The High Cost of Being Uninsured

When people talk about the risks and costs of no healthcare insurance in the United States, they often talk about the risk of something catastrophic, such as a major illness or serious accident. Those risks are significant, of course, but I think there’s another major cost that isn’t being discussed nearly as much. If someone in the US doesn’t have insurance, they are effectively charged dramatically more for everything than someone with health insurance is charged. My wife has had a number of surgeries and procedures over the past few years, so I’ve been able to see that dynamic in action repeatedly, but it’s there with everything from ordinary doctor’s visit to prescription drug costs. If you look at statements, it’s usually called something like the “insurance adjustment” and it’s often massive. I’ve seen the adjustment equal nine-tenths or more of the billed amount.

Remember, this is the amount the charge is reduced before either the insurance company or the individual pays anything. And that single fact is massively important. Let’s say that an individual or family, even with the ACA subsidies, can only afford a bronze plan with a $5,000 or so deductible before it pays much. With subsidies, such plans tend to be pretty inexpensive and should be in the reach of most everyone. A lot of people look at that amount and think the plan doesn’t provide any benefits for them until they have more than $5,000 in health care expenditures.

Nothing could be farther from the truth.

Because of this hidden benefit of being insured, a single ER visit for a minor fracture with x-rays could end up costing hundreds, if not thousands of dollars more for the uninsured patient than for the insured patient even if the insurance company doesn’t actually pay a cent because the deductible has not been reached. Even the difference in the amount charged for a single, simple office visit will likely be more than a month’s subsidized premium for a bronze plan.

Now, if you think the above is a horribly broken system, then I agree with you. But that’s reality in the US today. And as long as that’s the case, the benefits of being insured in America don’t start when the insurance company begins paying. They begin immediately and you receive those benefits even if the insurance company never pays anything at all.

So if you still have no health insurance and either don’t think it’s worth it or don’t believe you can afford it, you need to reevaluate your decision. It’s invaluable and almost essential in the US as things work today and you really can’t afford not to have it.

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The Gluten Free Diet is NOT a Fad Diet!

I wrote the following as a comment on another blog after someone said they couldn’t wait for the gluten free fad diet to go away. Usually I ignore those comments. This time, for whatever reason, I didn’t. The words poured out and I decided to edit it and post it on my blog. So without further ado, here is my response to those who believe the gluten free diet is just another fad diet.

Okay, that’s going to prompt me to pull out my soapbox. ;-) I have to confess, I have mixed feelings about the current faddish aspect of the gluten-free diet. On the one hand, it’s educated the broader population. A lot more people now at least know what gluten is. That makes it much easier for me to explain what I can and can’t eat. Restaurants have become a lot more sensitive and knowledgeable about food allergies, sensitivities, and intolerances in general and gluten specifically. (Even though what I have isn’t an allergy, the treatment is the same as that for an allergy.) And it’s now a lot easier than it was to identify a gluten-free food product with confidence. (Part of that is also a result of the labeling regulations the FDA has developed.)

With that said, it has also led to a widespread dismissive attitude by people who treat it like just another fad diet. Mostly I ignore it, but the stories of restaurant chefs and servers who deliberately contaminate food because they are irritated about this “fad”, though thankfully uncommon, are always in the back of my head any time we eat out. Even when someone isn’t malicious, they can still be careless if they think it’s just a fad. We’re very selective in the restaurants in the area that we know and trust, but there is always that first time you try a restaurant that isn’t already on your list. There have been times I simply haven’t eaten the food because something about the food or the service set off warning bells. ( I don’t make a scene based on a gut feeling, but I don’t like that I have to worry about it.)

Fundamentally, the gluten free diet is emphatically not a fad; it’s a medical diet. Nobody would dismiss a diabetic diet as a fad even if, for some reason, it gained a faddish quality among some people who did not have diabetes.

Celiac disease is at the top of the list of medical conditions that are treated with a gluten free diet. Celiac disease remains widely misunderstood by the general population, even when they’ve heard of it. It’s not an allergy or food intolerance. Nor is it limited to GI symptoms.

