a modest insight

I was having a conversation with my stepfather-in-law on Wednesday regarding health insurance reform and he remarked that change happens when doing nothing is worse than doing something. I observed that a little more was required: doing nothing had to be perceived as unacceptable. My sister-in-law then popped in with, aren't those the same.

We didn't get into it in any great detail at the time, and I revisited it with R. today, and after about a half hour of trying to figure out which aspect of this Mattered To Me, it turns out that R. views my addition as a subset of "costs" and trivially obvious: yes, you always have to take those into consideration. We harbor a suspicion that that was not was his sister had in mind, but we didn't ask her so we don't know. I was actually making a comment based in behavioral economics: the natural human tendency is more towards not doing anything, or at any rate, not changing anything.

The policy debate on health insurance reform has been prodded recently by a variety of progressive talking points, one of which my stepfather-in-law repeated. Another is referring to the people who don't want to do anything collectively as the status-quo lobby (and believe me, that does not have a good connotation in this context). People like my friend W.M. are a tad mystified by all this, because he doesn't necessarily believe that the status-quo is All That Bad, calling into question other talking points like premature birth (a highly problematic statistic that should probably not be used to "prove" anything, and which should be replaced by either a well-defined perinatal mortality number and/or death before age 5, depending on what your goals are).

It turns out when I say, doing nothing has to be perceived as unacceptable, I'm trying to articulate a very central belief. You could mock it: call it "change is bad" or "don't fix it if it ain't broke" or being conservative, but none of these are quite right, at least not to me. I think it's a hell of a lot closer to old-school Stoicism, because it ties into a lot of my ideas about remembering how much is enough, and having some standard that doesn't constantly escalate lifestyle and/or expectations, and reminds me to ask what exactly am I putting on the line to get some increment of something.

Also, I don't like being carrotted right off a cliff.

ETA: In case previous posts haven't made it brutally obvious, despite the sausage-y nature of the process and the product, I'm still pro-health insurance reform. Even if it costs us a bundle just to get rid of pre-existing conditions (which is to say, you are guaranteed they will offer you a policy, even if it is 2x or 3x or even more than it would be without that pre-existing condition), and even if the affordability bits are totally inadequate and blah, blah, bleeping, blah, I think just requiring health insurance companies to write policies for all comers is worth a helluva lot.

For one thing, once that requirement is in place and we see what the premiums look like down the road a piece, we can mangle things further if/when we collectively decide it is worth the hassle.

more on mammograms

I don't get it. But hey, here's a good sense of the range of response. First, a fantastic display of innumeracy and failure to understand the true costs of treating as cancer something like LCIS or DCIS or whatever, with all the risks attendant on such treatment (which include death), when odds on, nothing was ever going to happen, except the person would eventually die of _something_.

It's from Lakoff:

http://www.alternet.org/reproductivejustice/144177/47,000_women_could_die_as_a_result_of_the_new_mammogram_guidelines

Second, a letters to the editor collection to the NYT in the wake of their pair of editorials (which were both excellent, and I bought and am reading Aronowitz' book as a result of the op-ed):

http://www.nytimes.com/2009/11/21/opinion/l21cancer.html

The range here is better than Lakoff's foolishness; Lakoff is saying what virtually everyone center and slightly left of center is saying ("But how could it _possibly_ be a bad idea to _find_ and _treat_ CANCER! My God What Is the Matter With You!!!"), and which is only very marginally more sensible than what the right wing is saying ("Rationing! Soon they will euthanize you!"). The stupidest idea in the lettercol is the idea that you can somehow say no to the cascade after you start it with the mammogram. In theory? Sure. In practice? Oh, wow. Like holding back the tide.

Other sensible points -- made by people in health policy and by doctors -- include the dangers of radiation, the crappitude that is mammography as an effective screening device, and so forth. Best of all is this one:

"What has not been adequately explained are the other consequences of these false positives. How many of those 1,000 women die, and how many suffer greatly, as a result of needless surgery and toxic therapy? This crucial information is missing from every account I have read."

Thank you, David H. Raulet, "professor of molecular and cell biology in the Cancer Research Lab, University of California, Berkeley", and thank you, New York Times for printing his letter.

I would add to Professor Raulet's remarks that cancer != cancer, and the horror of millenia bears the same vague resemblance to breast cancer today that the wasting disease that was diabetes bears to what we call diabetes today, and the lethal killer that was high blood pressure bears to what we call high blood pressure today and so on and so forth, ad nauseum, I mean, seriously, retching and vomiting with disgust at how we can spend endless amounts of fear and angst and put ourselves through untold evils because we -might- possibly, in the future, be at risk of something really worth getting our knickers in a twist over.

Don't let me get started on PSA tests. Seriously.