Homebound senior wants COVID vaccine yet can’t get shot doctor prescribed

Here’s the story of one elderly American citizen who agreed to be vaccinated against COVID-19, yet hasn’t been able to receive a shot as of mid-June, 2021.

Someone I care about has a very complex medical situation. Her health is fragile, and her immune system is compromised.

My loved one is frail and almost completely housebound; it is a struggle even to get her to scheduled doctors’ appointments with ample notice. Sometimes, her body simply won’t conform to the constraints of sitting in a passenger vehicle. Hospital bed in dining room

She certainly would not be able to wait 30 minutes on a hard chair in a physician’s practice—let alone standing in an aisle at a local pharmacy—the way my kids and I did after our jabs. At the same time, due to a history of severe allergic reactions to drugs and vaccine components, the risk of an adverse reaction is higher than average for this patient.

Consultations with her various specialists resulted in a consensus that the Pfizer product is the only recommended COVID-19 vaccine for her.

Thus far, none of her providers has been able to offer access to a prescribed dose of COVID-19 vaccine during a routine visit. Internet-savvy family members continue searching for a solution that will accommodate her specific needs with no luck to date.

The patient’s state of residence now offers at-home vaccinations for those who are homebound. Unfortunately, the program sends its providers out with the Johnson & Johnson single dose vaccine only. According to the toll-free hotline, there are no exceptions unless the patient is under 17 years old.

This patient, though unable leave home for a shot, cannot take advantage of her state’s offering for housebound residents. According to the Journal of the American Medical Association, approximately 6% of U.S. seniors were completely or mostly homebound as of 2015.

Without a doubt, American wealth and power has provided a tremendous benefit to average citizens who’ve been amongst the earliest to access life-saving vaccines against the novel coronavirus. Public health, however, relies upon the breadth of its network to protect every resident. Many of our most vulnerable are still waiting as vaccines near expiration dates in medical center freezers.

Evidence of widespread vaccine hesitancy proves we must keep working to remove barriers to access for those willing, yet unable, to be vaccinated in currently available settings. Lives—and our loved ones—depend upon it.

Post-COVID, I’ll remember NCL, Delta & Alaska Airlines put safety first

Norwegian Cruise Line (NCL) Holdings announced on May 7th that, if Florida’s government holds to its misguided law preventing private businesses from enforcing vaccine compliance, NCL will take all of its sailings to other ports outside that state. For a Miami-based company, that’s a pretty bold promise.

While my sun-loathing, beach-avoiding tendencies made Florida’s appeal a mystery to me in the past, its near total lack of sensible governance paints it as a positively terrifying “vacation” destination today. I’m hardly the only one to notice Governor DeSantis’ lunatic anti-corporate stance on this question, either.

I want to commend NCL for making a rational commitment to protect passenger safety even as the pandemic wanes. I haven’t cruised with Norwegian yet, but taking a firm line on this issue after a year of unprecedented collapse in the travel industry gives me a powerful reason to consider them more seriously in the future.2012 Carnival cruise Saint John NB Canada - 3

I’ve only taken a handful of cruises, having traveled twice with Crystal Cruises, once on Holland America Line, and once with Carnival. I’m delighted that Crystal has also adopted a 100% vaccinated passenger policy at this time.

At the same time, allow me to commend Delta for being the airline which blocked middle seats longer than any other major U.S. carrier. Delta ended that policy on May 1, 2021.

By contrast, American Airlines decided after just a couple of months in 2020 (April to June) that cramming passengers three abreast on flights of any duration—while an airborne virus sickened tens of thousands per day in a way science did not yet clearly understand—was sound policy.

AA made this choice well before the second surge of cases and deaths in the United States.AA entertainment welcome screen above pocket with A321S safety card visible

You can bet that Delta has moved up on the list of airlines I’ll choose to fly with going forward.

The day I got my first vaccine jab, I booked tickets home to see my dad for Christmas 2021.

I noticed when Alaska Airlines made the news for banning Alaska state Senator Lora Reinbold. The dis-Honorable Senator Reinbold repeatedly ignored staff instructions, violating a mask order designed to protect her fellow passengers.

