Medicare Part D: Another year, another huge price increase

I signed up for Medicare last month. In addition to standard Medicare, I added Part D, the prescription drug benefit. My 2013  costs, if they had covered the entire year, would have come to $529 for insurance and $330 for prescription copays.

Today's mail brought the rates for 2014. The insurance premium has increased to $650, or by about 23%. Copays have also increased, to $616, or by nearly 87%. The total increase - assuming I won't need any additional medications - comes to 47%.

I was not happy when President Bush proposed and AARP supported Medicare Part D, the prescription drug benefit. The idea of insuring seniors' drugs was good. The resulting law, which specifically forbids the federal government from negotiating prices with pharmaceutical companies, was insane.

Well, "insane" is putting a good face on it. The financiers who supported the companies who bought the politicians who voted for the law were by no means insane. They were lining their own pockets, never mind the rest of us.

It's obvious, isn't it? If the government gives away money without limits and accountability, retail prices rise, insurance premiums rise, and consumers end up paying as much (or more) out-of-pocket than before the government stepped in.

Want proof? Take a look at this chart from the Kaiser Family Foundation. Notice that the U.S. government spends about as much of its GDP on healthcare as other developed countries (without, however, insuring everybody, as the other countries do). Notice that, unlike citizens of other countries, U.S. citizens spend a whopping amount in addition to what the government spends. The difference? Those other countries put strict limits on what pharmaceutical companies and other medical suppliers can charge.

Some Americans suggest that the government should just stop subsidizing things like health care and education. That doesn't make sense unless you think that only rich people should have access to schools and hospitals. But it makes more sense than subsidizing something without putting a ceiling on what the lucky recipients can charge for their goods and services.

I am going to look for a different Medicare Part D insurance company. I don't expect to find one that's much better, however, until our lawmakers learn to say Yes to middle-class and disadvantaged people and a loud, resounding No! to rich institutions and individuals who want to get even richer at our expense.

Let's talk about food: Maybe some of us should love food more

[Renoir, 1881: Le déjeuner des canotiers]

Q. What is one of the best ways to look good, feel good, and enjoy a long life?
A. Celebrate!

Yes, it's counterintuitive. Most Americans are convinced that if only we could eat little enough fat, ingest few enough calories, spend enough sweaty minutes at the gym, and drink exactly 5 ounces of red wine a day, then we might live forever--with enough expensive medical intervention, of course.

How dreary.

The French, par contre, are famous bons vivants. They enjoy butter, red meat, long loaves of fresh bread, and out-of-this-world pastries. They love their wine, they tend to avoid exercise, and they get 30 days of paid vacation every year.

In her bestselling 2005 book, Mireille Guiliano claimed that French Women Don't Get Fat. Some do, of course, but only about 18% (compared to 33% in America). Weight, however, is not the point, even though Americans are obsessed with it. Health is a lot more important. French women win in that category too, living to about age 85 (compared to 81 for American women).

How can the French eat so richly and live so long? Researchers call it the French paradox, and they don't agree about how it works. Here's my theory, for what it's worth:

If you really love good food, you'll stock up on fresh produce, fresh-baked breads, fresh meat and fish, scrumptious cheese, and homemade desserts (unless you live near a French pâtisserie). Why waste time on junk food, convenience food, or fast food? To quote scripture out of context, "Why do you spend your money for that which is not bread, and your labor for that which does not satisfy? Listen carefully to me, and eat what is good, and delight yourselves in rich food" (Isaiah 55.2).

If you really love good food, you'll eat it three times a day. You'll suspect that people who snack on crappy stuff all day and then come home too ravenous to cook real food probably don't have their priorities straight.

If you really love good food, you'll turn your meals into celebrations. You'll eat beautifully, choosing a variety of colorful foods and, sometimes, putting flowers on the table. You'll eat mindfully, savoring tastes and aromas. You'll eat gratefully, giving thanks for farmers and cooks and grocers and friends.

You can celebrate whether you're at a party, at table with family and friends, or eating alone. Eating regular, beautiful meals of fresh food is not all that hard to do. It doesn't have to be expensive. It's a lot more fun than the usual American way of eating. And, oddly, celebratory eating tends to make us look good, feel good, and live long.
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This is part of a series of short posts especially for people who attend St Barnabas Episcopal Church in Glen Ellyn, IL, where I'll be leading conversations about food on September 22, September 29, and October 6. I'll post about food every weekday between September 16 and October 4.

Let's talk about food: Naked, no doubt hungry, and definitely not ashamed

[Rodin, Le baiser]

It's odd that Christians--people who claim to believe that God created the earth, sustains it day by day, and intends to create a new earth--are often so mixed up about sex and food. How long would the earth's inhabitants last without coupling and eating?

