Top 5

Tonight’s blog belongs in the category of sexual and mental health. It is very important for your sexual health and your mental wellbeing to compose a list of your 5 favorite hot famous dudes. I sat down with notable sister Emmy “Demmy” Dingdong to get to the bottom of this important health topic.

SEMI: Ok, Emmy, who is on your top 5 list?

Emmy: I don’t know, I’m pretty picky.

SEMI: Anybody of note can be on your top five.

Emmy: Ok…. young James Spader.

SEMI: No, the top five list isn’t a time machine. It must reflect the status quo.

Emmy: I think Ben Affleck seems pretty quality. Except for the whole J.Lo thing.

SEMI: Veto.

Emmy: You can’t veto my top five!

SEMI: I can.

Emmy: Fine. George Clooney.

SEMI: mmmmmm hmmmmmm

Emmy: I don’t know. Who else? I’m not into actors.

SEMI: Like I said, it can be anybody of note, such as New Mexico congressional hunk Martin Heinrich.

Emmy: Who is that?

SEMI: What about Ryan Reynolds?

Emmy: Yeah, him. I like the muscles on his arms. I like that he tried to date Alanis Morissette.

SEMI: Dude, you are so right. What about John Hamm, too? Remember John Hamm’s john ham?

Emmy: Yeah, he’s sexy.

SEMI: Ok, you’ve got three. We need to flesh this list out a little more.

Emmy: I don’t know. YOU come up with some names!

SEMI: I gave you John Hamm and Ryan Reynolds!

Emmy: Yeah, I guess. Do you know what the ‘multi-tasking face’ Bare Minerals is?

SEMI: No, stay on task.

Emmy: Ok, prompt me more.

SEMI: Well, you like silver foxes. What about Ed Harris?

Emmy: I will shoot you.

SEMI: I think Ed  is kinda sexy.

Emmy: Eww. Sick.

SEMI: Ok.

Emmy: Why are you writing all of this down? Stop writing. I want people to think I’m cool.

SEMI: Don’t worry. I’m just taking notes.

Emmy: I guess I don’t have a top five. Just George Clooney.

SEMI: What about Billy Bush?

Emmy: (laughs)

SEMI: Seriously, I think I’m the only one that thinks he’s kind of attractive. Him and Seacrest.

Emmy: Get help.

SEMI: Ok.

So, dear readers, you can see how a person’s Top Five is a vital part of the health history, since it can reveal underlying psychiatric disturbances. This is a very powerful screening tool, and should be used at each and every health visit to screen for mental illness.

P.S. After reading this, it’s probably impossible to believe that I got me my own NEWSPAPER column, but, lo and behold, I did, and it debuts this week. Details to be posted soon!

Addendum: We’ve since added Matt Damon and Nathan Fillion (described as “pretty cute”) to the list of potentials.

Blue Girls

As a nurse and a soon-to-be primary care provider, I am very much aware of many of the challenges faced by our nation’s youth. Witness the touching testimony of one young lady, who weaves a poignant narrative of how hard it is to dance at clubs and keep your cool around celebs unless the Jay-Z song is on. This particular tale ends happily, with our heroine overcoming her harrowing developmental milestone by moving her hips like yeah. But I can’t help but wonder she’s going to continue to overcome developmental challenges and attain optimal health as she ages. Will she receive appropriate education and support concerning sex, childbearing, safety, and personal responsibility and security? Will she choose intimacy over isolation? Will her faculties for empathy and social consciousness be nurtured? Will she have educational and occupational opportunities? Will she have access to preventative health screenings, prenatal care, and social and economic safety nets? Will she avoid substance abuse, will she exercise and eat right and maintain herself in order to achieve generativity over stagnation? Will she receive annual mammograms after 40 and colonoscopies after 50?  Medicare benefits after 65, and sensitive, age-appropriate care in her twilight years? Does our society promote integrity over despair in our senior citizens? Or do we continue to worship at the altar of youth, borrow against our futures, and funnel money into war instead of the education and health of our children and society?

