. So one day I was walking around, carrying a box of floppy disks from one project to another, when on the mezzanine between two floors, I felt a sudden stabbing pain in my hip.

I stopped, stunned. I’d never felt pain like that in my life. Holy shit, was it strong! What the fuck!?

But by the time I’d even registered it, it was gone, so I kept walking. About ten minutes later, I felt it again. It was so absurd that I actually laughed out loud. It was perversely fascinating.

That day, my hip felt tender for awhile but it went away by nightfall. I didn’t even think to mention it to my boyfriend. Over the next few days, though, it started to come back gradually – not a sudden, stabbing pain anymore, but rather a sharp ache, like a cramped muscle or a joint that needed popping. It would almost reach a crisis point and then fade. I’d always had back problems, so I assumed it’d go away on its own, but it didn’t – instead, over the next few weeks, it got so bad that I began to have trouble walking. Not that I stopped walking; after all, I didn’t think anything was actually wrong. I considered myself kind of a sissy about pain. The limping? Oh, whatever, I figured everyone got that sometimes. Every day I’d walk downtown to meet my boyfriend for lunch and ignore the stabbing, aching, and squeezing that was going on around my tailbone. I’d have to stop several times to rest it and rub it (not that either had any effect). I still rode my bike. I refused to take pity on my pelvis. I kept pushing it to do whatever I felt like doing – except, as the pain got worse and worse, I began pushing it just to behave normally.