Health care in miniature

Meagan McArdle writes on a topic near to my heart, that is, the current policy with regard to pseudoephedrine in the US.

I should declare my bias in this matter: I have persistent, unpleasant allergies which stem from a congenital problems in my sinus cavities – specifically, the passages are too narrow, and since I’ve lived in Washington their natural state is to be about as porous as a brick. An allergy profile run by one of the top allergists in the country found that at 24 hours (the diagnostic point) I wasn’t allergic to anything, but at 48 hours, I’m allergic to everything. Therefore, my nightly cocktail is 1200 mg of guaifenesin, 120 mg of pseudoephedrine, and 50 mg of diphenhydramine. This approach is what I’ve come to after learning that most antihistamines work on a relatively small percentage of the population (that is, Zyrtec works for some, Claritin for others, and Allegra for a third venn-diagram overlapping group) – and none of them actually work on me for more than three days at a time. Happily, it’s kept me functional and able to sleep for the last few years. Unhappily, I used to be able to get guaifenesin + pseudoephedrine by prescription in a 90 day generic supply for $8, but then it went OTC in the form of Mucinex-D and now a 24-day supply costs > $25. Making bad news worse, under the new health care regulations which took effect this year, these costs are no longer eligible for reimbursement by an FSA.

So pseudoephedrine is a well-understood, well-tested, cheap, old medicine which is known to actually work. Wouldn’t this be precisely the kind of thing we should wholeheartedly embrace if we were truly concerned about the cost of health care in the US? The fly in the ointment here is that it can be turned into methamphetamine in a relatively dangerous but simple process by home-brew chemistry dropouts.

The lesson I learn from this highly specific case study is that controlling health care costs is not a priority when compared to other societal priorities – preventing losers from killing themselves by making or taking dangerous chemicals trumps our desire for rational cost containment. So if our expressions of Puritanism (that is, saving people from themselves) can trump an obvious cost containment measure, a fortiori other expressions of technocratic societal engineering will do so as well.

This is precisely why I am not a fan of the unconstitutional “affordable care act” – the sheer immensity and complexity of that work means that the quality and value of the health care will necessarily decline in the face of the well-intentioned meddling of thousands of people who want to save me from myself.

C.S. Lewis said it well:

Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.


Cholent Min-haShamayim

Josh received cholent from Heaven and transmitted it to Charlie; Charlie to Daniel; and Daniel handed it down to David. David said three things: be careful with peelers and sharp objects, transmit the recipe to many people, and make sure to start the cholent well before shabbat.*

2 fleshig kishkes
1 lb stew meat, rinsed
2 onions, chopped
2 medium potatoes, peeled, chopped
1/2 bag cholent mix beans or baby lima beans
1/2 bag barley
chili powder
handful of kosher salt, dissolved in a bowl of water

Put the ingredients in this order:

1 onion
1 kishke
chopped stew meat
chili powder
1 onion
salt water (cover everything with water)
1 kishke

Put it on about 11AM-1PM or so for it to be ready at lunchtime. Serves most of a minyan.

* If this paragraph doesn’t make much sense, try reading Pirkei Avot 1:1.

Chicken Vegetable Noodle Soup à la David

Inspired by an approach used in The Joy of Cooking:

One mutant, three-legged chicken, rinsed and eighthed (but not skinned)
two to four parsnips (I prefer more)
four carrots
five stalks celery
two large onions
fresh dill
very fine egg noodles
small amount of white wine
2 cloves garlic, unchopped
thyme, salt, pepper
roasting pan, colander, soup pot, very large bowl or second soup pot, large sauté pan, another pot for noodles

coarsely chop half of the vegetables and roast them, along with the chicken @ 425 until they’re just past golden-brown: in my case, 1:15. (Note: another variation is to add all of the parsnips here). Stir the roasting pan a couple of times in that period.

chop the other vegetables VERY finely: .25cm2 -> these are going to be sautéed and turned into mirepoix, but that comes later. Keep the onion separate from the others.

After the chicken has finished roasting, put it and the roasted vegetables into the soup pot. Deglaze the roasting pan with 1c water and add that to the soup pot. Deglaze it again with the wine and another 1c water, and add this to the pan (basically deglaze it really thoroughly). Cover the chicken and vegetables with water – should be about ~16c. Add most of the fresh dill (reserve a sprig or three) and the garlic (these are the bouquet garni). Also add a small amount of salt, pepper, and dried thyme.

Simmer this for ~ 3 hours or thereabouts, stirring occasionally. This should be quite dark, and the meat should be falling off of the bones.

Sauté the mirepoix – first the onions, and then the rest of it, until the vegetables are quite soft.

Strain the soup through the colander into the large bowl. Put the strained soup back into the pot, and add the mirepoix to it. Pick the chicken meat out of the strained vegetables and stuff. After you’ve gotten as much meat as you can (this takes quite a while), throw out the skin, bones and the rest of the boiled vegetables (by this point, you’ve gotten all of the flavour out of them). Finely chop the rest of the dill, and add this, along with salt and pepper to taste.

Cook the egg noodles in a separate pot – they are added to the bowl at serving rather than put directly in the soup. Serve and enjoy!

This makes a very hearty soup – the vegetable :: chicken ratio is high, but the soup is very filling.

She wears the (transparent) cone of shame!

Kacy distracted us a bit today – she injured her right front paw on something or other and wasn’t willing to load-bear on it, so we got her to Friendship Animal Hospital, and after that learned that she had probably had a sidewalk salt injury. The upshot of this is that now she must wear the cone of shame, can’t jump up a step (it gets caught), and keeps bonking her cone against furniture.

Sad, but hilarious at the same time.

It's hard to see, but the black stripe on the bottom is the velcro holding it together.