It’s the Worry that’s Killing Us

“Work is healthy, you can hardly put more upon a man than he can bear. It is not work that kills men; it is worry. Worry is rust upon the blade.” ~ Henry Ward Beecher, quoted in The Teachers’ Institute, Vol. 18, No. 1 (September 1895)

I used this quote today in my inspirational blog, and as I was writing, I knew I had to come over here, because this reflects something that’s been on my mind a while. Of course, I don’t have a lot of time to develop it today, but it’s a taste

I’m one of those people who works on weekends–that’s when the majority of my grading gets done. So work is on my mind today. I saw this quote, and it resonated greatly.

I do love my job, and even the grading doesn’t bother me overly much. I’d rather have fewer classes or the same number of classes with fewer students, and that’s where the worry comes in.

Am I spending enough time on each student’s paper? Will I get it done in time? Will I have time to spend with my son? Will I have time to sleep? Probably similar questions to what others have.

Education has changed in America, especially public higher education. As teachers, we know that the optimal number for a composition class is around 15 students or so. You want enough for a lively discussion but few enough so that the professor has time with each student. Depending on where I’m teaching (as one of America’s permanent adjuncts, I teach at up to three different schools at a time), I have between 29-45 in a composition class. Most of the time I have to teach six sections at a time to make ends meet.

So on average, I have about 150-170 students a term. And every one of them writes a paper, usually one a week. And some of those papers are 1200-1500 words. So in a heavy week, I can read 238,000 words. But I also grade them. Each paper takes me 10-20 minutes. Sometimes it’s longer if I have a particularly weak student; sometimes it’s shorter for a brilliant job. But even if I average 15 minutes a paper, that’s 2550 minutes during a heavy week, or 42 hours or so. I’m in the classroom 18 hours, have four hours of office hours (where I can often get some grading done), and so there you go. Welcome to the life of a composition adjunct.

So that worry about my students? I think you can see where that’s coming from. I went into this field to empower people with communication skills. That’s the theory, at least. How much am I really teaching them?

And like all positions, I worry about work related things that have nothing to do with my job. Because I’m not a permanent worker, every 15 weeks, I worry whether I will have work in the next term. Summers and January are the hardest times as jobs are scarce but the rent is still due. This is my reality. The vagaries of the student population and the state budget impact whether or not I’ll have work, but my friends in all fields face similar worry. I don’t think I have a friend who hasn’t either been laid off or had a spouse laid off in the seven years since I’ve been back in America.

Many have gotten new positions, but always at lower pay with more hours and no job security.

No wonder we are a nation of obese, unhealthy people. Our stress levels, worry levels, are off the charts.

Beecher is right. It’s the worry, that’s getting to us.

As a nation, we say we want to combat our national poor health and obesity, but we have created an employers’ paradise in which individual Americans have fewer days off than workers in most other industrialized countries. The Far East Asians beat us on hours worked, but they are about the only ones.

If we all just died from stress-related illness, that would be bad enough. But mostly we don’t die. We’re left on medications, or medically handicapped, and that is where it starts getting expensive.  According to Cornell University, obesity accounts for 21% of US health care costs. Now there are many reasons for obesity, but stress is a major factor, as is eating junk food or fast food as it’s called, which many who work long hours rely on.

I know that this term I have packed on pounds because I don’t have time to cook all the time, so dinner is often a peanut butter sandwich or two. I don’t like to eat fast food, so as a result, I eat far too many carbohydrates because they are quick and easy. No time to eat? Grab a bagel and go. Not the best of diets for a woman of my age, let me tell you!

So just putting this out there as some points to ponder.

 

The Unholy Trinity: Salt, Sugar, Fat

I just finished reading Michael Moss’s book Salt, Sugar, Fat: How the Food Giants Hooked Us. It was full of very appalling information, and if you haven’t been paying attention for the past 20 or so years, I highly recommend it.  Luckily, I have a mother who is very aware of the evils of processing, so she passes the fruits of her research on to me.

Sometimes we tease her about her diet choices, but the woman will be 81 in a few months and takes no medications. Her blood pressure and cholesterol are low, and in fact her 40-something physician told her that she wished her numbers were that good. So obviously Mom is doing something right.  And she’s regularly mistaken for being in her late 60s. It’s partly genetics, but also partly vigilance.

As I was reading the chapter on Lunchables–and yes, that particular product has its own chapter–I realized how lucky I was to have “missed” them.  We left America in 1995 when my son was 4; we returned in 2007 when he was 16.  His entire schooling was in other countries.  By the time we returned, his tastes and preferences had been set. And in other countries, at least the ones we lived in, children’s school lunches were serious business.

