Concerning the Moral Obligations of the Wealthy

I have come under some criticism of late for being uncharitable toward the rich. To be more precise, I offhandedly wrote, alluding to Ester’s piece on trust fund kids, that my policy concerning people born rich is to distrust them. Commenters took me to task for that, and rightly so: it is foolish and wrong to suppose that affluence, in and of itself, defines character. As one commenter noted, mine was “exactly the kind of ignorance several writers on the Billfold would preach against if it were any other kind of discrimination.”

I think that commenter was right, and I said so in comments and a note appended to the post in question. I also said, “We could have a separate discussion about whether there is any moral imperative on the inheritors of wealth to do something selfless and worthwhile with their money, or about the attitudes that may or may not prevail among them about whether they deserve their good fortune.” Several commenters later suggested that yes, that is a discussion worth having. This came to mind over the weekend, when I was engaged in that most proletarian of leisure activities, camping and reading the New Yorker. So let’s start our discussion about the moral obligations of the wealthy with a focus on how they help people with acute need.

I suppose I should not expect a worldview untouched by a certain elitism when I read the New Yorker, but more and more, I notice that there is an archetypal story about rare diseases and how progress is made in their cures. It goes like this:

1. An upper-middle-class couple notices something unusual about their infant child. 2. Doctors are either flummoxed and unhelpful or convinced that it is a terminal illness. 3. The parents refuse to accept the doctors’ assessment and devote large sums of money to (a) organizing and lobbying for more research on the illness; and (b) making all kinds of costly changes to their home, lives, and routines to accommodate their ill child and make the child’s life more enriching. 4. Progress in treatment results from the parents’ tireless efforts.

This sequence became clear to me while reading Seth Mnookin’s piece, “One of a Kind” in the July 21, 2014, issue. The article focuses on a couple, a college professor and an M.B.A., whose son has an extraordinarily rare genetic disease, and their ultimately successful quest to push the medical establishment toward more data-sharing and collaboration to develop treatments. (Spoiler: the disease isn’t quite as rare as previously believed.) The article is great and fascinating: in addition to following a family with the surname Might and involving a glycobiologist who is actually named Hudson Freeze, it illustrates how more base human motivations (researchers’ desire for sole credit on publications; institutions’ need to compete for scarce funding) can impede medical progress. It also has a happy-ish ending: the Mights’ son is showing surprising progress as he gets older; research is progressing.

But all that progress is predicated on the fact that this terrible disease befell not just Matt and Cristina Might’s child, but the child of Matt and Kristen Wilsey as well. The Wilseys, we learn, “are one of the most prominent families in San Francisco.”

CEO Wins Chance to get Killed By George RR Martin

In a perfect confluence of events, a wolf-loving Michigan CEO has won the right to be killed off by renowned wolf-aggrandizing author George R.R. Martin. Responding to a competitive fundraising call, Dr. Dave Cotton’s family made a $20,000 donation to a wolf-related charity in his honor — for father’s day. (Aww!)

Mike Cotton, chief operating officer of Meridian Health Plan and one of Dr. Cotton’s three sons, said his father had an affinity for wolves before he started reading Martin’s fantasy series, “A Song of Fire and Ice,” which was first published in 1996.

“We saw this crowdfunding come up online and we thought it would be perfect for his love of wolves,” Mike Cotton told ABC News. Mike’s brother, Sean, who is an administrative officer at the family-operated company, said their father loves the books and watches the HBO series “avidly.”

“He’s always referred to himself as a lone wolf,” he said of his father.

The ACA’s Effect on the Labor Force is Currently Foggy

The Congressional Budget Office reported today that the Affordable Care Act will shrink the American workforce by 2.5 million by 2024, not as a result of employers shedding jobs but because more people will choose not to work or "work fewer hours than they might have otherwise to obtain employer-provided insurance."

Sickness, Death, and Money

My mom passed away when I was a junior in college, and she got sick when I was in high school. There were a lot of trips to doctors, many close calls at the ER, and many out-of-pocket medical expenses.

Measure Your Life in Birth Control

My life divides neatly into AD — years of delightful innocence about the realities of life — and BC — when I had to dedicate a part of brain to thinking about obtaining, using, and paying for birth control so that my womb wouldn’t get any ideas about its outsized importance of my life and start throwing its weight around, dictating terms. Here is my life in birth control.

At first I used condoms, and though I bought them occasionally at less than $10 a box, my male partner almost always came prepared. (ba dum CHING!) Soon, though, I realized I wanted to own the control part of birth control. Besides, I hated the way latex smelled. I might have gotten the pill from my doctor at home, but when I tentatively broached the subject of sex with him, he told him dismissively that I was too young and ended the conversation. So I talked through my options with the thankfully less judgmental gyno at the college health center.