Rather, celiac disease is an autoimmune disease like lupus, type 1 diabetes, and a number of other pretty serious diseases. When a person has an autoimmune disease, their body produces auto-antibodies that attack itself rather than an invading pathogen. Unlike all the rest of the autoimmune diseases, we actually know what triggers the autoimmune response for those of us with celiac disease — consuming gluten. In a way, I consider myself fortunate. At least I have a chronic, incurable disease that I can keep in complete remission simply by maintaining a strict medical diet. People who have lupus, for example, aren’t so fortunate. All they can really do is try to treat the symptoms and keep it under control, but they are never symptom-free. And none of the medication is free of side effects. And if the first medicine used becomes ineffective, the next one is actually a chemotherapy drug. Similarly, I’ve known a number of people with type 1 diabetes. They have to follow a fairly strict medical diet, watch their blood sugar, and give themselves insulin shots. And their disease is never in remission or fully controlled.

A lot of studies have been done over the past decade or so, including a controlled study here in the US that tested something like 13,000 people in the general population across the country. So we know the rate of celiac disease. In the US, roughly 1% of the population has active celiac disease. That’s roughly the same rate as type 1 diabetes, making those two diseases by far the most common autoimmune diseases. Unfortunately, nearly 90% of those with active celiac disease remain undiagnosed. Moreover, other studies have shown that the rate of celiac disease in the general population has been increasing for decades and is still increasing. (They tested blood samples going back to the 50s and discovered active celiac disease back then had about a quarter of the rate it currently does.)

And that’s because celiac disease can be largely asymptomatic for years as it creates long-term damage. Or its symptoms can seem unconnected to each other and and can range across all the bodily systems. Since even most doctors still associate it exclusively with GI symptoms, if someone doesn’t present with those symptoms, they never consider celiac disease. In reality, celiac disease has over 300 potential symptoms ranging from the classical GI symptoms to neurological to diseases related to nutritional deficiencies and many more. The list is mind-boggling. Over the long-term, it can trigger other autoimmune diseases. It can cause depression. It can trigger ADHD or make it worse. Active celiac disease can even lead to cancer.

The presenting symptom for me when I was finally diagnosed was iron deficient anemia. However, I was then discovered to have osteoporosis in my spine (now almost completely returned to normal). I discovered the “aches and pains” I thought were just part of growing older largely went away. They were apparently the result of systemic inflammation. I was suffering from depression, which is now completely gone. I had mild neuropathy and “brain fog” now also gone. I was an extremely advanced case when I was finally diagnosed and even after almost five years, my body is still healing.

Active celiac disease will kill you. (Studies have shown it significantly reduces longevity.) And it will do so slowly and with significant suffering.

There is a strong genetic component to celiac disease. If you don’t have certain genes, it’s extremely unlikely you’ll ever develop celiac. As a result, though, that means that family members, especially first degree relatives, of someone with celiac disease are much more likely to have or develop active celiac disease than the general population. So after I was diagnosed, I let all my family members know, including my older children. (Unfortunately, except for my older son, I don’t think any of them have actually gotten tested.) My two younger children were both still minors at the time, so we had them tested as a precaution. We were shocked to discover they both had full-blown celiac disease. They were completely asymptomatic. Fortunately, unlike me, we caught it early with them. So they’ll never suffer the extensive systemic damage I did.

However, the diet is extremely strict. I forget the exact threshold, but something like 20-50 milligrams of gluten in a day will trigger a full-blown autoimmune response. (Yes, they’ve studied that as well.) And even smaller levels can trigger some autoimmune reaction. As a result, we talk about gluten as “parts per million” in any given food we consume to avoid reaching the very small daily thresholds. 20 parts per million is the threshold used in the FDA regulations, if I recall correctly. (Mostly I think that’s because we don’t have a test that will reliably detect lower levels of gluten.) But that means that food that has been fried in the same oil as flour battered items or has otherwise been in contact with a gluten-containing food is typically not safe for us to eat.

Moreover, once triggered by exposure, the autoimmune response can take weeks to completely subside and for the disease to return to full remission. (Generally, the acute symptoms from an exposure, if any, subside in a matter of days, but the autoimmune response itself takes much more time.) I recall another case study of a nun who strictly adhered to the gluten free diet except for weekly communion with only a small piece of the eucharistic wafer. Her celiac disease remained fully active even from that small weekly exposure. (I will note that both the Catholic and Orthodox churches hold that communion with either bread or wine alone remains the fullness of communion and can commune those with celiac disease with wine only.)

The doctors who research celiac disease are trying to get it added to the regular screening process like diabetes and cholesterol. Given that around 3 million people in the US have active celiac disease and roughly 2.7 million of them remain undiagnosed and since the disease can activate at any age, that seems reasonable. It’s especially reasonable since it’s so hard to diagnose from the symptoms and can even be largely asymptomatic for years as it damages the body. Moreover, they now have a blood test that is highly accurate and specific, so it’s relatively easy to screen. But the medical community generally moves pretty slowly on such things. Hopefully we’ll get there.