Most of those good people were likely Reinbold’s constituents, yet she couldn’t be bothered to don a few square inches of cloth to reduce the risk of infecting them all with a contagious disease. The senator couldn’t know if any those in her vicinity were high risk; she simply didn’t care more about human life than she did political posturing.Tail of Alaska plane visible on tarmac through airport terminal window

I’m incredibly appreciative that Alaska Airlines chose to institute a face covering policy even before the United States federal government implemented its own mandate. I’m proud to say that Alaska is the airline with which I’ve had elite status for the greatest number of years.

I’m gratified that I’ve regularly paid a premium for flights with this airline that chose to do the right thing, even when doing so cost them the business of customers who couldn’t—wouldn’t—be bothered to take any small measure to respect others.

It’s interesting to me that I’ve long felt that customer service was better on Alaska and Delta than on other domestic airlines, even as frequent fliers began complaining bitterly about changes in the latter’s SkyMiles Frequent Flyer program devaluing their points. Personally, I prefer good service and more stringent safety protocols to a higher return paid in free trips.

This post is the product of a lot of noticing, over the course of a pandemic, which big companies took specific kinds of thoughtful action, and how often those actions corresponded with my previous impression of a given corporation. Trader Joe’s and American Airlines disappointed me; Delta, Alaska, and NCL have earned a great deal more of my esteem.

I have a long memory, and I’m the kind of traveler happy to pay a premium to support my values. Here’s hoping some pandemic-era changes in the aviation industry remain, and that the skies stay a little friendlier in the future.

Taxing actual miles is better, but vehicle weight should be a factor for VMT

Because I’m in the 99th percentile for having strong opinions, a recent Washington Post article about some states experimenting with “vehicle-miles driven” (VMT) taxes in place of gasoline taxes got my attention. I’ve been complaining about the rampant up-ramping inadequacy of taxing only gas as a proxy for road usage for years.

Wear & tear is a cost of all cars, not just gas burners

Though they use less gasoline, it is obvious that hybrid and electric cars also cause wear and tear on roads, just like those powered by internal combustion engines do. Excluding those which weigh less than an average human being, every driver of any* vehicle on the asphalt should be paying a share of maintenance for streets, tunnels, and bridges.Pile of money

First let me point out that I think eliminating the gas tax entirely would be stupid. We should continue to tax fuel purchases for as long as they occur commercially because burning gas directly tracks with carbon dioxide emissions. Every breathing creature on the planet is affected by that pollution, not just the people driving automobiles. Taxing it is just!

I believe America’s leadership made a terrible mistake when it didn’t radically increase the fuel tax after 9/11. At that moment, patriotism might have mitigated the political hit. The true cost of every gallon of gasoline includes our spending on wars in the Middle East, defense against terrorism, and the ongoing environmental damage of carbon emissions and oil spills.

Gas is a dirty fuel in every sense of the word.USA flag - 1

With that being said, even 100% electric vehicles are not without deleterious effects upon our motorways. Never mind the generation of electricity—environmental issues there can be managed via different levers—but consider the physical reality of the cars themselves. A 2021 Toyota Camry rolls 3310 to 3475 lbs around our pavements depending upon trim level; a Camry Hybrid weighs in at an even heftier 3580 lbs.

That hybrid is eating some asphalt.

Space is occupied by hybrids as readily as by conventional cars

Add road congestion, parking issues, and traffic to the question of wear and tear. Engine type doesn’t affect those either.

To be clear, my position is that a combination of a fuel tax collected at the gas pump and VMT computed from individual vehicle data should start out with a total tax burden similar to today’s for a typical driver—specifically, those opting for efficient, mid-sized cars traveling an average number of miles.

I’m not advocating for a sudden huge jump in tax collection—though I believe most of us should be paying more than we do now to reflect the true cost of operating private vehicles—but for the choice of vehicle combined with actual miles driven to dictate the total tax burden per driver.

