Tuesday, January 26, 2010

How Sixty Votes Killed Healthcare

The confidence Obama radiated when it came to managing a generational and massive change in health care puzzled me. It was more than confidence, really: somehow fixing health care was such a sure thing he could give Congress all the time it needed to work out the details, none of which seemed essential to him. Occasionally he would make impatient noises, but not loudly enough to bother anyone involved in the process, if you can call with a straight face the months-long debacle we witnessed a "process."

But what was clear from the beginning was that the process involved having sixty votes, the supermajority necessary for the senate to pass anything more significant than a tribute to motherhood. Any filibusters could be overcome with sixty votes. Obama knew this, and many very smart people believed it. He wasn't that concerned then with the details: he wanted a few Republican votes too to sanctify the new bi-partisan, or maybe it was post-partisan, era.

Why not give in on a few details, like the public option, when, in the end, he couldn't be filibustered and he had a majority of the Senate? He was certain that he would get enough of what he thought was needed that the rest could be corrected and improved over time.

The only problem with this don't worry, be happy, give a little here, give a little there approach was that he didn't actually have sixty votes. I haven't been able to sort out how many he brought to the table with any degree of precision, but I'm estimating conservatively he was at least five votes short of the magic number.

I blame Howard Dean, who, as chairman of the Democratic National Committee, had the brilliant idea of heading up a fifty-state campaign rather than just sticking to those seats which, traditionally, the Democrats had won or held in the past. Dean's strategy worked, in a way. The Democrats won seats in traditionally red states, which is what got them within claiming range of the sixty vote trump card. When push came to shove, though, the idea that these red-state Democrats would loyally vote with their party (for cloture) rather than for what would sit well in their states (against), just seemed like political suicide to them. I would have loved to have been in the Oval Office when Obama realized that there was an important aspect of his sixty votes he hadn't fully thought through: he didn't have them.

As a result of this profound miscalculation he was presented in the end with a Democratic Healthcare Plan written by Republicans, insurance companies and Big Pharma, which, at the same time, fractured the Democratic party and its supporters. Obama found himself negotiating for the sixtieth vote with people who had no intention of giving it to him unless nearly everything important to Democrats, Independents, and Progressives, as well as everything objectionable to the various corporate entities, was deleted or watered down first. Even the bill's democratic supporters saw an opportunity, by hesitating, to add a bit of last minute local pork.

Independents and progressives abandoned him and his party wholesale. Unions are furious. Why should anyone support and defend an insurance-company give-away bill in the 2010 elections whose major feature was that it has a big D on its cover? Especially, why stick around now that it has become clear that the first item on the Republican agenda in 2010 is to repeal it should it pass? (The Republicans are alarmed now by the possibility that the bill won't pass!)

Which brings me to the haunting thought: what would the last year had been like had Obama realized from day one that he didn't have sixty votes? What might have passed the Senate and how might it have been done? I'm still puzzling over that one.

At this moment, the Republicans are undergoing a gut-wrenching reorganization of their party, and there's no doubt in my mind that a similar reorganization is beginning with the Democrats. Both parties desperately need the hard days to come to whittle themselves down to size and back to basics. Democrats will be far better off if today they give up the delusion that in some universe they have the sixty votes needed to break filibusters. Maybe the Democrats will then finally turn a degree of appropriate attention to Joe Lieberman (who in college had been a hero of mine in civil rights). The Republicans might find a way of unifying a party dangerously close to flying apart in ideological warfare and attract a broader swath of voters, especially independents.

Once the Democrats realize that they beat themselves on health care with their own delusions and fully accept a loss as great as any suffered by Clinton in 1994, once Obama stops trying to force them to be some mythical post-partisan party no one wants to belong to, they might actually be able to accomplish important things before their time runs out. But they will accomplish nothing until Obama accepts the full enormity of his blunder. Over the next few weeks, we'll see if he can.

