A Healthcare Rant

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I’ve had occasion to think a lot about our system of health care lately. Bubba is doing a big project at work for a new client that revolves around prevention and healthcare education and I love kicking around ideas with him on our evening walks, especially because I love that this giant organization is thinking in this way. The questions are huge and the obstacles seem enormous, but so do the implications if they can find a way to pull it off.

With 8 million people and counting signed up for the Affordable Healthcare Act, as a country we need to get it together with respect to the way we deliver (and even think about) healthcare.  In Washington state, the number of folks eligible for the Medicaid expansion has outpaced their wildest imaginations and it is increasingly becoming obvious that we need a new game plan in order to serve these people. Many providers refuse to take Medicaid and even Medicare because the reimbursements are so paltry compared to private insurers and there is a big question looming about whether or not we’ll be able to find enough qualified practitioners to treat these new patients.

While we may utter the word “prevention” a lot with regards to health, the simple fact is that the vast majority of people don’t truly understand what that means or how to put it in play in their own lives.  Yes, we all pretty much know that our lives will be better if we get enough sleep, manage our stress, eat healthy, exercise and don’t smoke or do drugs, but actually knowing how to implement those things regularly and effectively is tremendously difficult.  When so many people, especially those newly eligible for health insurance, are struggling to pay the rent every month, finding the time to locate honest resources where they can educate themselves about what healthy food is or learning effective stress-management techniques is pretty far down on the list of priorities.

So where do most people get their information about health care? Not from their physician, it turns out, because as a system, our health care priorities lie in treatment of symptoms and deployment of technology, not conversation.  Doctors get paid to write prescriptions and schedule surgeries or diagnostic tests, not to sit with their patients for an hour at a time and help them understand how to read a food label or coach them in relaxation techniques or set up a viable exercise plan.  And while there are some physicians who take the time to really listen to their patients and explain things in depth, it isn’t always easy to remember exactly what they said once you leave the office.  Yes, it is possible to find people who will teach us about nutrition and stress management and exercise, but they are rarely paid by insurance companies and most people can’t afford their services.  Why don’t we make it part of our health education to offer those services in the doctor’s office as part of the care? The first real nutrition education my mother got from her healthcare provider was a class on how to eat after being diagnosed with diabetes. Helpful, but maybe classes on how to avoid diabetes in the first place would have been better, given that now Medicare pays hundreds of dollars for prescriptions every month that might have been unnecessary.

I predict that, thanks to the ACA, many healthcare providers will find themselves overwhelmed by a glut of new patients with complicated health histories. There are some who are relatively young and healthy who have signed up for coverage and may choose to establish a relationship with a physician, but there will be many more who have suffered with chronic conditions for years because they couldn’t afford to have someone treat them.  It is here where the rubber meets the road and, I think, the issue that will prove to be the stickiest for this much-needed leap forward in our healthcare system.  A doctor who sees a middle-aged person with multiple complaints that have been ongoing for years will be hard-pressed to find enough time for a comprehensive introductory examination that can unravel years of health issues. Most of these patients will end up leaving their first doctor’s appointment in years with a fist-full of prescriptions that may or may not make a significant difference in their long-term health, and will more likely treat symptoms instead of causes. Additionally, if the fee schedules don’t change, the folks who have to pay for some portion of their prescriptions may find themselves unable to afford the treatments they’ve been offered.  Without some effort to integrate these individuals into a system that educates them and offers them someone to collaborate with when it comes to preserving their health or reversing chronic conditions, we are destined to continue to have the most inefficient, expensive healthcare system in the nation, albeit one that is covering more folks than ever before.  Until we revamp our priorities by paying more for consultations and less for quick-fix deployment of technologies like surgery or prescriptions, we can never hope to turn the tide from treatment to prevention. We will always be playing catch-up and we will never catch up to our national obsession with fast food and sugar and vapor cigarettes as a viable alternative to regular cigarettes, because we haven’t been educated by people who have credibility, with whom we have an ongoing relationship. We have to enlist our healthcare providers as educators and partners and pay them to work with patients to keep them healthy and help them make good choices instead of giving them incentives to do expensive surgeries and prescribe drugs that treat symptoms. Until we are willing to turn our attentions from quick-fix ideas to long-term prevention strategies, we are doomed to continue down this path of being one of the unhealthiest countries in the world. With some of the most educated healthcare workers in the world, it is an absolute tragedy that this is the situation we find ourselves in, but if we choose to use doctors and nurses as collaborators instead of auto mechanics, we can make a difference.

