I have noticed a trend toward the mediocre. This is not new, but lately it is really starting to annoy me. Maybe because it seems that the bar has been lowered, and what I consider to be sub-standard, not even passable, is viewed by the world at large as mediocre.
I consider myself to be a mediocre Home Health Physical Therapist. I know what it is like to be REALLY good at something. I understand the passion and drive for continual improvement, the attitude that if I don't have an answer, I will find it - because I want to know everything I can about a subject. I understand the desire to be the BEST, or at least the BEST I CAN BE. I don't have that with home health. Frankly - I show up at my patient's house, assess where they are at that given moment, what we need to do to steer them toward one or more of the goals we laid out in the eval, work with them: educating, pushing, cheering them towards that goal, document the day's work, and walk out. The skills I use are the ones I learned in PT school. Not the hours of continuing ed and research I have worked at in the past 17 years. When I take continuing ed now, it is how to document, or how to keep up with Medicare guidelines, not anything to do with improving my skills as a therapist. Sadly - this is interpreted by patients, employers and peers as "good" physical therapy. And it is not "bad," I am way too ethical to spend my time and Medicare money not providing reasonable and necessary care. I just know, for me, this is as lazy as I get. My job requires a strong back and a license. Any physical therapist can do what I do, but apparently many do not. It appears that if you are friendly, the patients will like you, if you get them to move at all, they will improve, or at least not decline, and patients (and families) do not have a point of reference for interpreting whether the care they get is quality or not.
It is not just PT, or medicine, for that matter. Everywhere I look, I see people going through the motions of their day, without really putting any thought into what they are doing, or if it is producing the desired effect - sometimes I wonder if people remember what their goals are with each activity. But as patients, or consumers in any industry, we remember the goals. We have a vested interest in the outcomes, much more than the professionals providing the service. So how to make sure that the care we receive is quality? That the goals being addressed are specific to our needs? That the care is really focused on the goal?
ASK QUESTIONS !
The provider may get a little annoyed - he/she will probably feel like they are being personally questioned, which they are. But if they thinking about the process, and answer will be available, and if they are not thinking about the process, you may jump start a dormant part of their brain that will improve the quality of service. As a caretaker, hang out during the session, observe (don't interfere) and prepare specific questions and observations for discussing with the provider after each session. Is the therapist doing the same exercises over and over each session? Are they the same exercises your mom does as a home program? If you can do them with her, or if she can do them on her own - do we need to use valuable treatment time doing them again?
This principal of observation and discussion can be applied in almost any scenario, PT is just the one I know.
So there is my rant - demand Mediocrity - it will be such an improvement over the norm.
Friday, July 8, 2011
Sunday, July 3, 2011
Way Back
I refuse to start each blog entry with an apology about not writing often. Except that I am sort of apologizing. It has been so long that BlogSpot changed the format to the point that I cannot figure out how to make the font bigger. So I am writing words that I can barely see. And NOT whining about getting old. NOT.
Currently, summer has invaded the household. I was so anticipating this. Visions of lazy summer days with the fam. Going to work without the usual mad craziness of getting the girl out the door to school, yelling about chores and remembering lunches and gym stuff. Summer is historically slow at work, so I thought I could swing by the house and take her to practice, pick her back up, hang out supervising the teenish activities. Relax. Maybe have some FUN?
Instead, I am actively working with patients from 5 of my 7 jobs, because everyone is on vacation. Trying to muscle through the Lymphedema course work, getting the girl and I through 4 chapters of the dive manual before we go on vacation, as we have had to bump our first class up a month. Dealing with the fact that my mainstay job has let me know (gently) that if my handwriting does not become more legible, they will no longer be able to use me. So now I am applying to home health companies that use electronic documentation, because I can only write legibly if I keep my caseload down to 3 patients a day.
I did start working out, on a nearly daily basis. That is a good thing. And, I am making progress toward my New Year's Resolution, which is simply "to drink more wine."
The girl leaves for Oregon next week, and I follow her the week after. She has a 5 day gym camp at OSU (go Beavs!). I may actually get to spend a little relaxy time - out doors. YAY! The Hubby is off to his guitar camp at the end of July. One of the classes he is taking is on song-writing, and he has been working on it a little on his own. I'm liking some of his stuff. He sings funny folk songs, and now he is starting to write them - a new chapter in his creative life - very cool.
Currently, summer has invaded the household. I was so anticipating this. Visions of lazy summer days with the fam. Going to work without the usual mad craziness of getting the girl out the door to school, yelling about chores and remembering lunches and gym stuff. Summer is historically slow at work, so I thought I could swing by the house and take her to practice, pick her back up, hang out supervising the teenish activities. Relax. Maybe have some FUN?
Instead, I am actively working with patients from 5 of my 7 jobs, because everyone is on vacation. Trying to muscle through the Lymphedema course work, getting the girl and I through 4 chapters of the dive manual before we go on vacation, as we have had to bump our first class up a month. Dealing with the fact that my mainstay job has let me know (gently) that if my handwriting does not become more legible, they will no longer be able to use me. So now I am applying to home health companies that use electronic documentation, because I can only write legibly if I keep my caseload down to 3 patients a day.
I did start working out, on a nearly daily basis. That is a good thing. And, I am making progress toward my New Year's Resolution, which is simply "to drink more wine."
The girl leaves for Oregon next week, and I follow her the week after. She has a 5 day gym camp at OSU (go Beavs!). I may actually get to spend a little relaxy time - out doors. YAY! The Hubby is off to his guitar camp at the end of July. One of the classes he is taking is on song-writing, and he has been working on it a little on his own. I'm liking some of his stuff. He sings funny folk songs, and now he is starting to write them - a new chapter in his creative life - very cool.
Saturday, March 12, 2011
Balancing Act
I have not written in a long time. The Wild Child is busy, full time gym girl mode, full time student mode, part time photo girl mode. Lots going on.
