Marie Myung-Ok Lee | The Nation

Marie Myung-Ok Lee

Marie Myung-Ok Lee

Thoughts on arts, culture, medicine, politics—to name just a few.

The Hidden Costs of the American Way of Healthcare

(Reuters/Jose Luis Magana)

I grew up in a small town in northern Minnesota, which had one small hospital and one anesthesiologist—my father. Thus, I grew up watching him being called away from dinner for emergency c-sections, chainsaw accidents, appendix ruptures, you name it. This instilled in me a very real sense of how ill health or a catastrophic accident could be just around the corner—for anyone.

It seemed a bit at cross purposes that I planned as a child to be a novelist and wanted an employment situation that was stable and provided insurance. I also wanted to live in New York City, because that’s where the writers and publishers were.

I started planning early; in college, for my major, I deliberately chose economics because I felt that would give me the most flexibility in terms of job choices and make me the most marketable for a “real” (i.e., insurance-paying) job that would be remunerative enough for me to live in New York.

I worked first at Data Resources, Inc., an econometric forecasting firm that was part of McGraw-Hill. They specialized in the kind of multiple regression analyses that I used to write my honors thesis, “Economic Development and Women’s Labor Force Participation in the Third World,” and, as I did while writing my thesis, I more or less hated every minute of it.

Later, I moved to Goldman Sachs for a position in equity research, and also hated more or less every minute of that job, too, but not only was I paid well, including annual bonuses (which allowed me to squirrel away money for my eventual escape), I was also treated to the kind of gold-plated corporate health insurance that even we peons got a taste of. My McGraw-Hill medical insurance had been pretty standard, including some encouragement to join an HMO as a cost-saving measure. But at Goldman, not only could we see any doctor we wanted, we even had a full-time office to facilitate health-related issues: they handed out lists of near-to-the-office doctors who were recommended, they had preventive health resources, such as regular in-office skin cancer screenings, and it was as close to a frictionless, moneyless, paperless system as could be—no out-of-pocket premiums, no deductibles, no co-pays.

I also hadn’t had dental coverage at DRI, but now when I visited my East Side dentist not only was everything covered, including every-six-month cleanings and thousands of rads worth of X-rays, a couple of times I received money back because my dentist had somehow been overpaid by my luxurious plan.

During those years, I wrote by getting up at 4 am to get in a few good hours before my subway commute to work—for which I had to get in early and often did not leave until very late at night. By basically jettisoning most of my social life, I completed an entire novel, but efforts to find an agent and sell it were coming to naught. So I started on another novel and dreamed of a time when I could write full time. Goldman had a generous vacation policy, and I used one of my weeks to write—and ended up happily working on new my novel for the entire time. Clearly, I was ready to be a full-time writer, but the mechanics my life weren’t ready for me. Without health insurance, I didn’t know what I would do.

Sure, I rationalized, it’s soul-killing to force yourself to do a job you hate, but being at such a large, successful firm meant I could write and not have to live with the precariousness of a starving artist. One year, my boyfriend and I decided to go to Belize, and the Goldman nurse not only gave us free gamma globulin shots to protect against some kind of Belizean disease (and checked me for melanomas when I got back), but she sent us to the Stock Exchange, where they had a travel clinic for banking employees, and we received matching dengue fever shots. My boyfriend, who worked at an independent publisher, just took it all in, gawping.

Eventually, despite my lack of publication, my desire to write became more important than my full-time job and the security of its lavish benefits. A small fellowship for my novel-in-progress eventually was psychically all it took for me to launch Plan B. I took my accumulated savings and started myself on COBRA, which lets you pay out-of-pocket for your insurance for twelve months—but because this had always been an invisible benefit, I remember being shocked by the monthly amount. Further, Goldman has a separate plan for its top executives for which it pays about $40,500 in annual premiums per family—compare this with the median family income of $51,000 with 48 million Americans lacking insurance at all.

