My kids’ mom

This is excerpted from a note I posted on Facebook with the same title. It’s about the events that followed a tornado hitting my ex-wife’s home in the early morning hours of April 28, 2011. Nothing in the world means more to me than my children, and after my separation and divorce from their mother, I sometimes questioned her decisions as a parent. I have always had difficulty with trusting someone else fully, especially if that someone has divorced me. I no longer have difficulty trusting her absolutely.

No one, not even I, could have done the kick-ass job that Tracy did in keeping our children safe through the tornado hitting their house and through the aftermath. I monitor weather watches and warnings in her county, primarily because of the kids, so I called within a minute of the tornado warning to ensure that they had not slept through the Wx radio alarm (as though my Imperial March ringtone would be louder…) but got no answer. After a little while on eggshells, I got a call from her reassuring me that the kids were safe, despite the tornado damage to their house. She got them to a safe place at a neighbor’s, gave me the neighbor’s phone number (throwing out the window the way we normally deal with each other) so that I could always reach the kids, and dove back in to helping her parents with pressing emergencies at their house. Despite everything that was going on, she kept me informed every time the kids changed location and made sure I had a means to reach them.

It amazes me that she finds herself in the position of being laid off as a teacher. If I were a school administrator, I wouldn’t merely retain her, I’d clone her, so that I could focus on problems other than school safety and learning, secure in the knowledge that my teachers had it covered. As a parent, I can only hope that my children end up with teachers like their mother for 12 years, so that they will be well-prepared for people like me as their university professors.

Personal and government emergency preparedness

This week, the northern half of Georgia is enduring the effects of an unusually heavy snow/ice storm. Practically all of the precipitation fell Sunday night/pre-dawn Monday morning, but continuous sub-freezing temperatures have prolonged its effects, causing, for example, widespread school closures for three or more consecutive days – unprecedented in my memory.  One might characterize this as a “once in a decade” winter storm for Georgia, though it is the second significant winter storm in the span of a month…in a state that often goes an entire winter without a significant snow/ice storm.

I grew up during the Cold War, and I saw how personal disaster preparedness became deemphasized for most people with the collapse of the Soviet Union and with it, the freedom from the ever-present threat of nuclear war. Of course, our nation was shaken from its complacency a decade later, and since then, there has been a renewed emphasis at all levels of government in encouraging us to be prepared and equipped to deal with disasters, natural or man-made. The federal government has been doing an outstanding job of communicating to individuals and local governments that, in the event of a catastrophe, we may need to survive on our own for several days before outside help reaches us. The rule of thumb for individuals and families is to maintain the resources to sustain themselves, while either evacuating or sheltering-in-place, for three days.

Though physical disability limits my evacuation options, I am fortunate that, because of my background (growing up in the Cold War, a former Boy Scout, a veteran, an outdoorsman, work experience in public safety/emergency management, etc.) my life required no changes in order to attain that level of preparedness and much more.  The only long-term survival need outside of my control is my reliance on prescription medications, a few of which are absolutely vital and, since they are tightly-controlled narcotics, would be difficult to obtain in the event of a prolonged breakdown of social services.

While I’m confident in my ability to weather a disaster and help others do so, an event occurred this week which shook my confidence in my local government to do the same, even at the level of essential services. This ice storm, while heavier than initially predicted, did not occur without warning. On Monday morning, after the precipitation itself, I had a medical emergency that I believed might be imminently life-threatening and could not be treated outside of a hospital. I dialed 911, and a fire/rescue truck and an ambulance were immediately dispatched. I live about 3 miles from the nearest fire station. About 15 minutes later, the dispatcher called to inform me that help was on the way, but the rescue truck and ambulance were having trouble getting to me due to road conditions. Another 20 or so minutes passed, and the dispatcher called to tell me that they could not get into my apartment complex due to the ice and asked if I could walk (several hundred yards) to the entrance of the apartment complex to meet the ambulance. Since my manual wheelchair lacks all-terrain tires, I told her that was not possible.  I began to think about whether a LifeFlight helicopter would have enough room to land safely in the parking lot in front of my apartment. Help finally arrived, well over an hour after my initial call, in the form of a fire department paramedic’s personal pickup truck equipped with snow chains. The paramedics assessed me and transported me to the waiting ambulance.  Fortunately, though there was no way to know without going to the hospital, I did not need to be admitted.  (On the ride home, though the temperature had remained well below freezing and road conditions inside my apartment complex had not changed, the cab had little difficulty taking me all the way to my door.) Last night, my home blood pressure monitor (faulty, as it turns out) provided a reading that indicated that heart damage or a heart attack was imminent. I called 911, and rescue and an ambulance arrived within 15 minutes. It only took the fire department and ambulance service 3 days to discover the invention of snow chains and to use this discovery to their advantage.

