#119: Can the US healthcare system crush my creativity? Also: Happiness, Future of Education, Student Loans & Assorted Links

😷 Life, work & what matters

Dec 05, 2020

December 5th, 2020: Greetings from Puerto Escondido!

👋 Welcome to many new followers. I found that my wordpress forms had not been capturing the signups since October so if you are receiving this out of the blue, it is because I’ve finally added you.

🤔 I’ve written a pretty personal take on healthcare below detailing some frustrating experiences I’ve had this year. I’d love to hear people’s reactions.

If you’re finding this from the web, you can subscribe here:

#1 Screw you, “healthcare”

When I was 27 I faced a health challenge with tick-borne illnesses that took me almost two years to recover fully. A series of misdiagnoses and side effects from medications left me with both long-term health issues and resentment towards the medical system.

Our “healthcare” system is not designed to keep people healthy, it is designed to treat sickness. Within sick people, it really is only able to treat the type of sick people that have a clear diagnosis. Have a skin issue? Go to a dermatologist.

Have gut issues, brain fog, fatigue and tingling in your arm? Go to a GI doctor, neurologist, get an MRI, and then hope and pray. Pray that they’ll have anything useful to say and pray that you won’t lose all your money in unexpected medical bills.

This is the situation I found myself in this summer.

This past March while in Spain I had to have a tooth extracted. The initial healing was a bit painful but everything seemed okay after a couple of weeks. At the beginning of May, all hell broke loose. Fatigue, nausea, tingling throughout my extremities and numbness in my legs. I couldn’t make it through the day without two or three hour-long naps. It appeared I had an abscess on my gums, but no dentist or doctor was able to tell me definitively. I took several antibiotics, had a CAT scan and eventually ended up finding an oral surgeon who operated on my gum and removed a piece leftover from the initial extraction. Apparently this happens sometimes.

My experiences dealing with complex health challenges when I was 27 popped the bubbles of youth and immortality. It also made me well aware that most of us are dealing with something. We just are all taught to pretend otherwise most of the time.

Given these uncertain health issues, many people urged me to come back to the US for the summer. We have a great healthcare system after all, right?

In some ways the American healthcare system is fantastic. We probably have some of the best cancer care in the world. But we also have soul-crushing bureaucracy that would make East Germany look efficient.

My first few weeks in the US I didn’t have insurance. Unlike Spain where I could walk into a doctor’s office and ask them the price (about $60), no such thing is possible in the US.

Price? We don’t know until we process your insurance.

I ended up getting a short-term indemnity coverage for my first week weeks that turns out to be some sort of bad joke. I paid $400 and what I ended up with was a discount scheme rather than insurance.

The neurologist I saw? That cost $473 and after a “discount” is was only $325

The neurologist didn’t know what was wrong with me and said as much. She suggested I get a blood draw of my B6 levels. In Spain the blood draw was free with the doctor’s visit. In the US, an extra $100+ after “discount”!

She also suggested I get an MRI just in case. I told her I was worried about the bill for the appointment and the scans and she acknowledge me, “yeah its a crazy system, I wish it wasn’t so bad.”

Even the doctors are helpless. Damn.

I’ll save you the details but after 60 days of seeing doctors, alternative practitioners and racking up thousands of dollars of non-help, I ended up finding one thing that seemed to help my fatigue and stop the tingling in my face, arms and legs: B12 injections. 12 shots for $5 at CVS.

I’m doing okay now and I feel quite lucky. The B12 shots seem to be working and for the past three months I’ve more or less been pretty healthy most days.

One might think I’m a bit crazy to be pursuing this self-employment path and living abroad with a less-than-stellar health history.

But getting sick at 27 is what gave me the courage to follow this path. At that time, I lost what I thought was important to me, my identity as a successful worker. For a while I swapped that identity with the identity of someone who is “sick.”

That wasn’t helpful either and slowly I realized that I would need to figure out who I was. Writing, creations and all sorts of experiments followed. More than five years later and I’m still not sure who I am but I’m also not sure that question is all that important anyway.

Almost losing my health in my twenties gave me the courage to chart a different path. I’ve talked to many people who experienced the same.

Yet I can’t advise most to take this path, especially Americans, who are the only people in the world who have access to healthcare tied to employment.

When I think about moving back to the US the biggest worry I have is healthcare. What states have decent plans for self-employed people? Will I need to get a full-time job? What are the alternatives? Will my health be okay?

The US healthcare system is a tax on creativity, innovation and freedom for many people. I keep getting bills from this summer that dare me to quit this path.

But fuck you, US healthcare system, I’m going to keep going.

📨 How does healthcare impact how you think about your life? I’d love to share some reflections with others next week. Hit reply!

#2 Conversation With Packy McCormick

🎧 You can listen here

I had a podcast interview with Packy of the Not Boring newsletter.

His competitive advantage:

“My only differentiation...is that I’m going to be having more fun than most people”

He’s understood the wisdom of creating work you actually want to do:

“What you write about defines who you’re going to spend a lot of time interacting with...It better be something you’re interested in or those conversations are going to be painful.

How he’s a self-employment true believer:

“I can’t imagine having to go back to a job where I have to work for somebody and two go to an office every day. Once you’ve had a taste for the other side it seems like a crazy constriction of optionality.”

Another convert to the “pathless path:

“Right now I feel really good not having goals...there’s been enough serendipitous things happening that im comfortable not setting those goals.

🎧 You can subscribe to Reimagine Work and listen here

#3 Student Loans

The lens I look at things is often through a lens of freedom. Not freedom-to, but freedom-from. Many people look at student loans through a lens of fairness. “They shouldn’t get their loans forgiven because I paid mine off.” Sure.

But do we really want to live with increasing number of fellow citizens who are held back by student loan debt? Matt Taibbi highlights the case of Chris, 59 and a law grad, who is still paying off his loans.

Through 2020, when student loan obligations were halted due to the coronavirus, he paid $190,000 on an original debt of $79,000. His current balance? The aforementioned $236,000.

I think we should think about enabling people to live a life with the freedom-from a lifetime of massive student loan debt. Should we forgive the student loans of a child of a rich family who spent $75k a year at Boston University? Maybe not.

But should we allow people to discharge their debt in bankruptcy? Especially 59 year olds who have already paid $190,000? I vote yes.

#4 A Couple Of YouTube videos I created

I’ve been experimenting with YouTube as part of Ali Abdaal’s course which has been amazing. It’s been fun to create on a new medium. I definitely don’t enjoy it as much as writing but I like learning these things such that I can help others.

Happiness, meaning & hacking a living in the modern world

Book Review: Education In A Time Between Worlds

A book of essays from Zac Stein who is dreaming big about the future of the education system. His general hypothesis:

“I have been arguing that all current global crises might best be understood as crises of education”

Would love to hear any feedback or requests if you want me to make any other videos!

#5 Other Links

Byrne Hobart had a great piece on the history of Taiwanese manufacturing. Venkatesh Rao had a great free post on The Art of Gig titled “Going indie is going amateur” as well as an interesting thread on how nation states will compete on healthcare (pairs well with above).