Hard Truths

Since our pseudo news outlets and social media pot-stirrers capture the imagination with stories that are largely untrue or focus on the wrong things, we seem to be ignoring hard truths. This concerns me as dialogue over factual information is greatly needed. Otherwise, we address the wrong problems.

America no longer is a country of upward mobility. We have fallen in the ranks of people climbing the socio-economic ladder and to whom and where you were born matters more than merit.

America ranked in the twenties in terms of science and math in world educational ranking the last time I checked. It may be worse now. That is not American Exceptionalism.

America has the most expensive health care system in the world but ranks around thirty-eight in quality outcomes. We have one of the hjghest maternal mortality rates in first world countries.

America was put on watch list for democracies around the world. That sentence speaks volumes. When people believe a former president who is known for being untruthful when he says the election was stolen, that gives me concern. The fact he cannot prove any of his wild contentions should be informational. He has won only one out of 65+ court cases and no recounts or audits. It is hard for him to lose any more than this, but he was still at it earlier this week.

That climate change thing is real and it is here. Storms are more severe and impactful. Drought areas are dryer. Wild fires are more intense. And, coastal areas are seeing more sunny day flooding. What is less discussed is the warmer weather pushes further north wreaking havoc on flora and fauna. The Maine lobsters are migrating north and we are seeing more tropical disease carrying insects up this way.

And, there are many other things we are not discussing.

Just a quick word on Jill

Our friend Jill is still having a tough time in her recuperation. She let me know she misses all of us and wishes she could start blogging more. As many of us know, Jill puts a lot of research into her posts, so her opinions are well -grounded. So, to her, blogging is more than just stream of consciousness writing. It is like cooking a well-prepared meal. She takes her time.

She hopefully will be having a treatment which will be beneficial to her. She had a couple of procedures last week to remedy a few related items, but she needs to have this procedure. I am sorry to be so vague, as I did not want to share too much of her personal travails.

Just keep her in your thoughts and let her know that you are thinking of her. If you would prefer to respond here, I will cut and paste into an email to her. The last time I committed to do this, she responded herself on my blogpost.

Jill;, we miss you and are thinking good thoughts for you.

Our children deserve better – a repeated pre-pandemic clarion call

The following post was written a couple of years ago. Although the pandemic has rightfully gotten our attention, this story bears repeating.

Two time Pulitzer Prize winner Nicholas Kristof wrote an editorial earlier this week in The New York Times called “Our children deserve better.” It is a clarion call to our nation showing the plight of kids in America.

Here are a few quotes to frame the issue:

“UNICEF says America ranks No. 37 among countries in well-being of children, and Save the Children puts the United States at No. 36. European countries dominate the top places.

American infants at last count were 76 percent more likely to die in their first year than children in other advanced countries, according to an article last year in the journal Health Affairs. We would save the lives of 20,000 American children each year if we could just achieve the same child mortality rates as the rest of the rich world.”

“Half a million American kids also suffer lead poisoning each year, and the youth suicide rate is at its highest level on record….The Census Bureau reported this week that the number of uninsured children increased by 425,000 last year.”

These are different views and sources of the threats to US children that note we have a problem. Another source I read a couple of years ago noted America has a much higher maternal mortality rate at child birth than other civilized countries, which further endangers children as well as the mothers.

Yet, these issues are not being discussed in the halls of government. We have a poverty problem in our country with too many living in or just above poverty levels. We have not expanded Medicaid in fifteen states* whose numbers are worse than these national numbers per capita. We have not addressed our national water crisis which has a Flint, MI like exposure to lead in too many cities and a volume of available fresh water issue in other places. We have not invested as we should to diminish crime and provide more opportunities for jobs in disenfranchised areas. There are several pockets of success that can be emulated in more cities.

We also need to address better gun governance, especially with the number one gun death cause by far being suicide and a non-inconsequential accidental gun death rate. And, we have not dealt with the continuing and rising exposure to technology and artificial intelligence which have taken and will take even more jobs in the future. Finally, there is that climate change thing we need to deal with.