I know, I know, moralizing on one’s personal blog is cliché and tiresome. And there are already countless reflections on the fragility of youth, the challenges of aging, the pervasive devaluing of the aged in our society, and the hilarities of Miley Cyrus out there. So I’m not really contributing anything new to the collective conscience with this post. But I’ve been thinking along age-related lines ever since, well, since the TV and the magazines at the gym taught me to. And now, as a nurse practitioner student, I find myself in the predictable position of providing care primarily for the baby boomer generation. And since  women utilize the majority of health care, it’s no surprise that most of my patients are middle-aged to elderly women. And so the question I get most often, as women squint at my face while I listen to their hearts or stare at my nose while I shine a light in their eyes is not “are you finding anything abnormal?” or “can I get a prescription for such and such,” but rather, “how old are you anyways?”

And when I tell them, they invariably get that tender, misty-eyed look as they remember themselves at my age and mutter, “oh, what I wouldn’t give to be your age again!”

The uniformity of this response… well, terrifies me. I am acutely aware of the fact that I won’t be this age forever, and that a future of  menopause, bone loss, indigestion, and jowls awaits me. I know my days of special treatment are numbered, that one day patients won’t look at me with misty-eyed tenderness, that I will eventually have to seriously worry about whether or not my outfits are appropriate for a “lady of my age.”

And so, in my terror, I ask my patients what it is they miss about being my age, or if they want to discuss some of the changes they have experienced. And usually blink once or twice. The misty eyes snap back into focus, and a hearty laugh escapes. “Oh honey, I’d never want to be your age again! That was a tough time. I just wish my body behaved like it was young again.”

And so we discuss exercise, diet and nutrition, bone health, sun protection, sleep habits, stress and coping, and the importance of joy, of family and friends and all that good stuff. And by the time they leave the office, they’re winking and chuckling and encouraging me to just hang in there, telling me that it gets easier, that it just keeps getting better. And so I choose to believe them, and I take good care of myself so I will be alive and well for the rest of the journey.

Caring for people across the lifespan has taught me to try to see a person in her entirety, as a child and a teen and a young adult and a middle-aged adult and an older person all at once, in order to understand the person in front of me, address unmet needs or unfulfilled development tasks and anticipate future needs. I find my ability to care for people is deepened when I acknowledge the frustrated young person behind the weathered face, or the lost elder emerging from the careless twentysomething. And I when I see people like Miley Cyrus, I anticipate the challenges they’ll face as the Jay-Z songs fade into obscurity, and I think wistfully of the Blue Girls and their future selves with “terrible tongues” and “blear eyes”. And I worry that mine will be a generation of thistle-prodders, of old women who look back and feel nothing but the ache of loss rather than the pleasures of a life well lived. Rather than standing tall to face the challenges that come with progressing through life, we pop in the earphones, turn the volume up and party in the U.S.A. Yeah-ah-ah-ah-ah-ah-ah.

By the by, this was all a very roundabout way of me telling you to take your antioxidant multivitamin in order to help prevent age- related macular degeneration.

The yeas have it

The U.S. House of Representatives narrowly passed its version of a health care reform bill 220-215 tonight, and  republican representative  Joseph Cao from Louisiana’s 2nd district, the lone “yes” vote from the GOP, emerges as the congressional darling of the moment.

Do I think this bill is good? Not particularly. Prohibiting recipients of federal subsidies from purchasing plans that cover abortion will really hurt some of the most vulnerable women and families in this country.  That’s just one of many disappointments in the bill. I hate that this is the best we can do.

But am I glad it passed?

Sure.

Now on to senate.

