Nina's Reading Blog

Comments on books I am reading/listening to

Archive for October, 2017

This Chair Rocks: A Manifesto Against Ageism

Posted by nliakos on October 23, 2017

by Ashton Applewhite (Gale Cengage 2016)

As my birthdays pile up (seventy is now within view), I am coming to terms with my age and with my aging. Ashton Applewhite’s manifesto has given me plenty of ideas to consider, supported by research that contradicts society’s assumptions about “olders”, as she calls us (in contrast to “youngers,” aka “old people in training”). For example, dementia is not a given: serious mental decline is not inevitable (MacArthur Foundation Study of Successful Aging), and a fifth of folks in their nineties function cognitively as well as those in middle age (Laura Carstensen, director of the Stanford Center on Longevity). In other words, though we are all going to die some day, we have a fair chance of dying with our mental faculties intact. Or “the happiness U curve”: people over eighty tend to be happier than younger folks–as happy as children, in fact. They are “more self-aware and confident, less fearful of being judged, and authentically happy.” They are also more comfortable with the idea of dying than are younger folks, who tend to assume that the closer one gets to the end of life, the scarier it must be. Wrong. Around the world, the most contented people are the youngest and the oldest, with the working stiffs in the middle being the most unhappy.

I’m a pretty happy person overall, but I think it’s true that I am happier now that I am retired. That’s how it was with a lot of the ideas in the book: when I think about them, they just make sense, or my own experience bears them out.

The book is divided into eight chapters:

  1. “The Problem with Ageism” – What ageism is and how it affects us. Aging isn’t the problem; ageism is.
  2. “Our Ages, Ourselves–Identity” – Why we are reluctant to own up to our true age after some arbitrary number, like 30 or 40 (thinking that after that number, it’s just a long slide into oblivion), and how we internalize the negative stereotypes of aging
  3. “Forget Memory — The Older Brain” – the stigmatization of cognitive decline, the assumption that it will happen to everyone, and how in some ways our brains get better as we age (e.g., we deal with negative emotions better, are more emotionally mature and adaptable to change, and are less anxious in social situations); there is a “neurological basis” to wisdom.
  4. “Health, Not Youth — The Older Body” – Longevity is a good thing. Yes, there is some physical decline as we age, but a large majority of folks over 65 “report no limitation in major activities.” We won’t live forever, but we can live long and well, as long as we take care of ourselves and have adequate medical care (which we might not have if ageism is allowed to influence decisions about who should have which treatment). By itself, getting older is not an illness!
  5. No Expiration Date–Sex and Intimacy – Why are so many people repelled by the idea of olders having sex? The many variations on sexual intimacy.
  6. “Not Done Yet–The Workplace” – how older people continue to be productive in old age, whether in a paying job (if they can get one despite ageist hiring policies) or a non-paying one, such as caregiving (for spouses, grandchildren, and others). Negative stereotypes hurt older workers, who have much to contribute to the workplace and to society.
  7. “Long Life Is a Team Sport–The Independence Trap” – how isolation is harmful, and some ideas for ageing in community; we all rely on each other (at any age, but certainly in old age); the importance of interaction with people of all ages, all the time
  8. “The Bull Looks Different–The End of Life” – how the older we get, the more reconciled, and less fearful, we are of death. Death (the bull) looks different when we get closer to it (when the matador enters the bullring). Knowing that we are not immortal helps us to appreciate each passing day more.
  9. “Occupy Age! Beyond Ageism” – We need to change our thinking about aging. We are all ageist to some extent, but we can overcome it in ourselves and help others to overcome it as well. An example would be how we self-deprecatingly claim “a senior moment” if we make a mistake or forget something. I’m one who has said that on numerous occasions, but I have vowed to stop. If I make a mistake, I will no longer justify it by claiming advancing age! This chapter has lots of ideas for making our society “all-age-friendly”, such as including older people in medical studies and trials, adequately funding the Elder Justice Act of 2010, and helping older people to stay in the workforce longer by providing more flexibility.

Each chapter includes a section called “Push Back!”, which suggests ways we can fight ageism.

Applewhite’s book is a must-read for everyone, not only those of us who are over sixty. Few people choose to die young, so most people will confront the fact of aging at some point. (We all aspire to be old.) We would all be happier if our aging were not complicated by ageist prejudice (our own or that of others) and discrimination.

