Anecdotes from The American Healthcare Front

teacher-kidney.jpg
Teacher at exit ramp looking for a kidney donation

I have some issues with my ears periodically, and over the past week, it felt like one was developing a minor infection. It felt full a lot and started to become painful. I knew that I was going to need to give it some medical attention. I thought about going to my primary care team at Emory, formerly Harken Health. In the Harken days, primary care appointments were included in your insurance and you could schedule to go by any time. They also managed patient load so providers would have time to develop relationships, and they partnered with health coaches that could deal with the para-medical stuff so the medical pros could focus on things requiring their specific skill set. Now that Harken’s gone, Emory still has great staff, but works like a regular doctor’s office – scheduling visits always takes a few days, visits are shorter, and the health coaches, where they exist, are swamped and can’t give the individual attention my Harken coach gave.

The ER was out of the question, that’s a minimum of $2K spend and a distraction from people who need truly urgent, serious care. (Don’t believe me? Stop by an ER and try it for yourself. A friend of mine had stress-related chest pain due to the amount he was working and how little pay he was receiving to cope with the other stressors in his life and got slapped with a $5K bill.)

Urgent care is probably the best option, but that was going to run me a bit as well. Not too much, maybe a hundred or so. But of course I already pay several hundred a month for insurance, so that’s frustrating that my insurance is really more “hit by a bus” insurance than health care.

I ended up repurposing some antibiotic ointment I had for a recent eye injury that unequivocally required a doctor’s visit (that I’m sure I’ll get a hearty bill for soon), and it worked. I’ll keep at it for a few days to make sure it’s good.

Now, I have the means to get decent health care, even if it’s not convenient and a little pricey. What are people who have no flexibility in their schedule doing? What do you do when taking a half-day off work means you may be eating ramen next week, or nothing, because you’ll be fired “at-will”? And what happens when you face a real challenge that’s out of your control, like the teacher above who needs a kidney to live? If he can find the kidney, he will probably have decent health care as a state employee, but what if he didn’t have great insurance? Who would pay for that?

Those who support interdependent community do ourselves a disservice by allowing Medicaid for all, or any of the other public options, to be portrayed as an altruistically valuable but optional program, a gift to the neediest among us. It’s not a matter of kindness and convenience, without which life would be a little less pleasant but still bearable. People are choosing between medical bills and house payments, between medical bills and food. And it doesn’t take a significant condition or a bad decision.

We in the middle class especially make the mistake of thinking that we are where we are because of good decisions. The rich are lucky, sure, accidents of birth, right place, right time, but not us. We scrimp and save. We plan. We forego instant gratification for the long term, and look at our lives as a result. If we can do it, anyone can.

The truth is, we make the same bad decisions as the poor all the time. We buy a car that’s a hundred a month more than we should be paying. We spring for that dessert, or that hotel upgrade, or that extra night out on the town. The only difference is that we are not on the line between sustainable and unsustainable, and have a bigger cushion to absorb those mistakes. If you are making just enough to live on, springing for dessert could make you miss a payment. Missing a payment causes you to hit fees that push up your effective interest rate into triple digits. And the spiral begins.

I listened to a couple on NPR a couple of years ago that ran a food truck in Wisconsin. They were struggling, as the spouse with a corporate job had lost it, and lost their benefits along with it. When asked how they would deal with the cost of health care as they aged, they shrugged (with indecision rather than indifference) and finally stated that their children would take care of it.

I don’t believe this couple was intentionally so selfish as to burden their children with such a responsibility. But the language of American self-sufficiency has backed us into a corner. We cannot conceive of a world where a public good is actually, well, good. However, we readily imagine that a giant corporation motivated by profit will take care of our needs as well as our consumer desires. We respond with a sort of Stockholm Syndrome, where anyone on the wrong side of a law that protects the right to profit without regard to human cost deserves nothing, deserves to be cast aside. We are the worthy ones, because we currently have what appears like favor, but instead is simply utility to a soulless, unfeeling set of economic machinery.