Then there is the ever present, slight feeling of impending doom as weird chaos infests the country, dismantling the framework of the democracy I know and love. The economy is in the crapper. Badly needed social programs are disappearing, basic rights of assembly and collective bargaining are being villanized and disbanded. Teachers, police and firefighters - the heroes of our society, are laid off, stripped of pensions, slapped down. Corporations are posting record breaking profits while unemployment continues to grow and tax breaks are aimed at the wealthy. Environmental politics are a disaster, The world is amok, and we are no longer the sterling bastion of democratic morality and righteousness our world once new.
I have a solution. At least to the economic part of the equation. It is one of those, "greater good," Utilitarian concepts. I realize that no one is going to go for this, regardless of your political affiliation.
This came out of conversation with my infinitely wise teen-age daughter. She suggested that we should adopt the Chinese philosophy of "1 child." A good idea, which I quickly pointed out would be against the concepts of freedom of action our great country was founded on. You can't go around dictating how many kids a family wants, even if that family can't afford to pay for the upkeep. Hell - the way it is heading, we can't use government funds to educate people about pregnancy prevention (or !horrors! termination), even if the burden of that child will be placed on the government. Population control, as a means for environmental responsibility, fiscal responsibility, social responsibility, well, that's a little like asking people to take personal responsibility for their actions.
My solution? a clause in taxation that would add huge amounts of money immediately into the federal budget, level the playing field for all citizens (OK, not level, but take some of the responsibility of an individual's choice off the back of the government).
Eliminate the deductions and tax credits for kids.
OMG - she did NOT just say that. To be fair, I milk my little tax break for everything I can, this was a huge negotiating point during the support settlement with her dad. She has bailed me out of deep financial holes more than once. Families depend on those deductions and credits. But why? Why do we give a deduction for something that increases cost to the government? More people means a larger need for police, fire fighters, teachers. The bigger the population, the larger the strain on all programs. Families may consider not having a kid, if each child was viewed as an expense; not a deduction. The next logical step would be to actually tax families more for having kids, but I'm already outside the realm of realistic.
I am all for a flat tax, fair to everybody, no deductions. How much did you make? give x% to the government. Don't really care how much you spent on interest for your 3 million dollar home, or how big of a "loss" your business took. When I had a business, I paid myself a salary, and taxes were taken out regularly, just like all of my employees. My business only once showed an actual profit. I was able, routinely, to deduct enough of the business expenses to get more than 50% of the taxes I paid back. Of course, I was delighted, but really? It makes me wonder how much people with BIG businesses are NOT paying, and how much of those costs are getting thrown back to the working Joe. If the money was just taken out of your paycheck, and that was the end of it, no squirreling around at the end trying to get some back, or "oops - I shouldn't have claimed all of those kids, now I have to pay more," just a straight - if it comes home, then the government gets some, and everyone pays the same percent, wouldn't that be nice?
I would be OK with maintaining the tiered tax brackets, the "make more, pay more" concept. (How Socialist of me) But frankly, minimum wage jobs cannot keep a family afloat, and I really wouldn't mind paying a couple of percentage points more in taxes than people hovering at or below the poverty line.
If they let me run the government, everyone would hate me, even the ones on my own team, because nothing that will work is going to make anyone happy. Compromise is hard and "win/win" is sometimes not feasible. Maybe we could be happy with "lose less."
Then there is the ever present, slight feeling of impending doom as weird chaos infests the country, dismantling the framework of the democracy I know and love. The economy is in the crapper. Badly needed social programs are disappearing, basic rights of assembly and collective bargaining are being villanized and disbanded. Teachers, police and firefighters - the heroes of our society, are laid off, stripped of pensions, slapped down. Corporations are posting record breaking profits while unemployment continues to grow and tax breaks are aimed at the wealthy. Environmental politics are a disaster, The world is amok, and we are no longer the sterling bastion of democratic morality and righteousness our world once new.
I have a solution. At least to the economic part of the equation. It is one of those, "greater good," Utilitarian concepts. I realize that no one is going to go for this, regardless of your political affiliation.
This came out of conversation with my infinitely wise teen-age daughter. She suggested that we should adopt the Chinese philosophy of "1 child." A good idea, which I quickly pointed out would be against the concepts of freedom of action our great country was founded on. You can't go around dictating how many kids a family wants, even if that family can't afford to pay for the upkeep. Hell - the way it is heading, we can't use government funds to educate people about pregnancy prevention (or !horrors! termination), even if the burden of that child will be placed on the government. Population control, as a means for environmental responsibility, fiscal responsibility, social responsibility, well, that's a little like asking people to take personal responsibility for their actions.
My solution? a clause in taxation that would add huge amounts of money immediately into the federal budget, level the playing field for all citizens (OK, not level, but take some of the responsibility of an individual's choice off the back of the government).
Eliminate the deductions and tax credits for kids.
OMG - she did NOT just say that. To be fair, I milk my little tax break for everything I can, this was a huge negotiating point during the support settlement with her dad. She has bailed me out of deep financial holes more than once. Families depend on those deductions and credits. But why? Why do we give a deduction for something that increases cost to the government? More people means a larger need for police, fire fighters, teachers. The bigger the population, the larger the strain on all programs. Families may consider not having a kid, if each child was viewed as an expense; not a deduction. The next logical step would be to actually tax families more for having kids, but I'm already outside the realm of realistic.
