Let's talk about health care

I'm old enough to remember 10 years ago, when health care was about insurance, and insurance was so valuable it was often reason enough on its own to take a job.

I'm an expat enough that I've been out of the country for most of the time the Affordable Care Act has been in effect.

I'm cynical enough to understand that "access to health care" is basically meaningless when it is shorthand for, "if you can afford it, you can buy it."

A lot of people smarter than I have written on this topic, so I'll keep this short.

Health care is not a luxury (like, say, a new iPhone) America as a country has strong incentives to have a healthy population--there is close correlation between health and economic productivity. All Americans benefit.

So given that, how do we make sure Americans are healthy? For most of my life, the answer was to have a government program that paid for health care for the very poor (Medicaid) and the old (Medicare), and everyone in between was left to fend for themselves. This was fine as long as you could either a) afford to pay your medical bills on your own, b) could afford insurance on your own or c) had a job that offered insurance.

The reality was that the simple expense of medical care and insurance was too much for many, and so millions of Americans went without either. This is an absurd thing to type considering the U.S. has the largest economy in the world by a huge margin, but there we were.

The Affordable Care Act tried to address that by (in simple terms) making health insurance mandatory and creating a system in which it was affordable. The mechanisms for both are of course incredibly complex. The results were pretty easy to see, with the number of uninsured Americans dropping dramatically.

The current plan to replace the ACA, for no real reason other than partisan spite, uproots a lot of what made the ACA work. It promises "access to health care," and its chief proponent, Paul Ryan, said the problem before was that healthy people subsidize sick people, which is both literally true and spectacularly dumb, considering people whose houses don't burn down subsidize firefighters to help those whose houses do.

Anyway. This brings me to Hong Kong, where I live now. Life expectancy and health in general are good in Hong Kong despite occasionally awful pollution. A large part of that is the public health system, which is staffed by well-trained doctors and is free. There is a private health care system too, as well as an insurance market.

First of all, it's important to note that even though the U.S. economy dwarfs that of Hong Kong, the 'Kong has extra money around because it does not fund a military. The current public medical system is largely a legacy of British colonial times but it is funded by current taxes, and Hong Kong, which is terrible at budgeting efficiently, always has money left over anyway.

The public system is effective. What it's not is friendly. You will feel like a number, you often will wait a long time for non-emergency care and you will not feel particularly comforted by your surroundings. You will also pay nothing, or very little, for your care. (Delivering a child and spending a few days in the hospital costs, all-in, about US$30.)

The private system is effective too--and friendlier, although bedside manner isn't really a thing in Hong Kong. What it's not, is cheap... let alone free. Getting a dose of oral vaccine for your kid at a no-frills clinic will run you about US$250 plus a consultation fee.

In my experience, doctors in the United States are more engaged with their patients and think more critically about their cases. A system that gives all Americans access to their expertise would benefit everyone.

You can see where I'm going with this. A system like Hong Kong's that allows private medical businesses to offer services while also guaranteeing free medical care to anyone who needs it--not just the poor or old--would be a huge positive for America. This is not a full-throated endorsement of medical care in Hong Kong, which can be frustrating and demeaning and even ineffective, but of the system that gives everyone access to a doctor.

Replacing the ACA because it was "the other guy's" idea is dumb and harmful. Improving it so every American gets health care, not just access to it is not.

In my experience, the latter can be done. It's a shame the Congressional majority is too focused on negative partisanship to realize that, or even try.

Tragedy, journalism and everyday life

It's true, I think, that when you get into journalism you know you're signing up for being exposed to things you can't unsee.

When I was reporting in Chicago, there were dead people. And body bags. And violent crime scenes that hadn't been cleaned up. But even if you never leave the newsroom, you're surrounded by images--on TV, the Internet and in print--that aren't always wonderful.

Right now, I'm more or less in the second situation: I've got a desk, two monitors and a phone. I deal with business news in Asia, which is never more than metaphorically depressing. But the refugee situation in Europe means that, like most of the world, I've seen horrifying pictures of dead children on the beaches of the Mediterranean.

Like I said, you know you're signing up for it. And for better or worse I think you get kind of inured to it after a while.

But for me, the emotion leaks through sometimes. There are two times this happened to me that stick out in my memory.

Once was when I was covering the kidnapping and killing of a boy (a celebrity's nephew, actually) in Chicago. I interviewed some of his family's neighbors. Talked to the police. Did normal reporting things. Was fine. Then I saw the picture we had been given to use with the story. It was from his birthday party. He was seated at a table, holding a balloon. A huge, innocent, joyous smile just radiated from his face.

Someone had taken that kid--defenseless and innocent--and killed him. I came home from work that night and cried. It was hard to stop.

The second time was today. You've probably seen the picture too: a three-year-old Syrian boy, lying motionless in the surf in Turkey. You can't see his face. He's dressed in a tiny red T-shirt and tiny blue pants and tiny black shoes.

He died because his parents are war refugees, unable to travel normally, legally, to a safe haven. I cried (discreetly, because I'm a professional) at my desk.

The latest one hit me harder, I think, because I have a kid of my own. I dress her every day. Sometimes she wears tiny pants and a tiny T-shirt and tiny shoes. She's defenseless and wonderful and I never want anything bad to happen to her. So what happened to the Syrian toddler seems all the more tragic and unjust. His parents' choice was to risk their lives living in a war or risk their lives trying to claw their way into a more promising country.

That's not a fair choice. Developed countries have plenty of room to help those trying to escape war, or religious or political persecution. It's the right thing to do, but if you're more of a "how does it help the bottom line?" type, the economic benefits of immigration--legal and illegal--are pretty unambiguous, at least in the United States.