“The Compassion Gap” and Other Musings

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Elizabeth highlighted this op-ed on her Facebook page on Sunday and, as it is fairly short, I urge you to go read it before you continue reading this post.  It makes me sad that the author is so spot-on as he calls out the responses of so many of his readers.  I agree with him that there is a lack of compassion in general in this country (and maybe in others – I don’t honestly know because I’m only here), but more specifically online. I think that it is much easier to assert our opinions in sound bite form with respect to challenging issues when they are stereotypical or beside the point.  I can cite several examples of nasty comments I’ve seen upon reading a news article or blog post that have nothing to do with the issue at hand, and serve only to attack either the writer or one of the main people in the story for superficial, usually physical, attributes or knee-jerk reactions to one minor point of the story.

We are all so conditioned to have an opinion and share it that we rarely stop to consider nuances and details of a story that may have eluded us. We are conditioned to talk instead of listen, and make up our minds but not change them.  Compassion requires a willingness to walk in someone else’s shoes, or at least acknowledge that their shoes are different from yours in a fundamental way. Compassion requires curiosity about the circumstances of another person’s life and it implores us to suspend (or altogether eliminate) judgment. In order to be compassionate, we have to take the time to build a bridge from the parts of us that are most human to the parts of others that are most human and that takes courage.

I struggle most with compassion when I am trying the hardest to keep fear at bay. When I see a parent grieving for their child, my mind races to find all of the reasons why that could never happen to me and often, that manifests itself as judgment. If that mom/dad hadn’t made the choice to ______________, this wouldn’t have happened. The more I convince myself that someone else is Wrong and my decisions are Right, the easier it is to feel safe, to believe that whatever horrible thing this person is suffering won’t visit itself on me and my loved ones.  Finding my way to compassion means that I have to step off of that righteous path and into the soft muck on the side of the trail, facing my fears and acknowledging that I am just as human as anyone else and I can’t know the details of someone else’s story. It requires me to open up and let fear and sadness move through me, to take up the mantle of shared humanity and responsibility and bear the weight of another person’s struggle along with them. It asks me to sit firmly in the knowledge that we are not ‘other,’ we are not separate, we all deserve love and acceptance and when we give it freely to one another we are stronger and happier for it.

It takes time and energy to be compassionate, much more time than is required to dash off a pithy, snarky remark about someone’s weight or tattoos or sexual proclivities. We have to be willing to consider, to listen, to really pay attention, and many of us don’t want to do that. We also have to be willing to forego the opportunity to see our own opinions in print or hear our own voices. One draw of the internet is that it allows us to all have our say. Our words can reach audiences we could never have dreamed of before and we don’t have to write an entire op-ed or letter to the editor of our hometown newspaper. But if “our say” is a twitter-length rant on how inferior someone else is or how they deserved whatever they got, it showcases our inability to understand the deeper connections and the vital points of any story.  Last week in our region an elementary teacher was convicted of having a sexual relationship with one of her students. The photograph of the teacher that ran on the news outlet’s Facebook page was of a mixed-race woman with facial hair. I cringed as I saw it, knowing what most of the comments would be like. Sure enough, there were hundreds of people questioning her gender, saying that of course she was a “child molester” given her physical appearance, and suggesting hateful things ought to happen to her, not because of her crime, but “because she needs to shave.” There were a few token comments from people outraged that the conversation was about her appearance instead of her crime, and a couple explaining the symptoms of Polycystic Ovary Syndrome which causes some women to grow facial hair, but the vast majority were hateful, even violent comments based solely on the photograph the media ran.

I asked Lola what compassion means to her and if she thought it was something that can be taught. She wasn’t very articulate about her definition of it, but she did say that she doesn’t think you can teach compassion. She said, “I think it’s individual for everyone. They need to come to it on their own and they can’t do it all the time. But you can put people in situations where they might think about it more – like volunteering at a homeless shelter or something – and then they might come to it faster on their own.”