I am all for a flat tax, fair to everybody, no deductions. How much did you make? give x% to the government. Don't really care how much you spent on interest for your 3 million dollar home, or how big of a "loss" your business took. When I had a business, I paid myself a salary, and taxes were taken out regularly, just like all of my employees. My business only once showed an actual profit. I was able, routinely, to deduct enough of the business expenses to get more than 50% of the taxes I paid back. Of course, I was delighted, but really? It makes me wonder how much people with BIG businesses are NOT paying, and how much of those costs are getting thrown back to the working Joe. If the money was just taken out of your paycheck, and that was the end of it, no squirreling around at the end trying to get some back, or "oops - I shouldn't have claimed all of those kids, now I have to pay more," just a straight - if it comes home, then the government gets some, and everyone pays the same percent, wouldn't that be nice?
I would be OK with maintaining the tiered tax brackets, the "make more, pay more" concept. (How Socialist of me) But frankly, minimum wage jobs cannot keep a family afloat, and I really wouldn't mind paying a couple of percentage points more in taxes than people hovering at or below the poverty line.
If they let me run the government, everyone would hate me, even the ones on my own team, because nothing that will work is going to make anyone happy. Compromise is hard and "win/win" is sometimes not feasible. Maybe we could be happy with "lose less."
Sunday, December 26, 2010
Time Flies
Time flies whether or not you are having fun. It has been 2 months since my last post. So much has happened, none of it particularly noteworthy.
Work has been up and down. Health care in Florida is fairly seasonal. Blame it on the snowbirds, or everyone having selective (not elective) surgeries - if you need a new hip, you NEED a new hip - but you can put it off for a long time if you can stand the pain. Whatever the phenomenon is, we are BUSY in the winter. Last year, one of the companies I worked for had 4 full time Physical Therapists, and 2 very busy per diem employees with a full time load, and we were still giving patients to contract companies, because the staff had all the overtime they could handle. Now, this same company has 2 full time and 2 per diem PT's, and none of us has a full case load. This is across the board - I have 5 jobs - only one of them is giving me patients, and I am not that busy. So what gives? In this crazy economy, health care is the one thing that is supposed to be stable, especially in the geriatric population. When I am slow, I usually run out and get a new job, because everyone will hire a per diem employee, even if they have no current need, especially this time of year - because they want to have coverage when the dam breaks.
At least I have time to spend with the family. In the last couple of months the Wild Child had a vendor's booth at the local Sunday Market of Seminole Heights. They moved the date because of weather, then it was freezing, and drizzly and damp all day, but she still did OK. Good enough to want to try again this month. (there are still calendars available)
Then it will be ON! Gymnastics season is about to slam into us. 2 meets per month, very few of them close to Tampa. Gym girl is now a solid level 7, she has almost all of her 8 skills, and they waffled on what she would compete, but I think she is more comfortable with perfecting her 8 skills while she competes 7 - so, go her. Back handsprings on the balance beam, and double back fly aways on the bar are unnerving for the momma - I'm happy with whatever she decides to do.
I have decided to take a certification course in the treatment of Lymphedema. It is 145 hours of independent study, then 8 straight days of classes in Orlando this October. After waiting for weeks to get my course materials in the mail, I was more than over-whelmed when they arrived. I huge text-book, like you you would expect for any college based science course, 2 Gigantic spiral bound manuals (really gigantic, not exaggerating), and 5 dvd's. This is just the supplemental portion of a mostly on-line course. Did I say overwhelmed? Plus, I am shocked to find out that I am old. My brain is losing all of those elastic/plastic qualities that I have depended on, that made didactic learning so incredibly easy for me when I was younger. My "study" habits have been pretty much read the material, maybe rewrite my notes, because I can't read my own writing, then never look at them again, 'cause I already got it. Not any more. I read it, write it, color it, watch the video, and it still all just looks like words on paper. Words that I understand when I read them individually, but when they are all strung together as part of a sentence, they lose all meaning.
I often make comments, especially after driving, or listening to the news that people are stupid. It has occurred to me that I, also, am in that category. ALL people are stupid. Maybe instead of bitching about it, I could make more allowances, because it is really nice when people react kindly when I do stupid things. Stupid is inevitable, Mean is a choice. My New Year's Resolution will be to choose "Mean" less often.
Work has been up and down. Health care in Florida is fairly seasonal. Blame it on the snowbirds, or everyone having selective (not elective) surgeries - if you need a new hip, you NEED a new hip - but you can put it off for a long time if you can stand the pain. Whatever the phenomenon is, we are BUSY in the winter. Last year, one of the companies I worked for had 4 full time Physical Therapists, and 2 very busy per diem employees with a full time load, and we were still giving patients to contract companies, because the staff had all the overtime they could handle. Now, this same company has 2 full time and 2 per diem PT's, and none of us has a full case load. This is across the board - I have 5 jobs - only one of them is giving me patients, and I am not that busy. So what gives? In this crazy economy, health care is the one thing that is supposed to be stable, especially in the geriatric population. When I am slow, I usually run out and get a new job, because everyone will hire a per diem employee, even if they have no current need, especially this time of year - because they want to have coverage when the dam breaks.
At least I have time to spend with the family. In the last couple of months the Wild Child had a vendor's booth at the local Sunday Market of Seminole Heights. They moved the date because of weather, then it was freezing, and drizzly and damp all day, but she still did OK. Good enough to want to try again this month. (there are still calendars available)
Then it will be ON! Gymnastics season is about to slam into us. 2 meets per month, very few of them close to Tampa. Gym girl is now a solid level 7, she has almost all of her 8 skills, and they waffled on what she would compete, but I think she is more comfortable with perfecting her 8 skills while she competes 7 - so, go her. Back handsprings on the balance beam, and double back fly aways on the bar are unnerving for the momma - I'm happy with whatever she decides to do.