My son went to school in Taiwan, Switzerland and Sweden, but at every school hot lunches were supplied every day, and children were not allowed to bring a packed lunch. They learned to eat what was put in front of them. If they didn’t like something, they could fill up on salad and bread.  Sweets were not allowed on school grounds, and the beverages served with lunch were water or milk. Plain milk, not chocolate.

So thanks to the rigidity of the schools he went to, I never had to fight the peer pressure of Lunchables or any of the other vile products marketed to children in this country. Although I almost always gave him plain oatmeal, sugary cereals were always available, but super sweet American cereals were not. When we came home to America on visits he was allowed a box of Froot Loops or Lucky Charms, his favorites, and I allowed him Pop Tarts, something I wouldn’t have had I lived here.  Ironic, I know, but as ex-pat moms, we just have different ways of working out our guilt.

Before we left America, I was much stricter. Until he was about 2 1/2 I had him convinced that rice cakes were cookies. The babysitter’s house disabused him of that notion, but at home, after the rice cakes deception was up, he got juice sweetened organic cookies. I was trying hard to give him good eating habits and not develop an overly sweet tooth.

Something worked as he’s not a sweets person. After the first few months back in the US, eating all the things he’d missed in Europe–Pop Tarts, donuts, root beer, sugary cereal–he mostly stopped. He felt glutted just like some tourists to America who come and eat all of our foods, loving it, but then are very happy to go home.

For me, though, reading this book was partly preaching to the choir.  Many of my students write papers about the obesity epidemic and almost all of them cite the cheap availability of fast food or convenience food as a main problem.  This riles me because I know for what you’d pay to eat at a fast food chain, even one with cheap menus, I could prepare a meal that’s half the price and immeasurably better for them.  I even once wrote a cook book (unpublished, alas) of cheap, unprocessed, healthy recipes.

And per pound, much junk food is much more expensive than carrots, apples or any in-season fruit or home popped popcorn not done in a microwave.  But as Moss points out in his book, we’re pretty much addicted to the salt, sugar and fat in junk food.

The overprocessing and over commercialization of food in America is a real and serious problem.  I have no answers for a quick fix.  As with everything, I believe education is an important step. More people should read Moss’s book. More people should read nutrition labels.

One interesting point that Moss does make is that poor nutritional choices are marketed at certain economic classes.  Upper middle class folks and above, well their children aren’t taking Go-Gurts and Lunchables to school.  I see this as problematic in two ways.

First, there is a perceived notion that “healthy” food is “expensive” food.  This is sadly true when it comes to organic in this country, but the fewer processed foods in the grocery cart, the lower the bill.  Even if we buy minimally processed goods, it’s still cheaper than buying convenience foods.  A can of tomatoes mixed with some garlic and herbs, dried is fine, makes a fine pasta sauce without the added sugar, fat and salt found in commercial pasta sauces. It also costs less.  A PB&J, even using natural peanut butter and spreadable fruit on whole wheat like I do, is still cheaper than an Uncrustables PB&J. I’ll get off the soapbox now.

Second, and I see this as much more insidious, children in certain socio-economic groups are getting poorer nutrition and are already facing high cholesterol, high blood pressure  and diabetes, all of which are debilitating. But what I see as even worse, they aren’t getting what they need for their brains to develop to their fullest potential.  In this way the academic divide between rich and poor is ever so slightly widened.  All I can think when I think of this is Aldous Huxley’s Brave New World in which the strictly delineated classes are fed differently from gestation on. This, to me, is chilling.

I’ve written about food in America before, and I do see this as a major problem of American society.  If you’re looking for some hard facts about the situation, a good place to start is Moss’s book. But I think this might be something I come back to.

Follow up: Shortly after I posted this, I saw a photography project I’d seen before: One week’s worth of groceries from around the world. There couldn’t have been a better visual if I tried.  You can find an article about Peter Menzel’s project here.

A Few (thousand) Words on Health Care Reform

“People are very open-minded about new things – as long as they’re exactly like the old ones.” ~~Charles Kettering

The health care debate has been raging all summer, and lucky me, I’ve been ignoring it.  I’ve been too busy working to pay attention, but that doesn’t mean I don’t care.  I very much care, as my son and I are part of the over 46 million Americans without health insurance.  I haven’t been able to find full time work for the past year, so I’ve been working three part time jobs.  That keeps the roof over our heads and the bare minimum bills paid. I pay the car insurance (because I can’t get out of my lease), but I can’t afford private health insurance.  I make too much for Medicaid, but now that my son is over 18, he can apply for coverage.  And now, thanks to my strong union, I will be eligible for health care through my employer in the fall.

