Scuttling a good idea

If everyone had an advance directive, end of life care costs might decline, families and providers wouldn’t have to guess about patient wishes and liability issues, and each of us might start to think more about our own responsibility for our health and our own expectations.

That seems to me pretty straightforward, a win for the individual, the insurer, the system.

So I suggested that a part of having health insurance should be requiring an advance directive. There are easy universal forms available. Each person can choose from wanting everything to wanting only to be made comfortable. If they can discuss with family, friends, clergy, medical people. No big deal.

Somehow this has gotten monetized, been folding into discussions on rationing, and there is now a proposal that Medicare reimburse for advance directive counseling. Medicare serves seniors and people with disabilities; this group has become inflamed. That counsel fee is being perceived as depriving seniors their rights to be helped with costly interventions.

Sure we are talking about unsustainable Medicare costs, but we are also talking about sharing costs and social involvement.

We’d have a similar impact if everyone who had insurance was required by the insurer (public and private) to have an advance directive. That directive could just fold over into their coverage when they became Medicare-eligible. Maybe not as fast, but simple.

I don’t know who introduced the idea of associating directives with Medicare. Maybe someone was not thinking beyond a short-term budget savings, not thinking of the personal reaction. Maybe someone was deliberately trying to upset seniors with the hope of scuttling all healthcare change. It’s hard for me to understand how this good idea actually got included in the package in sure-to-fail way.

Up to my nose

Up to my nose

I woke up feeling good up to my nose.

From my toes to my nose,

Body signals were go.

And sad stays a bandit,

Masking my eyes,

Arresting the flow.

No go.

Using language to separate

Mental illness has its own medical specialty, its own volume of diagnostic codes, and its own vocabulary.  The word stigma is one of the words that is now used in a special way.  The coupling in the phrase “the stigma of mental illness” is pervasive.  Instead of its intended use to eliminate stigma the constant reminder serves to maintain the concept of stigma in the public mind.

“Stigma” means discrimination and prejudice and shame.   The mental health leadership would better align psychiatric disability with other disabilities and use the human rights language that they use.  

Even anti-stigma campaigns maintain the separateness of things related to mental illness by using language to separate instead of to bridge.

Early

Early

She has arrived early, has had time to collect her self and her appurtenances, waits.

The appointed time passes and so does her calm.  Anxiety tromples her peacefulness.  She wonders about often being early, and often giving up her sense of self as the time passes.

She is early in her life, too, having finished, at 64, her life review, is accepting of what she has done, has raveled the loose ends, is a bit bored, a bit patient, a bit nonchalant, wondering what she’ll do for the next expected 20 years.

She thinks about how to calculate how many minutes/hours/days she has spent being early and what the value has been and the learning.  Well, she has never missed a plane!

She waits, early 

She waits.

4/22/2000

Healing through diet

In addition to the known or suspected connections between certain foods/diets and certain body and mood reactions, I think that abrupt extensive changes to one’s ordinary diet, such as severe restrictions on categories of input, cause a shock to the system and that within that shock the system can reorganize and symptoms can fade and disappear.  Sometimes that reorganization doesn’t last, and the system reverts to dysfunction and symptoms reappear.

Getting lost when there is too much input ...

The possibilities for the internet to facilitate outreach and inclusion excite me.  In the US, the new administration is using social networking tools to gather input and allow dialogue.  Except there are thousands of ideas and I have some and have just spent 30 minutes trying to figure out where my input should go and how to actually post.  And then it would be somewhere down around 3000 on a list.  Who would read that far?  And I understand networks are using outreach tools to boost favorite ideas to the top of the list.

So here is this wonderful tool being used to disadvantage outliers.  

I have given up and am therefore here posting two ideas about fiscal economies.  I’d like to be able to submit these formally to the person recently appointed to do a full spending review of budget and spending.  CPO, chief performance officer, is a position covering federal government budgeting and reform.  Nancy Killefer was former assistant secretary of the treasury in the Clinton Administration.  Her boss is White House budget chief Peter Orszag.

.

First, I think there could be a suggestion program, a bit more formal than commenting on blogs.  Just as there are now mechanisms to comment on, for instance, health care, I'd like to have a place to make suggestions about government efficiencies, ways to conserve and consolidate.  Sometimes end-users of services and programs have straightforward ideas about reducing complexities and layers of bureaucracy.  Submitters of adopted ideas could earn points, privileges, invitations, even dollars.  Or there could be contests between geographic Assembly Districts, which could save the most.

A suggestion that occurs to me is to combine certain letter carrier and census taker functions.  Letter carriers are familiar with their routes, know every residence.  In conjunction with the 2010 census, the Census Bureau is hiring contract workers to verify residential addresses.  It seems to me that letter carriers could be offered a voluntary overtime day and could each do their own route very efficiently.

Tools for connection

In the 90s, email was a way to bring together people for whom their local universe was insufficient. It provided community and mobilization. And then it became so popular as to become burdensome. Social networks, chat, instant messaging, phone texts created a weave of affinities which demanded both attention and bandwidth. For some it became overwhelming, with many disjointed pockets, not coalescing. What began as an anarchy skilled at self-organizing became out of control,

Enter new tools.

Dgroups describes itself as “simple, non-commercial (no ads), respectful of privacy, and targeted at low bandwidth users in the South”, a tool to be used by advocates who would uplift the developing world.

A health discussion dgroup is moderated, and “to ensure integrity, the forum is overseen by skilled moderators. As a subscriber, you can be assured that all messages you receive will be relevant, readable, and understandable. Messages are proofread before posting to ensure they are reader-friendly. All internet addresses mentioned in emails are checked for functionality.”

No typos, no name-calling, no rough edges. I wonder what kind of an exchange or community is built when interventions are so edited, massaged, moderated, smoothed. Doesn’t this put a great deal of power in a few hands, create a hierarchy that will perpetuate in the developing world the style and values and politenesses of the already developed world. Capitalism, democracy, and culture all globalized.

Another instance: a website prides itself on “selected, current [health] knowledge from peer-reviewed journal literature via C-Channel”, assuring that nothing too unusual will be available for the viewer.

Like is finding like to the exclusion of all else - making universes smaller instead of larger, and those in power believe they are helping those with less. Will we all become homogenized?

“A closed system limits choice, but it is more stable and more reliable. An open system is far more fragile and unreliable – this is the price of freedom.” Leander Kahney, Inside Steve’s Brain, 2008. p 248