Shine, Perishing Republic

I’m sure that today’s headlines will mature into fodder for tomorrow’s brilliant Woody Allen film-cum-social commentary on love and happiness within the larger misery of the human condition –I mean, I can picture the scene where Cate Blanchett, impersonating Woody Allen, throws her hands in the air while exasperatedly pondering the absurdity of an American military psychiatrist opening fire on a crowd of U.S. servicepeople, killing a dozen and injuring scores more. How do these things happen? How are we supposed to receive, process, and reflect this information with our subsequent behavior, our ability to keep going and to find meaning in the broken world that surrounds us? Somehow methinks Cate Blanchett’s character will learn to love in the end, will accept the yin with the yang, will realize that for every violently deranged gunman, there are a hundred sensitive, kindly bloggers out there trying to make the world a better place. But meanwhile, back here in non-movieland, the forces that be continue to tiptoe around the fact that military suicide rates are climbing, and active and veteran servicepeople are at substantially higher risk for committing suicide than civilians (Kuehn, 2009, JAMA, 301(11), 1111-1113). As per violence, even the DOD admits that domestic violence against spouses of servicepeople is “a problem.” Unfortunately, data on rates of military suicide, homicide and other noncombat-related violence is hard to come by: searching CDC, NIH, PubMed, PsycheInfom, CINAHL and PMC databases didn’t yield much. Kuehn (cited above) determined suicide rates by extracting data from general CDC surveillence reports. I couldn’t find anything specific to the military. If you’ve got a source, lemme know!

Mental health is a hot topic for military PR right now, and the rising rates of active-duty and veteran violence and suicide has them Army boys sittin’ around scratchin’ their balls asking, “why?” That’s right. The NIH, the Army, and $50 million in taxpayer money are teaming up to investigate why soldiers commit suicide!!! Don’t get me wrong: I theoretically support suicide research and figuirng out why it happens. But in the case of  young men and women participating in and subjected to extreme violence, I think the answer is a little bit self-evident. Still, okay, okay, it’s good to study factors that protect servicepeople against suicide, because if we know what the protective factors are, we can keep asking “non-suicidal” people in the service to do our dirty work in intolerable environments without worrying that they’ll just kill themselves first. Ok, maybe that’s pessimistic of me. Maybe we’ll use the knowledge to screen for mental illness and treat suicidal ideation, or change military policy to accomodate those prone to suicide or mental illness (uh, yeah right). Or we can pile “protective factors” onto those at risk for suicidal ideation. Like how some of the first meth addicts were military pilots who were given meth in order to protect them against combat fatigue.

Today’s other headlines weren’t the counterbalancing pick-me-ups I’d hoped they’d be. Anti-abortion, anti-immigrant democrats (forgive my extreme ignorance, but I didn’t know there was such a creature) may jeopardize health reform, and H1N1 vaccines magically reached Wall Street before other needy clinics. Hey, you people who think the “honor system” is alive and well in the medical industry: I have already seen H1N1 vaccine go to members of non-priortitized groups, because someone asked nicely or somebody knew somebody or somebody was a VIP or whatever. I have objected, but some providers seem to be of the opinion that a little bit off the top won’t hurt. My most esteemed government, next time you can keep your honor system and instead hold providers accountable for each and every dose of vaccine you ship to them.

FYI: Hoarding of the swine flu vaccine isn’t just a domestic issue. It’s projected that there will be about a billion doses for the world’s six billion people.

Looking at today’s headlines makes me shake my head, and I can only borrow the thought of a visionary born a century before me (no, not Woody Allen): Shine, perishing republic.

H1Mew1

PSA:

Dudes, if you find yourself sick with swine flu, please refrain from making out with your cat. Really, it’s not fair to the cat. Also not okay to make out with when you’re sick:  Chorizo, your pet pig;  your dog MazelTov;  little children; pregnant women; pregnant children. All of these populations are vulnerable to catching swine flu. Keep your airborne viral particles to yerself!!!

Love,

The Management

In Vitro Infertilization

I don’t know about you, but my birth control experience isn’t satisfying unless I can be confident that my own immune system will be used to destroy my ability to harbor new life. Enter the promising up-and-coming antifertility vaccines, some of which target either the infamous pregnancy-sustaining hormone called human chorionic gonadotropin (hCG) or the libidinous hypothalamic henchman known as gonadotropin releasing hormone (GnRH) (Talwar, Vyas, Perswani & Gupta, 2009). Essentially, these vaccines work by stimulating your immune system to wipe these endogenous hormones from your system. Without these hormones, becoming pregnant or maintaining pregnancy is impossible. Furthermore, since cancerous cells can develop fun party tricks like hormone production and secretion, some cancerous cells (such as certain T-cell leukemias) are known to produce GnRH and/or hCG. Antibodies that target these hormones seem to help neutralize some of these cancers. Prostate growth is also stimulated by GnRH, and phase I/II clinical in Austria and India show atrophy of the prostate and improvement of prostate cancer in vaccinated patients.