I have decided to take a certification course in the treatment of Lymphedema. It is 145 hours of independent study, then 8 straight days of classes in Orlando this October. After waiting for weeks to get my course materials in the mail, I was more than over-whelmed when they arrived. I huge text-book, like you you would expect for any college based science course, 2 Gigantic spiral bound manuals (really gigantic, not exaggerating), and 5 dvd's. This is just the supplemental portion of a mostly on-line course. Did I say overwhelmed? Plus, I am shocked to find out that I am old. My brain is losing all of those elastic/plastic qualities that I have depended on, that made didactic learning so incredibly easy for me when I was younger. My "study" habits have been pretty much read the material, maybe rewrite my notes, because I can't read my own writing, then never look at them again, 'cause I already got it. Not any more. I read it, write it, color it, watch the video, and it still all just looks like words on paper. Words that I understand when I read them individually, but when they are all strung together as part of a sentence, they lose all meaning.
I often make comments, especially after driving, or listening to the news that people are stupid. It has occurred to me that I, also, am in that category. ALL people are stupid. Maybe instead of bitching about it, I could make more allowances, because it is really nice when people react kindly when I do stupid things. Stupid is inevitable, Mean is a choice. My New Year's Resolution will be to choose "Mean" less often.
Friday, October 8, 2010
Smooth Sailing
I have been happily bustling around in "mom mode" lately. The weather is gorgeous, and there is enough chill in the air that the house is starting to smell like a spice rack. Pumpkin. Pumpkin. Pumpkin. Pumpkin scones. Pumpkin cream cheese muffins. Pumpkin pancakes (with caramel syrup). I LOVE October. I've sort of cleaned up the back yard, so it does not look as much like the aftermath of last years forty freezes - ok, there were only five, but they were hard freezes and all right in a row. I kept waiting for the hisbiscus to come back, but it never happened, and I have finally faced up to some of the losses that I was hoping weren't real.
The upside to all of that is this weekend's annual fall plant sale at USF. Yay. I will actually have fresh herbs to cook with again. Lemon Balm tea cookies in the very near future. We even had a fire and roasted s'mores last weekend.
The girl child is in the middle of a very intense school project. I will not rant about puppy mills yet. When her presentation is done, we will post on YouTube. We have spent the last week inundated with some of the saddest images and stories I have ever seen. She is very dedicated to this project, and what little I've seen of it is VERY good. We spent Saturday at the saddest place on earth (the local pound), getting lots of footage. Then I went with the girls while they interviewed a woman that has been involved in several puppy mill rescues. Lots to learn. Kind of shocking how cruel and insensitive people can be.
Work is FINALLY starting to speed up. I was almost considering a full time placement again (ugh). Now I'm back to happily working my 5 jobs. Only two of them are actually giving me patients right now, but I have options, and enough patients to keep me mostly out of trouble.
I'm hoping to pick up the 2011 Wild Child Pics Calendars today. If so, the pre-orders will be out in the mail by Monday. Go Photo Girl!
The upside to all of that is this weekend's annual fall plant sale at USF. Yay. I will actually have fresh herbs to cook with again. Lemon Balm tea cookies in the very near future. We even had a fire and roasted s'mores last weekend.
The girl child is in the middle of a very intense school project. I will not rant about puppy mills yet. When her presentation is done, we will post on YouTube. We have spent the last week inundated with some of the saddest images and stories I have ever seen. She is very dedicated to this project, and what little I've seen of it is VERY good. We spent Saturday at the saddest place on earth (the local pound), getting lots of footage. Then I went with the girls while they interviewed a woman that has been involved in several puppy mill rescues. Lots to learn. Kind of shocking how cruel and insensitive people can be.
Work is FINALLY starting to speed up. I was almost considering a full time placement again (ugh). Now I'm back to happily working my 5 jobs. Only two of them are actually giving me patients right now, but I have options, and enough patients to keep me mostly out of trouble.
I'm hoping to pick up the 2011 Wild Child Pics Calendars today. If so, the pre-orders will be out in the mail by Monday. Go Photo Girl!
Saturday, September 18, 2010
Poverty and Posturing
This going to be convoluted, as my thoughts on the subject are still not set. Recently an article was floating around face book from a young doctor on a rant about the cultural problems with health care/poverty in the United States. I googled him, to find a more stable link to refer to and the first up was Snopes.com, proving that yes, indeed, this letter is attributed appropriately to Dr. Starner Jones. Not that it matters in anyway who wrote this. From the comments I saw - the FB world is largely in agreement, and the lone dissenting voice was berated for his bleeding heart.
I agree with Dr. Jones, that it is a cultural problem. He points out one example of a young woman in expensive clothes with an expensive phone, with expensive vices, that is on Medicaid, and how our culture encourages these people to live off the system, and not take care of themselves. In FB many healthcare providers jumped in on the rant. Many examples. All of them about how these people have no respect for our hard earned monies. One dentist talked about a medicaid patient that put out $2,000 cash for a gold grill for his teeth. Deplorable. Despicable.
Let's tackle the expensive vice problem first. Alcohol, tobacco, and drug use are not only the vices of the very poor. These are horribly expensive, very damaging habits that cross all lines of socioeconomic status. I did not see a single rant from healthcare providers that have to care for older COPD patients (chronic obstructive pulmonary disease, a basket term for all the things that slowly kill the lungs of smokers) on Medicare. This is expensive, largely self-inflicted, and covered by - oh no - don't say it - a Government Sponsored Insurance program - one that your grandma is probably on, one that is paying for the cost of my Mother's lung cancer and COPD care, one that my tax dollars pay for. For those that don't have Medicare yet, but have insurance, these bad-vice related problems are paid for from ever-increasing cost of insurance premiums. It is illegal for the insurance company to charge you more because you are a smoker and drink like a fish, so to cover the cost of your health care, they raise my premiums, and everyone else's. Darn smokers - I'm paying for the poor through Medicaid, the old through Medicare, and everyone else by out of control, crazy high insurance premiums. I DON'T SMOKE.