These are real problems. And, they will get worse. Data driven analysis of causes and solutions are needed. They are both multi-faceted. Investing more now, will save huge amounts later. This is not just an urban issue, it is rural one as well. The opioid crisis is rampant in these impoverished rural areas, for example.

None of the solutions will fit on a bumper sticker. And, political attempts to oversimplify issues should be questioned. Here is an easy contradiction to spot – if people believe gun deaths are a mental health issue, then why the effort to eliminate or not expand mental health benefits?

Please make your legislators aware of these issues and ask pointed questions. These questions deserve answers, not bumper sticker slogans. These concerns deserve to be talked about, studied and acted upon.

*Note: The number of states who have not expanded Medicaid is now twelve. Here is a link to a tracking of the states who have and have not. What puzzles me is this change would help people in rural areas, which tend to vote more conservatively. So, not expanding Medicaid hurts health access, but also rural hospitals and economies, with the federal government funding 90% of the cost. As former Republican governor of Ohio and presidential candidate John Kasich said, Medicaid expansion is a “no brainer.”

Shore up the ACA – letter to the editor

My local newspaper ran my following letter to the editor Sunday. I have been preaching the message of improving the Affordable Care Act for seven years offering suggestions. I will link to one of those posts below. What I have never cared for is the naysaying, sabotaging and attempts to repeal it that have been a substitute for debate in the Republican party.

The legislation Republicans almost rammed through in 2017 was ill-conceived, poorly developed and punitive to multiple millions of Americans. These were the key reasons Senator John McCain saved the GOP from itself and voted it down before he died.

“Three times now the U.S. Supreme Court has upheld the Affordable Care Act in the face of Republican attempts to rule it unconstitutional.

Per this retired actuary, benefits consultant and benefits manager, the ACA is not perfect and could use some improvements. But it is helping Americans, including provisions required in employer sponsored plans, which people tend to forget.

What has puzzled me for 10 years is that the law is somewhat based on Republican ideas, the latest being Romneycare in Massachusetts, which at least one Tea Party leader, S.C.. Sen. Jim DeMint, once supported.   

My strong advice to my former party, stop trying to screw Americans by killing the ACA and let’s find ways to shore up its deficiencies.”

Please stabilize the Affordable Care Act NOW to help Americans | musingsofanoldfart (wordpress.com)

A Tuesday tale

I met with an old friend last week for lunch. He was visiting his daughter and we decided to get together, masked appropriately. He shared a wonderful story that I hope will warm your heart, as it did mine and my wife’s when I told her.

He said his daughter is a specialized nurse. He and his wife had adopted both of their children in their first week. For medical history reasons, his daughter wanted to find out about her birth parents. He gave a nice piece of advice to be prepared for the consequences which may not turn out like you want.

He went on to say she was adopted when they lived in Ohio, who changed their laws to allow for open records, provided the birth parents did not specifically say no during the transition form sealed records.

After much legwork given a common name, they found the birth mother and father. It turns out the birth mother was also a nurse and her father was the doctor her mother worked for. It was the mother who turned down the doctor’s proposal to be married, so they put the child up for adoption.

So, if that does not give you enough tingles that people she never met were also in the medical field, the next item might. We live in North Carolina, not Ohio. And, the daughter does not live in her home town having moved within the state. It turns out the birth mother lives nine miles away from the daughter.

The rest of the story remains to be told. I will add the mother who raised her is in medical research, so her daughter’s interest is most likely due to her influence and example, but DNA to help others might have also been a factor.

The story is not intended to judge anyone’s motives or reasons for placing a child in adoption. We do not know the circumstances or history of those involved. I would only surmise decisions like this must be difficult.

Franklin was on the side of the Angels and got chastised

I have written before when Franklin Graham has used his pulpit to denigrate groups of people who do not worship, love or gender present like he does. I have added it detracts from the many good things his Samaritan’s Purse organization does, when he demonizes groups. Yet, this time he is getting flak from his own followers for suggesting that people get the COVID vaccine.

Here are excerpts from an article called “Franklin Graham believes Jesus would take COVID vaccine. He’s still catching grief”.by Joe Marusak of The Charlotte Observer. A link to the article is below.

“Evangelist Franklin Graham is still catching grief from some of his Facebook followers weeks after saying Jesus would have supported getting a COVID-19 vaccine.