As far as I can tell, interest in an antifertility vaccine began in the late ’60s/early ’70s. Significant gains were made in the ’70s and ’80s, and much of the work on the actual hCG/GnRH vaccines seems to have been done by various members of a small team of researchers out of India headed by our good friend G. Talwar (cited above.) If clinical trials continue to go well, Mr. Talwar’s baby (no pun intended) may live to see the light of the free market within the next five or ten years.

Objections to the vaccine are obvious: Groups or governments will abuse the vaccine;  vaccines  treat pregnancy like a disease; the vaccine is intended to impact populations and therefore supports a woman-blaming approach to population control; the H1N1 vaccine is actually the antifertility vaccine; since hCG is produced by a fertilized egg, the vaccine kills babies; babies conceived despite vaccination may be harmed by the antibodies; etc.

Some concerns are valid, though women’s advocacy groups will be happy to know that researchers are also making progress on an anti-sperm vaccine as well (Naz, 2009). And the rather one-sided focus on the cautionary arguments overshadows the possibility that this technology will be of enormous use in battling cancer and inexpensively, harmlessly controlling animal populations (Fayrer-Hosken, 2008). Still, one wonders whether the forty years worth of immunocontraceptive funding would have been better spent supporting sociopolitical and economic liberation of women and girls, or efforts aimed at environmental health and sustainability. Perhaps. Perhaps not. It takes more time and money to tackle population control by addressing overarching global problems like inequality, poverty, cultural and social rot, and systematic poisoning of the planet than it does to teach my immune system to bounce  any pesky hCG-secreting embryos hoping to get into my hot uterine nightclub.

 

Halloween Vaccine Sampler

For all you parents of trick-or-treaters worried about creepy neighbor Jerry popping a roofie into your kid’s “fun-sized”  glucose glob, I’d be more concerned about Junior’s little costumed friends and the sticky, slobbery, flu-infested mucosal secretions all over their chubby hands. Why? Because swine flu doesn’t seem to understand that it’s supposed to kill off old, sick people languishing in nursing homes instead of healthy little children and glowing pregnant women. That’s right. 95% of hospitalizations have occurred in those under 65 years old, with 45% occurring in children under 18. Believe it or not, the situation isn’t all just media hype and scare tactics. It’s ugly out there. True, not everyone dies or ends up in the hospital, but even an uncomplicated course of swine flu will park your ass in bed for a week or longer. So these days, I’m more worried about kids catching H1N1 than swallowing a razor blade hidden in a popcorn ball.

So there’s the usual “I don’t trust the government/science/western medicine/drug companies” grumbling over the H1N1 vaccine. Yeah, I get it. Sure, sure. Whatever. You’re not going to blow my freakin’ mind with the argument that the pharmaceutical industry WANTS us to be scared and WANTS us to get the vaccine because that means lotsa cash for them. I understand that profit is a motivating factor. That doesn’t really change the risk/benefits analysis all that much, nor does it change the fact that both the H1N1 shot and nasal spray are safe and effective, even for pregnant women (Tamma, Ault, del Rio, Steinhoff, Halsey, & Omer, Sept. 2009). So, if you’re able to, I’d toss a dose of H1N1 vaccine into your Halloween treat bag this weekend. Here’s info on how to pay for it. Here’s info on who should get vaccinated first. If you live in New Mexico, you can try these clinics, or contact your regular health care provider (if you’re lucky enough to have one). While you’re there, consider getting a seasonal flu vaccine as well (seasonal flu is different from H1N1 swine flu, and you’ll need a separate vaccine for each one.)

Hey, you also might want to throw a pneumococcal vaccine into your goody bag as well, since many viral flu deaths occur in people who develop bacterial pneumonia in addition to the flu.

And while you rot your enamel with sweet sugary Halloween candy, ponder the fact that we’ll soon have a vaccine against cavities (Li et al., 2009; Nui et al., 2009; Lui et al., 2009; etc., etc. Apparently Asia is all over this one.)