But in the time I spent overseas, I lived in two countries with national health and one with mandatory health insurance.  Taiwan and Sweden were the national health countries, and in Switzerland, insurance is mandatory. If one isn’t covered through an employer, there is an affordable option available through the government.

Sweden is often held up as the exemplar for national health, and while I wouldn’t go that far, I can say that in most instances, it was fine.  My son is an epileptic, and as a child under 18, all of his medical care was covered.  When we came to America, even with the insurance I had the first year, my co-pay was over $300 on an office visit and some blood work.  And he’s supposed to see the doctor twice a year.

Of course, on the flip side of that, my taxes in Sweden ran close to 50%.  Through taxes, I paid for the care there, as well, but when my husband and I were out of work, my son still got the care he needed.  I checked some policies, and private health insurance for myself alone would cost about 25% of my yearly income; for the two of us, about 44% of my income.  Add my taxes to 44% and I’d be paying well over 50% of my income, so cheaper in Sweden.

One major problem with the Swedish system is that it’s overtaxed. Unemployment is high—about 10%–and with an ageing population, there’s too much going out and not enough coming in. And Sweden only has a population of nine million people.  Administrative costs are relatively low.

Swedes also register with the government and are assigned doctors, whether you like them or trust them or not.  I was very lucky with my son’s doctor, but terribly unfortunate with the “specialist” I was assigned.  To be perfectly blunt, she was inept at treating my disease and prescribed something no longer prescribed, in fact, something contraindicated.  When I balked, so did she and my care went downhill from there.

I can’t see Americans enjoying registering with the government and being assigned doctors.  According to the White House, this isn’t even something on the table, so I can relax about that.

America has fine health care, but it’s just not affordable.  And one thing alone is not going to fix the mess we’re in.  America’s health care woes are caused by many factors: profit-driven insurance and pharmaceutical companies, foolish laws, core ideals about personal responsibility and American’s poor health habits.  And frankly, labels don’t help. Am I left or right? Am I socialist or capitalist? Am I liberal or conservative? Throw out the labels and just think.

Insurance rates are high for doctors.  People sue for huge damages, so doctors have to have the insurance.  On the other hand, I’ve seen firsthand the devastation that can happen to families in which there has been a medical mistake.  Friends who are unable to sue for damages because their state has a statute of limitations have faced bankruptcy while caring for their son who incorrectly treated following his premature birth.

But the insurance industry in this country is not a nice group of kindly folks, no matter what image their PR firms try to show.  Michael Moore’s Sicko was typical Moore showboating, but it did point out some hard, if obvious, truths.  People in healthcare shouldn’t be profit-driven. But in a capitalist society, that’s how it works.

Insurance companies lobbied for laws so that doctors could not charge people without insurance lower fees.  They got the law. Sounds fair at first glance, but in reality, doctors rarely get the billed amount sent to insurance companies.  They are usually sent a percentage.  So when I walk in the door without insurance, I have to pay the full amount, but the person next to me, with insurance, pays a co-pay, and the insurance company pays “the rest”. But the insurance company doesn’t always pay all of it, so I’m stuck paying a larger price. Also insurance groups often get “group rates,” something the non-insured can’t get.

Insurance companies have also pretty much killed off the idea of a lone doctor practicing out of his basement.  When I was growing up, and I’m not yet 50, my doctor practiced from home, as did most of the doctors in town.  And I grew up in suburban New York, so not exactly the “boonies”.  When I moved back to my mother’s in the 90s, my same old doctor was still practicing.  He was a wonderful physician, and he apologized that an office visit was now $35.  The doctor I’d had just a few years earlier in “upstate” New York charged $50 for a routine office visit. This week I paid $95 for an office visit for my son and was shocked it was so low.

One reason for the cost is that now thanks to insurance companies, doctors spend small fortunes on paperwork alone. Couple this with sky high malpractice insurance premium, and you have a recipe for disaster.

A friend of mine who is a veterinarian has complained about the mark-up medical doctors give to supplies—vets and “human” docs use the same materials in most instances.  She has a point, but then I thought of the costs associated with running a physician’s office.  Most people don’t have pet insurance—the number is growing, but it’s considerably less than human insurance—so there’s no one who has to do that paperwork.  And vets do have malpractice insurance, but as much as we love our pets, they aren’t human.  There are no lost wages or multi-million dollar settlements made on pet care errors.  So for physicians, the cost of insurance has to be covered somehow.

