Yesterday I took a trip to the Big City nearby to do some errands, and to have dinner with some dear friends. It was a very enjoyable outing, even if much of our talk focused on the sad state of Amerikan life. But before I get to that ...

I drove a Ford Focus part of the way -- it's a friend's car and is being stored here while he's off adventuring. It is an aggravating piece of shit car. The first time I attempted to drive it, I ended up aborting the effort because I couldn't determine how to put the damn thing into reverse. Turns out one must pull up on the boot that covers the gear-shift stick, but there's no obvious sign that that's the magic key. [Yes, I know that Ford has been using tricksy maneuvers for reverse access in its cars for years -- I used to own a Mustang. Even that knowledge didn't help me figure out what to do.] Yah, maybe I should've read the manual before hopping into it, but a car that requires one to do that before being able to use fundamentally important stuff has been poorly designed. To get the front seats to fold forward in order to access the rear seat area, one must find and pull two levers, one of which is annoyingly close to the door panel. And, worst, there's a stupid upshift indicator arrow that lights whenever the car decides the driver ought to shift. Damn thing comes on even when one's downshifting. I easily solved that problem, though -- I moved the seat until the top of the steering wheel obscures the arrow. The gear shift is sloppy to the point of requiring active attention to ensure one's shifting into the proper gear. The car's peppy enough for an economy car, and it is fun to be driving a stick again, but the engineers who did its interior would benefit greatly from a refresher on ergonomics and good design.

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Much of the drive to the Big City is on a road that's under construction -- from a two-lane road to a divided, four-lane road. Much of the fun is also being sucked out of the road -- curves and/or hills are scaled back or eliminated completely as the road sometimes moves quite a distance from its original path. The project has been a controversial one for years 'round here, and folks whose land was stolen to enable it are still voicing displeasure. One barn has this graffito:

If taxes were income we'd all be rich.

At first blush, I took that fairly literally (in terms of the redistributive aspects of taxation) and almost dismissed it. But then I thought about it again ... and there's truth in those words. Instead of thinking in terms of receiving money, but rather of lifting the burden of paying all the taxes Amerikans labor under, many of us (especially the less wealthy) would be much better off.

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We met up with our friends at our usual place for dinner; all of us seemed to have a grand time discussing issues and ideas fairly freely [as freely as anarchists dare in public establishments these days]. The talk turned to health care ... not mine, but our friends', as they both have a condition that can be tricky to diagnose and bring under control. She's just now going through that process, and her story was quite telling, particularly for the amount of control her [allegedly good] insurance has over the care she's offered. After a short course (under two weeks!) of one oral med that wasn't working, it was recommended that she move to a much more serious, and invasive, treatment -- even though many other oral meds, with varying mechanisms of action, remain as viable options. She fortunately knew about a test that could show if the suggested course would help her, and insisted upon getting it before considering the invasive treatment option. The results revealed that it would be disastrous for her -- yet her MD is still pushing that course. My friend wants to try a different medication, having researched it online, but despite her willingness to pay for it all out of pocket, the MD is reluctant to prescribe it. It appears that's the case in part because the MD isn't very knowledgeable about this med. Why not? It isn't in the formulary (a book of the drugs available through the pharmacy provider and covered by insurance).

Of course, my friend is free to choose another insurance option -- during the one month of the year when such changes are allowed. In looking over the "choices", she discovered that all the plans use the same pharmacy provider, so switching wouldn't help her.

It's bad enough in my opinion when insurance -- which was originally intended to help an individual or family cover unforeseen medical expenses -- becomes a gatekeeper to basic diagnostic and treatment options. It's unconscionable that insurance policies have apparently helped breed lazy physicians who don't care enough about their patients to stay up to date on new options, irrespective of whether they're covered or not.

One could argue that this physician is one of the worst ones in that regard, and that others are better. But even in my insurance-free forays into the world of medicine recently, I've seen signs that the decline into McMedicine is broad. I remember when the patient was the customer, and even though the doctor held much of the power in the relationship, he knew that and took it seriously, trying to do the best possible for his customer. Those physicians seem to be in extremely short supply these days, at least in mainstream medicine. SimpleCare seems to be an exception, but isn't too widespread. But overall, insurance seems to be just another means of wresting control from individuals -- and to some nontrivial degree, without the knowledge of many, as they still trust that their healthcare providers are making recommendations based on what's best for them rather than what the policy will allow. A sobering cautionary tale for anyone who relies on the mainstream medical system ...

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Okay, enough from the curmudgeon within. It's shaping up to be a nice day here, and I intend to spend much of it away from the computer (a welcome change!) and enjoying myself. I'll be tinkering around on various projects about the place -- including some glass work, I hope -- and lounging on the trampoline, reading. What, you've never stretched out on a sun-soaked trampoline? One of the best possible places for a snake to bask ...