I hope she’s right, or maybe I don’t. I’d like to think that compassion is something we can teach, but even if we can only plant the seeds and hope it spreads, that’s at least something I’m willing to put a lot of time and effort into, at least in my own household.

Love Conquers All

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I don’t know how the Dalai Lama does it. Except maybe he was never the parent of a teenager. Because when the explosion happens, like a fiery plume from the Deepwater Horizon, up from the depths, burning through water to spray into the sky and rain down, it’s hard to respond with love instead of panic. As the person under fire, I’d like to curl into a ball, tuck my head and limbs underneath me, and slink off to safety. As the parent, I know the thing to do is stay calm, dig deep into the recesses of my brain for parenting strategy, and endure the onslaught as I try to slow it down.

At the end of the talk someone from the audience asked the Dalai Lama, “Why didn’t you fight back against the Chinese?” The Dalai Lama looked down, swung his feet just a bit, then looked back up at us and said with a gentle smile, “Well, war is obsolete, you know ” Then, after a few moments, his face grave, he said, “Of course the mind can rationalize fighting back…but the heart, the heart would never understand. Then you would be divided in yourself, the heart and the mind, and the war would be inside you.”

My war is inside. Not only because I want to fight back, to dispute each thrust (even those that come out of nowhere – from the left and the right when my focus is straight ahead) with an equally adept parry, but because I am her mother. Because while my own wounds are stinging, I hurt for her, for the wound that is the source of all of this, the one thing she won’t let me see.  The one thing I don’t have an answer to because she keeps it so well hidden.  And because I know fighting back won’t change a thing. My head wants to delve in and examine, understand why she is so upset. My heart knows that the only way to fight fire is with water, the only way to fight hatred and fear is with love.

As the insults and hurtful words rain down, I struggle to stay in my heart. I wish that the sheer volume of my love was enough to spill over and fill her up. I want my boundless affection to swallow her anger and fear, consume it and move on like The Blob, spreading love like so much blue slime, neutralizing the pain. I want her to find the part of her that simply can’t accept my love and touch it, probe it, examine it. I want her to push into it even as it hurts and discover that it holds no sway anymore. I want her to discard it like the decoy it is and turn to me with open arms.

As the fireballs fly, it is increasingly difficult to stay open and radiate love. Every instinct I have pushes me to close down, pull in and fling well-aimed water balloons, or at least put up a shield. Eventually fatigue creeps up and I remember to listen to my heart. No matter how much it hurts, the only way out is love. I’m trusting the Dalai Lama and Martin Luther King, Jr. I’m going on blind faith, here, that if I just refuse to fight back and repeat myself, eventually the message will get through. I love you. I love you. I love you. No matter what.

Versus

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Americans love a dichotomy. Black and white, right and wrong, good and evil. Reducing any situation to its most basic elements is a specialty of ours, forcing a decision about which “side” you’re on using carefully crafted sound-bites, facts and figures and charts chosen strategically to illustrate the stark differences between those two sides. Make a choice. Are you in or out?

When I was in high school and first discovered dichotomous keys, I couldn’t have been happier. Of course, growing up with sports-loving boys and men in my house, I already knew about playoff brackets – those visual aids used to whittle the pool of teams down to just two, eliminating half of them every time until you got to the final championship game. I found them stark and calming, clear and concise.  But I was interested in life sciences in school, so learning that I could key out any plant or animal using a very similar method gave me chills. (Yeah, I know – total geekdom.)

I went around gleefully separating plants in my neighborhood by simple or compound leaves, evergreen or deciduous, flowering or non-flowering. Occasionally I came across a question I couldn’t discern the answer to, either because I didn’t quite understand the distinction or because the plant’s characteristics lay in somewhat of a grey area.  In such cases, I tended to blame my own ignorance, assuming that there was a definite category in which everything belonged that simply eluded me. I forgot one simple thing: humans created the dichotomous key to make our own lives easier and more understandable. The key was not a Real Thing to which the laws of nature adhered. It was a false construction that was somewhat helpful but not absolute. No matter how hard I tried to force a particular organism to fit into my perfect notion of what it was, there would likely still be outliers and things I couldn’t account for.

