Letter to Rodney Davis on the Affordable Care Act

Below is the letter I just sent to my congressman.

I undoubted spent way more time drafting this letter than it was worth. I have no illusions that my congressman will read it and be swayed by my logic. As a practical matter, the best I can hope for is that someone on his staff will look at it carefully enough to add one tick to the column for “constituents opposed to repealing Obamacare.”

And yet, I think it was worth the effort I put into writing it—partially for my own benefit, as a way to clarify what I thought the most important points were, and partially for any local folks who might read it and be moved to weigh in with their own thoughts on the matter.

The Honorable Rodney Davis
1740 Longworth House Office Building
Washington, DC 20515

Dear Congressman Davis:

I am writing to urge you to preserve three key elements of the Affordable Care Act, which Speaker Paul Ryan’s “A Better Way” agenda does not protect: that policies cover the full range of essential care, that coverage be available at standard rates regardless of preexisting conditions, and that credits be available to help lower-income people buy health insurance.

With the Affordable Care Act’s rules, it’s possible to buy an insurance police and know that a full range of important care is covered. The “more choices” supported by Speaker Ryan’s plan would mean that people could “chose” to buy insurance with incomplete coverage. I have first-hand experience with how much work it is to analyze and compare insurance policies, trying to read between the lines to see what essential coverage is missing. The result of the Speaker’s plan would be many people who thought they were getting a good deal on their insurance would face bankruptcy because of hidden gaps.

With the Affordable Care Act, the last four years have been wonderfully free of the anxiety that any illness could turn into the “preexisting condition” that would make health insurance unavailable. Speaker Ryan’s plan to condition this on “continuous coverage” is a poor substitute. Sometimes people suffer a financial catastrophe and are temporarily unable to afford to maintain their insurance. It is terribly cruel to compound such a catastrophe with the additional penalty that health insurance—once they can afford it again—be unavailable or unaffordable.

My wife and I have modest incomes, and make some use of the credits available through the Affordable Care Act, which have made my insurance much more affordable. Speaker Ryan’s plan would eliminate these credits and replace them with a single credit which would probably be much smaller—and if as large, would be enormously generous to people with high incomes who scarcely need help affording their health insurance. The current means-tested credits seem much more likely to advance to goal of making health insurance available to everyone.

I urge you preserve these key elements of the Affordable Care Act.

Yours sincerely,

Philip M. Brewer

There are plenty of other things I might have included as well. For example, under the Affordable Care Act an older person can only be charged 3 times as much as a younger person for the same policy, whereas the Speaker’s plan would increase the multiple to 5x. If enacted, that change would cost me a lot. But I thought these were the most essential points: That insurance actually be insurance, that it be available, and that it be affordable.

Theory and Practice of Neurogenesis

Even though I’m finding my self-care regimen for seasonal depression pretty adequate these days, I’m always interested in more tools. One thing that caught my attention recently was an interview with Brant Cortright in which he talked about his book The Neurogenesis Diet and Lifestyle.

Cortright has a bunch of interesting things to say, one of which I already knew: that depression is not a disorder of serotonin deficiency. According to him—and this I did not know—the way SSRIs work is by promoting neurogenesis. In the interview he said that depression turns out to be caused by a lack of neurogenesis, as are several other disorders (e.g. Alzheimer’s).

I checked the local libraries for copies of his book without success, but in my searches I happened upon this article: Successful brain aging: plasticity, environmental enrichment, and lifestyle by Francisco Mora, which seems to cover pretty much the same ground.

People are looking very hard at drugs besides SSRIs to promote brain plasticity, but the whole idea sounds problematic to me, so I’m interested in the various non-drug interventions suggested by Cortright and Mora. Fortunately, it seems that neurogenesis is easy to increase, by doing the obvious things we already know about:

  • Environmental enrichment
  • Calorie restriction
  • Aerobic exercise
  • Adequate levels of certain nutrients (omega-3s, vitamin E).

I think of my artist dates in particular as environmental enrichment, but of course time spent in nature counts as well. The parkour I do probably counts double, because there’s learning how to execute the moves, but there’s also learning to see the environment as a place where those moves are useful.

My weight loss practices have been substantially motivated by the science around calorie restriction as a way to improve health generally, with additional neurogenesis just one factor.