When I was on my own, I wasn’t able to afford any insurance that would allow me to choose my own doctors (or see any of my previous ones), so I joined an HMO, which was terrible—interminable waits in a waiting room that itself looked infectious, a doctor who was allotted five minutes to examine me and ascribed my headaches and fatigue (Epstein-Barr) to sinus infections and kept prescribing useless antibiotics. But after writing full-time with little to show for it, even that became unaffordable for me.

Eventually, I drifted to a “catastrophic” plan, which cost me about $5,000 a year, the money I earned by, well, doing freelance work for a different investment bank. That plan gave me some mental serenity—I’d be covered up to a million dollars if I was hit by a bus or had cancer. But being young and healthy, I didn’t realize that cancer or an accident could easily breach the million-dollar mark, and luckily I stayed healthy. Penny wise and pound foolish, I also skipped routine screenings and physicals, toughed out illnesses because I didn’t want to pay the money. If I were still at Goldman, I’d probably be happily having my mole screening done right in my office.

But here’s the rub: if I’d stayed at Goldman, I probably wouldn’t be writing this right now, either. And if the Affordable Healthcare Act had been around, I probably would have run out of there even sooner—maybe a novel or two’s sooner.

The GOP’s obstruction of Obamacare is cruel and illogical. Senator Ted Cruz and others keep insisting that what is more important is not to make healthcare accessible but to grow the economy so there will be better jobs.

However, that entrepreneurial and job-creating spirit they so cherish is stultified by our odd (the only industrialized country—with dozens of choices—that decides to do it this way) employer-based system. The most innovative and creative types tend not to fit well within the traditional corporate model. But if their healthcare depends on hewing to this model, it’s logical that they’ll stay put as a wage-earner instead of going out and starting a new company. Or creating the kind of art that 1 percenters will pay good money to see or acquire.

It would take me too long to catalog the myriad ways creative people I know have been compromised by our system. A diabetic friend has to shop for jobs not by the work but by the insurance coverage. A friend’s daughter wants to be a musician, but can’t afford the medicines she needs to take for a hormonal condition on her waitress’s salary. A number of friends’ kids can’t even find jobs, no less one that they find fulfilling and with adequate insurance coverage. We need to ask ourselves: How many Steve Jobs—who himself had very complex health problems—might we be losing because of our healthcare system?

I myself am now a full-time novelist and essayist beholden to no employer, so how did I achieve health insurance equilibrium? Senator Cruz famously and proudly announced that he doesn’t take any government handouts and that he opted out of the rather lavish congressional health insurance (one that doesn’t quit during furloughs and sequesters). I also worked hard and got my insurance coverage the old-fashioned way, just like Senator Cruz: I got married. Although, sadly, my spouse is an academic while Senator Cruz’s wife is a top-level executive at—wait for it!—Goldman Sachs. My spouse and I have pretty big co-pays. I surmise the Cruzes do not have to ever open their wallets at a doctor’s office.

Instead of focusing on taking and keeping healthcare away from people, perhaps we should take a minute to feel what having accessible healthcare can be. An American poet friend, New Yorker–published, had, for whatever reason, stopped writing for the last five years. She recently moved to Canada and recounted to me how amazed she was at how quickly and efficiently she was seen by the list of medical specialists that, in true American fashion, she had put off for years because of the costs. There was no six-month wait, she received excellent care, and she mentioned how strange and then how freeing it was to have no insurance paperwork or money changing hands. It almost seemed like healthcare was a right. Who knows if lifting this mental burden of worrying about healthcare made a material change in her life? But after she moved to Canada, she did start writing again.

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When I quit my job at Goldman, my colleague, Anne, an aspiring poet, had shared dreams of us leaving together. Poetry, of course, is even more of a financially perilous career than prose, and I understand why she stayed. Years later, she attended my first book signing. Still at Goldman, but I expected her imminent departure. I left New York to go on a Fulbright, and we lost touch shortly after that.