Friday, January 15, 2010

Days of Disaster

On Tuesday, I needed an long infusion of Igg because after looking at my immunoglobulin panel, it became clear that I have no or few working normal immunoglobulins. I may rewrite this post when able with explanations because this is the 4th day of a 40mg dex pulse and I'm incompetent as hell today as a writer, but for now, accept that the results of the Igg test, not normally used by light chainers like me in disease management, scared me. This allo transplant has to begin and it's being delayed for bureaucratic insurance reasons unclear to me.

On Wednesday, 10pm, after I finished a conversation with an high-school buddy, I went to brush my teeth, and was stunned to notice a vast flow of blood coming from my nose, beard blood red. It was a complete surprise. The blood high up in my nose, beyond the range of probing fingers, was coagulated and involved one nostril, no flow to the rear, so was able to rule out correctly pulmonary involvement. At least I hoped my conclusion was correct. The flow took more than an hour to stop. Because of complicated insurance issues, I tried to avoid urgent care. I held on instead.

This bleeding happens when the density of platelets in the blood drops enough to stop coagulation of wounds. Wednesday early I nicked my thumb on a knife cutting a bagel. Tiny and annoying. Bandage. Done. Thursday, brushing my teeth, the old scratch opened up as new and I was covered in blood again. Off to urgent care now, no hesitation. We tested the hell out of me, I recovered on my own, and now I think the recovery may be stable. Some weird consequence of the Igg infusion is my guess. No one seems to know. I have acquired a bit of phobia of nose blowing. I was in urgent care for nearly three hours before the decision was made to let me go after fighting the blood since 7 am. Exhausted.

I am stoned out of my wits at this moment on steroids, and this post is in no wise as carefully written as I would like (I think I'm writing pure jibberish), so maybe a clear head day will come soon and I'll fix it. But I thought you'd want to know that my life seems to be hanging by a thread, but the thread from Scripps Clinic is a good strong one so I'm still ok. Still, I would feel better if someone removed the sword. Like Damocles, I'm having trouble relaxing under it.

Friday, January 8, 2010

An Apology to my Readers for my Silence

The most important miracle in my new life, my marriage with Ivonne, I've talked about. The second miracle, the medical miracle I discovered that may yet save my life, I have talked about. What I haven't talked about is the terrifying, confusing, hostile, dangerous process of bringing her to live with me in America. I have written a substantial post on the subject, or at least a crackling-good first draft of it, that I had intended to post this week now that the seemingly more dangerous phases have passed.

On the other hand, I have become afraid of my own government and feel caught up in an American system that I truly believe is as hostile to Americans as it is to foreigners and is perfectly capable of doing anything they want to do to me and my family including destroy us. So I can't post about our experience until I feel perfectly free from personal retribution from my own government. If you're thinking I've taken a paranoid turn, believe me, if and when I can tell you about what has happened, and the risks involved, you will understand why this rare condescension to madness is necessary.

So I will remain silent, and I ask for your patience, for one day this year all of the issues will have been settled. Then PERHAPS I will feel free to lay the whole terrifying story out for you.

But the silence just kills me because this blog is about telling the complete and utter truth about everything I write about, and to write about everything of importance relating to battles with cancer and my struggle to gain peace of mind and hold on to it come what may. The struggle I can't write about has done more to undermine my sense of peace than even the cancer, and I want to explain why, because that's what I do: I explain. Without exaggeration. As clearly as I possibly can.

Lately, I have learned the four key answers to all questions from authority: Yes, No, I don't know, or I don't remember. If none of those work, I try, May I have a glass of water?

I chafe at the muzzle. One day, I hope I will feel that Ivonne and I and the children are sufficiently safe that I can talk. Not yet. I am sorry for my lack of courage at this point. This may be the first time in my life I've caved in to fear.

Monday, January 4, 2010

New Years: A Day of Personal Recognition & Appreciation

The New Year holiday has never meant much to me. I don't think I've been invited to a cocktail party in thirty years. I don't make resolutions. I do like to watch an exciting, close football game but if the score isn't close I regret wasting my time. I have no favorites except Yale.