As for me, I'm glad I'm not too calloused to react emotionally like that. I'd be worried if I were. But I hope--naively, I know--that the world will improve, and there will just be fewer images like this for me to react to.

That's the world I want my daughter to live in. Not the one where generosity is seen as weakness, and refugees treated as a nuisance.

The Art of Old Guy Basketball, Part II

Good evening, dear readers. I write this to you from a chair, which is not in itself unusual, but it is a chair from which I will not easily rise. That's because for the first time since arriving in Hong Kong, I played ball.

Oh, yes.  The Parents of the Blog got me a basketball for Christmas. I had been in the market for one for a while; our digs in Hong Kong are basically surrounded by public sports facilities, including some nice basketball courts. Many a day I walked by, taunted by the pristine nets--not chains!--well-maintained backboards and playing surfaces that, as far as I could tell, appeared to be scrubbed weekly, if not daily.

Someone pays close enough attention to the courts that the trapezoidal "international" foul lane…

The geometry makes it more fair, or something.

… had been scrubbed out at some point and replaced with the NCAA standard free-throw lane. Not only that, but the NCAA three-point line, which was recently moved to 20 feet, 9 inches, was up to standard. And you could see where the old one was before the groundskeepers scrubbed it off.

How to use the NCAA three-point line.

Anyway, the point is, I had been wanting to get out and see how bad my shot had gotten since hooping it up in the Middle East. Today, I did it (after buying an air pump at Toys R US. Don't judge; the sporting goods store was "sold out" of pumps).

The result is, as I mentioned above, extremely sore knees. But I finally got a glimpse of what street basketball in Hong Kong means, at least in our little overplanned high-rise forest of a neighborhood. Several observations:

1) On the courts where I was playing, everyone wanted to be a guard.

2) No one played a ton of defense.

3) The average height was greater than that of the rest of Hong Kong, but still less than 6-foot-3, i.e., me.

That meant several things. Point (1) meant that I, a guy who somehow managed to be a post player in high school (second-most blocked shots in freshman history, holla!), had an advantage in not just height but know-how. Everyone was willing to give up position in the paint, no one seemed to see my patented, and by that I mean totally telegraphed, shoulder-fake coming, and I boxed the hell out of anything that moved.

Point (2) meant that when I did get away from the basket, I could square my shoulders, set my feet, not jump, and have a clean look at the hoop. It also meant that by playing any defense AT ALL, I could affect the game. This type of nominal guarding saved me the embarrassment of wheezing to a halt on a court full of young whippersnappers.

Point (3) meant the obvious--even my 36-year-old, bad-kneed self could get away with not jumping a whole lot and still getting rebounds, blocking shots, and so on.

In short: It was the perfect recipe for a game of Old Guy Basketball. I didn't dribble much. I passed a lot. I didn't shoot more than a couple of times beyond three feet. I was probably really annoying to anyone chasing a rebound under the basket.

And my team won.

I will take comfort in that as I ice my knees.

This won't hurt a bit

I have a confession to make: I never visited a doctor in the UAE that I was not forced to. I got a physical because it was required for my insurance when I first arrived; I got a blood test because the government wanted to make sure I wasn't importing any horrible diseases.

But beyond that, I stayed away. This was partly because I didn't have any serious health issues, but mostly because I did not fully trust the system or my health insurance. In my work I encountered enough stories about badly trained doctors--or worse, doctors who had been kicked out of their home countries for some serious screw-ups--to make the idea of scheduling an appointment unappealing. Judging by my co-workers' experiences, a trip to the clinic was a bit of a dice-roll. Some people got good care, others got terrible care and just about everyone complained about Daman, the state-owned insurance company.

There's a lot more to say about health care in the UAE, but that isn't what this post is about. It's about Hong Kong and my first trip to a doctor here.

And I can sum that up easily: it was excellent. The office was clean and modern; the doctor was from Hong Kong but had trained in Britain; the process was efficient; the paperwork minimal. I literally had to sign one form and everything was taken care of. No money changed hands at all, not even for prescriptions. (I realize that for the Brits in the audience--wave so I can see you--this is not novel. But for me it most certainly is.)

The major difference from medical care I have gotten in the U.S., which has been excellent if not always easy to access, is a focus on treatment rather than prevention. It was my first time there, but no one measured, or even asked, my height and weight. The doctor took an extensive oral history from me, but his main concern was why I had come to see him and what he could do to fix me.

Like I said, all in all a great experience. It can be intimidating, at least mentally, to put yourself in the care of a physician in a foreign country, but this felt entirely comfortable.

I know I have a tendency to, shall we say, extrapolate good experiences; I didn't know what to expect from my visit, which made expectations easy to exceed. So this is not to say that there aren't bad doctors and decrepit offices in Hong Kong. But knowing you have someplace good to go for health care takes a little bit of the sting out of living far from home.

Horror movies

You know, I was considering some nice, harmless post about the oddly alien architecture here (which I may still do), the relative merits of real bacon vs. beef bacon (ditto) or even just how excited I am about the prospect of a leisurely weekend.

Instead I was exposed to something so horrific, I have to share it with you.

Thanks, Karl.

Yes. Canada's queen of pop is trying to not just cover but imitate a guy who, at least during the "Bad" era, sweated more panache changing a light bulb than Celine Dion has mustered up in her entire career. The whole performance, really, is summed up by her hair, which I pray to the follicle gods is a wig.

None of this, by the way, should serve as commentary on the Jackson-fest that we witnessed a few days ago. It was a little embarrassing how over the top everyone, including, perhaps most offensively, the media, went in mourning (celebrating?) the death of a guy who wrote some good songs and got weird when he was older.*

I guess you can count this as my contribution. Now... off to go contemplate bacon.

*And speaking of embarrassing, that was quite a comma-tastic sentence. Sorry.