Allowing these rates to rise gradually over time would protect commuters from a sudden financial shock while allowing for desperately needed infrastructure improvements to begin across America. Escalating costs for operating outmoded, oversize vehicles in inappropriate environments would also nudge manufacturers and consumers toward more rational conveyances designed specifically for the types of trip actually being made day in and day out.

That Camry I mentioned occupies about 96.6 square feet (192.1″ x 72.4″ per Toyota’s specs) standing still. I’m pretty broad in the beam, yet my own standing square footage requirements are about 1.5′ × 1′ or 1.5 sq. ft.  math working out square footage of Toyota Camry

For reference: An average bicycle is 68″ long by roughly 24″ wide; therefore, a bike occupies about 11 ¹⁄3 sq. ft.

Here’s a quick visual comparison of the relative square footage occupied by a human body (lady) vs. an average bike vs. that same Toyota Camry. Remember to consider this graphic should be multiplied by the almost 8 billion human inhabitants of planet Earth to fully grasp the big picture.sketch on graph paper showing relative sizes of lady, bike, car

As a person with some physical disabilities, I’m hardly suggesting that all of us should walk or bike everywhere instead of using powered machines we’ve improved for that purpose over the course of millennia. Still, I’d argue that the ideal single person vehicle should be much closer to the size and weight of a bike if not the human body itself vs. a Heavy Duty pickup truck or even a sedan like that Camry on which I keep picking.

Even “compact” private vehicles operating with single passengers are a wildly inefficient use of space. That’s a more noticeable issue in dense cities, but the inappropriateness is blatant in any context given a modicum of though.two children stand next to blue hatchback

Again, as a person with physical limitations, I remain loathe to ban passenger cars outright from most spaces—even urban cores—but I absolutely support governmental policies that reflect the full, true costs of our dependence upon personal vehicles sized to hold entire families or a small sports team yet routinely carrying individual bodies.

A preposterous percentage of Americans—who carry multiple occupants on a given vehicular trip only 49% of the time, on average, per 2011 data from the U.S. Department of Transportation Bureau of Transportation Statistics—elects to drive something rather larger than a sedan.

According to Edmunds, in 2020, four of the top ten “Most Popular Cars in America” were full size trucks; three others were SUVs. That makes 70% of the favorite American choices for mostly carrying one human body even larger than the Camry I’ve been offering as an example of a standard passenger car.

According to this Bloomberg City Lab article, “Since 1990, U.S. pickup trucks have added almost 1,300 pounds on average. … the biggest vehicles on the market now weigh almost 7,000 pounds.” It would appear that human bodies in America aren’t the only ones experiencing an obesity epidemic.

The way that larger trucks have regulatory status as commercial machines, not passenger vehicles, making them exempt from EPA fuel economy reporting rules must be addressed. A solo commuter to an office should pay—literally, via her tax bill—for inefficient choices that affect others.

Those hauling heavy machinery or farm equipment may be reasonably held to a different standard of taxation. Differentiating between legitimate commercial vehicles and passenger use in calculating VMT strikes me as wise.

Major popular objections to VMT as implemented in 2021

Returning to the specifics of the states currently enacting—or testing— VMT in 2021, two major objections are noted (from the same Post article from paragraph one, bolded emphasis mine):

“Surveys of drivers involved in pilot programs revealed questions of privacy and data security as top concerns. Many environmentalists also are opposed, saying that taxing gasoline also[sic] is also an effective tax on carbon dioxide emissions. Under a miles-driven system, the highest-emission vehicles stand to gain a tax break.”

I see simple solutions to both of these non-problems with implementing a sensible VMT.

Environmental solution via VMT: factor in weight

To address the concern that fuel-guzzling trucks and SUVs will be under-taxed given their tendency to pollute, the miles driven tax rate ought to be multiplied by the weight of the vehicle.

Accounting for actual weight corrects for the environmental damage done by over-sized SUVs and pickups used frivolously in place of fuel efficient passenger cars for urban commuting. A Gross Vehicle Weight Rating (GVWR) is already required of all manufacturers. Use that information to tax drivers based upon their chosen vehicle multiplied by the number of miles s/he drives. That result offers a pretty reasonable assessment of how much wear and tear one individual puts on our public roads.