And yet most Christian writers right up to the 16th century praised celibacy, sexless marriages, and arduous fasting. Bless Martin Luther for loving his wife (and the beer she brewed), but lots of us still seem to think that good sex and good food--if not actually sinful--are at least pretty low on the religious values hierarchy.

Has it escaped our attention that, according to our most sacred literature, God made a naked male and a naked female, put them in the midst of grain fields and orchards, and told them to multiply?

Have we noticed that, in the great poem that is the last book of Christian scripture, the celebration of the triumph of good over evil is portrayed as a marriage supper?

Why are we so nervous about our bodies?

Well, such nervousness has a long history. Philosophers going back at least as far as Plato have favored the soul over the body. St. Paul often sounds like he does too (though theologians, e.g. E.P. Sanders, point out that his spirit/flesh dichotomy isn't really talking about the soul vs the body at all). And the Roman Empire was full of teachers who posited a radical dualism between soul and body--with the soul, of course, on top. The author of the first letter to Timothy described such teachings, and rejected them:

They forbid marriage and demand abstinence from foods, which God created to be received with thanksgiving by those who believe and know the truth. For everything created by God is good, and nothing is to be rejected, provided it is received with thanksgiving; for it is sanctified by God’s word and by prayer (1 Timothy 4.3-5).

I wanted to illustrate this post with a painting of Adam and Eve enjoying themselves in paradise. I thought it would be easy to find: just Google "creation" or "paradise" or "Eden," throw in "Adam" or "Eve" to narrow the search results--piece of cake, right?

Sadly, no. Just about every painting that came up was about the Fall. Eve having a chat with a snake. Eve sharing her apple with Adam. The primal pair fleeing Eden, earnestly hiding their genitals.

My Google search discovered no rejoicing in the beauty and goodness of the fresh-made earth. No sumptuous breakfasts prepared by the Creator for the wakening humans. No primordial picnics au naturel.

Just guilt.

Hey, Christians, can't we do better than that?
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This is part of a series of short posts especially for people who attend St Barnabas Episcopal Church in Glen Ellyn, IL, where I'll be leading conversations about food on September 22, September 29, and October 6. I'll post about food every weekday between September 16 and October 4.

Let's talk about food: The apple wasn't the problem

[Cranach the Elder, 16th c]

If we're going to talk about food, we need to start with theology. Before chocolate was invented, a snake put "sinfully delicious" and "decadent" on the menu. Somebody fell for the marketing ploy, and we've had a complicated relationship with food ever since.

We've also had a complicated relationship with sex, and with siblings, and with weapons of mass destruction. It's all there in Genesis (where the WMDs are swords). And pretty soon, right-thinking people started coming up with rules to keep people from doing bad things. You can have sex with this person but not that one. You really shouldn't deceive, sell, or kill your brother. Beat your swords into plowshares.

The rules helped to restrain bad guys, and they gave would-be good guys some helpful pointers. Still, there were plenty of bad guys to go around, and good guys could get pretty anal about what other people should or shouldn't do. Anyway, it's obvious that you don't create a good marriage simply by avoiding sex with the wrong person, and you don't have a pleasant Thanksgiving dinner simply by not killing your siblings, and you don't banish war simply by wiping out as many weapons as possible. The rules are helpful--adultery, fratricide, and genocide are really bad ideas--but if you want a Peaceable Kingdom, you're going to need more than rules.

Same with food. We have a food problem all right: famine, starvation, and food insecurity in some places; morbid obesity, addictions, and eating disorders in others; and everywhere an amazing increase in diseases exacerbated by eating badly. So of course we have come up with rules: Cut back on fat. Cut back on salt. Avoid sugar. Avoid carbs. Eat low-glycemic index carbs. Eat less meat. Eat no meat. Count calories. Eat your vegetables. Eat organic. Eat local.

Some of our rules are nonsense, and some exist so snakes can sell more products. But many--such as Michael Pollan's famous "Eat food. Not too much. Mostly plants"--are excellent. Trouble is, though some of us follow the rules (sometimes with the result of improving our own health but sometimes to the point of obnoxious self-righteousness), the world still has a major food problem. In fact, it seems to be getting worse.

So here's the theology, which may sound vaguely familiar to people who have read St. Paul's letter to the Romans:

• Food is good, though the world has a serious problem with it.
• Rules for healthy eating are good, though nobody follows them perfectly.
• Even if we followed food rules to the letter, we would not solve the world's food problem.
• We need a whole new way of thinking about food: one that emphasizes celebration, hospitality, and sacrament.
• Then we can just forget about the rules, right?
• Wrong. Many of the rules are excellent in their place; they just aren't capable of restoring paradise.
• Only celebration, hospitality, and sacrament can do that.

