I want to credit the journalists, academics, and my fellow healthcare providers who continue to write in this inhospitable-to-truths environment. I don’t know how you do it.
I’m hotter than a billy goat in a pepper patch. I can’t put it together. I can barely speak.
On this blog I’ve made the turn from facts to feelings in the last 100+ days, likely because facts seem to have suffered a fatal blow in this unrecognizable version of the world.
Here’s my feeling: I just left CancerCon (post in process), a group of many hundred sparkling, talented, mutually supportive young adults with cancer. Every last one of them contributing and (this is my bottom line) not any less human than before they got sick. THROUGH NO FAULT OF THEIR OWN. I’m one of those hundreds.
The Affordable Care Act was my civil rights legislation. Its “replacement” is the repeal of my and my legion of patients hard fought and nightly worried over civil rights. To adequate care. To freedom from unnecessary physical suffering and premature death and disability. Freedom from fear of sinking ourselves and those who love us into destitution to pay for our care. That’s all I have for now.
Am I less than my healthy counterpart? Is my humanity so easily disregarded by my country?
So you’re an audio/visual learner. Maybe you prefer to watch Aaron Carroll talk about Medicaid block grants on Healthcare Triage. Five minutes to being smart enough to policy wrestle any date in the D.C. metro area this week. THERE WILL BE A QUIZ.
1.) What are some of the “perverse incentives” created by Medicaid’s current funding model? (HINT: think fee-for-service care). Does block granting address these incentives? Include direct and indirect implications for state budgets.
2.) If per-person spending has remained relatively flat, and Dr. Carroll is correct in saying that the increase in overall Medicaid spending comes from the increased number of enrollees, and enrollment eligibility is tied to the federal poverty level (as well as qualifying criteria such as being a child, a pregnant woman, or disabled) what can we assume about poverty in America? HINT: I really pointed you right at this one. You don’t need a hint.
Now go out there and get’em.
There’s no magic in how Congress reduces spending under a block grant mechanism. It just says it will do so, and leaves the hard decisions to others. It’s possible that some states will come up with solutions we haven’t been able to see before, and find a way to reduce spending without causing problems. If they can’t, though, they will have to make do with less, make the hard choices and face the brunt of the blame.
This column is A++. Apparently, block grants are simple: states are given a set amount of money to sustain their Medicaid population. If their needs exceed that amount the state has to come up with the difference or make cuts: recipients, services, costs covered. States that rely on a higher percentage of federal dollars for Medicaid are more likely to come up short in this equation. Many of these states have things in common. They are poorer, health disparities greater, outcomes worse. The fear is that these states, already behind, will slip further if a gap in funding grew. It disconcerts me greatly that Americans are resigned to the great divides that exist among us in health measures and life expectancy. Block grants forewarn of further disengagement of rich from the poor, North from the South, urban from rural, one race from another. Our federal government and it’s protective policies and programs unite us, remind us that we are in fact one nation, interdependent.
Sometimes I pledge allegiance to bureaucracy. When nothing else will hold us equal, it comes in with it’s maddening and obstinate rules. It does.
DEET. Use it liberally.
You might have noticed that one of my favorite humans in health care is Dr. Fauci, Director of NIAID. Link below is his review of Zika up to now. It is solid and made for laypeople. He’s of the older school (patriarchal but not exclusive to male MDs) where doctors were bosses, not patient partners. This almost out-of-fashion kind of doctoring is reassuring in an emergency when the doc wears his title as a moral obligation to get the right answers and fix it fix it fix it. The perfect amount of condescension so you feel confident that he’s one of the smartest people on the planet and you’re lucky he’s working for you.
I find the mass of information put out by CDC hard to wade through. This press conference covers brief history, current state of the science, vaccines in development, funding issues.
Fauci at the National Press Club
And I enjoy the image of Dr. Fauci in his DC backyard knocking standing water off of plant leaves.
CDC queries= my mood boards.
SO lots of facts and figures this week. The gun deaths data used by every pundit, editorial author, and Facebook meme maker (well maybe not) in this country can be found in our national database of mortality statistics compiled by the CDC and available for anyone with internet access to search. I did a therapeutic amount of searching this morning. This is a great tool and resource and one of the public health biggies with open access. It’s government data and PubMed abstracts for me until I decide to drop out of life and get that sweet academic journal access that comes with being a Ph.D candidate. Pffft. Right though: http://wonder.cdc.gov/
Mortality and morbidity statistics are tracked by ICD medical billing codes. Because if there’s two things you can count on it’s death and your survivors being billed for your death.
The design is not good but what were you expecting? That’s how you know it’s authentic. I could spend all week in this.
Narrow your search. Slightly less easy that learning how to properly use MeSH search terminology.
Results for all codes under “firearm” reporting data from the entire United States in the year 2014. But go have a look for yourself, too. Compare it to cancer. Compare it to car accidents. Dare to look at medical error, too. It’s in your hands. We need help.
In the old days, when we were in need of entertainment my spouse might offer up this question:
“What time in history would you most like to live in?”
“Do I get to be a man? Cause if not I’m not going anywhere.”
I like that I can own property. Maybe I will someday! I am grateful for the sacrifices made by many over the centuries opening vast realms of what was a man’s world to all life creating, cycling with a m-fing celestial body human women.
Nursing is to its core, in all the best and all the worst ways, a traditional women’s profession. Essential parts of a critical care training I did today included tactics for manipulating a provider into completing a task (use their pride), how hard work is mandatory and don’t count on being recognized, and the importance of your intuition. These things I will happily lean into in the workplace. I love women’s work. But God help me I’m going to elevate it. I want recognition with my effort. I want power with my responsibility.
But hey. Now I find the great quandry of the woman in her childbearing years is all up on me. I can’t be all the nurse I want to be, and I can’t be all mother.
When I’m woe is me I turn to my fav lady sage, Madeleine Albright, who I liked before she said that there was a special place in hell for women who didn’t help each other. Now I love her.
I subscribe to her advice (actually I keep a clip from the American Master’s film Women of her on my phone so I always have a little guru with me). You can have everything. But not at the same time. Women’s lives come in segments. Also you do not have time turn this into a Vimeo clip so you video the thing and post it on your dusty old blog.
Happy Women’s Day!
If the criminal justice system is the largest provider of mental health services in the US, then I think Obama’s executive action on solitary confinement is relevant health policy. Give the op-ed a read. I’m enjoying so very much the final lap of his presidency as I see, to quote him quoting every lapsed Catholic’s favorite pope, “every human person is endowed with inalienable dignity” written all over his moves.