I believe the best policy in a free society is to allow the real price of operating even the most bloated conveyance to convince drivers to make better choices when conscience fails. I wouldn’t ban Hummers, but I’d like to see their owners pay for more of what they’re currently getting away with stealing from future generations.

Allow people to continue to “express their individuality” by driving one of the most popular “cars” i.e., full sized trucks if they wish, just make them pay their fair share of what they’re using.

Privacy objection to VMT: read the odometer, stupid

The privacy issue is hugely important to me, but carrying an intrusive GPS tracking device at all times is hardly the only option for implementing VMT.

You don’t need location data to assess miles driven. There’s an odometer built into every modern vehicle.

States like mine already require annual safety inspections of any vehicle operating on public roads. Adding an odometer reading to that process—done in state-certified facilities in every community—would add only a trivial amount of time and effort to that process. Remitting one’s “actual miles driven” tax after an annual safety or emissions inspection could be required before new window or license plate stickers were provided.

States could offer tracking devices like those used in Oregon’s program to those who prefer to pay smaller, more manageable, more frequent periodic bills, but also allow drivers to accrue billable mileage with collection due quarterly, annually, when registrations are renewed, or simply upon sale of the vehicle. That could lead to a large tax bill for someone making the latter election, but it effectively removes all privacy issues from the tax.

Odometer readings could be self-reported or taken at government facilities or in approved private garages such as car dealerships or service stations; any discrepancies could be caught upon sale or transfer of the vehicle. Deposits based upon averages—the individual’s historic mileage as these programs persist over the years or from data captured by auto insurance actuarial tables—could be held in escrow by the state if necessary.

In the longer term, odometers could be designed to transmit readings without coupling that information to GPS location data. Data transmission of this type is well within the bounds of current technology.

In short, there are no insurmountable technical or privacy obstacles to implementing a fair, cost-effective collection of VMT in 2021.

Bigger, heavier vehicles take up more than their fair share of space, they cause roads to deteriorate faster, and they represent a greater threat to the health and safety of pedestrians, cyclists, and other motorists. A properly designed VMT should tax individuals for their choice of vehicle in combination with the quantity of miles driven. That would be by far the most fair and reasonable option I can imagine.

* Though this may not be a universal position, I believe that every human has the right to navigate the world under his or her own power without taxation. Bicycles and skateboards probably do exert a small toll upon the surfaces they transit, but I suspect their effects are negligible compared with that of most powered conveyances.

The electric bike pictured in the photo to the right of the construction trucks was used by my father to commute to his last full-time professional job before retirement. He was in his 60’s at the time and found the electric motor assist necessary to cope with a particularly steep hill between home and office. To be fair, he always had access to a car for days when the Oregon weather made cycling miserable or unsafe, but Dad makes a fair proxy for a non-young, not-above-average-in-fitness commuter.

Again, from the same Washington Post article, here’s a description of how Oregon is currently implementing its VMT program:

“Participants in the state have three ways to sign up — two privately run systems and one administered by the state Department of Transportation. The private companies send drivers a device that logs where and how much they drive or pull the data directly from vehicles. Then they send out bills and turn over the revenue to the state. Drivers get reimbursed for gas taxes they pay at the pump.

The companies keep drivers’ data for 30 days, and participants have options that include not sharing information about their locations.”

Where is the line between infrastructure and socialism?

Where do you, personally, draw the line between infrastructure and socialism?

Merriam Webster dictionary definition of infrasctructure, the system of public works of a country, etc.I ask this sincerely, with no desire to engage in polarized internet snipe-fests, but in the spirit of attentiveness to what government services various individuals might deem “necessary” and which are “overreach.”

Even more interesting than the what, is the why.

Only deep ignorance of history allows one to pretend there’s anything universal about this question. Our republican forebears in Rome—whose architecture we aped in the United States capitol in part due to the Founding Fathers’ lionization of that civilization—prioritized very different governmental interventions than we do today.