As usual, any critique of the current order by an American must be met with “but I’m not talking about socialism!” So let’s get that out of the way. Public goods controlled by elected or especially appointed authorities who are not accountable to the people is just authoritarianism. This is what we saw in every single country that we love to hold up as inevitable outcomes of socialism. So no, I’m not talking about turning America into a giant commune or turning everything over to the government, certainly not while we have an apathetic republic that won’t hold its elected officials accountable in any consistent way. I’m also not talking about eliminating inequality. Human nature is to be rewarded in a proportion to effort, and any system that doesn’t allow that will eventually be overthrown by one that does.

But why do we think that this relentless pursuit of profit is the best of all possible worlds? We generate money printing machines that consume the landscape and crush the spirits of the people, and aggregate more and more for the machine’s makers. More importantly, we have created a mythology around poverty that causes us to see it more as damnation from a god that has refused your feeble sacrifice, while wealth is a blessing and a reward from a god that respects your hard work. This mythology is why we have the IRS losing money to chase small debts while corporations that evade billions in taxes are ignored. It’s why we won’t pay for Medicaid for All and are trying to dismantle food programs, quality public education, and other portions of the safety net, even though evidence keeps coming back that these investments are cheaper than the alternative.

Where the Christians have it right is that this is a heart issue. America loved the social safety net when it primarily benefited white men in the New Deal era. When the program was expanded to benefit more Americans through the Great Society, subsequent administrations quickly set to work dismantling them. Beyond the cost savings many properly implemented programs could bring, we have to ask ourselves what intangible cost our individual lack of accountability to our community brings. Are we safer when everyone is on their own financially? Are we less stressed when everyone has to work long days in cold environments? Are we happier when our neighbor cannot be counted on to care for us if we’re in need? Are we freer when every gift we give has conditions?

Who is my neighbor? And what is my obligation to them?

Singing America

I, too, sing America.

I am the darker brother.

They send me to eat in the kitchen

When company comes,

But I laugh,

And eat well,

And grow strong.

Tomorrow,

I’ll be at the table

When company comes.

Nobody’ll dare

Say to me,

“Eat in the kitchen,”

Then.

Besides,

They’ll see how beautiful I am

And be ashamed—

I, too, am America.

-Langston Hughes

A stray browse on Ancestry.com turned up the white ancestor on one side of the family yesterday. Most black people in America have a white ancestor. When black people were enslaved, slaveholders asserted full dominion over black bodies, and children produced from rape were endemic. For many of us, the trail goes cold at 1865, as individual slave records were much less common. After all, no one reports the names of their cattle even today.

It was appropriate that I found this ancestor around now, as it’s the time America celebrates its rebellion and creation of a new country. My 5 times great grandfather fought in the Revolutionary War. He also owned slaves. His son, who carried his last name and was my 4 times great grandfather, was listed as “mulatto”, or mixed-race. My 5 times great grandmother is not documented by name.

Once I found the white ancestor, my automatically generated hints went from a trickle to a flood. Hundreds of clues about colonial settlers, landed gentry, and nobles appear. This is also unsurprising. As most white people who don’t want to face race conversations will point out, the majority of white people didn’t own slaves, and as such wouldn’t have likely had interactions with black people to produce children once racial caste was codified. If you are black and your white ancestor was a slavemaster, it’s thus likely that your ancestor was a person of means.

I traced that section of family to Welsh nobility and English gentlefolk. I even discovered that B. F. Goodrich, the tire manufacturer, is a distant cousin. I couldn’t help but feel a sense of fascination and yes, a bit of pride in knowing these interesting stories behind these portions of my family. It also made me sad.

I think of my 4 times great grandfather William. Under what circumstances did he leave home? Was he sent with resources? Was his father’s wife kind or cruel to him? And I think of the family rich enough to have named land within the town they lived. What did they pass on to their “legitimate” children?

This is the balance, the contradiction, that Langston Hughes talked about in his poem “I, Too”. A Revolutionary War soldier, descended from Quakers, owned slaves, likely forced himself upon my ancestor and produced the line that ultimately made me. I’m descended from enslaved people and nobles. I am a product of documented history and secrets.

When I was in 8th grade, I was talking with a white friend about heritage. I said I didn’t know what mine was, but I knew on one side of the family I had some Creole ancestors. She went on a rant that would have made a white nationalist proud. She said, “you know what Creole is? A mixture. That doesn’t mean anything. My ancestors were Irish and Polish, and came over on X boat X years ago. That’s a heritage!” Being young and not especially versed in self-esteem, I made the mistake of allowing that to make me feel ashamed.

