An Almost Civil Disagreement

Max and I disagree.

But we are civil enough to at least attempt to discuss our differences.  We both admit that neither of us should expect to sway the other one at all.  We also will try to present our ideas in terms that could possibly be consistent with the other person’s values.  But really, since we certainly don’t share values, we have a tough time understanding why the other person is such a moron, especially when the truth is so obvious.

However, to begin with, we actually both agree.  We agree that our great country, the land of the free and home of the brave; home of the creative, the entrepreneurial; beacon of hope to the world, with a government of the people, by the people and for the people, — is a mess, and headed in the wrong direction.  We also agree that part of the problem is how terribly divided the population is, and that this division has become more hostile and disrespectful. 

We disagree about America’s priorities, more specifically about what to do about taxes, health care, big government, wages, education, race relations, immigration, refugees, war, weapons, guns, banks, the Fed, welfare, climate control, energy policy, Donald Trump, Hillary Clinton, All of the Bushes, Israel, Muslims, Christians, Jews, China, the Middle East, the whole defense budget, cities, suburbs, sex, the electoral college, the right to vote, abortion, transgendered people, soda and salt, and many, many other ways in which people care, govern and relate to each other.

We have some overlap in our ideas about Russia, job training, Ben Carson and gay people.

If you want to know more specifically what his positions are, then watch Fox News and read the Wall Street Journal.  He has those positions down pat, almost word for word. My ideas, which I like to think are the result of hours of thought and refection, after reading many sources, are actually close to what you get from the New York Times and NPR.

Not surprisingly, Max was raised in a rich semi-rural suburb in Virginia.  I was born in Brooklyn, NYC.  Really, that’s all you need to know.

Here are some of my generalizations of where we disagree.  If you want to read what Max  thinks, then you can go find his web page. He believes that people should be self-reliant.

Max believes in good and evil.

I believe in cause and effect.

Max believes that the most basic American freedom is the opportunity to make as much money as you can, and that the government should stop messing around with that.

I believe that America’s greatness comes from how it guarantees freedom of speech and thought. The government is there to protect us all equally from being exploited, intimidated or harmed by anyone. I also believe that the government should do whatever it can to help all of us improve our lives, liberty and pursuit of happiness.

Max says he believes that all people are created equal and are free to do whatever they want with their lives.

I believe that the rich and powerful have always, always, exploited those who are poorer and weaker, and that they very rarely give up their advantages without a struggle, often with violence, but not always.

Although he hides behind euphemisms, Max believes that some people, mostly those like him, are intrinsically worth more than others, due to their native endowments.

I believe that we are all equal in our insignificance.

Max believes that men and women are equal, but also that they are basically different, and they should both keep to what they are best at doing.

I believe that is bullshit, sexist and exploitive.

I believe in science, and in using data to see what is going on and to help make the best decisions.

Max feels that science can be confusing and can be used to prove anything, and that good, common sense is enough to decide what should be done.

I believe that due to rapid advances in science and technology, shifts in population dynamics, and climate change, this country is going through a major transition, and once all of those things are recognized and accepted, and we learn how to integrate all of these new things into how we live and work together, our country will be much better and stronger.

Max agrees with all of that except that last three words.  He would substitute weaker and worse.

I think we both would like to find some common ground, but we don’t know where.

We have tried talking.  We have even tried listening.  But we both have very strong core beliefs that we can’t give up. It makes compromise difficult.

Why all this?

My girls are stressed. They are worried about wild animals and poison ivy.  But they are four and five years old and they have just been able to realize that the world is full of danger, especially if they're away from Mommy or Daddy. It's a normal reaction.  They have found out that the world is full of difficulties, but that's never going to change.  The difficulties these two little girls face are ripples in the water compared to the waves that most of the children of the world have to deal with, but everything can look ominous when you're four.

What saddens me more is how much fear and stress so many adults seem to be carrying around, and I'm not talking about the folks who are risking their lives to find safety, fleeing from countries where governments and rebels kill everyone in their path.  I'm referring to people who are trying to earn a living, support a family, pay for college, plan for retirement, take care of a sick or old person -- all the things that happen in a life.