My life may depend on how well I prepare for every conceivable contingency as I stock my disaster kit. Many lives depend on how well our city and county governments prepare. YOU NEED NOT WAIT UNTIL AFTER THE DISASTER to find out how prepared your first-responders are. Every local government should have a written disaster plan, and you should be able to view it. In Georgia, you can probably obtain a copy at nominal cost, pursuant to the Open Records Act. Ask your elected officials what the local government’s plans and capabilities are in the event of X. If you aren’t satisfied with the answer, get your county and state emergency management agency involved. Get involved yourself, if you have the time and the skills (this is very common among HAM radio operators).

Don’t wait until AFTER it hits the fan to find out whether your community is prepared for it!

More information about preparing for various types of disasters can be found at Ready.gov and The National Weather Service StormReady Communities Program.

Trying to blog more often…

One of the goals I intend to accomplish is to record something every day.  It’s a goal I’ve had for years. I have better tools than ever: I carry at least a Moleskine journal and a “Rite in The Rain” waterproof-paper notepad, along with quality pens, one of them waterproof, everywhere I go. My Palm Pre Plus has software to make it easy to post blogs from anywhere. This wealth of tools poses its own problem: there is no central place for daily journal entries of a general nature. There is no place or method to record cross-references.

Okay, so Christmas Eve may be an odd time for an atheist to “come out”.

Gentle Reader, for an unknown reason my thoughts have turned toward the philosophy of religion and toward my own beliefs on the matter. My understanding of faith is belief in the absence of evidence. I obviously can’t prove that reading this entire post carefully is worth your time, but I ask it of you anyway. If we are close, long-time friends and any of this still comes as a surprise, I beg you to give me the benefit of the doubt and don’t feel offended: in the specific example of which I’m thinking, we’ve been friends longer than I have been able to say the words “I am an atheist” even to myself, and our friendship means more to me than keeping you posted on belief changes that I believed would strain that friendship for you, perhaps past the breaking point, at the relatively young age at which I got honest with myself about what I really believe.

I have raised my children to believe that there is nothing worse than lying, and it is vital for me to live by what I teach my children, and, conversely, to teach them by example. A lie of omission is no less a lie, and fear of how the hearer will respond to the truth is no justification.

Yes, this IS an odd time, but I hope that my friends know better than to think that my intent is to insult or offend.

Below is a communication I sent to a friend who I came to know relatively recently and whose friendship and wisdom I came to value immediately. In it, I refer to Pascal’s Wager and the high value I place on my own intellectual integrity. Allowing others to simply assume what they will about my beliefs on religion doesn’t seem like the action of someone who values his intellectual integrity so highly, does it?

I believe that all people have a spiritual side, and we have for thousands upon thousands of years…even prior to the Neolithic Revolution, back when our species still lived as hunter/gatherers, driven by the annual cycles by which our wild food crops became ripe and edible. In every era, that which cannot be explained by the practical knowledge of the day, which we’ll call “science” or “nature” for succinctness, was attributed to the supernatural (again, “gods” or “magic,” for brevity). Given that we as a species have existed for thousands and thousands of years, and that we did not develop the ability to directly see things that were much smaller or much larger than ourselves until about 500 years ago, it was natural that, to paraphrase badly, whatever could not be explained by science was attributed to magic and the gods. Many people whose spiritual nature is expressed through religion may look at the birth of a child or a majestic mountain view and see these as “proof” of the supernatural. My having the same experiences fills me with awe, too, even though I see it as “nature just doing its thing.” My unaccounted-for spiritual (for want of a better-understood, more precise word) feeling in these situations made me question everything else I believe about the way nature and logic work…until I remembered something unstated that I consider an axiom: regardless of what we BELIEVE, myself included, we don’t KNOW everything about ourselves or the universe. The honest among us will be the first to distinguish between our beliefs about the universe and our knowledge about it. Knowing the science and STILL being able to experience the sense of wonder is A Very Good Thing, I think.