There’s an unmoored, lost feeling many of us as black Americans feel when it comes to ancestry. The trails stop cold in 3-4 generations usually. People disappear due to lynching or rapid moving away under duress. Families uprooted and fled north in patterns that we would call “ethnic cleansing” today. With resignation, we see it as another thing taken from us, like wealth under Jim Crow and what came after, like dignity under enslavement.

I’m still learning how to navigate the genuine feelings of pride I have in America and the anger and disappointment I feel toward it. And as I imagine my ancestors near, I wonder how old Reuben Roberts navigates an afterlife alongside those he enslaved, witnessing who I am becoming, and who my sixth cousins on the other side of the racial line have become.

I’m thinking of going to his grave to ask, but the dead are notoriously difficult to get answers from.

The Talk

What you’ll learn here is important.
Sit quietly, now, and let me explain.
I will show you how this works.

First, be perfect. No errors in diction,
in posture, attire, stride, or movement.
What you’ll learn here is important.

Second, be patient. Watch your grandfather,
mother, brother, daughter, push the rock uphill.
I will show you how this works.

The rock will slip at the top of the hill,
but see! This time it falls not quite so far.
What you’ll learn here is important.

The secret is blood and bone, piled so high,
the rock can slide no further. Progress!
I will show you how this works.

Your ankles’ skin will serve for bootstraps,
and one day, your flesh will shorten the day’s work.
What you’ll learn here is important.
I will show you how this works.

-C. G. Brown
9 April 2018

Y.N.D.

“Your nigger dead.”
Checkmate. A King just got shot.
“Your nigger dead.”
I had to shoot. He was smoked out on that pot.
“Your nigger dead.”
He had a gun, crowbar, toy, a cell phone.
“Your nigger dead.”
He shouldn’t have carried that in front of his home.
“Your nigger dead.”
He was twelve, but he looked like a grown man.
“Your nigger dead.”
He left me no choice. It wasn’t my plan.
“Your nigger dead.”
She shouldn’t have mouthed off at that cop.
“Your nigger dead.”
If you weren’t a criminal, the violence would stop.
“Your nigger dead.”
He shouldn’t have tried to run away.
“Your nigger dead.”
He was a threat, even still as he lay.
“Your nigger dead.”
Selling loosies is a crime.
“Your nigger dead.”
It’s better that we skipped the judge this time.
“Your nigger dead.”
Stop saying you didn’t do nothing, you lie.
“Your nigger dead.”
You come for me, it’s gonna be “Die, Nigger! Die!”
“Your nigger dead.”
You can’t treat Samaritans with respect.
“Your nigger dead.”
She’s a slut. We stone. What else did you expect?
“Your nigger dead.”
Talking about some, “I am”! Who are you?
“Your nigger dead.”
He should spend some time with real Jews.
“Your nigger dead.”
Enemies of the state get crucified.
“Your nigger dead.”
“Your nigger dead.”
“Your nigger dead.”

Naw, death’s gon’ die. We still alive.

-C. G. Brown
4-5 April 2018

Fifty

Fifty years.
Fifty years since one of the greatest theologians and social activists of the 20th Century was shot down.
 
Who is Rev. Dr. King to you?
 
To too many Americans, he is a messiah of cheap grace, who finished the work of racial reconciliation in his blood, because it was too hard for us. In this false good news story, we are now clean, blameless, and above reproach. For this group of us, challenging systems and behaviors that persist is insulting, unreasonable, and unfair.
 
To many more of us, he’s a Great Figure of History, like Frederick Douglass, George Washington, and so on. For this group of us work is important, formative, but vague and disconnected from our daily lives.
 
As I meditate on his life and death today, I think about how far we can progress in fifty years. When I went to my college Reunions parade for the first time in the 90s, the fiftieth anniversary alumni had their first black members. My class wasn’t at the proportion of the country as a whole, but there were hundreds of us. When my father registered people in the Alabama countryside to vote fifty years ago, the experience seemed more like one of the countries we cluck at today, with citizens afraid to vote because what might follow was state-sanctioned murder by the white members of the community. Today, it’s a short and easy trip to Memorial Drive to vote early, or across to a nearby church to vote on the day. I’m far more worried about being late for work or late for dinner as a result of voting than I am about making it back home.
 