I really don’t mind physicians getting a large salary.  Most made years of sacrifice and paid through the nose for their educations, and they hold my life in their hands.  I would love to be making what they are (the average US general practitioner, internist or pediatrician makes just under $150,000 a year according to the website payscale.com) since I have as much education, and I hold the future of the country in my hands, but that’s another story.  Of course, that’s the average salary.  That means that there are selfless physicians working for $30K in America’s rural and urban poverty centers while there are profit-driven folks raking in obscene amounts. But that’s capitalism.

Doctors today are major employers—they have nurses, LPNs, office staff and so on.  Physicians have to pay salaries and often benefits, as well.  All that is reflected in the price of a visit. I get that, as well.

Many states also succumb to pressure groups, making insurance companies cover all sorts of things on minimum plans.  Boston Globe columnist Jeff Jacoby wrote a very enlightening piece on this “Healthcare: Do we need the Lexus?” that I highly recommend.  Let me include one very eye-opening paragraph:

Forty years ago, there were only a handful of benefits that health policies were required by law to cover. Today, the Council for Affordable Health Insurance identifies an astonishing 1,961 mandated benefits and providers. While any one mandate may not add appreciably to the price of an insurance policy, in the aggregate their cost is huge. The Cato Institute, citing the Congressional Budget Office, estimates that state regulations increase the cost of health insurance by 15 percent. And since “each percentage-point rise in health insurance costs increases the number of uninsured by 300,000 people,’’ as scholars John Cogan, Glenn Hubbard, and Daniel Kessler point out, it is clear that the proliferation of insurance mandates is one reason why millions of Americans are uninsured.

Frankly, if the insurance mess was cleaned up, there would be a lot more affordable private insurance that would be available for people to purchase.

I haven’t even treated pharmaceutical companies here.  One example: my son’s epilepsy medicine costs me about $170/month.  I just discovered, after 23 months in this country, that the generic version is less than $12/month. Don’t get me started on advertising drugs on the TV and in magazines.  I am a very educated, pro-active patient, I research (and not on Wikipedia, but in medical databases—I’m a doctor, too.  Not a medical doctor, but research is research).  Americans for the most part have wised up about the over prescribing of antibiotics, but we still love to medicate ourselves.  I’m not anti-medicine. But I do think we overprescribe and just generally overmedicate. Learning about all the new drugs while watching the after dinner TV shows is too much.  I went to the pharmacy in Switzerland to get children’s cold medicine for my son and the pharmacist handed me some homeopathic tablets. They worked fine and were cheap.

Alternate treatments are marginalized here.  I’ve ingested thousands and thousands of dollars of harsh drugs that have left me with permanent side effects because I have stage IV endometriosis.  In Sweden I tried acupuncture, and it worked. I was off pain medications for years thanks to that treatment.  It’s not for everyone, but it works.  My American doctors laughed at the notion (so did my Swedish doctor, but once I had my run in with her, I was on my own for health care).  My Swiss doctor, who is a world famous researcher of endometriosis, prescribed hypnotherapy and massage therapy, as well as herbal treatments, all of which provided relief.  On a whole, Swiss doctors, along with many other European doctors, are not threatened by blending traditions.

And finally, the thing I am seeing get in the way of discussion so that we can’t even make a small change is America’s core values.  As many have correctly pointed out, health care is not something to be provided for by the government. The Constitution and Bill of Rights don’t mention health care at all.  Of course, in 1776, health care was a pretty rudimentary item. Catastrophic medical bills weren’t an issue.

America also likes to pride itself on being a caring country. Some people claim that we are a Christian country, and while I don’t agree, our culture, like all of Western culture, is solidly based on Judeo-Christian-Islamic values (all three are sons of Abraham, following the same basic rules given to Moses).  Just about any religious value system includes caring for the sick, so that’s at odds with our capitalist values on some levels.

Of course, we say that people have the right to life, liberty and the pursuit of happiness. I guess health care falls under the life part.  So it can get sticky.

When we discuss issues that involve core values, things can get heated.  We see this by the knee jerk reactions on both sides of the discussion.  People are no longer discussing health care—they are discussing what it means to be an American.  They don’t articulate it, but that’s what it is.  In America, the word “socialist” is a bad word, but we have Social Security and Medicaid and Medicare.

As you can tell by the previous 2000 words, this is a complex issue.  As the New York Times notes in its helpful article “A Primer on the Details of Health Care Reform:”

Each side hopes to win ground by boiling down one of the most complex policy discussions in history into digestible nuggets.