This year is different. My bizarre brain, which generally does whatever it wants to do, is obsessing on redefining the holiday to be something important. The highest part of my mind, a kind of self-observing consciousness created during sixteen years of psychoanalysis, warns me of possible neurotic reactions or generally crazy thoughts. It got my attention. We had a long discussion about whether not this redefinition is bizarre in general, a one-time good thing that is more properly categorized as working down my bucket list, or a permanent redefinition of the holiday. The resolution: I'll know which it is next year, if I make it that long. And since when has bizarre been a problem for me?

It is not unlikely that I could die soon, although I'm doing my level best to postpone it. As for now, what better time than the present could there possibly be to acknowledge the gratitude, a completely inadequate word, I feel for those people in my life who volunteered for their own reasons and with no expectation of return to make my life easier or better when I desperately needed my life to be easier or better?

So I made a list and contacted them. The list include Charlotte, my high-school civics teacher (who was never actually my assigned teacher!), who for whatever reason decided to make high-school much easier for me to survive (I never should have been in public schools). She gave be a "job" that got me out of dreaded lunchroom so that with my unlimited hall pass (another story, another gift) and my exemption from PE (another story) I could spend my free time in the safety of the small History/Civics teachers' office. She successfully fought for my inclusion in the National Honor Society despite the furious opposition of my Spanish teacher and others. She did many other things for me, some of which I'm sure I'm still unaware, for no comprehensible reason other than she wanted to. She claimed no credit, took no bows, asked me for nothing. I loved her. Still do.

In fact, nothing she did she was obliged to do, nothing she did for me can be characterized as something I deserved or earned. It was a pure gift from a great person who sized me up in a suprisingly short time and made a personal commitment to help. These are the kind of persons on my New Years list. They are still alive. Some are still with me and still giving.

They are my rescuers.

So I called her up. She's old as dirt today but still smart as a tack. I prepared with much deep thinking before I was satisfied that what I wanted to say was as clear, correct, and forceful as I could possibly make it. Dedicated fans of this blog know just how effective I try to be. The message got through. She was happy. So was I. Sincerity and clarity isn't repayment in the slightest. Delivering my message may actually diminish the purity of the gift for a few of these truly anonymous givers who already know their gifts were not wasted. I apologize to them. I have to try.

It's not a long list, these special volunteers who came from nowhere to decide to make my life better, easier, or safer, but the ones on that list have been in fact, the purest, greatest gifts of my life. Because I am not always good at thanking people, and reveled in these gifts as if I deserved them, I have the obligation to make it clear that I am not an insensitive, unaware beneficiary. Now, while I still can, I need to tell each one of these amazing people how vitally important to my life they have been. Each call or meeting takes my best effort. Every one gave me something different, no gifts were the same, because what they gave was a part of themselves. I spent hours of practice before each contact, clarifying in my mind what the most effective way to ensure they receive the full extent of my appreciation and meaning. It has been a long, complicated holiday leaving me emotionally spent. There are still two of the most important people to go. Paradoxically, I am now emotionally stronger than ever and more at peace.

[A curious aside. In most or all cases, these volunteers, angels if you believe in angels,  sized me up in a very short time, many within minutes. Their private decision to treat me differently was made, unbeknownst to me, and without any overt indication. If I earned such great gifts in any sense of the term, and that's questionable, all I did was present myself. Each saw and understood what I was, that I needed something they could give, and on the spot they decided to give it to me. Some of these extraordinary gifts have continued for life. The only way I have really had to thank them, until I redefined New Years, was to make the most it. That just isn't enough for me now, not nearly.]

I cannot describe the vast peace of mind that that doing this has has given me in return because each story is unique and I would have to tell them all to you in specific the way I told each of them. I wish I could, but to me, sharing the specifics would be inappropriate. I can only hope that my clarity, sincerity, and, in a couple of cases, tears, in some sense has made them feel that I know they have done good and wonderful things and that I refuse to die before offering my vast, stunned, appreciation.

Maybe everyone has some like this in their lives. Not a friend, exactly, they are on a different list. If you are fortunate to have had such people in your life, such angels, you might want to think about reimagining New Years too. Or better yet, thank them now, while you still can.