Sugar ain’t your thang? Perhaps the upcoming anti-nicotine and the anti-cocaine vaccines are more your style.

Too old to need anti-party vaccines? Keep holdin’ out for that vaccine against Alzheimer’s!

But whatever you do, don’t toss the condoms just yet. The new HIV vaccine was only 30% effective (which is still a major breakthrough).

There’s a whole exciting world of novel vaccines out there. From anthrax to cancer, the boring ol’ CDC vaccine schedules are about to get a whole lot more interesting. For now, though, I’ll be happy if I’m able to get immunized against the dreaded swine flu before I catch it from one of my germy little patients. Secretly, though, I’ll keep my fingers crossed for an anti-cellulite vaccine…

WICked

There were three men in my class during nursing school. One was very handsome and had a master’s in public health, one was a good-lookin’ musician who witnessed the long, painful death of a beloved family member when he was young, and the third guy… well, he ate a lot of cheese. Lots of cheese. Everyday. Like, a pound of cheese in his lunch, alongside a weird variety of other foods.

I asked him what the deal was with all the cheese one day. He looked at me, a little shyly, beneath long eyelashes (why is it that men always get the long, thick lashes?) “Well, my wife applied for WIC awhile back, and one of the few quality things you can buy with WIC is cheese.”

WIC, or the Special Supplemental Nutrition for Women, Infants and Children program, is  a program funded by the U.S. Department of Agriculture intended to supplement the diets of low-income moms and kids. A few years ago, people realized that the food packages available through WIC were devoid of key nutrients such as whole grains and fresh produce, so the USDA has recently changed the guidelines for WIC food packages to include healthier options. Through regulation of food packages, WIC aims to affect the dietary quality and habits of participants. WIC is not intended to be the primary source of food or simply general food assistance for participants. “Rather, WIC food benefits are scientifically based and intended to address the supplemental nutritional needs of a specific population–low-income pregnant, breastfeeding, non-breastfeeding postpartum women, infants and children up to five years of age who are at risk”  (USDA, 2007). Food package guidelines are intended to give state’s considerable flexibility in designing food packages to meet their population’s specific needs. In addition to food supplementation, WIC also provides nutritional assessments, counselling, referral, and other services.

The issue of WIC resurfaced recently in my life when a classmate and I discussed a project she’s working on to increase access to locally grown produce and locally produced foods via WIC. This prompted one of those “I know, right?” conversations in which I shared an anecdote of recently noticing that the only WIC-approved cereals at my local grocery stores were chocolate-blasted corn crushers or whatever. After vigorously applauding her efforts, I addressed my mounting curiosity on the subject of WIC-approved foods by consulting a trusted Internet colleague, Dr. Google. A list of currently approved foods for New Mexican WIC participants can be found here, while comparison of old WIC food packages to new WIC food packages is here. And though I’m not claiming that putting cocoa-covered sugared corn bombs into the hands of toddlers is the absolute best use of public money, I did learn that those cereals (which now have to have a whole grain content of at least 51%) are an extremely important source of iron for WIC participants, and so the whole whole-grain-or-not debate is really secondary to the nutritional goal of iron supplementation. Most remarkably, my classmate’s goal of increasing access to healthy, local foods has already begun to surface here in New Mexico with WIC’s farmers market program. I couldn’t find any information on whether or not the farmer’s market program has increased the currently inadequate fresh fruit and vegetable consumption (Ponza et al., 2004) among participants, though.

Now, I am grateful that WIC exists. But, like my classmate, I believe if WIC exists, it should exist in the most effective form possible for participants and for the community. Which means there’s still work to be done. For example, WIC moms are less likely to breastfeed than eligible non-participants (Jacknowitz, Novillo & Tiehen, 2007; Ponza et al., 2004). Whether this is because moms who enroll in WIC are less likely to breastfeed in the first place (perhaps they are more likely to work outside the home than their eligible non-participant counterparts?) or because WIC makes infant formula available is unclear. Much of WIC’s interventional energy is aimed at promoting breastfeeding through support (for instance, moms who breastfeed exclusively receive a heftier food-package benefit than non-breastfeeding moms) and education, so this finding is worrisome. Of course, this begs the question, what is really the best way to promote breastfeeding in this population? Does it have more to do with the available food packages or education/support services or with perhaps with other factors that we can’t hope to address with a program like WIC?