First I paid about $10/month for a subsidized patch. Its adhesive sides collected masses of fuzz from my flannel sheets, which meant what should have been a subtle flesh-toned square swiftly turned a garish violet. Then I got sick. Very sick. After a dizzying week, I ended up in the clinic overnight for Valentine’s Day with a fever of 103.5 and had to get an extension for my seminar paper on the American steel industry. I hate not being on time.

Finally, tired of trying to tough out the patch, I ripped it off. The college gyno next tried me on the ring, also sold subsidized at $10/month. It gave me staggering headaches from the hormone shifts and the opportunity to come to grips with myself — specifically my cervix — twice a month. The ring didn’t kill me within the week or render me invisible to all but Sauron, so I dealt with the side effects for the next decade.

1 is the Loneliest Number That You’ll Ever Do …

Thursday is a great day to do that 1 thing you don’t want to do but also don’t want to continue thinking about doing.

The thing I really should do is go to my stupid health insurance webpage and find a stupid doctor to take care of a small but annoying problem. It’s the kind of problem that surfaced LAST YEAR just before my family’s 7-week Great Escape and I waited for it to go away on its own as we made our way through two or three different countries, until I finally limped into a Spanish hospital and begged for help. A punctual, kind, and handsome, though sadly not very English-speaking, doctor gave me a temporary fix, and then said I’d need to get real attention once I returned to the States.

Of course, I didn’t. Now that it’s summer again the problem is getting harder to ignore. I hate bureaucracy and the thought of maybe having to have surgery (!) and not being able to walk (!!) so I just keep putting it off. But. Today I will change all that. Today I will find and call a doctor. Today I will DO 1 THING.

How about you?

The Doctor Will See You in 18.5 Days

A survey of physician practices in 15 metropolitan areas across the country, which was taken before the health law expanded coverage, found that the average wait time for a new patient to see a physician in five medical specialties was 18.5 days. The longest waits were in Boston, where patients wait an average of 72 days to see a dermatologist and 66 days to see a family doctor. The shortest were in Dallas, where the average wait time is 10.2 days for all specialties, and just five days to see a family doctor.

“We have too few providers, which is creating a significant access problem,” says Travis Singleton, senior vice president of Merritt Hawkins in Texas, which conducted the survey. The health care and physician search consulting firm spoke with 1,399 medical offices between June and November 2013 in five different areas of specialization: cardiology, dermatology, obstetrics/gynecology, orthopedic surgery and family practice. Researchers called the practices and asked for the first available appointments for new patients needing routine care, such as a heart check-up or a well-woman visit.

How long did it take you to set up an appointment to see a new physician? When I first moved to New York, an office told me it’d take seven weeks to fit me in. I ended up going to a college clinic that said they’d be able to see me in a few hours. Or maybe I could have flown to Texas.

Photo: Consumerist

Fox News on the Affordable Care Act, Two Ways

Kohn was able to find a better and cheaper plan on the health insurance exchange sites. Kohn's lesson: Try the exchange, and look at the options that are available to you—it might surprise you.

Do 1 Thing (And a Report on a Successful Thing!)

Thursday is a great day to do that 1 thing you don’t want to do but also don’t want to continue thinking about doing.

Before I get to this week’s 1 Thing I want to report that I saw a doctor about a small lingering health issue from LAST SUMMER. I got all freaked out initially because the first doctor I saw about it, a year ago, seemed incompetent *and* told me it might be cancer, so my natural reaction was to shut down, hide under the bed, try to pretend there are no such things as hospitals, etc. A couple of months later, when I couldn’t ignore the problem any more, I saw a doctor in Spain. He spoke only enough English to assure me it probably wasn’t cancer, but he did say I might need surgery.

Again: shut down, under the bed, pretending.

AT LAST, thanks to “1 Thing,” I made another appointment with a new English-speaking doctor who hopefully wasn’t incompetent. Turns out she’s the greatest. It’s not cancer! I don’t need surgery! In short everything’s fine. Thanks, 1 Thing!!

My next 1 Thing is to mail a care package to friends of mine who are having their first baby, and it should be super fun because I get to pack it full of stuff that is haloed with love & good wishes. What’s yours?

How Medical Bills Can Easily Damage Our Credit Records

Elisabeth Rosenthal, who has been writing a series on the cost of health care in the U.S., wrote a piece in the Times Sunday Review this weekend looking at how chaotic medical billing can affect our credit.

Doctor Breaks His Neck, Appreciates the Work of Nurses More

Seeing this comment this morning in my post about our culture of being overworked reminded me of this piece I read last night in the New York Review of Books by Arnold Relman, a physician with six decades of experience who fell and broke his neck and saw a new perspective on what it's like to be critically ill and cared for under the U.S. medical system.

The High Cost of Breathing

Elizabeth Rosenthal's series in The New York Times on why the U.S. leads the world in health care expenditures has been really good—she's previously tackled colonoscopies, pregnancies, and joint replacements—and her fourth story is on prescription drugs, namely, asthma medication. The high costs are due to patents, which have prevented generics from competing in the market, and, yes, lobbying from pharmaceutical companies.