Recently, while going through some papers, I found some lovely, old-fashioned letters Anne had written me, as well as the drafts of a few poems she’d shared. Moving back to New York plus seeing the documentary Inside Job, which included many Goldman characters that populated our world, spurred me to try get back in touch with her. Google was my first stop, and I hoped it would reveal that some of her poetry had made it out into the world. Instead, I found her obituary. After she’d left Goldman, it said, she’d gone on to work for a pharmaceutical company. Insurance, I thought immediately. She was a responsible woman—her father was a doctor, too—the Obamacare obstructionists would say, see? She had healthcare, that was great. Is anyone but me going to mourn for the poems that went unwritten?

Read more from Marie Myung-Ok Lee on how Prabhjot Singh is breaking the cycle of hate.

Breaking the Cycle of Anger

Dr. Prabhjot Singh. (Courtesy of The Sikh Coalition)

Last Saturday, Prabhjot Singh, a professor at Columbia University, where I teach, was beaten near his home by a group of about twenty young men shouting racial epithets and calling him “Osama” (he is not Muslim but a practicing Sikh and wears a turban). The assailants pulled his beard, fractured his jaw, kicked him and knocked his teeth loose, and didn’t stop beating him until bystanders intervened.

Whenever I see a hate crime like this, I’m always brought back to growing up Asian-American in an all-white town in rural Minnesota; one of my earliest memories is being 4 and an older kid coming up and punching me in the face for being a “chink,” I remember thinking the sky looked really weird from that angle (flat on my back, where I’d fallen), the almost comforting feeling of the warm blood on my face. Or walking back from the school bus and then suddenly needing to run because I was being pelted by snow and ice-balls. Having people yell “jap!” at me from cars. There’s a double anger not just at the wrongness of it but the ignorance—don’t they know Korea is a country separate from China and Japan? And that I was born in the United States, which the Constitution says makes me a citizen? And that my parents were citizens as well?

My physical coping strategy was basically to avoid all known racists throughout elementary, junior high and high school; my mental coping strategy was to secretly belittle my assailants in my head as ignoramuses and yokels that I’d leave far behind when I grew up and moved to New York. My secret feeling of superiority was a shield, especially that year I had two particularly persistent bullies who wouldn’t leave me alone. But this shield was also a separation, and dehumanizing in its own way.

I didn’t understand just how this self-righteous shield was actually walling me off from people until the Jack Johnson (not his real name) incident. In second grade, a terrifyingly tough kid (second grade!) decided it was his job to make my life miserable. He called me every racist name there was (and also, weirdly, “Hot Lips,” from the M*A*S*H* character). The worst was when he pushed me, hard, and I fell backwards, knocking my head against some metal monkey bars. In the nurse’s office, where I lay woozily in bed while waiting to be picked up by my parents, I recall hearing the prinicipal screaming, literally screaming, at Jack Johnson for what he’d done.

A traumatic incident like that, no matter how small you were, stays with you. I spent an inordinate amount of time hating Jack Johnson for making my life miserable. But then elementary school ended, we entered junior high, he dropped out of school and I never saw him again.

Probably thirty years after that, I was giving a talk on my experience with bullying to a group of teachers, and afterward I was approached by someone who lived in my hometown and actually knew Jack Johnson. I hadn’t mentioned him by name, but to this teacher, the person I had described was clearly Jack. He informed me that after a hard life full of drugs, crime and domestic abuse, Jack Johnson had died some time between 30 and 40, violently. I had never wanted to know anything about him, but hearing that he had grown up with a single father, a vet who probably had PTSD and was very “hard” on him, I can start to piece together a bit of the human Jack hiding behind that snarling face that used to give me nightmares. It’s possible his father had been at war in Asia, and that Jack’s singling out of me was, in its own warped away, just a bid for attention or love from his father.