Not only are the sides turning this complex discussion into sound bites, most Americans seem to be perfectly happy with looking no further than those sound bites.  When I started really looking into President Obama’s health care reform, I found it confusing and amorphous. And I have 20 years of experience reading freshman compositions.  I am not being facetious. Most students today have incredibly weak logic skills, yet I read their papers and ferret out meaning.  Before I was a teacher I was a legislative correspondent. That’s a fancy term for being a reporter in the state capitol, reporting on legal stuff.  I’ve read more bills and laws than most non-lawyers.  I’m not a neophyte at this.

At the end of the day, I do wish there was a way I could afford health care for my son.  I don’t mind paying premiums at all, but I can not afford to pay 44% of my salary to cover us both.  As President Obama rightly points out, health care costs in this country are out of control. Something should be done.  Now we have to see exactly what gets put on the table. It all seems unformed still.

One final point: Americans have to take responsibility for their health. Americans are some of the fattest people in the world, and even many who are thin have deplorable diets.  I’ve written about this before, what and how Americans eat, but we need to take control of our lives.  When I am a rich philanthropist, my ultimate goal in life, I want to teach nutritious cooking to young people and young mothers. And I mean real nutrition, not the government-sponsored ideas of nutrition.  I’m overweight myself, and I work at getting thinner, but I do know that my diet is relatively better than the average American.

Drunk driving is also something Americans do more than most places I’ve ever lived.  In Sweden, a country known for massive drinking, people simply don’t drink and drive.  Not just because there are stricter laws; driving while drunk is stupid, and almost every Swede I’ve ever met at parties, where I was the designated driver, has asked why Americans are stupid enough to drink and drive.  Answering that we have the freedom to do what we want just doesn’t sound right.  How many millions does drunk driving cost in medical bills per year?

Weighty Matters

One thing that has bothered me about American culture for years is its obsession with bodies. We attack celebrities for being too heavy or too thin. Who is just right?

Since I’ve come back, I swear it’s gotten worse.

Women’s magazines inevitably have a diet featured on the front cover. Just looking at some magazines in my room I see: “Lose up to 14 pounds!” and “Have a Bikini-Ready Body by June!” and “Better than Gastric Bypass! Lose 9 lbs a Week”.

But those same magazines also have stories on easy treats–Boston Cream Cupcakes, chocolate chip cookies and “fun party cakes”.

And one  magazines that published recipes for an everyday meal totaling 1065 calories and 55 grams of fat, also carries ads for Hydroxycut, Super Dieter’s Hunger Control Slim Mix, Apatrim and Xenadrine RFA-1. In fact, there are only three other ads in the magazine, so that’s a pretty overwhelming message to readers: You’re too fat!

And we are.  According to the Centers for Disease Control, over 66% of Americans over 20 are considered either overweight or obese and 24% of them are obese.  That’s a frightening trend.

In an earlier blog entry, I mentioned that when I returned to America, the shapes of some Americans frightened me so much that I lost weight.  Luckily, that trend has continued.  I’ve lost 40 pounds since I’ve been back.  That’s not an amazing amount over two years, but at least I buck the national trend of gaining weight every year!

By no stretch of the imagination could I ever be considered not overweight, but there are days when I’m riding the subway in NYC, especially when I’m not in Manhattan, and I look around and think: “I’ve got the smallest butt in this car!”  That breaks my heart!  Seriously, it does.  When I see young people, male and female, severely overweight, it frightens me.  Once in the grocery store, I heard a little girl, no more than 10 years old, talking about her high cholesterol with her mother!

What’s going on? Part of the problem is the complete and utter junk that passes for food in the country.  There is also the portion distortion that we hear about in the news.  In an effort to lure in customers in these financially lean times, fast food restaurants are offering more and more grease and carbs for your money.

Even nicer places are doing the same.  My family went to a seafood restaurant, and my sister and I took home so much of our dinners that we each got two more lunches!

One thing I do find worrisome is how weight is such an accurate class marker, especially here in New York City.  Riding the subway in the Bronx, I can feel pretty good about myself.  Once I cross over into Manhattan, people are radically smaller and healthier looking.  It’s no surprise that more money means better nutrition as well as better education.  But being able to eat healthily should not be a privilege of wealth and education.   That’s just a national shame.

I have no solutions.  It’s just a scary trend I see now that I’m back in the States.  And since I have so much to say about so many things, I thought I’d start with some scary observations just to get them off my chest.