My experience over the previous 30 years convinced me that approaching calorie restriction in a numerical, analytical fashion—tracking what I ate, estimating the calorie content, aiming for some target X% below maintenance—would be unsuccessful. Instead, I came at it from the other direction: If I’m losing weight, I must be restricting my calories.

The caloric deficit implied by my weight loss over the past five years is just about 100 calories per day. Maintenance for me is probably around 1800 calories per day, so I’ve averaged about 5.5% below. It would probably be more accurate to say that I’ve averaged about 10% below maintenance for about half that time, as I’ve generally lost weight during the summers while maintaining a stable weight through the winters. Either number is well shy of the “20% to 40%” reduction that’s been shown to decrease the rate of aging of the brain, but I rather suspect that the benefit exists even at these lower levels—with the added bonus of being sustainable over a much longer period of time. (I mean, how long can you maintain a 40% deficit below maintenance before you simply waste away?)

According to Mora, aerobic exercise seems to increase neurogenesis by the same chemical pathways as calorie restriction. According to Cortright, it has to be aerobic activity of substantial duration—some twenty minutes or more. In particular, the sort of HIIT workouts so beloved of the paleo/primal folks don’t seem to produce the same effect. That’s fine with me: Humans are much too well-adapted for endurance running for me to buy into the idea that primitive humans didn’t do marathon-distance runs when they needed to. Besides, I enjoy long runs.

Of course, neurogenesis is reduced by the obvious things:

  • Neurotoxins (mercury, lead, pesticides, etc.)
  • Traumatic brain injuries (concussions, etc.)
  • High blood glucose levels
  • Stress.

My parents made a considerable effort to keep me and my brother free of neurotoxins, and I have managed to avoid concussions so far. I’m sure I subjected myself to excessive blood glucose levels for years, but I think I’ve got that under control now. I also subjected myself to excessive levels of stress for years, due to the vicious circle of my seasonal depression making me unproductive, my lack of productivity making me stress about losing my job, and the stress no doubt worsening my depression. I’ve got that under control now as well.

Really then, this whole neurogenesis thing doesn’t so much give me new strategies for staving off depression, as provide a conceptual framework for organizing the strategies I’m already using.

Even just that seems worthwhile.

(The image at the top is of these great doors at the Environmental Education Center at Kennekuk County Park. The branching trees reminded me of neurons, a little.)

Experimenting with low-carb

I’ve resisted low-carb eating for a long time, even as the evidence has increased that high-carb diets are terrible for us.

Via Christopher McDougal’s book Natural Born Heroes, I discovered Phil Maffetone and his two-week test, which caught my eye.

I’m generally very healthy and feel great, but I do have a few health issues—and there seems to be at least some evidence that a low-carb diet might help all of them. The point of the two-week test is to test exactly that: If you go very low-carb, does it make things better? If not, then you’re done—excess carbs are probably not your problem. If it does make things better, then you follow up the two-week test by gradually experimenting with adding carbs from various sources in various amounts, and figure out how much (and which kinds) of carbs you can consume without problem.

The things I’m hoping a low-carb diet might help are these:

  1. Allergies. Over the last twenty years I’ve gone from claiming that I don’t have allergies, to admitting that I get sniffles for a couple of weeks in the spring and the fall, to needing to take both Claritin and Nasacort daily. There’s some reason to believe that a low-carb diet might reduce inflammation. If true, that might ease my allergy symptoms (besides improving my general health), and might mean that I could eliminate those drugs, or perhaps just reduce them from constant to occasional.
  2. High blood pressure. My blood pressure is well-controlled with lisinopril, and I’ve been able to cut the dose since I’ve lost some weight these past 5 years, but it’s another drug that I take daily. It seems very likely that a low-carb diet will reduce my blood pressure, very possibly eliminating the need for this drug as well.
  3. High blood sugar. Back in 2003, I got a high blood glucose reading, and a stern talking-to about pre-diabetes. I responded by sharply reducing my consumption of soft drinks. That brought my blood glucose down to 91 in just six months. The past two years, though, my glucose has been ever-so-slightly high again. It’s not at a scary level, but I don’t like it even a little bit high. Undoubtedly, a low-carb diet will improve this.
  4. Weight loss. My weight is in the normal range, and has been since 2014. Further weight loss probably has no health benefit. Still, purely for aesthetic reasons, I’d be pleased to lose another few pounds. A low-carb diet will probably produce this result as well.