I’ll put the soapbox away now. But please, even though there is presently a faddish quality to the gluten free diet, don’t dismiss it as simply another fad diet. It isn’t. It’s a life-saving necessity for those of us with celiac disease.


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Elder Cleopa on Prayer

Every time I watch it, I’m struck by Elder Cleopa’s description of prayer, especially prayer of the heart. It’s a lot different than how many people today describe prayer, but the Elder describes something living and powerful. I don’t pray well or, as the reporter in the video notes, nearly as much as I should. But I do desire more. In the interim, I pray the Jesus Prayer in my own poor fashion and keep stumbling forward.

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I also note the brief segment in the video where the Elder describes himself as a “rotten old man.” I’ve mentioned in past posts the video I once saw of an old monk saying that all would be saved and he alone would be damned. I’ve never been able to find that video again, probably because I don’t remember any of the context. But the image of that monk’s face as he uttered those words remains fixed in my brain. It haunts me.

It often seems in the Protestant/Evangelical world that there’s often an air of confidence and self-assurance among its leaders that increases as they age and mature. In Orthodoxy, I see the opposite. The holier (at least in my perception) people become, the more conscious they seem to be of their own sin and need for repentance. They begin to see themselves as they truly are and not through the favorably distorting lenses we all wear when we examine ourselves. In Christ, they are able to see themselves in an undimmed glass without being destroyed.

Of course, all Orthodox proclaim themselves the greatest of sinners before receiving communion, following the path of the publican rather than the pharisee. But it seems like the more clearly we can see ourselves, the more we understand that the parable is true; it describes reality.

While I didn’t know it at the time, it appears the monk’s words from the video are deeply rooted in Orthodox monasticism. They appear to come from a story about St. Antony the Great. God told St. Antony there was a man in Alexandria, a cobbler, who exceeded him in holiness. Antony sought out the man, but he seemed perfectly ordinary in every way. But then the cobbler explained that as he went about his day, he thought of everyone he passed by or with whom he interacted that they would be saved and he alone would be lost. That story isn’t in St. Athanasius’ book, “The Life of Antony”, but I did find it referenced in a story of St. Siloaun.  It’s long, but an engrossing read.

Keep Your Mind in Hell and Despair Not

I particularly like the part where he realizes that the existence of mankind is inextricably linked to our own individual existence. “Our brother is our life.”



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Am I Saved? (Fr. Thomas Hopko)

Fr. Thomas Hopko discusses salvation.

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Are You Saved?

Metropolitan Kallistos Ware describes a time he was asked that question, what salvation means, and how he answered the question.

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Are You Saved? An Orthodox Christian Answer

I remember I listened to this podcast numerous times after it was released. I don’t remember if I had stumbled across the youtube version of it before. Molly Sabourin attempts an answer that at least exposes the depth and breadth of the question, “Are you saved?”

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Is Hell Real? And Reading the Real Bible

Fr. Stephen has posted two excellent posts. The first poses the question, “Is Hell Real?” I’ve made some effort to address that question in my own series on the topic which you can find in the sidebar under Hell. But Fr. Stephen drives right to the heart of the matter. And then he posted a longer commentary on the flat, literalistic reading of the Bible today and what we mean when we call something real. I strongly urge anyone who reads my blog to read those two posts if you haven’t already read them.

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Zilker Summer Musical – Little Shop of Horrors

Zilker Summer Musical PosterLittle Shop of Horrors!

Seymour! Audrey! And that strange and interesting plant, the Audrey II!

What time is it, everyone? It’s time once again for the longest running free summer musical in the country, the Zilker Summer Musical! Personally, I’ve been to almost every performance since the 80s. I know that since 1990, the performances in 1996 and 2007 are the only ones our family has missed.

As sponsors, my wife and I attended the BBQ dinner and preview performance on 7/11. The performance was wonderful. (If you’ve only ever seen the movie version, there might be a surprise or two in store for you.) The dinner put a slight damper on things. I could have sworn I read something that indicated Green Mesquite would be catering it again like they did last year and I had researched the food and knew what I could eat. As it turns out, though, Pok-e-Jo’s catered it instead. Unfortunately, I didn’t notice until after I had eaten the food. And while I saw after I checked their site that I could have eaten safely, unfortunately two of the items I ate were not gluten free. :-( Sometimes it sucks to have to celiac disease. It just reinforces that I always have to check and double-check every time before I eat anything my wife or I didn’t prepare.