And Fast Food. How can these people eat that artery clogging, blood pressure elevating drek day after day? Because it is cheap. And convenient. And advertised to be nutritious. And buying, cooking and cleaning fresh, healthy food is expensive. It requires time, and education. A lot of my middle class, insurance packing friends, deplore the "fast food" culture while fixing sodium heavy, fat filled, chemically enhanced pre-packaged, expensive "meals" for their families. Of course, they don't walk 3 blocks to the bus stop, take 2 buses and 45 minutes to get to the grocery store that is barely 2 miles away, haul all the groceries you can carry back, then stuff them into the little tiny refrigerator/freezer, then prepare them. It is way easier to hit the McDonald's on the corner. And there is one. On every corner.
Yes, but what about those spendthrift "poor," using my money to fix they're sniffly noses while talking away on their expensive cell phones. Don't I get to rant about that?
I think most of the people that were commenting on the article in FB were gainfully employed, and most likely have employee sponsored healthcare. I'm assuming. Never a good premise for an argument - but as it is my blog, I get to create my antagonists in whatever image I choose. Even if you see the money coming out of your check, it is difficult to really understand the costs associated with insurance in this country. My husband and I pay for insurance. We found the best plan that we could afford, based on what was important to us. We are relatively healthy. So we really need emergency care, and follow up care for any such emergency. We have a $7,500 deductible, which means for non-emergencies, we pay everything, every year, up to $7,500/per person. To put it bluntly, we pay over $500/month for a family of four for the security of knowing that if I slip off a ladder and hurt myself, we are not going to have $30,000 in medical bills to deal with while I am out of work. We still pay for all doctor visits and testing out of pocket. We still only go to the doctor if death is imminent. Our last insurance plan had "well care," so we did not have to pay for healthy check-ups, but the premiums were almost $200/month more.
So lets take this into the world of those slacker "poor." The thing with insurance, is that you have to pay for it. Consistently. There are no allowances for people that are late on payments, you don't pay, you aren't covered. People with unreliable incomes, even if they are working a little, are not going to be able to budget $500/month for a healthcare plan that is not in anyway helpful to them if they get a flu or sprain an ankle. I have been very poor. When you struggle for every little thing, trying to pay your bills, put food on the table, etc. those rare instances of "found money," you know, when money appears that is not in your budget - the extra check 2x year when you budget for 2 checks a month, winning $50 from a scratch off lottery ticket - that extra money is a little mini vacation. Yeah - you could put it away to pay for 1/2 of your kid's next doctor's visit - but how are you going to come up with the other half? or you could spend it on those cool shoes you've been wanting. What the heck - I deserve a little somethin' somethin' for working so hard feeding all these kids, wipin' these snotty noses, picking up after that drunkin' man. I'm gettin' me those shoes. or Whatever. The one thing we know is that the money is not consistent, and saving it for 3 months, to hope to get enough money to pay for one month of insurance, that won't even pay for a doctor's visit is not an option.
I still agree that this is a cultural problem, but it is bigger, more pervasive, and subtle than my usual rant against the entitlement culture that is being showcased here. The biggest problem that I see is largely the blame of the middle class. We are a society that lives beyond our means and outside of our budgets because we love and value status. We live in America, where everyone is equal. Our kids go to school and everyone is carrying Vera Bradley bags, cool cell phones, designer clothes. We can't afford to keep up with all of that, so we buy on credit cards, shift things around, figure it out, because it is IMPORTANT. Different families have different ways of working it out. Some people work themselves to burn out with multiple jobs, in this economy, that is very hard, finding one job is sometimes a struggle. Some go into deeper debt on credit cards, take advantage of the reduced interest rate and slow foreclosure rules from the banks, hoping things will get better before they lose the house. Some turn to older, more fiscally responsible family members. I actually know a family that made sure that all four of their kids had the iPhone when it first came out. Not something I would condone even if I could afford it. This family was consistently borrowing from the grandparents to pay mortgage. Of course, their dirty little secret didn't end up in a medical record to be ridiculed on face book.
So when the very poor take steps to look like everyone else - this is America, we are entitled to equality - we jump all over them because we have to foot the bill for their healthcare. If we weren't doing that, we wouldn't have to go so far into debt to look like people that are significantly better off than we are. This is a significant cultural issue. We live in a society that values "image" above basic health. Do not think for a minute that this is a cultural crime of the very poor. If as a society, we valued "people" over "status," we would have fewer Medicaid recipients hanging out in the ER wearing designer jeans, fewer healthcare workers that notice the brands they wear, and we may actually have fewer emergency room visits for things that could have been fixed if we put our money toward healthier living, instead of keeping up with the Montgomery's.
I agree with Dr. Jones, that it is a cultural problem. He points out one example of a young woman in expensive clothes with an expensive phone, with expensive vices, that is on Medicaid, and how our culture encourages these people to live off the system, and not take care of themselves. In FB many healthcare providers jumped in on the rant. Many examples. All of them about how these people have no respect for our hard earned monies. One dentist talked about a medicaid patient that put out $2,000 cash for a gold grill for his teeth. Deplorable. Despicable.
Let's tackle the expensive vice problem first. Alcohol, tobacco, and drug use are not only the vices of the very poor. These are horribly expensive, very damaging habits that cross all lines of socioeconomic status. I did not see a single rant from healthcare providers that have to care for older COPD patients (chronic obstructive pulmonary disease, a basket term for all the things that slowly kill the lungs of smokers) on Medicare. This is expensive, largely self-inflicted, and covered by - oh no - don't say it - a Government Sponsored Insurance program - one that your grandma is probably on, one that is paying for the cost of my Mother's lung cancer and COPD care, one that my tax dollars pay for. For those that don't have Medicare yet, but have insurance, these bad-vice related problems are paid for from ever-increasing cost of insurance premiums. It is illegal for the insurance company to charge you more because you are a smoker and drink like a fish, so to cover the cost of your health care, they raise my premiums, and everyone else's. Darn smokers - I'm paying for the poor through Medicaid, the old through Medicare, and everyone else by out of control, crazy high insurance premiums. I DON'T SMOKE.