The main purpose of this post has simply been to get my thinking in order regarding what I’m hoping to accomplish. I have little doubt that a low-carb diet will produce the latter two improvements, but those issues could be dealt with easily enough through less drastic means. I have much less confidence about the former two, but improving those things would be a big deal for me—big enough to undertake the two-week test (at least), and maybe to change the way I eat going forward.

The myth of age-related illnesses of middle age

You know this, right? Age-related diseases—at least, those of middle age—mostly aren’t. Rather, they’re lifestyle diseases that seem age-related because it takes years or decades for the harm done by the lifestyle to start showing up as symptoms.

I’m prompted to write this by something Charles Stross wrote over a year ago, where he talks about the symptoms of aging. I almost didn’t link to that post, because he’s really talking about something else—his post is about the political effects of reasonably foreseeable improvements in medicine—but along the way, he describes his current circumstance:

. . . chronic low-grade pain of the middle-aged body: joints that creak and pop, muscles that need an extra stretch, sore feet.

And goes on to compare it to his hypothetical world with science-fictional medicine:

Unlike today’s senior citizens, you don’t ache whenever you get out of bed, you’re physically fit, you don’t have cancer or heart disease or diabetes or Alzheimer’s, you aren’t deaf or blind or suffering from anosmia or peripheral neuropathy or other sensory impairments, and you’re physically able to enjoy your sex life.

Of course there are age-related diseases—Alzheimer’s and anosmia probably are. But especially the ones in the first quote—the age-related difficulties of the middle-aged body—aren’t age-related at all. To imagine that they are is to make a category mistake—and a serious one, because the error makes it much more difficult to recover your health.

I’ve hesitated to write this post, because I realize that I’m speaking from a position of privilege—I’m healthy. This is partially a matter of luck, partially a matter of good genes, partially a matter of a lifetime history of good health care, access to adequate nutrition, and so on.

Even so, I’ve got real first-hand experience with exactly the list of middle-aged body problems that Stross lists.

Eight or ten years ago, I was feeling old. Tasks that required strength were more daunting than they had been—especially ones, such as carrying things up or down steps, that added additional weight to my already excessive body weight. My balance wasn’t as good, making slippery tubs and icy sidewalks seem like serious threats. My plantar fasciitis was kept at bay only by being scrupulous about wearing supportive shoes and by limiting the amount of standing I did. I could still get down on the floor and get up again, but it was hard enough that I didn’t do it when I didn’t have to. I had trouble getting a good night’s sleep, because my back would ache when I lay still too long, and when I did sleep through the night I’d need considerable stretching before I could move normally the next morning.

I viewed all this as normal aging. Partially, I think that was because I was actually in pretty good shape. I could walk 5 or 6 miles. I routinely bicycled to work when the weather was nice. I went to the fitness center two or three times a week to use the weight machines and do some stretching. Despite all that, my physical capabilities were declining, and I didn’t see anything I could do about it, except perhaps spend even more time exercising, which didn’t seem practical for someone with a day job.

It wasn’t true, though. Over the past six or seven years, I have felt better each year. It is not a strain to carry things of ordinary weight, even going up and down stairs. My static balance is excellent—I no longer fear slippery tubs, although I do still try to be careful on ice. My feet don’t hurt when I stand a lot, even when I’m barefoot. I make a point of sitting on the floor, just to add some variety to the day. I sleep well, and I wake up able to move.

What did I do? Nothing extraordinary.

Starting to do tai chi was probably the key shift, because it changed so many things at once about my movement practice. Somewhere along the line I ran across parkour, and then even before I had done more than play with that I discovered natural movement as a thing—and that was what gave me a framework for thinking about movement the same way I’d come to think about food.

Trying to figure out the best diet is a waste of time. It’s computationally infeasible, and anyway unnecessary—just eat a wide variety of foods (and limit your consumption of industrially produced food-like substances) and your body takes care of the rest. (See Michael Pollan’s In Defense of Food for details.)

Similarly, trying to figure out the best exercise regime is a waste of time. You are far better off to get a wide variety of movement (and limit the time spent doing things like sitting in chairs and wearing shoes). Once again, your body will take care of the rest.

What struck me—what prompted me to write this post—was that Stross’s description of what his science-fictional medicine feels like is what I’ve felt like. It’s not exactly aging backwards, but it is a recovery of a feeling of ease and comfort that had slipped away under cover of “normal” aging.

My life feels kind of like a science fiction story, with the science-fictional medicine being just recovering normal patterns of movement.