I apparently didn’t get a ton of gluten, so while I didn’t feel great later that evening and yesterday, it wasn’t as bad as it has been in the past. Of course, I don’t tend to have as strong a set of acute symptoms as some people who have celiac disease, which is why I had such extensive systemic damage by the time I was finally diagnosed. Still, it didn’t ruin my evening. My wife and I loved the performance and had a great time.

After the dinner and before the show, we headed down to Barton Springs pool and stuck our feet in the water for a while to cool down. It really helped a lot, especially since my wife is sensitive to too much sun and heat.

Tomorrow I’ll be headed back with my youngest daughter and one of her friends. We’ve been doing Shakespeare in the Park and the summer musical for some years now. When we go, we make it a full day. We spend it at the pool, which has lots of space to lounge and read and relax between dips in the pool. My daughter and her friend never stop talking until the show starts! Even as teenagers, sometimes they’ll head over to the nearby Zilker Playground. We pack plenty of drinks and food and make sure to get our blankets out right at 6:00 (the earliest you’re supposed to place unattended blankets).

If you live in the Austin area and you’ve never been, try to work it into your summer schedule this year. It’s a lot of fun and you won’t regret it!

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11 Sounds Our Kids Have Never Heard

Check out these 11 sounds that those of us in our 40s and older will definitely remember, but which our children (and grandchildren) probably have never heard except in an old movie or TV show. Obviously, I remember them all. I also remember the days when you couldn’t buy a phone, you had to rent them from Ma Bell. My Dad disabled the ringer in a phone he found somewhere so we could have another one without paying extra for the privilege.

Anyone have some more sounds our kids have never heard? Or if you’re reading this and you’re under 40, how many of them do you remember?

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Sex, Marriage, and Evangelical Purity Culture

These past several weeks there have been more posts than usual about sex and the dominant purity culture in modern evangelicalism among those I read. If you’ve not read any of the posts, here is a sampling.

As those who have read some of what I’ve shared can probably imagine, I have a very hard time relating to the evangelical purity culture. I’m aware of it, of course. I’ve spent the last twenty years in a Southern Baptist church and I’m neither blind nor deaf. But I do not and have never understood purity culture. Very little I’ve heard anyone say about sex or marriage in that context makes any sense whatsoever to me. (And some of it, like the father/daughter purity balls outright creeps me out.) But I think a few things have become clear to me and I’ll try to touch on them in this post. I doubt I’ll be able to do more than scratch the surface, but that’s a start, at least. I would also recommend Fr. Stephen Freeman’s recent post, The Beauty of Truth and the Existence of God.

I’ve written elsewhere about the mystery of evil. On the one hand, evil is not a creation of God and as such cannot be said to exist in the same way creation exists. On the other hand, all of us who have experienced and witnessed evil know it is very real, indeed. But I’ve noticed an error underlying much of evangelicalism and its purity culture in particular. Evangelicals tend to treat sin and evil as though they were synonymous or congruent categories. I don’t believe that’s true. Moreover, if you start from that premise, it renders much of the Christian narrative unintelligible.

Instead of congruent categories, I see sin and evil as overlapping circles in a Venn diagram. There is evil that is directly related to sin, there is sin that is not evil (and could even be considered beautiful and good), and there is evil with no direct, causal relationship to sin. Frankly, the black and white, non-overlapping categories of “good” and “sin” that seem to dominate purity culture look more like the categories of Law and Chaos in Michael Moorcock’s fantasy novels than anything from the Christian narrative.

But before we even start to categorize sexual activity, let’s begin with its created nature. We are embodied spiritual beings created by God and as with all of God’s creation, we are fundamentally a good creation. God cannot create anything that is not good. Sex is part of our embodied, spiritual existence and is a creation of God. Sex is good. That is its nature.

Sex can be perverted into evil. Evil is always a perversion of the good rather than something self-existent. How can sex be perverted into evil? I would suggest that any time it is used to take actions foreign to the nature of God, abrogating the will of another and turning the other into an object of consumption, sex has been perverted into something evil. Rape is evil. An adult using a child for their own sexual gratification is evil. Treating another human being as an object for your pleasure is evil.