Despite this, we still have problems. Racial animus wasn’t erased, it was buried. Individuals who actually got to experience life with people from other racial groups were better for it, as we found none of us neatly fit into the stereotypes and tropes created to keep things as they were, or created to protect the vulnerable. (As an aside, something you must understand is that while white stereotypes can be hurtful and unfair, they were created to protect vulnerable people of color in a system designed to keep them oppressed and to eliminate those who got out of line, while stereotypes about people of color were designed to dehumanize and justify the continuance of same system. So while we should let go of all stereotyping, the hand-wringing and false equivalence should be released as well.) But as black people moved in, white people moved out. Old laws that were explicitly, undeniably racist, were not removed from the books, but simply (usually) not enforced.

Grandparents and parents who grew up in a system designed to protect their benefits and raise their preferences at the expense of everyone else taught their children how unfair it was that these people now were getting such large slices of the pie. Looking at the slivers being cut for others, they’d say, “Why, there’s hardly any left for us! We used to have the whole pie, and now these people who didn’t even help bake it get to eat it up. What about us? We’ll starve!” All the while, their eyes remained averted from the kitchen where the pie was made.

We plow on as resolute and relentless individuals, completely unaffected by the portions of the past we find distasteful, and clinging to those portions of the past we think are critical. We have had no lament about where we have been, no place to process any sense of collective shame or guilt. We have had no reconciliation. Given this, is it any surprise that we have elected leaders at multiple levels of government who are individualistic, who have no sense of shame or guilt, who have no ability to weep with those who weep?We could speculate about what King would do or say if he were still here to guide, to be a conscience, but there are only a few people who have studied him enough to be qualified to do that. What I’m more interested in is what I’m going to do and what you’re going to do.

If you are white, ask yourself the following questions:

  • Am I in multiple actual relationships with non-white people where we talk about real issues and feelings?
  • Am I under the leadership of non-white people in any aspect of my life? Professionally? Spiritually?
  • When I disagree with non-white people about where we are on race in this country, do I look for other non-white people to validate my beliefs?
  • Have I ever borne an emotional burden about something they’ve experienced regarding race with a non-white brother or sister?
  • Have I ever felt shame or guilt, untempered by resentment or resistance, around the way things are in this country, even if they’re not my fault?

If you are not white, ask yourself the following questions:

  • Am I in multiple actual relationships with non-white people of different ethnicities than myself where we talk about real issues and feelings?
  • Am I under the leadership of someone non-white of a different ethnicity in any aspect of my life? Professionally? Spiritually?
  • Do I center the pain of my ethnic group and compare it quantitatively against the pain other ethnic groups have experienced, or do I lament with other stories of injustice?
  • To what extent am I complicit in holding up systems of power that unfairly preference those that have historically held power?

The reason why none of these questions are reciprocal toward white people is because since white is the historically dominant group, all of these preference raising questions come naturally. It’s not anything magical about the notion of whiteness; it’s just how cultural dominance works. You will be in relationship with the dominant group in some form. You will be under leadership from someone in the dominant group. You will understand their preferences and cater to them if you want to thrive. So for those of us new to this conversation, please understand this isn’t a finger-wag at something you were born with. This is about being intentional about dismantling imbalances in systems of power.

When I hear King the philosopher and social activist speak, I hear him asking us to seek the Beloved Community. When I hear King the pastor speak, I hear him asking us to lay down our preferences at the Cross and seek the well-being of our brothers and sisters at both an individual and systemic level.

Looking at 2068, what kind of country do we want for our grandchildren? Do we want a country that’s still in a cold Civil War that’s now 200 years old? Do we want a country that sits in resentment, fear, and individualistic separation? Or do we want to make the braver, harder, choice, and plow forward in love, letting lament and a sense of righteous shame break our stone hearts and remake them as flesh, then letting our collective love and intimate knowledge of each other heal and reconcile?

It sounds like a pipe dream when you put it like that. But just sixty years ago, I’m sure someone sat at their dinner table and thought “I appreciate what King is saying, but he’s crazy. Things will never change.”