I have found it helpful to remember that fact in my daily life.  Here are just a few of the false dichotomies I have encountered in my Facebook feed in the last 48 hours:

  • Is Richard Sherman (cornerback for the Superbowl-bound Seattle Seahawks) a cocky a**hole or not, as evidenced by his comments immediately following the end of last Sunday’s football game?
  • Does refusing to vaccinate your child put everyone else on the planet at risk for contracting sometimes fatal diseases such as measles and mumps?
  • Is breastfeeding better than formula feeding?
  • Is marijuana more harmful than alcohol?
  • Are employees unions ruining our economy?
Some of these questions come from friends, others from pages promoting specific products or ideas or blogs, but they are all the same in that they begin with a statement and end with a question. Most often the question is formulated to stimulate conversation (ie. “What do you think?” or “Thoughts?”). The problem, in my estimation, is that instead of encouraging a wide range of discussion, they generally set up the notion that there are only two possible answers.  That you ought to choose a side and defend it. In my experience, this prevents an actual exchange of ideas from occurring. Individuals spend their energy attempting to convince others that their position is the correct one, generally by attacking the folks who think otherwise. In the end, very little new insights are gained and nobody really leaves feeling good.
At this point, you may be thinking, Duh, so what? Herein lies the rub. If we convince ourselves that there are only two sides to every important story (the mass media is either perpetuating misogyny or it isn’t), and everyone who cares falls into one of those two camps, we are robbing ourselves of the chance to make any forward progress.  There may, from time to time, be a convert or two that heads to the other side after an important life experience or an impassioned conversation, but for the most part, we are inclined to say our piece and throw up our hands. Hate the way your state’s governor is running things? Oh well, just wait until the next election and cast your ballot and hope things go your way. 
In cases like Richard Sherman’s, choosing one side over the other may not matter much to anyone but him, but if we think about how important advances have been made in our lives, it isn’t because a majority chose one side over the other. It is because someone, or a group of people, chose to think outside that false dichotomy, brainstorm new ways of doing things and seeing the world, and listen to individuals who may have seemed crazy at first. Prior to the invention of the birth control pill, it was widely assumed that if you had sex, you were running the risk of getting pregnant. Sex = risk, no sex = no pregnancy. But at some point, at least one person thought,  Wait, abstinence doesn’t HAVE to be the only way to keep from getting pregnant. What if…?

What if, indeed. What if, instead of vilifying the makers of vaccines or those who choose not to have their children vaccinated, we toss that discussion out altogether? What if we recognize the intent (humanitarian, not capitalistic) of ensuring that our children don’t die of diseases like rubella and talk about whether there are safer methods than the vaccines we are currently using?  
I often talk about how my goal is to change the conversation about certain polarizing issues, but I’m coming to realize that all of this back and forth most of us are doing in Facebook and online, taking polls, commenting on incendiary essays and blogs, adding our two cents, is not conversation at all. It is empty posturing.  And while it is likely harmless much of the time (I don’t really mind if you think Robin Thicke isn’t a misogynist pig – it won’t convince me to buy his music or let my kids listen to it in my car), it sets up a pattern that is helping us to forget what actual discourse is. So maybe, instead of changing the conversation, I’m hoping to catalyze a conversation. A respectful, honest discussion of some incredibly complicated issues about which we all tend to have knee-jerk reactions and try to boil things down to two sides – ours and the other guys.

Why Media Literacy is So Important For Our Kids

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I am writing this as a parent who is incredibly grateful that the school my girls attend teaches media literacy aggressively and early. Beginning in the 5th grade, the teachers present the students with examples of how we are barraged every day with messages that may or may not represent us, but whose sole aim is to sell us something, even if couched in the guise of “entertainment.”