But sex itself is good.

Even when, from a Christian perspective, it might be sin.

After all, what is sin? Sin is missing the mark and Christians proclaim that the mark is Christ. In terms of sexuality, there are two such paths Christians have upheld. There is the ascetic path of a celibate life. Paul and Jesus walked this path and Christians have followed in their footsteps ever since. And there is the ascetic path of Christian marriage. But what is Christian marriage? We see that in Ephesians 5. Christian marriage is a mystery or sacrament and properly lived out is an icon of Christ and the Church. (Note that vows to each other are a rather late addition to Christian marriage ceremonies.)

And that should make the distinction between sin and evil clear. When our marriages fall short of an icon of Christ and the Church (however that may look) we have missed the mark. That is sin. But it is not evil. The marriage can still be either good and working for our salvation or evil and pulling us to destruction. But it can “miss the mark” along the way and remain good.

Similarly, while a sexual relationship outside of marriage may “miss the mark” it may also be for our salvation. And the relationship itself can still be good. Or it can be unhealthy (another category that is neither good nor evil which I would interpose). Or it can be evil. But its category is independent of the fact that it “misses the mark”.

And I believe this is another area in which evangelicalism itself can miss the mark. God is always working for our salvation. That’s the whole point behind the Incarnation. And salvation does not mean some future disembodied existence akin to Plato’s Happy Philosophers as many seem to imagine. Christ has come to rescue us. Now. As embodied spiritual beings. From all that oppresses us.

And that always involves a spectrum. God is not a distant figure wagging his finger sternly at us when we step off the straight and narrow. Wherever we find ourselves, Christ is always there with us — even when we do not acknowledge him. So when we’re in the ditch, Christ is there and he always says the same thing. Well, here we are. And from where we are now, this is the first step out. Life is a constant continuum of movement toward God and true existence and away from God toward non-existence.

As a teen parent twice over, I’ve been a parent practically my entire life. All but one of my children are now adults and my granddaughter is older than I care to face. Most parents wish good for their children. Let’s say a child was spiraling out of control. It could be anything. Alcoholism. Drugs. Gambling. Eating disorder. Whatever the cause, you could see it as their parent but nothing you tried helped stop the spiral. How desperate would you be?

But then your child develops a relationship with another person. That person stops the spiral. They rescue your child. And together things get steadily better. Perhaps they even have a child together. As a parent, do you obsess over their marital status or lack thereof? Or do you love the person who helped save your child? Do you consider the relationship evil or good?

Why would a God who loves us all and is working to rescue us be any less of a loving parent?

By the time my wife and I met, I would say my sexual experiences and relationships had ranged from unhealthy to evil. I can’t remember ever being the sort of “innocent” many people seem to have in mind when talking about children. But I was … vulnerable and in some ways broken. And those built on each other. Some preyed on my vulnerability and in other cases I tended to gravitate toward other broken people. I can safely say that my relationship with my wife is the first one I would describe as unequivocally good — well before we were married. She saved me. And she helped save my older son. I don’t know where either of us would be today without her. And she was not without her own past, so I hope there was at least something of a mutual aspect.

My wife was a lapsed Catholic and I despised Christianity when we met, so Christianity wasn’t in our consciousness at all. But I still believe Christ was with us even when we did not see or acknowledge him. And our relationship was both good and given to us for our salvation. Of course it missed the mark. We not only couldn’t see the target, we weren’t even aware a target existed. But our relationship was good from the beginning. Nothing will ever convince me otherwise.

I’m reminded of something a speaker did when my younger son was in our church’s youth group (and I was a volunteer youth leader). It was one of those weekend events focusing to a significant degree on sex. At one point she did an illustration where sheets of colored tissue paper were glued together on a white poster poster. When they were peeled off, there were many colored pieces left behind. She related that to what happens when you have sex as though it was a bad thing.

Of course, that’s not what happens when you have sex with someone. That’s what happens when you build a relationship — sexual or non-sexual — with another human being. We are relational beings and when you invest in someone else, you leave your mark on them and they leave theirs on you.

And though it can be perverted in unhealthy and evil ways, that’s fundamentally a good thing. Pause and think for a minute of all the people who have helped shape the person you are today. Sex is just another potential facet in those relationships.

An informed, consensual, healthy sexual relationship that strengthens and reinforces our humanity and is not destructive to ourselves or others will always be good even when it misses the mark. Trying to make the two mutually exclusive is a false dichotomy.

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