And Fast Food. How can these people eat that artery clogging, blood pressure elevating drek day after day? Because it is cheap. And convenient. And advertised to be nutritious. And buying, cooking and cleaning fresh, healthy food is expensive. It requires time, and education. A lot of my middle class, insurance packing friends, deplore the "fast food" culture while fixing sodium heavy, fat filled, chemically enhanced pre-packaged, expensive "meals" for their families. Of course, they don't walk 3 blocks to the bus stop, take 2 buses and 45 minutes to get to the grocery store that is barely 2 miles away, haul all the groceries you can carry back, then stuff them into the little tiny refrigerator/freezer, then prepare them. It is way easier to hit the McDonald's on the corner. And there is one. On every corner.
Yes, but what about those spendthrift "poor," using my money to fix they're sniffly noses while talking away on their expensive cell phones. Don't I get to rant about that?
I think most of the people that were commenting on the article in FB were gainfully employed, and most likely have employee sponsored healthcare. I'm assuming. Never a good premise for an argument - but as it is my blog, I get to create my antagonists in whatever image I choose. Even if you see the money coming out of your check, it is difficult to really understand the costs associated with insurance in this country. My husband and I pay for insurance. We found the best plan that we could afford, based on what was important to us. We are relatively healthy. So we really need emergency care, and follow up care for any such emergency. We have a $7,500 deductible, which means for non-emergencies, we pay everything, every year, up to $7,500/per person. To put it bluntly, we pay over $500/month for a family of four for the security of knowing that if I slip off a ladder and hurt myself, we are not going to have $30,000 in medical bills to deal with while I am out of work. We still pay for all doctor visits and testing out of pocket. We still only go to the doctor if death is imminent. Our last insurance plan had "well care," so we did not have to pay for healthy check-ups, but the premiums were almost $200/month more.
So lets take this into the world of those slacker "poor." The thing with insurance, is that you have to pay for it. Consistently. There are no allowances for people that are late on payments, you don't pay, you aren't covered. People with unreliable incomes, even if they are working a little, are not going to be able to budget $500/month for a healthcare plan that is not in anyway helpful to them if they get a flu or sprain an ankle. I have been very poor. When you struggle for every little thing, trying to pay your bills, put food on the table, etc. those rare instances of "found money," you know, when money appears that is not in your budget - the extra check 2x year when you budget for 2 checks a month, winning $50 from a scratch off lottery ticket - that extra money is a little mini vacation. Yeah - you could put it away to pay for 1/2 of your kid's next doctor's visit - but how are you going to come up with the other half? or you could spend it on those cool shoes you've been wanting. What the heck - I deserve a little somethin' somethin' for working so hard feeding all these kids, wipin' these snotty noses, picking up after that drunkin' man. I'm gettin' me those shoes. or Whatever. The one thing we know is that the money is not consistent, and saving it for 3 months, to hope to get enough money to pay for one month of insurance, that won't even pay for a doctor's visit is not an option.
I still agree that this is a cultural problem, but it is bigger, more pervasive, and subtle than my usual rant against the entitlement culture that is being showcased here. The biggest problem that I see is largely the blame of the middle class. We are a society that lives beyond our means and outside of our budgets because we love and value status. We live in America, where everyone is equal. Our kids go to school and everyone is carrying Vera Bradley bags, cool cell phones, designer clothes. We can't afford to keep up with all of that, so we buy on credit cards, shift things around, figure it out, because it is IMPORTANT. Different families have different ways of working it out. Some people work themselves to burn out with multiple jobs, in this economy, that is very hard, finding one job is sometimes a struggle. Some go into deeper debt on credit cards, take advantage of the reduced interest rate and slow foreclosure rules from the banks, hoping things will get better before they lose the house. Some turn to older, more fiscally responsible family members. I actually know a family that made sure that all four of their kids had the iPhone when it first came out. Not something I would condone even if I could afford it. This family was consistently borrowing from the grandparents to pay mortgage. Of course, their dirty little secret didn't end up in a medical record to be ridiculed on face book.
So when the very poor take steps to look like everyone else - this is America, we are entitled to equality - we jump all over them because we have to foot the bill for their healthcare. If we weren't doing that, we wouldn't have to go so far into debt to look like people that are significantly better off than we are. This is a significant cultural issue. We live in a society that values "image" above basic health. Do not think for a minute that this is a cultural crime of the very poor. If as a society, we valued "people" over "status," we would have fewer Medicaid recipients hanging out in the ER wearing designer jeans, fewer healthcare workers that notice the brands they wear, and we may actually have fewer emergency room visits for things that could have been fixed if we put our money toward healthier living, instead of keeping up with the Montgomery's.
Saturday, August 28, 2010
Bearing Arms
As my daughter approaches her 13th birthday, I realize that there are some core family experiences that I have unintentionally denied my daughter. Things that were so common in my life, that I am horrified to think that she is nearly a teen-ager and she has not yet faced responsibilities that were common-place to me at a much younger age. She has cooked meals, but will not even touch raw meat - kind of goes without saying that she has not plucked a chicken, or milked a cow. What really rankles my family values, and puts her behind the curve of the kids of my childhood friends?
She has never shot a gun.
I had my hunter's safety permit at the age of 8, had already started shooting a little before that. I own the little bolt action, single shot .22 rifle that everyone in my family learned to shoot with. Dad learned at the age of 6. When we moved to the farm, we kept a loaded shotgun at every door of the house. My mom was determined that no predators would get her "babies." This is a weird dynamic, as "predators" included raccoons and owls and hawks. I can no longer conceive a place in my head wear shooting a hawk is OK, but we are talking about my childhood environs. By the age of 10, I was not allowed to go for long walks without a gun and a dog. Our chickens ran loose on 80 acres of land, sometimes Mom would gather them from their roosts at night, but more often, butchering day was also target practice. We knew which young roosters were on the block for the day, and we set out with our 22 rifles, the only rule was that it had to be a head shot.