For my Christian friends, with all my heart I wish you a wondrous and Merry Christmas.

For those looking around for the unfriend button, or on the ground for the first stone, please take a moment to read my message to my friend, in full.

Dear (my valued friend whose name I have omitted for your privacy),

You might have surmised that we don’t share the same religious belief. That doesn’t cause me any discomfort, and I want to humbly and respectfully take the initiative to ensure that it doesn’t cause you any, either.

I am an atheist, and I have been for as long as I can remember throughout my adult life. The word “atheist” is so over- and misused that it doesn’t convey any reliable meaning, so I shall elaborate. I am not what I call a “militant atheist” – a kid who mistakes belief for knowledge and thinks he knows better than the rest of the world…or who has suffered some tragedy and reacts by railing against his religious belief system. I was raised Baptist as a child, though I never believed that what I was told was literally (or even figuratively) true. It’s just that, prior to my late teens, I felt that I wasn’t free to assert what I DID believe. Part of that was apprehension about the ramifications with my family.

I explored other religions, particularly Buddhism, as a young adult, but ultimately I reached the same stumbling point – the supernatural element.

To summarize my worldview, when I look at physics and biology, I believe that everything that exists can be explained by the laws of nature and logic, without a need for some supernatural force. I also believe that the laws of nature and the laws of logic tend to rule out the existence of a being with the attributes of the Christian God. Of course, it is impossible to KNOW that God (or the enlightened Buddha, etc.) does not exist, known as proving a universal negative, because one cannot see every nook and cranny of existence at the same time.

I believe that the vast majority of those who believe in a religious worldview learned their beliefs from their parents and the culture in which the happen to be born. They never pause to question why they believe as they do. That’s understandable – religion is a great comfort, and its absence can get cold and lonely.

That sums up what I BELIEVE. I freely admit that I could be wrong and you could be right.

Pascal, in his famous Wager, would argue that I should conduct myself as though I am a Christian, because I have everything to gain and little to lose if Christianity is fact, and I have (in his view) lost nothing in life or death if atheism is fact.

If I could respond to Pascal, I would say that my intellectual integrity is a very high price to pay in order to go through the motions of being a Christian, and that doing so would be an affront, not only to my beliefs, but to yours, as well.

I live a life of integrity, as best I can. I strive to conduct myself in accordance with ETHICAL teachings that Jesus, Siddharta Gautama (the man who became the Buddha), and the Dalai Lama would recognize and, I believe, approve of.

Beyond that, I will take my chances, with my eyes open, if my beliefs turn out to be erroneous.

Finally, I don’t teach my beliefs to my children. I try to keep them from forming ANY beliefs about religion until they are old enough to think rationally, weigh evidence, and articulate why they believe what they believe.

I just want to be truly understood, and I want there to be no discomfort between us if the topic comes up. As I said publicly (and tell my grandmother repeatedly), it doesn’t bother me in the least if someone says they are praying for me. I take any well-wishes in the good faith in which they’re intended, and as damaged as I am, I’ll take all the help I can get!

And yes, when my son was gravely ill with meningitis as an infant, I prayed to God, Allah, Buddha, every benevolent Hindu, Greek, or Mayan god I could think of, along with the Mount Fuji and the Golden Gate Bridge!

I deeply hope I haven’t overstepped any bounds or your comfort level.

With love and respect,

Jeff

“In the whole wide world there’s no magic place,

So you might as well rise and put on your bravest face.”

- Neil Peart/Rush, “Bravest Face”

 

Inauguration Day

For years, I have used LibraryThing.com to manage my personal library. A few times, I have accepted free advance copies of books from publishers, distributed through the site, in exchange for reviews. In the course of doing this, I found that I enjoy writing reviews for the books in my library, especially those works that have been the most influential in my life.

To facilitate this, I have started a new blog: http://biblioreview.wordpress.com.

It’s off to a slow start: other than the works already reviewed, I’m going to reread the books specifically with an eye toward reviewing them, rather than attempt to work from memory. For now, feel free to enjoy http://jeffreydbrown.wordpress.com and my philosophy blog, http://ethikos.wordpress.com.

If you get nothing else from them, I hope it IS enjoyment.

Reflections on Music

[This originally appeared on my Facebook, and I thought it worth preserving.]