Proving myself, as always, a true dilettante and no real scholar, I’ll begin by pointing to a series of mystery novelsthat I read years ago. They turned me on to a startling fact: the ancient Romans had no police force.

police car parked at justice centerRome, civilization par excellence, did not feel that it owed average citizens the protection of civil police. The military kept order to an extent that suited the needs of the state, but there was no one to call when your silver was stolen. It wasn’t until the great republic became an empire that Augustus formed the Praetorian Guard in 27 BCE… to protect himself.

And all this in spite of the fact that the Ancient Greek city of Athens had seen the nascent formation of a police force (c. 400 BCE) to keep order and arrest and manage prisoners using publicly owned Scythian slaves. Investigating and detecting crime, in the ancient world, was the responsibility of individual free citizens.

So, is a police force a basic piece of infrastructure, a right that should be available to all, or is investigation and detection by paid government agents an imposition against individual freedoms as the Romans seemed to believe?

In spite of our turbulent times and the fraught political environment, I’ll admit it: I think this is a fascinating question. In a democracy, it is, in fact, the duty of every citizen to ponder these essential assumptions.

Do modern American people on the right and on the left really have such different ideas about what a government ought to do, or are our differences more about degree and descriptive nomenclature?

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Vote your conscience, by mail or in person

In another one of life’s little ironies, the pandemic brought me around full circle to voting by mail this year.

I grew up in the Pacific Northwest in the first state that made all voting into mail in voting. I cast my first ballot as an 18 year old college student via the U.S. Postal service from a few thousand miles away from home.Official Election Mail trademark authorized by US Postal Service

Voting exclusively by mail in my home state was contentious for a few years in the 1990’s, but voters overwhelmingly informed the legislature that they preferred the privacy and convenience of casting ballots remotely as of 1998.

Oh, yeah, and my birth state routinely gets double the turnout* for primaries and other less sexy elections, so enfranchisement is definitely a thing. To be clear, every type of individual achieved greater representation via mail in voting in Oregon. People of different ages, political affiliations, races, etc., all saw higher turnout in my state, and fraud has never been a significant issue.

As an Independent voter who eschews the false polarity of the American political parties, I believe in enabling the enfranchisement of every eligible citizen. When anyone acts to suppress another’s vote, I assume that group lacks natural authority or the right to wield power.

Mail in ballot envelope labeled State Election Ballot EnclosedToday, I dropped my completed ballot—and those of my spouse, mother-in-law, and father-in-law—into an official drop box outside our town’s City Hall.

I sent an email first to confirm that it was okay to submit a ballot on behalf of a family member! This year would be a terrible one in which to make a foolish logistical mistake that invalidates one’s ballot.

Turning in my envelope reminded me of how, the first time I voted, it felt a bit like I was missing something by not setting foot in a polling place. Having voted in person for a couple of decades now, I particularly missed receiving my “I Voted” sticker.I voted Election sticker - 1According to the Boston Globe, I’m not the only one who feels this way.

I will trade the fleeting pleasure of a celebratory sticker for the enduring satisfaction of taking part in a democratic election, however. I’m exceedingly grateful that I live in a state where everyone is entitled to the peace of mind granted by access to absentee ballots in the midst of a worldwide health emergency.

I voted early in hopes of alleviating congestion at the polls on election day. I voted early because there are no close races on my ballot that require further study or reflection. Now, I will hope and pray that every citizen of age in America will be given his or her own opportunity to do the same thing, and to vote his or her conscience.

Here are two great things I’ve learned about as I’ve read up on the current election:

  1. In my state of residence, I can track my absentee (mail in) ballot online. Check your state’s web site or this CNET article and see how you can do the same where you live.
  2. Teens can pre-register to vote in many states as early as age 16. By doing so, they are less likely to forget this important civic duty in the run up to an election at a busy time of life, like being away at college for the first time.

Screen shot of ballot tracking page from state web site showing state electionYour opinions matter. Your vote counts. Exercise your right to be heard!

God bless America.

USA flag - 1

* Compared to states using more traditional, in person polling places, according to this OPB article. You can see for yourself at Ballotpedia that Oregon has exceeded average voter turnout in every election since 2002.

According to the comments, however, a lot of Massholes think my feelings are stupid!