I've been reading the book Sapiens by Yuval Noah Harari. In the early part of the book he makes the point that the move from the life of the hunter/gatherer to the agricultural way of life was a big step for civilization, but not a good move for most of the people the vast majority were peasants and had to work the land as long as the sun was up.  A few nobles and royalty lived the life of leisure. Now, I can't say that I agree with this, as I have not interviewed too many hunter/ gatherers. The lives of some of the  adolescent street kids I see actually seem to depend upon many of the same skills that helped the survival of our very early ancestors, and the lives of these kids is certainly quite stressful, so I'm not sure I agree with him.

But the point is this, technological advances, whether it is the ability to harvest wheat, develop GMO crops, find directions with a GPS, or ask Siri how to make onion soup, are all ways that make life easier, but also have the unintended consequence of making life go faster, and thus making people more stressed.

One hundred years ago, when T.R. was president, he would work from 9 Am to noon.  He would send out letters and and wait two weeks to get an answer.  Now everything is instantaneous. The result is that people have to work all the time. If you open an email people expect an answer, immediately.  Now people won't read their emails.

Even fifty years ago most people worked 9 to 5, went home, had a cocktail, watched TV and went to bed.  Now people can work at home, but they also feel the pressure to be working 24 hours a day.

AND, since everything is running constantly, businesses have learned to charge on a subscription basis.  There are fewer things you own; that can be paid for once and that's it.  Every month we pay for cable TV, protective software, phones, cloud storage, data, software,.  Medical companies have caught on.  Drug companies have developed medicines we need to take a pill a week or every day for the rest of our lives.  Nothing is cured; we pay on subscription.  Oxygen tanks are rented, breathing machines are leased.

That means we have to keep on working to make the monthtly payments.  Even a mortgage had a 30 year limit. Iinternet, wireless and medicines go on for ever.

It's supposed to make us healthier, but it creates stress.

So don't worry, the coyotes who roam suburbia won't eat you, but the corporations, who are just there to make a living -- except for places like Volkswagen who knew they were cheating us-- will help keep the stress level high.  And stress corrupts our immune system, which makes us more vulnerable to depression, cancer, diabetes, and just plain irritable pissed-offedness, which stresses relationships.

I don't know if there is a way out, except all of my patients who are over seventy seem to have found the TV station that plays only shows that ran before 1972.  Gun Smoke, Mayberry, and Leave It to Beaver seem very reassuring as the antidote to stress.  Fox News brings on heart attacks.

another upbeat week

Let me repeat, as I may have said it before, and that in itself is part of the problem, I mean, me saying it before, and again. And what I'm saying is, that sometimes, part of it is, that growing old kind of sucks. And I'm not even that old, or even in bad shape or anything. But there are the things you don't know, and can't even think of when you're young(er). You can't know; and you don't think you will get like this, but you will, even with super-growth-hormones.

"Old man, take a look at my life, I'm a lot like you are." I remember that song from when Mr. Young and I were both 23. Now, we are getting to be (get that,only getting to be) the old man.

But that's OK. The getting old is OK. What makes it hard is that everything just comes around again. Just when you gather up enough hope to think it's better, it gets washed away. How many times? Many.

And I feel like a sucker each time, that's what hurts more. Each time I get riled up and think maybe I, we, they, have figured out a way, to make it better and to make it last. But then it gets washed away, like the castle in the tide, and now the hard sand on the beach is all flat again.

Does it matter? Not really, to me, directly in many ways. I'm still OK, my kids are OK. I am basically healthy (but slower) solvent, no real debt. The house is warm and dry. I have more 'stuff" than I know what to do with. The internet works fine. I could spend the rest of my left playing Soduku. Who would notice? My wife doesn't really know what I do up here anyway. I gave up porn years ago when I saw what could have been one of my clients in one of those movies. Really freaked me out.

I heard an early Dylan song also. He was running down the road because someone called him a Communist. They still chase you down the road even if the think you're a Socialist.

And who get hurt? As I said not me. Yes, people get hurt, many. The same ones. The ones in the cheap houses, with no credit to get the pipes fixed when they freeze. They live on the low-lands near the river and get flooded when the snow melts and the river rises. They lose their jobs when the factories move to China. Their kids have to drop out of college because they are smart enough to get a $10,000 scholarship, but college costs $47,000. So they go back to selling Toyotas, and now even they are busted.