It makes me want to advocate these lifestyle changes, perhaps more strongly than is advisable. As I say, I recognize that I’m writing from a position of health that isn’t available to just everyone. I can’t say that if you’ll just start walking and running and bicycling and lifting weights and doing taiji and experimenting with parkour and natural movement, you will reverse the aging process and feel young again. There are kinds of impairments that cannot be completely recovered from, and perhaps some that cannot even be improved.

And yet, I do advocate these lifestyle changes. Move better. Move more. Eat food. I bet you’ll feel better—especially if you’re starting to suffer from the symptoms of “normal” aging.

Obamacared

I was one of the first people to try to sign up for insurance on healthcare.gov. That turns out to have been a mistake. At least, that’s my theory.

With considerable effort, over a period of a couple of days right at the beginning of October, I’d gotten through the first part (where you verify facts about yourself to confirm that you’re you). Then I’d done the part where they ask about your income, etc.

At that point—when I’d entered all the info about my and Jackie’s contact info, race, ethnicity, income, and so on—I clicked the last “submit” button. . . and waited.

After a long time, the submission timed out.

Not wanting to have to go through all that entering again, I just backed up a screen and clicked submit again. . . and waited again. And it timed out again.

I did that over and over again, hoping that eventually I’d get a successful submission. And at some point I did get one. In fact, I got a bunch—many of those failed submissions had apparently gone through before they failed. But (I now believe), something about them had gotten corrupted at some point.

On the first visit after that, I’d gotten through to the point of seeing what policies were available to me and how much they’d cost. I printed the list and reviewed it with Jackie and investigated the networks offered by a few plans and picked a policy (sticking with Health Alliance, but going for one of their new Silver plans). But when I returned, there was a glitch: I could no longer sign up for insurance for Jackie and myself; it offered me a policy only for myself, with no sign as to whether I’d be able to get Jackie signed up after.

Yesterday, I finally gave up on making my way through the signup process, and called the telephone interface.

Turns out, the people on the other end of the phone go through the exact same interface. So, of course, they ran into the exact same problem I did.

After escalating to the senior tech guys, the proposed solution was to reset my account and have me start over. (Something I would have done a long time before, if that interface were available.)

Sadly, I couldn’t make that work either.

Finally, I started over completely. I created a new account (with a new login name, using a new email address), re-verified my identity, and re-entered all the info about me. This time, having already selected a policy, I pressed straight ahead and enrolled.

So, I have successfully signed up for insurance through Obamacare. It took about an hour, once I started over from scratch. I suspect it would have worked pretty smoothly, if I hadn’t tried so persistently to sign up in those first few busy days.

Despite the aggravations of getting signed up, I’m pretty pleased. Obamacare is going to save me hundreds of dollars a month. Our insurance bill had been our largest bill—quite a bit higher than our rent. Now it will be just another monthly expense—bigger than our phone bill, but less than rent or groceries.

And yet, the cost savings is far from the most important thing. Before, I worried constantly that any major medical problem would ruin us—make it impossible to get affordable insurance; trap us in a policy that all the healthy people had fled, with premiums spirally inexorably higher until they consumed all our money. Now, at last, we have some security on that front. Cheap or expensive, at least our insurance is actually insurance. A major medical problem would still be a big deal—one of us would no longer be healthy. But at least it would just be that, and not that and a financial catastrophe too.

Peanut butter is good

We usually buy our peanut butter from a local health food store that grinds it fresh. The owner comes out from behind the counter, grabs a 1-pound package of peanuts from the cooler, and then takes it back behind the counter and grinds it while you wait. (I think you’re supposed to get the package yourself and bring it to her, but I didn’t know that. Jackie usually does the shopping there.)

Sadly, we just used up our package of freshly ground unsalted unsweetened peanut butter, and for lunch today had to make do with our backup supply—some national brand peanut butter. We keep it on hand for two reasons. It’s less runny than good peanut butter, which is nice when we’re making peanut butter sandwiches to take to a lunchtime lecture at OLLI (or any similar brown-bag event) and want a minimally messy lunch. And it stores well.

It’s not as healthy. It’s salted and sweetened. Worse, some of the healthy peanut oil has been replaced with some less runny oil. (Although they now use less hydrogenated vegetable oil than they used when I was a kid.) But you know what? The commercial stuff tastes good even so.

Still, we’ll get some more freshly ground peanut butter first chance we get.