It wasn't that my family was "fringe," everyone I knew hunted. I did not know that gun racks were not standard in pick-ups until I moved to Florida. Opening day of hunting season was a school holiday, no one, kids or teachers, were going to show up anyway. And during deer season, almost everyone brought guns to school so they did not have to run home before heading to the woods. I'm not much of a hunter; not that I am opposed. I honestly feel that a quick end to a wild life, with no waste of the animal's parts is better for the animal, and the human consumer, than the horrible way we industrialize meat in this country - but that is another rant. I am way too antsy, noisy to be good on a stand, and not a good enough shot to hunt while "pushing." But, in my world, hiking was a rare phenomenon, and hunting was a socially acceptable way to get out in nature.
Then I moved to the south. I went hunting once. Completely different - I had never used a shotgun for deer before. Out west we had long range rifles, lots of open country, and clear views of anything we were pointing at. In the south, we have thick woods, low visibility, and crazy rednecks shooting at noises. OK - I realize that all parts of the country have crazy drunk rednecks shooting at noises, but my dad ran a very tight camp. No body drank until the guns were put away, and no one pulled a trigger without a clear head shot, anything else was a waste of meat.
Now we get into the arms debate. Having spent most of my adult life in a "big city," I get a lot of the fear around guns. I also feel that much of that fear is media and politics driven. Our founding fathers did not put the 2nd amendment in as an after thought. I do not believe that a couple of centuries ago the New World was an Utopian society of no violence. In fact, I would hazard to guess that violence was more prevalent, and more personal. Oftentimes, the pro-arms camp talk about self-protection. What if my family is threatened by a home invasion? I must protect myself. This is an important argument. But the key reason we have the 2nd amendment is to stand as a populace militia against the dictatorial rule of a hostile government. Wow, pop that one around a few NRA conventions and they might lose the political support that they have.
But aren't guns dangerous? of course they are. But so are cars, and boats, and hammers and power tools, and the way I use scissors. So why the big debate? We have a moderately dangerous tool, with constitutional backing, and it is a constant freak session of rant on both sides. Why? It is the emotional element. The romanticizing of gun related tragedies. Accidental death, poetic suicide (The Highway Man comes to mind), heartless murder, mass killings. All of these things have happened with other tools, but none have the emotional impact of gun-related violence. In these incidences we blame the gun almost as much as the killer. It is never the poison's fault, or the bomb's, or the hammer's.
Very few people question the right of anyone to own a car. Can't drive one without a license. License indicates education, some level of competency, and in Florida, you have to have insurance. It is along these lines that make me fairly comfortable with most of the gun control laws. I've been in the woods with idiots, it would be nice to know there was training involved. I don't think we need more laws. I think we need more education. Teaching Gun Safety in schools would be my favorite option. I can't imagine that I would get any political backing, but seriously, if you want people to understand something, respect it, and treat it properly, registration and punishment are not nearly as effective as good old-fashioned training. I would love to see the media handle gun-related violence like all other forms. Yes, mention that a gun was used, but don't do a million back stories on gun violence, gun control debates, and unrelated tragedies, just report the facts.
What about the whole licensing for use idea? I did compare gun use with car use - and we all think licensing is great for cars. This gets sticky. We have a constitutional RIGHT to own guns - and walk around with them for that matter, but I'm really not condoning that. I think that licensing is an invasion on the essence of this amendment. We have the right to pursue domestic tranquility - but no one is seeking licensure for happiness. When something is a Right, it needs to be accessible to all, without yards of red tape and coughing up personal information. In my opinion, we are back to the education thing. More information, fewer mistakes. And oh - yeah - personal responsibility, we need lots of that. I have no problem with harsh penalties for crimes involving guns. We have a right to keep them, not threaten or kill innocent people with them.
I use to be against hand guns. Not politically, just personally. The only real use for a hand gun is shooting people (or hog hunting, but I did not know that then), and I was really uncomfortable with that. Then I spent my first weekend of school in Miami right after Andrew. I had my concealed weapons permit and first handgun (a Walther PPK .380, if your interested) by the end of the month. That gun was by my side, loaded and ready, everytime I drove anywhere alone at night in Miami. Once I was done with school, I let the permit lapse, and haven't even taken it apart and cleaned it in 13 years.
I still have no use for, and am a little freaked out by the assault weapons collection phenomenon. The people I know that have them are occasionally on a political fringe, but are completely careful about the safety, maintenance and use of their guns. If any of these people go on a spree, it will not be an accident; but, it will be significantly less messy than a car bomb. Remember that the political and constitutional reason for allowing these people to keep their guns are to prepare for an event that most of us cannot if imagine as reality. Of course, every time we get a political regime change, a different group of people imagine it vividly and loudly.
So what to do about the horrible mom dilemma? I am personally little rusty on the mechanics, and very particular about who I would allow to take my daughter out shooting, and frankly wouldn't even know where to take her. I friend of mine, a collector and expert marksman, has offered - its just a matter of getting her over to the other side of the state. And she is pretty excited about it - just to have the experience, and understanding, and lose some of that morbid fascination and fear that our society builds up over the issue. I keep thinking when I am home I should drag my brother off to the woods with the appropriate guns. Or my sister, who is probably the best shot in the family. It will happen, just not sure when.
She has never shot a gun.