Or they live in Gaza city.

And so many more people are getting on the State Insurance now, just like people were afraid of. State run stuff, can't be good. And you know what? That's true too. The state pays me less and they send out new, incomprehensible rules every day.

Private insurance companies are greedy. They lie, cheat and swindle. They take your money and throw you in the gutter. Public insurance is complicated, incompetent, and inefficient. They take you taxes, put you in a dirty bed, and leave you there.

The problem is that they are both run by people. THAT's the problem.

Can't blame people though, because that's who were are: cute, lovable, well-meaning, but flawed.

Can't just sit around either. That makes me feel as if I've given up, kind of useless, old. Don't want that.

So, I guess it''s back at it. Or at least it will be on Monday.

How's that for a happy ending.

The future has arrived

I got a good glimpse of the future today as a big package arrived from one of the managed care companies I try to avoid dealing with. They informed me that they have taken over two of the state's biggest contracts -- the ones that are sure to get bigger as more people turn to The Commonwealth Connector to get the insurance they are mandated to have. There was a nice letter congratulating me for being invited in to the select group of providers. I can now accept patients from two of the state sponsored plans that previously only could go to semi-private under-funded full-service clinics staffed by pre-licensed social workers and non-English speaking psychiatrists. Now, it is my privilege to see these multi-problem families at a low rate of pay, with a high co-payment, thus insuring that many will drop out of treatment when they realize what it will really cost them.

Since I have already adopted the attitude that going to my office almost qualifies on my tax forms as a hobby, I will probably sign the contract, and in that way I will be able to see all of my old patients who had gotten laid-off and lost their good insurance.

The truth is I really would not mind working this way, as long as I could be sure that the people who run this managed care company were getting the same hourly rate that that I am. Probably not the case.

heath care rant of an old psychologist

I put the follwoing rant up on a psychologist bulliten board. I thought I would put it here too.

(rant starts here)

It looks like the Senate Finance Committee has delivered its version of the Heath Care Bill, and guess what …. We, as a nation, and psychologists as a profession, are f**ked. Not a big surprise.

The Senate version does not have a public option. Max sold out to the insurance and drug lobby. The Republicans are against a public option. They say that government can’t run anything well and they don’t want to trust their medical care to the government.

They have a good point. Here in Mass, where we have health care for almost everyone, many of the subsidized people are getting moved off of the usual Medicaid program and on to a new, more bare-bones plan. The plan is low-cost, with high deductibles and high co-payments. And guess what, mental health services get paid less, much less. And guess what else, they have carved out the mental health services to a managed care company from Dallas. So, what’s new there? Nothing.


America has a great deal of trouble finding a way to provide health care to its citizens. In my small mind there are three major reasons for this:

1. Too many people are making money on health care and they don’t want to stop. In most other countries doctors makes less, hospitals are run more efficiently, and not as a business, and no one financially benefits from asking for more tests, owning stakes in MRI labs, giving out the pills of certain pharmaceutical companies, running a nursing home, or using people’s illness as a ticket to leveraged riches.
As a note to this I need someone to explain to me how private insurance is allowed to sell policies to young, mostly healthy people, and to make a nice profit on them, and then, when they are old and need much more costly medical attention, they are then put on the government’s dollar, on Medicare.. Of course Medicare runs a deficit. They have all the old and sick people. The young people send their money somewhere else.

2. Americans hate to pay taxes. They feel that every dollar they acquire, through work, dividends, inheritance, lottery, poker, cheating, stealing, or lying, is their money, and they don’t want to give much of it to the government. Of course, the government should provide the infrastructure, should keep them safe, educate their children, blow-up all possible enemies, subsidize farms, banks, unions, scientific research, mortgages; keep air and water clean; save the fishes, worms and birds, and do anything else the population may need to make money and stay healthy. But no one sees a need to pay taxes.
Look at California. They approve of many great programs, for science, education, the environment, and many more BUT they don’t approve any money to pay for it. So guess what? They are bankrupt.