Joyce, Racine & Yunzal-Butler (2008) wrote an illuminating article on the matter of how effective WIC programs actually are in terms of reducing adverse birth events and improving health of women and children. They essentially conclude that, although the success of WIC has been overstated, modest effects on fetal growth and emphasis on positive lifelong habits justify continued funding of the program. They say that more emphasis should be placed on reducing smoking among WIC moms, promoting breastfeeding, establishing positive life-long habits, and providing support— in essence, the educational and social support services are just as important as the food packages provided by WIC.  Which simply illustrates how nutrition doesn’t exist in a vacuum, and seemingly cut-and-dry programs designed to increase the amount of protein available to pregnant or breastfeeding women or calories to growing children must address numerous not-so-cut-and-dry factors like culture preferences/practices, education, and the tendency to select cheese over swiss chard at the grocery store..

Barely Legal

Being a nurse can be really fun. You get to watch babies being born. You get to dry a seconds-old human off with a stack of soft receiving blankets fresh from the warmer. You check the first set of post-uterine vitals, clear gunk from the airway, count fingers and toes, adorn the kiddo with her first bling (a hospital I.D. band), and place that slightly smushed pink bundle of joy against her 13-year-old mother’s chest for first the first time.

As you try to help the new mother breastfeed her baby, you can’t help but notice that mom seems confused and distracted. “Let’s put the cell phone away for a few minutes so you can hold your baby with both hands,” you gently instruct this lucky young lady. “Hold on, I’m in the middle of a text,” she replies. You wait patiently. Baby yawns. Suddenly a gaggle of middle-school girls barge into the room and flock towards the baby. “Oh, she’s so cute!” they exclaim. “Is it too soon to pierce her ears?” one asks.

Baby’s hungry and starting to fuss. You tell mom that her baby needs to eat. “Can we do it later? My friends are here!” she says.

Now, I’m not relating this anecdote, which I’ve experienced with nearly every young teen mother I’ve taken care of, in order to laugh at the frivolities of teen girls. Nor is this to say that all young moms and dads are too immature to function as parents. Just most of them. Which is why I welcomed Obama’s strategy to prevent teen pregnancy back in May, which put an end to abstinence-only funding and instead focused on evidence-based interventions. Sadly, the fun didn’t last, and I aspirated chunks of my own partially digested freedom fry when I read this a few weeks ago, which says that those rascals over in the Senate Financing Committee voted to reinstate funding for Jesus only abstinence-only education.

For practical purposes, the most important part of the abstinence-only versus comprehensive sex education debate is the evidence demonstrating how woefully ineffective abstinence-only education is (Kohler et al., 2008; Roosa & Christopher, 1990; Underhill, 2008; etc. etc. etc.) and how effective comprehensive sex-education programs can be (Oringanje et al., 2009). Unfortunately, the paucity of well-designed studies from either camp means that there isn’t really strong support for a definitive statement on the matter. Furthermore, pinning the phenomenon of teen pregnancy solely on the shortcomings of sex education is dangerously short-sighted and allows us to conveniently ignore larger cultural, sociopolitical and economic factors that contribute to teen pregnancy. So why am I choking on my own vomit at the thought of funneling $50 million of federal money into abstinence-only education? I don’t know. Maybe it’s because of the subtle and not-so-subtle messages of sexism, racism and classism embedded in most abstinence-only curricula (Froyum, 2009). Maybe it’s because the teen pregnancy rate is rising at the same time that contraceptive use amongst teens is declining (Contraceptive Technology Update, 2008). Maybe it’s because I was socialized to think poorly of early childbearing and think highly of education and financial independence. Maybe it’s because I didn’t learn Jesus and so I believe that teens will do what their healthy, fertile, baby-friendly little bodies tell them to do. I don’t know. Maybe it’s just because one of my little 13-year-old mamas told me she hadn’t heard of condoms before she started having sex. Had she been privy to the forbidden secret of wrappin’ it up, she might not have to face the emotional trauma and economic instability that naturally arises when one attempts to text message and breastfeed at the same time.