And so I was not terribly surprised to see the article in this morning’s New York Times regarding the MTV reality series “16 and Pregnant.” (Disclaimer: I have never watched, nor do I anticipate ever watching this show. I cannot speak to the relative merits or pitfalls of it, and I’m more interested in the larger theme of media influence, in any case.) The Nielsen company, responsible for television ratings among other things, released a report suggesting that this show and others like it may have “prevented 20,000 births to teenage mothers in 2010.” Don’t ask me how they did the study. I didn’t delve too deeply in to it, but I suspect some other folks will, given the voices that have been raised in opposition to shows like this since their beginning. The people in that camp believe that these shows glamorize teen motherhood by featuring the teens on television, thus rendering them celebrities, and may convince young girls to go out and get pregnant before they are ready to.  Again, I don’t have a dog in this fight, at least not with regards to this particular blog post.  What strikes me is that what both sides have in common is the assertion that television shows, among other media sources, have a strong impact on their audience, so much so that they can influence major life decisions.  With that, I will agree.

Last week on the way home from school, Eve reported that the 8th graders had begun a new unit in their health class involving body image.

“We’ve had two classes on it so far and, man, there’s no way we’re ever gonna get through even fifteen minutes without someone bursting into tears. I mean, even though we know that pictures are Photoshopped and nobody looks like a Barbie doll, some of the girls in my class have such low self-esteem because they think their bodies are all wrong that they can’t stop sobbing.”

I confess to being surprised.  This is a school that has encouraged families to watch the critically acclaimed Miss Representation with their children, a school that has the 7th grade students create their own posters using images from magazines to demonstrate their understanding of media messages and how harmful they can be, a school that embraces and holds up diversity as a source of power. And yet, there are girls who are still so divided in their loyalties to themselves versus someone else’s idea of what they ought to look like that they can’t make it through a class on body image without feeling awful.

Let us not underestimate the power of both the media and the perpetuation of those messages among our youth. Let us continue to talk to our children about what is truly important and worthy. Let us help them to think critically about what they see and hear and decipher which messages are there to lift them up and which ones are there to tear them down and open their wallets.  As Stephen Colbert once said:

“But if girls feel good about themselves, how can we sell them things they don’t need?”

Texas Outdoes Itself

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I wonder if the government of the state of Texas is prepared to pay a whole hell of a lot of money in a civil suit. I suspect so, given their seemingly intractable belief that women do not own their own bodies when it comes to reproduction, but then I can’t even begin to understand what they’re thinking now. We might as well be talking to aliens from Mars.

By now, I’m sure you’ve heard about Marlise Munoz, the woman who is on life support against her own wishes and the wishes of her family, but just in case you haven’t, I’ll fill you in.  In late November of 2013, Marlise collapsed at home and her husband, a paramedic, rushed her to the hospital to discover that her brain had been deprived of oxygen too long. She was officially brain dead.  Marlise, a paramedic herself, had previously expressed her wishes to her family to be taken off of life support should she ever find herself in this position and had even, some reports say, gone so far as to complete a living will to that effect.

Unfortunately for her and her family, Marlise happened to be 14 weeks pregnant at the time of her collapse and happened to live in a part of the world where the government gets to rule your body after you get pregnant.  She remains on life support until such time as the baby can safely be delivered. She remains on life support against her wishes and the wishes of her family. 


There is so much wrong with this case that I am almost uncertain where to begin. Almost. 


First of all, her family is presumably being held responsible for the incredibly expensive cost of keeping her alive. Even though the state is forcing the issue, I suspect they aren’t offering to foot the bill for the machines that are doing her breathing for her and nourishing her brain-dead body to keep the fetus alive and healthy.


Second, there is no guarantee, or even much evidence, that suggests that this baby will be born at term or healthy. Has there been any consideration of what happens if the baby is born with significant deficits in development due to his or her mother’s condition throughout the pregnancy? And if the father, who is currently raising another child now on the salary of one paramedic by himself, is forced to be a single parent to a child with special needs who requires additional care beyond what he is able to provide, is the state of Texas going to pay for that? Not only has this man lost his life partner and the mother of his other child, he is being forced into debt and relieved of making some of the most important life decisions on his own by the state of Texas – decisions that will affect him and his children for the rest of their lives.  


This situation is certainly a tragic one and the child with whom Marlise is pregnant was, by all accounts, wanted. Had her husband tried to go against the wishes expressed in her living will in order to save the fetus, there would certainly be a different ethical question at hand given that the child is his as well. But in this case, he is actively trying to comply with his wife’s wishes and the government has intervened in an area they have no business messing around with. If they continue to push the issue, I see no reason why they ought not to be held financially responsible for any hardship they have created by doing so.