This Sunday at St B's midhour, we'll talk about food as celebration. Next Sunday, September 29, we'll look at food as hospitality. October 6, we'll discuss food as sacrament. We probably won't talk about food rules at all.

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This is part of a series of short posts especially for people who attend St Barnabas Episcopal Church in Glen Ellyn, IL, where I'll be leading conversations about food on September 22, September 29, and October 6. I'll post about food every weekday between September 16 and October 4.

Let's talk about food: The Bible says "Let's parteeee!"

[From the Schmalz Brewing Company]

If you are under the impression that the Bible recommends a life of dour deprivation--especially of good food and drink--read Deuteronomy 14:22-26 for comfort:

Set apart a tithe of all the yield of your seed that is brought in yearly from the field. In the presence of the Lord your God, in the place that he will choose as a dwelling for his name, you shall eat the tithe of your grain, your wine, and your oil, as well as the firstlings of your herd and flock, so that you may learn to fear the Lord your God always. But if, when the Lord your God has blessed you, the distance is so great that you are unable to transport it, because the place where the Lord your God will choose to set his name is too far away from you, then you may turn it into money. With the money secure in hand, go to the place that the Lord your God will choose; spend the money for whatever you wish--oxen, sheep, wine, strong drink, or whatever you desire. And you shall eat there in the presence of the Lord your God, you and your household rejoicing together.

And the tradition continues in the New Testament. Remember the winemaker for the wedding at Cana!

[Andrea Boscoli, 16th century]

L'chaim!
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This is part of a series of short posts especially for people who attend St Barnabas Episcopal Church in Glen Ellyn, IL, where I'll be leading conversations about food on September 22, September 29, and October 6. I'll post about food every weekday between September 16 and October 4.

Let's talk about food: EAT WITH JOY

 No, let's not talk about food.

Not if food means a dreary presentation about weight control or pesticides or glycemic indexes or, God help us, "nutrients."

But wait... what if food brings to mind generosity, friendship, hospitality, pleasure, healing, creativity, gratitude--JOY?

That's how Rachel Marie Stone has learned to think about food, after several years of seeing food as the enemy. Now, by contrast, Rachel believes that "God made eating sustaining, delicious and pleasurable because God is all those things and more. When young students begin at yeshivot," she writes, "they are given a dab of honey on squares of wax paper--and admonished: 'Never. Forget. What. God. Tastes. Like.'" Her book, Eat with Joy, might change the way you think about food too.

There is no textbook for the conversations about food we'll be having at St. Barnabas for three Sundays beginning September 22, but if Rachel's approach interests you, you may want to buy (paperback or Kindle download) or borrow (the Glen Ellyn library has a copy) Eat with Joy and read at least the introduction and chapter 1 before the 22nd.

I interviewed Rachel for Christianity Today when her book came out last spring. You can read the interview, "Happy Meals," here.

And definitely read Ellen Painter Dollar's delightful review of Eat with Joy, which begins:

It is fitting that I’m writing this review of Rachel Stone’s new book Eat with Joy (InterVarsity Press 2013) while eating lunch at a local French café—an establishment that embodies why Rachel insists on seeing an authentically made French baguette as a gift to be enjoyed, white flour and all, in her generous, thoughtful, creative, challenging, God-centered vision of what food is, and can and ought to become.

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This is part of a series of short posts especially for people who attend St Barnabas Episcopal Church in Glen Ellyn, IL, where I'll be leading conversations about food on September 22, September 29, and October 6. I'll post about food every weekday between September 16 and October 4.

Let's talk about food: Chocolate Cake

Someone has just offered you a big piece of chocolate cake. What do you say?

--Oh, I shouldn't.

--Could you give me just half a piece?

--I'll diet tomorrow. 

Chocolate = Guilt. Shame. Regret.

Right?
Unless, of course, it's your second birthday.
Or unless you've been reading your Bible about food.

"Let us eat and celebrate."
Luke 15.23

"Eat what is good,
and delight yourselves in rich food."
Isaiah 55.2

"Feasts are made for laughter."
Ecclesiastes 10.19

So when did we trade celebration for guilt, delight for shame, laughter for regret?

What did Jesus mean when he said, "Unless you change and become like children, you will never enter the kingdom of heaven" (Matthew 18.3)?

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This is the first of a series of short posts especially for people who attend St Barnabas Episcopal Church in Glen Ellyn, IL, where I'll be leading conversations about food on September 22, September 29, and October 6. I'll be posting about food every weekday between September 16 and October 4.