What I Learned: 18 Jan - 24 Jan

 I'm starting to realise the form these weekly posts are taking. Originally, I had envisioned them as weekly reflections, but now they read more like short posts that I couldn't turn into my usual posts. I will be more intentional about extracting the lessons I learned and sharing those with you.

Let's begin:

• Health insurance is arbitrary as all hell.

I've been shopping around for private health insurance, and I've been trying to find one that meets my needs at my current stage. However, many exclude family planning but will offer to cover whatever children I may have and that annoys me. From an economic perspective, you would rather pay the hundreds of thousands to cover my future children, than the thousands to cover my contraceptives? I have yet to find anyone that can explain to me why this is, so I've been left to figure it out for myself. In my mind, there are two reasons; (1) financial and; (2) moral.

Regarding the former, perhaps the insurance companies have an understanding with the pharmaceutical and medical device companies to exclude contraceptive care so that patients can pay the "full" cost of the care. The reason why I have described "full" as such because hospital chargemasters are notoriously opaque and subject to market dynamics (such as the relationship between hospitals and pharmaceutical companies), and when the opaque chargemaster price forms the basis of negotiations with insurance providers, I find it hard to believe that what I am paying is THE "full" cost, merely A "full" cost. Equally, private health care providers may be relying on public subsidies on contraceptive care, and may elect not to pay for it (a la "Why should I pay, when someone else is paying for it?"). In essence, the dynamic between players in the healthcare industry creates a financial incentive to exclude and include certain diagnoses and treatments.

Regarding the latter, the moral reason is where I think the impetus lies for the financial reason. The people designing the policy do not think that contraceptives are moral and so, make the arbitrary decision to exclude it from coverage. The arbitrariness is exposed when you look at the benefits of such coverage. The non-partisan Institute of Medicine (IOM), recommended that birth control is fundamental to improving, not only women's health but the health of their families. A Guttmacher study demonstrated that women who had access (not just knowledge, but the ability to finance) to birth control, and contraceptives, were able to take better care of themselves or their families (63%), support themselves financially (56%), complete their education (51%), or keep or get a job (50%). Medical research has demonstrated this fact for decades. Improved access to birth control is directly linked to declines in maternal and infant mortality.

It is important to note that access to birth control goes beyond condoms, and to IUDs, The Pill (male and female), the Implant and so on. In excluding coverage in public and private health solutions, it creates a class of people who can afford such care, of the highest quality, and can therefore reap the benefits of such care, and a class that cannot. Though the Kenyan government does subsidize family planning and reproductive health solutions, the quality of that care may not be guaranteed (looking at you Dalkon Shield). Furthermore, September 2018 Study by USAID and Health Policy Plus on the impact of health insurance coverage on access to family planning showed that only in Kenya did insured women, in both the poorest and wealthiest quintiles, use the private sector more than uninsured women did. Which means that the private sector, private insurers included, is obliged to ensure that such care is affordable and accessible. Excluding it from coverage, does neither.

What this point boils down to, is the arbitrary nature of health insurance. I paid $250 for something that should have cost $80 or should have been free, because it was not covered by my provider, at the time, despite the overwhelming evidence of its benefits. In trying to find insurance that covers family planning and reproductive health, I am learning how arbitrary the decision to exclude such coverage is. And it frustrates me to no end.

• Disney has a chokehold on my childhood.

When driving to work every morning, I pass a myriad of kindergartens and primary school, emblazoned with Disney's intellectual property. Mickey, Donald, Goofy and the entourage of Princesses guarded the gates, literally, and the idea of childhood, symbolically. Disney, through their intellectual property, reinforced their idea of childhood as innocence and simplicity. It's why they've been reluctant to change their IPs to reflect current societal ideals (i.e. representation, not tokenism, reflecting different family structures and life experiences). When compared to their direct competitors, Dreamworks, Nickelodeon, Cartoon Network, Hannah Barbara, they seem almost cookie cutter and unrealistic. The rest present childhood as messy but fun, scary but manageable, through their properties like Avatar, Hey Arnold, Courage the Cowardly Dog and Tom and Jerry. But we rarely see Courage painted on the sides of books, or a packet of crisps. At least not to the same degree. Disney has shaped my childhood, my expectations of childhood and, ultimate, the reenactment of it through my own children. More than that, Disney has homogenised the idea of, and perhaps the expression of, childhood across the globe. I'm not sure how I feel about it yet, but it does have me worried.

• When people call for "unity," they often mean to cover up their differences.

While some differences can be easily papered over (you say pot-a-to, I say pot-ah-to), others cannot and should not (I say pot-ah-to, you say healthcare should not be universal). Unity should not come at the expense of eschewing the substantive differences that built the divide, to begin with, but should work through those differences to build something new. It's like getting married to someone, without addressing any divergent beliefs you may have; eventually, those differences will rear their ugly heads and you will have to deal with them later.

Lastly, and as promised, last week I promised I'd start reading academic papers more and giving my thoughts. In the last 7 days, I've spent my time learning about Hermeticism. Specifically;

• Allan Moore's conceptualisation of Hermeticism.

Hermeticism is trying to seek an understanding of the world through a combination of alchemy, astrology, and theurgy; theurgy is the goal of reaching spiritual perfection near to godliness. What drew me to this philosophy, is the idea that the immaterial world is a world we conjure up due to the senses in our body and our perception of the material world. Which, in my opinion, means that we can bend our physical reality to our mental conceptualisations. Moore proposes we become more intentional about this change; trying to actively change the physical by undergoing intense spiritual and mental training. He provided a manual in his magnum opus Jerusalem, in which he attempted to alter our collective reality. But this already happens. At school, as we learn more and more about the world around us, the material world changes. We learn about photosynthesis and pollination, and we see it around us. We learn about racism, class structures and injustice, and the material world changes. Its a truly underrated form of magic, that we are all capable of. Question is, how do we become more purposeful about the way we use it?