Based on the parable of the Good Samaritan, Graham said he concluded that Jesus would have supported getting all types of vaccines.

He said nobody should have to endure what some of his staff and their family did after contracting the coronavirus…

‘My wife and I have both had the vaccine; and at 68 years old, I want to get as many more miles out of these old bones as possible!’

Some of his followers, however, are still fuming about his COVID vaccine recommendation.

‘You my friend Franklin Graham are leading your sheep to slaughter,’ a woman posted Friday.

‘Satanic sell out,’ another woman posted.

‘STOP,’ said another last week. ‘It is NOT your job as a pastor to try and talk people into taking a vaccine that is considered experimental.’

Other comments were along these same lines. Just in the selection of these three, only one-half of one them raised an actual issue that gave him or her pause referencing “experimental.” The vaccines were rushed, but we have had the benefit of seeing the results of such along with the stops and starts. The J&J vaccine has some issues they are looking into, but for the vast most part the vaccines have been safe.

What amuses and concerns me is the vitriol used to share their opinions with the reverend, who is just trying to offer encouragement. He did exactly what I did after getting my vaccine and that is to share a positive experience. “Satanic” is a little harsh as a retort and offers no counter argument.

That is a bigger problem where people are replacing arguments with bullying and name calling. The latter does not improve anyone’s argument, even when they are a current or former politician. Being smug does not make one right, it just makes one smug.

Franklin Graham says Jesus would get COVID shot | Charlotte Observer

What do these folks have in common? (a reprise)

The following post was written almost eight years ago. While more states and cities have increased their minimum wages and the Affordable Car Act helps greatly, this post remains relevant.

The following people have something in common. Please scroll down the series of descriptions and let me know what is common for all of them. The names of have been changed to protect their confidentiality, but the stories are very real.

Anna is working as an office manager working full-time making $8.00 per hour. She has is separated due to a domestic violence situation and has two children.

Hope is working two jobs – one full-time as an Administrative Assistant making $11.75 and the other part-time as an intake specialist at a Human Services agency making $11.00 an hour. She is also separated due to a domestic violence situation and has four children.

Julie is working full-time as a CSR (Customer Service Representative) for a bank making just over $14 an hour. She is unmarried with three children.

Nina is working full-time as a CSR for a utility company making $12.25 an hour. She is unmarried with one child.

Sarina is an assistant manager at a fast food restaurant making $12 an hour. She is unmarried with three kids.

Paul is working full-time on a cleaning crew making $11.00 an hour. He is unmarried with one child.

Carrie and Michael are married with four kids. Michael was laid off and Carrie is working in hospitality at a local hotel making $9.00 an hour.

Felicia is a Certified Nursing Assistant making $9.60 an hour at a hospital. She is unmarried and has one child.

Dedrick is a full-time security guard making $9.25 an hour. He is unmarried with three children.

Cassandra is working two part-time jobs, one as an afterschool teacher assistant making $11.25 per hour and the other as a retail clerk for a discount company making $7.95 per hour. She is unmarried with two children.

Terry is working as a public school teacher assistant making $11.00 an hour. She is unmarried with one child.

I could go on, but let me ask the question. What do these folks have in common? They are all homeless. When I tell people that the homeless people the agency I volunteer with have jobs, these people do not believe me at first. How can they be working and be homeless? It takes some people time for that to sink in. In fact, 84% of the families we help are working. The median wage for those 84% is $9.00 an hour. I purposefully used higher figures to illustrate a point – you can make above the living wage for an individual, but still be homeless if you are a parent. The living wage in my area for an individual is around $10.00 an hour and for a one-parent, one-child family is around $19.00 per hour.