I had my hunter's safety permit at the age of 8, had already started shooting a little before that. I own the little bolt action, single shot .22 rifle that everyone in my family learned to shoot with. Dad learned at the age of 6. When we moved to the farm, we kept a loaded shotgun at every door of the house. My mom was determined that no predators would get her "babies." This is a weird dynamic, as "predators" included raccoons and owls and hawks. I can no longer conceive a place in my head wear shooting a hawk is OK, but we are talking about my childhood environs. By the age of 10, I was not allowed to go for long walks without a gun and a dog. Our chickens ran loose on 80 acres of land, sometimes Mom would gather them from their roosts at night, but more often, butchering day was also target practice. We knew which young roosters were on the block for the day, and we set out with our 22 rifles, the only rule was that it had to be a head shot.
It wasn't that my family was "fringe," everyone I knew hunted. I did not know that gun racks were not standard in pick-ups until I moved to Florida. Opening day of hunting season was a school holiday, no one, kids or teachers, were going to show up anyway. And during deer season, almost everyone brought guns to school so they did not have to run home before heading to the woods. I'm not much of a hunter; not that I am opposed. I honestly feel that a quick end to a wild life, with no waste of the animal's parts is better for the animal, and the human consumer, than the horrible way we industrialize meat in this country - but that is another rant. I am way too antsy, noisy to be good on a stand, and not a good enough shot to hunt while "pushing." But, in my world, hiking was a rare phenomenon, and hunting was a socially acceptable way to get out in nature.
Then I moved to the south. I went hunting once. Completely different - I had never used a shotgun for deer before. Out west we had long range rifles, lots of open country, and clear views of anything we were pointing at. In the south, we have thick woods, low visibility, and crazy rednecks shooting at noises. OK - I realize that all parts of the country have crazy drunk rednecks shooting at noises, but my dad ran a very tight camp. No body drank until the guns were put away, and no one pulled a trigger without a clear head shot, anything else was a waste of meat.
Now we get into the arms debate. Having spent most of my adult life in a "big city," I get a lot of the fear around guns. I also feel that much of that fear is media and politics driven. Our founding fathers did not put the 2nd amendment in as an after thought. I do not believe that a couple of centuries ago the New World was an Utopian society of no violence. In fact, I would hazard to guess that violence was more prevalent, and more personal. Oftentimes, the pro-arms camp talk about self-protection. What if my family is threatened by a home invasion? I must protect myself. This is an important argument. But the key reason we have the 2nd amendment is to stand as a populace militia against the dictatorial rule of a hostile government. Wow, pop that one around a few NRA conventions and they might lose the political support that they have.
But aren't guns dangerous? of course they are. But so are cars, and boats, and hammers and power tools, and the way I use scissors. So why the big debate? We have a moderately dangerous tool, with constitutional backing, and it is a constant freak session of rant on both sides. Why? It is the emotional element. The romanticizing of gun related tragedies. Accidental death, poetic suicide (The Highway Man comes to mind), heartless murder, mass killings. All of these things have happened with other tools, but none have the emotional impact of gun-related violence. In these incidences we blame the gun almost as much as the killer. It is never the poison's fault, or the bomb's, or the hammer's.
Very few people question the right of anyone to own a car. Can't drive one without a license. License indicates education, some level of competency, and in Florida, you have to have insurance. It is along these lines that make me fairly comfortable with most of the gun control laws. I've been in the woods with idiots, it would be nice to know there was training involved. I don't think we need more laws. I think we need more education. Teaching Gun Safety in schools would be my favorite option. I can't imagine that I would get any political backing, but seriously, if you want people to understand something, respect it, and treat it properly, registration and punishment are not nearly as effective as good old-fashioned training. I would love to see the media handle gun-related violence like all other forms. Yes, mention that a gun was used, but don't do a million back stories on gun violence, gun control debates, and unrelated tragedies, just report the facts.
What about the whole licensing for use idea? I did compare gun use with car use - and we all think licensing is great for cars. This gets sticky. We have a constitutional RIGHT to own guns - and walk around with them for that matter, but I'm really not condoning that. I think that licensing is an invasion on the essence of this amendment. We have the right to pursue domestic tranquility - but no one is seeking licensure for happiness. When something is a Right, it needs to be accessible to all, without yards of red tape and coughing up personal information. In my opinion, we are back to the education thing. More information, fewer mistakes. And oh - yeah - personal responsibility, we need lots of that. I have no problem with harsh penalties for crimes involving guns. We have a right to keep them, not threaten or kill innocent people with them.
I use to be against hand guns. Not politically, just personally. The only real use for a hand gun is shooting people (or hog hunting, but I did not know that then), and I was really uncomfortable with that. Then I spent my first weekend of school in Miami right after Andrew. I had my concealed weapons permit and first handgun (a Walther PPK .380, if your interested) by the end of the month. That gun was by my side, loaded and ready, everytime I drove anywhere alone at night in Miami. Once I was done with school, I let the permit lapse, and haven't even taken it apart and cleaned it in 13 years.
I still have no use for, and am a little freaked out by the assault weapons collection phenomenon. The people I know that have them are occasionally on a political fringe, but are completely careful about the safety, maintenance and use of their guns. If any of these people go on a spree, it will not be an accident; but, it will be significantly less messy than a car bomb. Remember that the political and constitutional reason for allowing these people to keep their guns are to prepare for an event that most of us cannot if imagine as reality. Of course, every time we get a political regime change, a different group of people imagine it vividly and loudly.
So what to do about the horrible mom dilemma? I am personally little rusty on the mechanics, and very particular about who I would allow to take my daughter out shooting, and frankly wouldn't even know where to take her. I friend of mine, a collector and expert marksman, has offered - its just a matter of getting her over to the other side of the state. And she is pretty excited about it - just to have the experience, and understanding, and lose some of that morbid fascination and fear that our society builds up over the issue. I keep thinking when I am home I should drag my brother off to the woods with the appropriate guns. Or my sister, who is probably the best shot in the family. It will happen, just not sure when.
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