I do live in New York now, and do feel comforted—as I always knew I would—being surrounded by so many different kinds of people. We sometimes forget that America is so heterogeneous, with hundreds of ethnicities, native languages, religions; that the fact we are able to exist as a country at all is almost something to admire, despite its problems. I don’t expect there could have been an afterschool special–type rapprochement between me and Jack Johnson, where I’d have him to our house and he’d learn that we were just a nice American family who ate pizza on Sunday nights, and I in turn would help him with his homework so he wouldn’t have had to flunk out of school. That’s unrealistic. But what’s not is the idea that had Jack been able to mediate his anger and racism—which really were just outward symptoms of many things going wrong in his life—that maybe the trajectory of his life would have gone a little better.

So it was with admiration and surprise to read a few days later in the school paper, the Columbia Spectator, that Dr. Singh, now out of the hospital, had held a news conference whereby he declared, “It’s critical to see that this is not the community we expect and certainly not the country we expect.” And he went on not to excoriate his still at-large attackers, but to extend an invitation for them to learn about Sikhism.

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“It would be under a bit of duress,” he said, with levity belying his broken jaw. “I would invite them to the Gurdwara, where we worship, to share who we are.” He feels that through education and community outreach, that perhaps American perceptions will move away from the group’s coincidental visual connection to Osama bin Laden.

He wasn’t saying that the young men shouldn’t be prosecuted for what they did, but he felt that more needed to come out of this, other than sending these youths on a Jack Johnson–esque path to incarceration, which breeds more anger, which breeds more violence. Instead, he told the New York Daily News, “Even more important to me than my attackers being caught is that they are taught.”

In American culture, sometimes we are too quick to act when what we need to do is listen. “Shoot first, ask questions later,” the tough guys say in the movies. But maybe what we need to do is ask questions first, then we won’t have to shoot.

Read Marie Myung-Ok Lee’s article on the intersection between gun violence and mental health issues.

When Mental Illness Meets US Gun Culture

The National Rifle Association executive vice president Wayne LaPierre. (AP Photo/ Evan Vucci)

After a shooting that injured thirteen people—including a toddler—in a park in Chicago last week, my friend complained it didn’t make the national news. Likely, there are just too many mass shootings competing for our attention: a few days earlier, Aaron Alexis had slaughtered thirteen people in a Washington, DC, naval office building.

The National Rifle Association exploits an easy tautology whenever we have a mass shooting: if anyone is so awful to do this, they must be mentally ill. If the person was a video gamer or a violent movie watcher, even better. This kind of reverse engineering creates a reliable narrative of an “other” that gives false reassurance that we would never have neighbors, friends, spouses who would do such a thing.

In a fascinating piece in The New York Times, Stanford professor of anthropology T.M. Luhrmann explores cultural differences in schizophrenia, specifically the commanding inner “voices.” I always assumed the voices were always dark, along the lines of “Must…kill…” However, the dark auditory hallucinations that mass shooters such as Adam Lanza and Aaron Alexis were said to have experienced may actually reflect a peculiarly American violence-and-gun-saturated culture. In a surprise twist, Professor Luhrmann and her colleagues at the Schizophrenia Research Foundation in Chennai, India, found that in Chennai, the commanding voices could be dark, but most often said a version of “Must…do…chores”; an example cited from one patient: “Go to the kitchen, prepare food.”

It is easy to square away mass gun violence by blaming violent video games, movies, and/or mental illness, but then we fail to understand the connection between it and the ubiquity of and easy access to guns in our society, as well as guns’ roles in our culture and self-image. It probably isn’t a coincidence that so many mass shooters spring not just from the ranks of the mentally ill but directly from gun culture, like Major Nidal Hasan at Fort Hood. Or Christopher Dorner, the Los Angeles shooter, an honorably discharged Navy Reservist and former policeman. These mass murderers were, also, at a different time, one of NRA Executive Director Wayne LaPierre’s oft-cited “good guys with guns.”

In a gun culture world, more guns equal more safety. But most other industrialized countries seem to feel the opposite, and interestingly, their gun homicide rates are a fraction of ours.