There are five additional things I want to mention that are important to understanding, preventing and climbing out of poverty:

  • Family size is highly correlated with poverty. We must do a better job on family planning and providing birth control means and education. For my evangelical readers, your kids are going to be tempted to have sex. Please do not preach a message of abstinence alone. Teach girls how to say no. Teach boys to treat girls as more than sex objects and that no means no. But, let them know that if they must have a sexual relationship, to use protection.
  • Education is key. While the economic downturn altered this statement with layoffs and downsizings, for the most part, the higher your education, the less likely you are to be homeless. For kids that fall off the track, getting them back in school or on a path to a GED is essential. Fortunately, the community college systems in cities and regions do a pretty good job at getting people educated and developed with new career skills.
  • Healthcare is very important. The absence of healthcare is the key reason for personal bankruptcy in the US and an important reason for homelessness. People cannot afford their employer plan and one of the kids get sick or has an issue. Or, the parent stopped taking his or her medications due to cost and the resulting physical or mental issue causes a problem for the family or on the job. Fully implementing Obamacare will help, but the states who did not expand Medicaid need to do so.
  • Minimum wage needs to at least be the living wage for an individual. The homeless we help work hard, sometimes at more than one job. People like to say that increasing the minimum wage impacts the number of jobs. To be honest, most studies do not support that contention. We need to increase the minimum wage to the living wage for an individual. These jobs perpetuate poverty (please read “Nickeled and Dimed in America” by Barbara Ehrenreich). Short of that, we need to increase it more than it is now and graduate it to a higher level. Yet, the same people who decry people on welfare, also don’t want to pay people for an honest day’s work. If we pay people better and not like an economic slave, then the economy will actually flourish more.
  • Domestic violence is real. About 30% of the people in our program have come out of an abusive relationship. So, the spouse is making due without one of the incomes (for the most part) as well as dealing with a court-ordered spouse to stay away from her and the kids. I have said this before. If you are in an abusive relationship – leave. He will not change – leave. He will move beyond verbal abuse and it will become physical – leave. For the sake of your kids – leave. You can live a more normal life. Domestic violence is about power and control. It is difficult, but please leave.

Our agency is built with a model of helping people climb a ladder out of homelessness. The past fiscal year, 91% of our families were back to self-sufficiency in 21 months.  We provide rental subsidies based on their ability to pay, but they must work with a social worker and meet certain milestones. We also offer Hope Teams to mentor the family and kids. We do not do for them what they can do for themselves, so they must have a savings plan, take classes on Bridges Out of Poverty, and achieve certain milestones.

We all need to better understand our poverty problem in America. We must do better, but it must begin with realizing how it happens and helping people climb ladders out of poverty. We cannot solve this problem by kicking them when they are down and placing ill-founded labels on them as reasons to dismiss them as undeserving. Not only is that cold-hearted, but it is harmful to our economic growth. As Gandhi said it so well, “a society’s greatness is measured in how it takes care of its less fortunate.”

Time to get shot – vaccine shot that is (an update)

It is my time to get the first of the COVID-19 vaccines. I went Saturday to an event sponsored by Atrium Health at Bank of America stadium on Saturday. It was actually well organized and very quick, but more on that later. And, the only side effect is a tender arm where I was shot.

When I signed up through my hospital system, it was like buying tickets online for a concert. I had several locations to choose from, but when I hesitated to actually read something they wanted me to, my choice locations vanished. And, I had to start again. That is how I ended up at the football stadium. I promise I did not spike the football after getting shot. The other locations are drive-throughs at various hospital locations.

Nonetheless, I am glad to have started the vaccine train with its two stops. Three weeks from now, I will get number two and be done. These have been scary times the past fifteen months. I did see there is an uptick of COVID-19 in more places. Cavalier attitude toward socializing is the likely culprit along with politicians saying more political than prudent things.

Those not interested in the vaccine are an enigma to me. I cannot understand why something that is so needed is avoided. I cannot understand why something that is relatively easy to do is avoided. If people are so doing because they have an anti-vax attitude, I understand it more, but still don’t understand it enough. If people are avoiding it because of the pace of the development, I understand that a little more, but the stories of side effects get more air time than the countless no problems. Yet, if people are doing so for a political statement, that is just inane. Politicians now campaign all of the time rather than govern, so we must take what many say with a grain of salt.

The event was smooth sailing. The only waiting was for parking as it was bottle necked to one lot. I eventually bailed and went to another lot. I walked right on in and two check points later got my shot. I was out in thirty minutes counting the fifteen minute observation wait at the end.  I was encouraged when they sent me a text to NOT show up earlier than fifteen minutes before my appointment time. 