It must really suck to be my neighbor on a morning when I’m NOT overwhelmed by depression: the windows rattle with my “happy music.”

Fortunately for them, it’s rare. Even if I wake up okay, something as small as HB’s (my pet name for my life partner) leaving for work can be enough to put me in an unrecoverable tailspin.

The list of things that bring me joy and counter the tendency toward the darkness of depression has shortened dramatically over the past decade or so. Some that remain, like spending time with my kids, I only get to enjoy for short bursts, with seemingly infinite periods in between. Others, such as spending time immersed in nature, are victims of physical disability. Only my music is always there. It pulls me back from the brink. It lets loose a torrent of tears, when (hopefully controlled) catharsis what I need. It helps me forgive myself for my personal failures, which is a lot to ask of anything.

It partially fills a role for me that, for others, may be filled by religion.

 

This is My Mind on Crutches. Any Questions?

For the past two decades, I have grown accustomed to having my body let me down. A shipboard accident at the age of 18 left me suffering from knee injuries that never resolved and devolved into osteoarthritis and other degenerative joint conditions. That disability cut my Navy “career” extremely short – if my knees had failed while I was working in my normal workplace, a carrier flight deck, my life and likely others’ would be endangered.

After leaving the Navy honorably due to my knee disability, my life was without direction, and I was still coming to grips with the fact that I was limited to desk work for the rest of my life. I had a hard time psychologically, going from a literal lean, mean fighting machine to someone facing a limitation I had thought of a concern for old age, and it was hard for me to even grasp old age.

Given my reliance on my intellect throughout my life, it isn’t really earth-shattering that I would end up working with my mind, rather than with my muscles, but the sudden closing of all of those doors was extremely depressing. I was fortunate that a family friend was the Chief of Police for a small city in the Atlanta area, and his department was in need of a dispatcher. It turned out that I was very good at the work, and, like my service in the Navy, I had the personal satisfaction that I derived from public service. The job turned into a career, culminating in my working in the communications center of the state Emergency Management Agency, a position which let me turn my lifelong interest in computers into one of my duties: information systems administrator for the communications division. I was given a lot of leeway in developing applications. I was proud to develop the software that the communications division adopted for statewide  incident management. It remained in service for several years after my departure and marked the point when my career really changed from public safety or emergency communications to information technology, especially infrastructure systems and database administration. The same small city where I had started as a 911 dispatcher years earlier hired me as its first IT manager.

Actually, I was the entire IT department, and although the city had created the position, it had made no preparation for me to actually start work. I had to find or commandeer literally everything I needed: an office, computer, telephone, furniture – everything. The city’s computer systems and network were completely undocumented.  The flipside of having to do literally everything myself was the rare opportunity to design and implement everything from the ground up.

I had enough on my plate to justify at least three full-time-equivalent positions, supporting the life-critical 24/365 operations of the 911 center,  fire/rescue, police, and jail.  Since those additional l FTEs didn’t exist, I was never truly off duty. I stayed so engaged that I didn’t recognize the toll it was taking on my family life. The heavy work pressure seemed necessary to support my family, and, as long as I had a good, hands-off supervisor (the city manager), the extreme stress felt like “good” stress. It was rewarding.

When circumstances changed, particularly the replacement of the city manager by a new one who had never held that position before, my ideal career quickly started to unravel. The new city manager was a micromanager in the extreme, made worse by his mistaken belief that he knew anything about information technology and his habit of praising performance one day and condemning the same performance the following day.

My major depressive disorder, which had been chemical/organic in origin throughout my adult life and well-controlled by medication for several years, began to become reactive to external life situations – a development with which I had no experience and for which I had no coping tools. In addition,  I began suffering from acute panic and anxiety attacks. I began finding reasons to work at night or at locations other than my office in city hall. Within a few months, the anxiety/panic reached the point of my seeking medical attention for it, and my psychiatrist starting me onto anti-anxiety meds (benzodiazepines).  As I continued to worsen, I was compelled to seek an ADA accommodation and formally notified the city of my intention to take FMLA leave. I was utterly speechless when the city manager fired me the following afternoon with no warning. I suggested to my then-wife that she might want to go ahead and take the kids to her parents’ – I didn’t want them to see Daddy have the complete breakdown that followed – one from which I still haven’t fully recovered, despite improvement with the anxiety disorder. The separation from my family…and then the marital separation…there seemed to be no bottom to the abyss of my depression.