For that year I lived in Korea as a Fulbright scholar, only thirty-five miles from one of the most militarized borders in the world, the lack of guns was noticeable to me. Among my young adult Korean cohort, there was much talk about the two years of military service all the men were going to have to do, and that unlike in the United States, every Korean man over a certain age has handled a gun. In the civilian world, however, guns are illegal, police and security guards are unarmed and even directors shooting Korean War or gangster movies need go through a laborious process to obtain permits for each fake gun. The crime roundup in the nightly news showed police running after perps, the occasional taekwondo kick, but never dramatic shootouts.

And yet, Korea is even more wired than America: it has a video gaming culture that is (given the number of “Internet rooms” devoted solely to game playing) likely even more involved than the US’s. While LaPierre blames mass shootings on “blood-soaked films out there, like American Psycho,” (psst, Mr. LaPierre—get Netflix and update yourself a little), Korean directors such as Park Chan-wook pioneered über-violent gangster films that inspire American directors like Quentin Tarantino. But even if the mentally ill in Korea want to go more like Park Chan-wook’s killers in Oldboy than doing the dishes, in Korea there is not the means to fulfill their mass shooting fantasies. We can’t forget that Cho Seung-Hui, the shooter who killed thirty-two students and faculty and injured seventeen at Virginia Tech, was a Korean immigrant. Cho appears to have suffered from various forms of mental illness since he was a child. He was obsessed with guns and took pictures of himself posing on Oldboy-type stances. But the difference here was that he was able to purchase his Glock and his Walther semiautomatic pistols (with the requisite background checks) legally and go on to commit mass murder.

The United States is a gun culture. We see a cop, we see a gun. We are proud of it. Putting aside obvious Freudian references to guns = manliness, gun culture is part of an American myth that makes us feel good about ourselves: we protected ourselves, we “conquered” the frontier, we remember the Alamo. Don’t forget that John Hinckley shot and almost killed President Reagan because he believed that was the only way to “impress” the actress Jodie Foster.

Writing for The Guardian, Henry Porter points out that in the last forty-five years, more Americans lost their lives from firearms than in all wars involving the United States (which, on its own, is a lot). A raw look at the numbers, he says, suggests that a world-governing body, such as the UN, should get involved, just as it would in any other country mired in a bloody civil conflict.

Where does this culture get us, ultimately, especially when it intersects so dangerously with mental illness? With no medical credentials, I cannot comment on possible mental health issues George Zimmerman may have, but a Korean George Zimmerman (or a GZ of any other industrialized country, all of which have stricter gun laws than the US) would have had to live out his vigilante/hero fantasies by confronting his putative perp mano a mano. Had this been so, in a matchup between the vigilante and the teen, Trayvon Martin might have had a chance to finish the many years likely left to him.

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Further, we have a shining example of “give peace a chance” staring us in the face. A school bookkeeper named Antoinette Tuff averted a second Newtown school shooting with a deliberate rejection of gun culture. While face-to-face with a gun-wielding intruder who had broken into her school stating his intention to shoot (he had already shot at the police), instead of pulling a Calamity Jane and pulling out her own gun (Clarksville, Alabama, has opted to arm its teachers and staff), Ms. Tuff used compassion, empathy and emotional skills to engage the shooter. Mr. LaPierre has stated as a mantra after each successive mass shooting that “the only thing that stops a bad guy with a gun is a good guy with a gun.” But here, there were no guys. And no guns. Only a courageous woman willing to face a semi-automatic weapon and 500 rounds, as well as the person holding them; the shooter was confused, paranoid, agitated, possibly mentally ill. But because of the unarmed Ms. Tuff—who ordered the police to stay back during this entire interval—the shooter gave himself up peacefully, no children died—and neither did he.

The NRA’s other favorite mantra is that guns don’t actually kill people, people do. But the intrinsic illogic of this is clear. Even the NRA itself, for its annual meeting this weekend, notified the attendees that there will be no guns. People will willingly, peacefully do what they are always accusing President Obama of theoretically scheming to do: give up their guns, of any sort, open or concealed carry, military-style, etc.—in order to enter the auditorium where the conference is being held, probably making this venue one of the safest places to be in America this weekend.

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