The Gatekeepers

Though I typically role-play only within the privacy of my own home, I thought we’d try a little exercise here on SEMI. Lets pretend that we’re presented with a group of starving people. Why are they starving? I don’t know. Pick a reason. Ok, let’s go for broke here. Maximum emotional impact. Extreme example. They’re starving because they are in a concentration camp, duh!

“I want to help!” you say. “Let’s get these people some food!” A group of your friends agrees. You go about trying to devise a way to get these poor starving folks some food.

“We’ll give them money, and they can go out and buy food,” offers somebody. Another person points out that, unfortunately, even with all the money in the world, these people will still be burdened by a lack of access to food, seeing as they are, uh, confined to a concentration camp. Not a lot of food providers around these parts.

“Ok, let’s distribute food directly to them,” counters someone else. Someone in your group objects, claiming that they believe your group is too inept to perform such a task yourselves.

As a group you mill over various ways of providing the people in the camp with money, food, and access to food for a while before another person in the back raises his hand and jumps up and down excitedly. “Oh, I got it! I got it!” he shouts. You recognize him. Wow! It’s Republican Senator Grassley from Iowa.”Let’s give money to the people RUNNING the concentration camp! They seem like they know what they are doing! Then people in the camp can apply to these wonderfully organized, efficient camp managers for food!”

This proposal receives robust support from the camp managers. Your group of friends cuts a check to them, and everyone goes home.

Is this a poor way to illustrate Sen. Grassley’s proposal mentioned in today’s Washington Post?

“Some Senate Democrats, along with a key moderate Republican, Sen. Olympia J. Snowe (Maine), are now discussing ways to increase assistance for individuals and families who could face premium costs of up to $15,000 per year by 2016. Sen. Charles E. Grassley (Iowa), the ranking Republican on Baucus’s committee, is suggesting government assistance to insurance companies to help them control premium costs.”

Maybe. Is it extreme to compare insurance companies to Nazis? Sure, I suppose. I don’t know. The Nazi/Hitler analogies have been rampant of late, so I’m just jumpin’ on the bandwagon here. But in this case, many people have died from treatable conditions due to denial of coverage. Could this perhaps be because an insurance company’s existence is predicated upon taking money and keeping it?

Another choice quote from todays WaPo article:

Obama sought to ease concerns among young adults, who are now among the least likely to purchase health insurance, but who would be required to do so under the Baucus plan. Healthy 20-somethings are key to successful reform, because their payments to insurance companies would offset the costs of care for older adults.

You know, this is really funny. Like how young workers would pay into social security to offset the costs of all the old folks collecting social security? Except now the young people, like me, get to cushion a private company’s profit margin so that they can continue denying the claims of old or sick people. Fantastic! So here’s my open appeal to old people:

My dearest Old People,

I understand that, through no effort of my own, I am young. I understand that being young furnishes me with responsibilities towards those older folks who built the world in which I am living today, and as such are no longer young. I am prepared to accept this responsibility. But couldn’t I just give y’all the money directly, or couldn’t I just pay taxes and work a job in which I directly care for old and sick people like I’ve been doing for the past five years?

Smooches,

SEMI

P.S. My most precious Old People, I eagerly await your reply.

By the by, I can’t wait to live in a world where we all spend 20% of our income on goddamn “health care”:

For families buying insurance through the exchanges, the expenses are likely to mount even more rapidly, the CBO said. For example, a family of four making $78,000 would face insurance premiums of 13.9 percent of income, or $10,800, in 2016. Add deductibles and co-payments, the cost could rise to $15,300 — just under 20 percent of income.

Note: even a family of four that does not access health services even ONCE during the year is still legally obliged to pay almost $11k for insurance.

So we’ve heard the financial projections on the Washington side: this plan costs about $800 billion over ten years, it doesn’t add to the deficit, and amending the plan will naturally result in a higher price tag. But what about the financial projection for insurance companies and other “industry leaders”? I can’t wait to hear about their third-quarter earnings following enactment of this legislation.