As-Is

This house is falling apart.
The paint crinkles, bends backward,
ripples like skin on cold soup.
Beneath, drywall experiences ennui,
waits for a purpose beyond demarcation.
The ceiling and the walls recede.
The floor bends, tilts to one side or the other.

The load-bearing wall talked to me this morning.
She’d had enough of the weight.
She told me how, overwhelmed by the pain,
she whimpered at night. The floors creaked
in sympathy, but then were silent.
The front wall said, “me too,” but offered no buttress.

This house is falling apart.
One day, the occupants who so blithely reside
will find themselves awakened to a crash,
as a wall awkwardly ambles down a suburban side street
and facades, shocked by their loss of bearings,
try not to crush them on the way down.

-C. G. Brown
2 April 2018

“God Is In Control.”

Advance Note: You’ll see me use the word “conservative” a lot in this. While there is overlap with the political meaning, I intend it less as opposed to politically liberal and more specifically referring to the traditionalist and fundamentalist perspective of the conservative Christian church in America. I’m doing my best to look at a conservative witness against itself and against the Gospel rather than against a liberal witness or liberal view on the Gospel. 

I recently had an exchange with a friend about the current state of politics in America. Like many, even though she’s not a Trump fan, she downplayed my concern about Trump’s authoritarian leanings, citing that he was just one man. I said “sure, but the Republican Congress is moving in lockstep with him from a policy perspective.” She said, “not always.” I responded, “Name one major policy area where they haven’t. ACA? Consumer Protection? Deregulation? Immigration? Foreign Relations?” We could not identify an area off-hand, and I’m also not aware of any Republican-led initiatives that prompted Trump to use his veto power.

She responded to my restatement of concern about where America could end up with a favorite phrase of comfort among evangelically-minded people: “God is in control. God is sovereign.” I was reminded in that moment of an exchange I’d had in 2016 on social media with a friend who was pretty much diametrically opposed to me politically, where she responded to my fears of a then merely-possible Trump presidency with the same statement.

Another friend with whom I was conversing pointed out that that comforting phrase about God’s sovereignty is seldom used to assuage fears of cultural change, or immigrants, or crime. It only seems to appear when people are expressing concerns about conservatism going too far. Regardless of intent, the phrase can seem to the listener to be saying, “God is in control because I am comfortable, and it doesn’t matter if you are not.”

Like Paul, I can claim the title “chief among sinners” in seeking my own comfort and convenience, though I actively work against it. However, the Church is supposed to be a place where we support each other through the incredibly rewarding but often quite uncomfortable and countercultural life of Christianity. What is this desire that has taken hold in the American Church for comfort above witness? Comfort above compassion?

“God is in control.” is a phrase that reminds me not to worry or obsess about temporal matters, however massive they may seem at the time. It breaks me out of my navel-gazing social media loops and friend circles to recognize that both problems and solutions are bigger than I am. It reminds me to recognize that the arc and scope of God’s goodness is not limited to my narrow view, but expands and unfolds at the periphery and beyond.

Much of the American evangelical church uses this powerful phrase now as a blindfold, a gag, and binding rope. It blinds the speaker to human needs directly in front of them. It silences those that complain about social injustice by telling them that there is a problem with their faith if they don’t see how God’s point of view is aligned with the speaker’s, even if it is hurting the listener. And it ties the hands of both, telling them to be passive and let God’s wonderful plan finish playing out without meddling.

If God’s sovereignty means that I should not take any action to protest against conservative policies that seem to be literally killing people either through hostility or inaction, then why does God’s sovereignty not equally apply when I see abortions being allowed, or cultural changes that I don’t agree with spreading, or when immigrants come across our border to seek a better life? Why is it that when it is a conservative point of view that needs assurance and patience, we need to take action in protest or policy change? But when the concern is that the conservative perspective has become Pharasaic, or that it has become a hypocritical, compromised witness, then God’s sovereignty becomes a call to be still, silent, and show a passive grace.

God is in control. Yes. God is sovereign. Absolutely. But if you’re saying it to reinforce your comfort, your culture, your understanding to someone else who is challenging those things, then it’s time to re-examine your heart. Would you still say God is in control if it were you who was uncomfortable? If it were you who were being persecuted or treated unjustly? And if not, who is?