Enter the knees again. They continued to degenerate, as my daily life had sunk to the point that muscle atrophy was inevitable, and my orthopedist referred me to a pain management clinic, adding OxyContin and then MS Contin (due to intolerable cognitive side effects with the former) to the potent mix of psychotropic drugs I was already taking.

Despite  the generally effective antidepressant and anti-anxiety regimen (and the generally ineffective pain regimen consisting primarily opiates due to an allergy to NSAIDs) and the addition of therapy with a psychologist, things have remained fairly constant over the past few years – unpredictable depressive episodes, often with suicidal ideations, persist, and I still experience cognitive effects such as short-term memory loss. The military and other organizations have a maxim that “if it’s not in writing, it doesn’t exist.” For me, that has become literally true. My memory can’t be trusted, which is part of why I write down what many consider Too Much Information. Putting it in a publicly-accessible location allows me to reach it from any computer, and, perhaps more importantly, it might let people in similar situations know that they are not alone.

It took me years to fully come to grips with my physical disability. The awareness that my mind is letting me down, and that it MIGHT not get better, is a much tougher pill to swallow. My life feels like someone in a waking coma – the machine is still working, but it is very difficult to control the input/output: focusing my mind on a new problem or adding new capabilities is often beyond me.

I have worked hard throughout my life to make the contents and capabilities of my mind valuable, not just to myself, but in the marketplace, and if I’ve lost that,  I can’t envision a Plan C.

Georgia’s Water Crisis and A Potentially Collossal Train Wreck

Georgia residents, PLEASE PLEASE PLEASE take a moment to contact your elected officials in the Georgia General Assembly about this CRITICAL issue: Protect Our Waterways from Harmful Water Grabs

These water diversions would be devastating, not only to our river ecosystems, but also potentially to our drinking water supplies. In particular, the withdrawal of an additional 200 MILLION GALLONS every day from wells in South Georgia is of particular concern, even if you have no interest in protecting our beautiful state’s environment. The aquifers in South Georgia are already strained to or beyond their sustainable capacity. The Floridan Aquifer, in particular, is already being overdrawn, leading to seawater being drawn into municipal water supplies along the coast from Hilton Head, SC to Jacksonville, FL. The Floridan and other aquifers, in their natural state, are recharged with fresh water by rainfall in certain inland areas of our coastal plain. The water is filtered as it seeps through the ground , and it flows into the ocean through vents in the seafloor. By withdrawing more water from the aquifer than it receives as rainfall from the recharge zones, we effectively cause it to operate in reverse, drawing seawater IN through the vents in the ocean floor. No drinkable water on our coast would mean no tourism. What would the seawater do if introduced into Metro Atlanta’s water supply? What would it do to Atlanta’s antiquated sewer system? Or to the Chattahoochee and those downstream who rely on it for THEIR drinking water?

There is no time to lose. The 2010 session of the General assembly begins on January 11, 2010. Find Your Legislator – Project Vote Smart

Memories from the San Joaquin Valley

A bit of background: On December 7, 1988, I reported to my first U.S. Navy fleet duty station: Attack Squadron 22 (VA-22), “The Fighting Redcocks,”  based at Naval Air Station (NAS) Lemoore, California. The squadron has since been redesignated as Strike Fighter Squadron 22 (VFA-22), but the Fighting Redcocks remain based at NAS Lemoore, the Navy’s west coast premier air station and home to Strike Fighter Wing (formerly Light Attack Wing) – Pacific. The Naval Air Station is located on California Hwy 198, a few miles west of the town of Lemoore in Kings County. It is approximately a 30-minute drive to Fresno, in the heart of California’s central valley. Each winter (at that time) a thick blanket of fog would settle into the valley, probably due to a reaction between the relatively mild winter temperatures and the colder air blowing in from the Pacific: San Francisco on an enormous scale.