By the way, I am old enough to remember some shot we all got when I was in elementary school. I don’t remember what it was, but we all lined up for our poke in the arm. I do remember the kids behind me asking “did it hurt?” which everyone one was asked. By the way, this did not hurt. I exercised the next morning and today am without any tenderness.

Sidebar: A funny story happened, which my wife chuckled at when I told her later. The person giving me my shot was a pediatrician who was my age as she commented when I told her my birthday. When I asked her if I needed to roll up a sleeve, she said if we just unbutton the top button on your pull over shirt, we can roll it down enough to give me the shot. To my surprise, then she started doing it. And, I said don’t you need to know my first name to start undressing me. She laughed and said I am a pediatrician so I am used to just doing things. Everyone needs a chuckle, especially those doing repetitive things.

Time to get shot – vaccine shot that is

It is my time to get the first of the COVID-19 vaccines today. While I am an old fart, I am only now qualifying by age and one other condition, that hypertension thing. So, I will be participating in a hopefully, well organized cattle call at the football stadium downtown.

When I signed up through my hospital system, it was like buying tickets online for a concert. I had several locations to choose from, but when I hesitated to actually read something they wanted me to, my choice locations vanished. And, I had to start again. That is how I ended up at the football stadium. I promise not to spike the football after getting shot.

Nonetheless, I am glad to start the vaccine train with its two stops. Three weeks from now, I will get number two and be done. These have been scary times the past fifteen months. I did see there is an uptick of COVID-19 in more places. Cavalier attitude toward socializing is the likely culprit along with politicians saying more political than prudent things.

Those not interested in the vaccine are an enigma to me. I cannot understand why something that is so needed is avoided. I cannot understand why something that is relatively easy to do is avoided. If people are so doing because they have an anti-vax attitude, I understand it more, but still don’t understand it enough. If people are doing so for a political statement, that is just inane. Politicians now campaign all of the time rather than govern, so we must take what many say with a grain of salt.

So, hopefully it will be smooth sailing. My guess it will require a lot of waiting. But, I was encouraged when they sent me a text to NOT show up earlier than fifteen minutes before my appointment time. By the way, I am old enough to remember some shot we all got when I was in elementary school. I don’t remember what it was, but we all lined up for our poke in the arm. I do remember the kids behind me asking “did it hurt?” which everyone one was asked.

Internal Bleeding – Be your own Health Care Advocate

The following post was written about nine years ago. Since that time, some of the changes noted below have taken shape, but the message remains important. Be your own health care advocate.

A few years ago, two doctors looking to improve the quality of health care in the US, wrote a book called “Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes.” Since Drs. Robert Wachter and Kaveh Shojania wrote their book, improvements have and continue to be made, but with the concern over the US’ 38th position in health care quality, while being the most expensive system in the world (according to the World Health Organization), I think it is appropriate to belabor a few of their key points, in particular, being your own health care advocate.

In today’s world, we must be the navigators of any customer service we receive whether it is at a bank, the driver’s license office or in a retail store. We must be diplomatically relentless in trying to gain the service we expect and need to resolve an issue. Service providers, in particular those in a Call Center, need to stay on script as much as possible. When your problems get them off script, then your navigation diplomacy skills are needed the most.  I mention this as context for what we also must do in gleaning good health care service.

A few years back there was a study conducted by a combined group called the “Leapfrog Group” to improve the quality of health care in hospitals. Leapfrog came up with three major ideas – (1) Electronic orders were a must (poorly written prescription orders were killing people), (2) Intensive Care units need to always have a doctor on site and (3) Medical procedures of import need to be done in centers of excellence, not where a hospital may have done only a handful of surgeries in this area. “Internal Bleeding” echoes many of these same issues, especially the one on electronic order taking. Yet, they also go beyond these Leapfrog issues.