3. Too many people, and too many businesses lie. They probably always did, but now with constant, total communication, it just seems to be pervasive. I don’t believe any advertisement. Whenever I see something on TV, on a web site, or if someone is selling me something, I believe the opposite of what is being said. Perhaps I am old and cynical, but doing this has saved me a great deal of money and aggravation.
I have come to believe that we now live in a culture that accepts this. We don’t expect anyone to do much of anything that is not directly in their own best interest. We don’t want to see this country as a cohesive society. And we certainly won’t give a dime to an “alien.” It was not always this way. But once some people and some businesses began to take advantage of other’s good intentions, it became clear that unless you got tough and suspicious someone would take advantage of you. So people learned.
So many psychologists are good caring people, doing as good a job as they can with the limited tools at their disposal, and guess what? Most of us, who are part of the system, have not gotten a raise in fifteen years. Now, as a reward, we will get paid less, no matter how this turns out.
I think Mr. Obama made a sincere effort to change the system. I think at times he may wonder why so many people deserted him when he thought he was doing what they elected him to do. I’m sure he can’t understand why people are more willing to pay $900 a month to a for-profit company, when they could probably get similar service by paying $400 a month in taxes. But, as I said, they won’t pay taxes.
We will inch forward. We will probably find a way to make sure that people with existing illness can get coverage, and that even if you don’t have a job you can find a way to buy health insurance, even if it is a lot of money for a not very good plan. Yet, in truth, this is progress.
Anyway, soon I will be on Medicare. I don’t want the government messing with my Medicare. And “death panels” don’t scare me. When the time comes I’m buying a Harley.

(rant ends here)

more discussion

It seems that, among others, we have a "Right-Wing-Radio-Republican" in our midst. There are hordes of people who have been out there for over twenty years now who have decided that the best way to enter into a political discussion is to scream, slander, debase, and just throw all kinds of hyperbolic charges at the opposition. It's the "all Democrats are dangerous," and "Liberalism is a disease" type of argument that only leads to greater divisions in the country. Everyone says they are against it untle they realize that it takes only 270 electoral votes to win.

But, as we can see from the last two Presidential elections, it works. Perhaps a lie is still a lie no matter how many times you say it, but then how many people still believe that Saddam Hussein had anything to do with 911?

Now we have McCain leading the cheers for Ms. Palin, as if she has become the next American Idol. Her qualifications seem about the same, cute, popular, and can give a good scripted come-back. Ms. Palin may be strong enough to be Vice-President, but she seems to be a kept hot-house flower who is not allowed to speak for herself without a card to read.

Once again, it's great theater. How many times can we run the 9/11 movie?

Obama must be amazed that McCain can flip from being the "experience" guy to being the "new change guy" just because he says so. Who has time to really see if it means anything when you really are worrying about making the next mortgage payment?

Oh, and on health-care. That's the field I work in. Everyday I see how intrusive, wasteful, inefficient, insensitive and expensive our "free-market" system is. It is designed to make people money (even me) much more than to keep people healthy.

Here they come again

Here is the real problem. They call themselves "Health Care Companies" or health Management Companies" or some other misleading euphemism. But the truth is they are financial companies. So, when they come after me and tell me to fill out their Patient Outcome Management Forms, of their Patient Wellness Assessment Forms, or TOP Patient survey, I get upset.

They tell me that they are trying to help me make clearer diagnoses. Or they tell me they are trying to help their subscribers find the best clinical matches. It's all a lot of shit.

All they are trying to do is trying to find ways to justify their existence AND to pay us less.

Two of the major conditions necessary for successful psychotherapy are trust and understanding. I don't trust these companies, and I don't think they really have any understanding of what we do. I don't want their "suggestions" of how I should do treatment. If they know hoe to do it they should be out here doing it. Their suggestions don't come from any research that I respect. The symptoms they want me to treat are not symptoms that I really care about -- they are symptoms, not the problem.
They will go away when the issues are addressed.

But now it is fashionable for each company to begin to make their therapists accountable and monitor their effectiveness. Except they really don't know how to do that.

It's all about the money. They've collected it from the subscribers and they don't really want to give it away to us, the care-givers. An adversarial system of health care is never a good one.