At that time, almost all of the squadrons at NAS Lemoore flew the same type of aircraft: the A-7E Corsair II, a carrier-based light bomber. Although the A-7E was capable of flying missions in all weather, the extremely poor visibility at Lemoore was deemed an unnecessary risk for training flights. As a result, we spent 4 or 5 months out of the year playing cards. As I had arrived near the beginning of a particularly long foggy season, I literally did not know what my base looked like for the first 6 months I was there. I could not see a person standing three feet away from me. A shuttle bus ran between the administrative area of the base, where our barracks was located, to the more restricted operations area a few miles away. My new shipmates helped me by making sure I knew which direction the bus stop was and how many paces as I walked out of the barracks. They did the same for the enlisted club, the operations mess hall, and the brightly-lit, but still invisible, McDonald’s directly across the street from Barracks 12, which our squadron called home. I could get to work, food, and alcohol. The necessities having been taken care of, the rest would have to wait for spring.

I have always loved the beauty of the outdoors. The following is a post about some of my memories (caveat: from 21 years ago, but still as vivid as yesterday) about my first spring after the fog finally lifted. It was previously posted on my Facebook page, and it meant enough to me that I wanted to preserve it. It has been edited slightly from the original post for contextual reasons.

I still remember working nights, and the sun coming up directly in my eyes on the way home as it rose over the Sierra Nevada around 9am, an hour or more after “sunrise” and the first time I ever saw the peaks of the area of Sequoia and King’s Canyon National Parks from Visalia. I had arrived at Lemoore in the middle of the fog, and after it finally lifted, I just assumed they were clouds for weeks afterwards. Nothing east of the Mississippi is that high in the sky except clouds or aircraft vapor trails.One day something made me just stand there and watch them – always in the same place and never drifting.

That’s one of the (few) things I loved about NAS Lemoore in summer – I could see from the peaks of the Sierra Nevada, over the Coalinga Hills to the Coast Ranges. That and the friggin jackrabbits. We used to have to hop into trucks and chase the jackrabbits and coyotes off the runways and taxiways so that we could conduct flight ops. You’d think a big, loud A-7 or F/A-18 coming toward them would have been as much of a clue as a grey truck. Of course WE had 54mm flare guns. I don’t advocate setting coyotes on fire with red flares, but this was the Cold War, and as exhilarating as it was to be the tip of the spear, we knew who the adversary was, and he had a spear, too. Although if we were “on the beach,” we were training, rather than in an operational role, but we took our jobs no less seriously than those who maintained and flew the B-52s with the white undersides or the Air Force Strategic Air Command tankers that supported them. If you’ve lived long enough to remember the Berlin Wall, hopefully you can understand that there was no such thing as a “just practicing” mentality at that point in the history or our Armed Forces. Nor should there ever be.

More Thoughts on Healthcare

The current state of healthcare isn’t literally about healthcare at all. It is about the enormous and continuing rise in the cost of healthcare due to the separation of healthcare consumer/patient and the entity that pays for the care, typically an HMO or the government. To give an example of “HMO-driven inflation,” before transferring my care to the Veterans Health Administration (VA), more than one of my providers had a “standard” rate at which they billed HMOs and presumably Medicare, and a second, significantly lower rate that they charged to individuals without health insurance or other third-party payer. I was shocked to find an example even within the VA. Under certain circumstances, such as lack of available bed or inability to provide a service in within a mandated time limit, the VA contracts with private healthcare providers to handle their overflow (at no cost to the veteran – the cost is billed directly to the VA). I had occasion to be treated by a private provider on behalf of the VA, and I came to learn that my care was billed to the VA at a rate that was TWENTY-FIVE PERCENT above the standard rate that was billed to HMOs or other payers. As shocking as that is, I suspect it’s more of an example of the government ironically being price-gouged because its needs are frequently immutable, rather than being a major contributor to “HMO inflation.”

The problem and its causes are no great mysteries. More important are solutions that avoid a massive new Federal government entitlement (when some major current programs are of questionable sustainability) and pricing healthcare out of reach of more Americans, straining non-profit hospitals by further turning the ER into a primary care clinic. I don’t advocate the abolition of HMOs, but I do propose doing away with absurdities like the “sky’s the limit” surgery in exchange for a $20 copay.  We need to look at reviving features of “traditional” 80/20 insurance (which has never gone away for small businesses or the self-employed), such as DEDUCTIBLES and a reasonable, realistic (for patient and provider) percentage match. Nothing onerous that would prevent a person from obtaining needed care, an amount sufficient, if only symbolically, to restore the patient/consumer’s awareness that increased consumption of medical resources costs proportionately more, a basic lesson of economics that seems to function normally until someone with a lab coat and stethoscope enters the picture.