Applewhite blogs at https://thischairrocks.com/blog/ and http://yoisthisageist.com/.

Watch her passionate TED talk (around 10 minutes long) at https://www.ted.com/talks/ashton_applewhite_let_s_end_ageism.

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America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System

Posted by nliakos on October 7, 2017

by Steven Brill (Random House 2015)

Did you think I had given up books because I had not posted in a while? Actually, I was slogging through this 455-page look at the Affordable Care Act, aka ObamaCare–how it came into being, the fight to pass the bill, the disastrous launch, and all the pros and cons. It wasn’t an easy read by any means, but I came away with a better understanding of some basic truths.

First, America got off on the wrong foot with healthcare  in the 1940s, when the National War Labor Board’s ruling that benefits (including health insurance) were not subject to wage controls encouraged employers to offer workers health insurance, letting the government off the hook for either insuring or providing healthcare to its citizens. The fact that health benefits were not taxed exacerbated the effect of this ruling, which “would forever change the course of healthcare in the United States.”

Second, the ACA became law only because people made a lot of compromises that included giving up some of the most crucial aspects of the original plan, like including a public option. Some of these sacrificed items constituted broken promises to people, companies and industries that gave their support to reform.

Third, random events like Democratic candidate Martha Coakley’s vacation, which ostensibly cost her the election (for Ted Kennedy’s Senate seat), jeopardized the passage of the bill and necessitated still more compromises to appease reluctant Members of Congress and induce them to vote for it. Much of what transpired was due to pure chance.

Fourth, the ACA was designed to expand coverage to the uninsured, not to improve coverage for the majority who already had it. The framers of the ACA made a conscious decision not to tackle the obscene cost of healthcare in the United States compared with other developed countries. Their bill purported only to solve the problem of the millions of Americans who had no health insurance; it did not address the related problem of soaring costs. In this (increasing coverage) it has been fairly successful, but because costs continue to skyrocket, premiums are bound to reflect that. Provisions within the ACA ensured that billions of dollars in new business would accrue to the hospital industry, the pharmaceutical industry, and the medical devices industry. Meanwhile, doctors and insurance companies (yes! because they, like the patients, have to pay the bills) were squeezed.

Fifth, the disastrous launch of the ACA, following years of delay writing the regulations needed to implement the law, could have been averted if the administration had managed the website build better, by making one person responsible for its success, by hiring more competent professionals to build it, and by thoroughly testing it prior to the actual launch (duh)–as the state of Kentucky did with its kynect exchange, which worked as expected because the extensive testing had uncovered the glitches before the launch, leaving time to fix them. As it was, when a group of Silicon Valley stars was brought in to rescue the federal exchange, they had to correct almost every detail of the website. It was embarrassing to read about how incompetent everyone else was.

In the final chapter, Brill proposes a way to fix the mess we are in by encouraging giant hospital chains to become insurers (or giant insurers to buy hospital chains). He points out that what at first glance seems like putting the fox in charge of the henhouse would actually work better because doctors and hospitals would be motivated to keep patients healthy, and not to over-treat them or order needless expensive tests. In fact, this was exactly why I loved Kaiser Permanente so much when I was a member. I trusted them to do the right thing because it was in their interest to do the right thing. This was especially true when I was pregnant, at a time when C-sections were becoming almost routine. I didn’t want a C-section, and I felt confident that my Kaiser doctor wouldn’t advise me to have one unless there was really no good alternative. Kaiser didn’t have its own hospital in the Washington, D.C. region (as it does in northern California, and as  does the University of Pittsburgh Medical Center [UPMC], which insures its own patients–this was the example Brill provides of how his suggestion might play out), but as everyone probably knows, Kaiser doctors and nurse practitioners provide the vast majority of care that its members receive outside of a true hospital setting, in Kaiser centers around the region.

I think Brill’s view of the ACA is pretty balanced. He describes the good, the bad, and the ugly (and there is a lot of bad and ugly) objectively and fairly. The reader who makes it through to the end will come away with a much better understanding of how we got into this mess in the first place and why the ACA has met with such resistance. It’s a pretty depressing read, but it’s an important topic that we should all understand better.

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