They noted that often times in hospitals, fewer critical questions are asked closer to the time of the procedure. Sometimes, the critical mistake may have occurred very early in the process. They used the analogy of all of the holes in Swiss cheese aligning to allow a mistake to pass all the way through. They used the example at Duke University where a famous heart transplant for a minor child occurred. The doctors at this very fine medical center, one of the best, were so excited when a heart of a young deceased donor became available, that they assumed others had checked that the type of blood of the donor matched the patient. It did not and the patient died. Similar examples occurred when doctors operated on the wrong leg, arm, kidney, lung, etc. The doctors failed to ask the very basic of questions and assumed these issues had been resolved.

In addition to the above and related to the Rx orders, the authors advocate the patient understand fully what is being done to them in the hospital or before they get there. They recommend you introduce yourself to every care giver who comes into the room, ask questions of them relative to medications you are being given and make them fully aware of other medications you are taking. They recommend if you cannot speak for yourself or are uncomfortable in so-doing, to delegate this important role to someone you trust. In other words, they are recommending being your own health care advocate. This will help minimize mistakes.

Health care is both a science and an art. It also is a trial and error business, so the doctors may not know for certain what is wrong with you and have to figure it out. They will do their best, but they do not know you very well or at all. So, you have to play the role of information provider and advocate.  Using the authors’ recommendation supplemented by other sources of information and experience, you must be your own health care advocate and do the following to get the care you expect and need.

– Write as good a summary of your and your family medical history as possible. Make it available to others you trust who may need to speak on your behalf.

– Before you see the doctor, write down your symptoms and questions as you may get stage fright when you see the doctor’s white coat.

– Do not be scared to ask questions, especially if you do not understand the diagnosis or remedy – he or she is there to serve you. I tell my kids you show your intelligence by asking questions, not by failing to ask.

– Get a second opinion on major diagnoses. For example, it takes a lot of practice to read a mammogram correctly and a non-inconsequential percentage of misdiagnoses occur. Using this example, computers cannot take the place of human fingers in doing a self-test. If you feel a lump and the first mammogram shows negative, get a second opinion.

– Make sure you inform your doctors and pharmacists what drugs you are taking. There are a number of drugs that contraempt the drug you need (make its use less effective) and some which are toxic when taken together. I ask my pharmacist questions all the time about some over counter drugs that may be harmful when taken with the prescriptions my family is taking, including me.

– Take your medications as prescribed and through the dosage. Many people stop taking their meds when they start feeling better.

– Be truthful with the doctor about your drinking and extra-curricular drug use. Doctors tend to believe patients understate their drinking, so help them out and tell them the truth. You drink more than you say you do.

– Make sure you get treatment for a major problem at a place that does a lot of what you need – a center of excellence. This is especially true with back or spinal surgeries and surgeries on any major organs. If you are having heart surgery, do you want it done where they have done 25 in the past year or 250, e.g? I have two friends who are having major back complications after spinal surgeries were done poorly.

– Get all the information you can around procedures to make informed decisions. In some cases, living with a mild discomfort with medication may be better than invasive surgery. Ask the doctor what are the options, what are the chances for success and what are the risks. If he/ she doesn’t know, ask him/ her with whom you can speak.

– Be diplomatically relentless with Call Center personnel at insurance companies. Mistakes do occur and sometimes you may be allergic to a substituted generic prescription. So, you can appeal a claim if you feel under-served.

– This one comes courtesy of Dr. Sandra Steingraber, an ecologist, biologist and cancer survivor. Family history needs to recognize your environment as well. She was adopted, but her bladder cancer at the age of 21, also occurred in other family members who lived nearby (as well as other cancers). Bladder cancer is a bell-weather cancer. It is largely caused by environmental toxins. If your family, neighbors or community has some longevity in an area and more than one or two bladder cancers have occurred, start doing some fact-finding. It may be more than a coincidence. Since people move around, showing environmental causes is difficult as the exposure may have occurred years before.

– Finally, take care of yourself in a sustainable way. Walk more. Reduce portions. Eat more slowly and ingest more calories earlier in the day. These measures can be sustained whereas diets cannot.

These are just a few ideas, but the key message is be your own health care advocate as you are the only constant in any equation about your health. If you feel you cannot serve this role well, please take a trusted friend or family member with you. Doctors and nurses are marvelous care givers, but they are not perfect. You have to improve their service by being present in the conversations. It is only your or your children’s lives.