Imperfect coverage for imperfect victims

How many times has a GoFundMe for health care services popped up on your newsfeed?

How many times have you donated to help someone pay for care related to their health needs?

Why? Which ones warranted a donation and which ones didn’t?

Was it because you knew the person? Was it because they were poor? Or was it because they were the ‘perfect’ victim?

Data suggest that we are most compelled to give to someone who was doing everything ‘right’ and something went wrong. Someone who runs ten miles a day but was struck down with a heart attack. Someone who was wearing a helmet on a bike and hit by a car. Someone who was volunteering abroad and caught a vicious disease.

But are these ‘perfect’ victims the only people who deserve assistance with their health care costs?

We have a blended health care system. We cover the disabled, poor mothers, children and elderly with government-sponsored and privately-administered health care plans.

The rest of us use a private market-based system.

Health insurance coverage does not have to be tied to employment status. In fact, the employment-based health insurance system that evolved in our country was a happy accident during WWII. The US government, afraid of severe inflation seen in Europe post-WWI, instated wage and price controls during the war. With a limited employee pool and strict wage controls, union groups looked for other ways to remain competitive and attract employees. They lobbied for a tax-exemption for health insurance coverage and they succeeded. To this day, we now associate health insurance with employment status.

The ACA/Obamacare/death panels/etc. sought to improve our health insurance market by working within our existing coverage model. It instated regulations on health plans, expanded (in 32 states) Medicaid to the poor childless adults, and offered subsidies to those between 138-400 percent of the federal poverty level to buy private insurance plans through exchange marketplaces.

This was to appeal the existing industries and infrastructures.

It wasn’t perfect and Congress defunding reinsurance and risk corridor programs didn’t help to stabilize premiums, but it helped 20 million additional people gain health insurance coverage.

President-elect Trump now says he wants to allow states to sell insurance across state lines and abolish the ACA (except for the ‘good’ parts like the guaranteed coverage provisions for people with pre-existing conditions and keeping young adults under 26 on their parents health insurance plans).

Do you expect the FDA to make sure the food and drugs you buy are safe? What about smoothies on the internet? What about supplements (which aren’t currently regulated)?

The ACA instated regulations to make sure that the plan you spend hundreds of dollars on a month actually provides you benefits when you are sick. Buying a cheap plan from North Dakota because the state doesn’t ensure that the plan actually covers anything, won’t help anyone. It will drive a race to the bottom and everyone’s plans will be essentially worthless (but cheap). Car insurance is regulated in states and people are required to maintain a minimum amount of coverage to safe guard others on the road. The ACA provided much needed health insurance oversight.

We expect the government to provide services that are a ‘public good’ and don’t necessarily make market sense. Public schools. Clean water. Utilities.

Does health insurance make market sense? I’m not sure.

But I know that no one, even if they are a smoker, or a sky-diver, or a reckless teenage boy, should be dependent on the generosity of his social network to cover his health care costs.

Incrementalism

This week has been really, really hard. My stomach physically hurts. My heart aches. It feels like a break up…but without the weight loss.

That pain. That anger. That disbelief. That grief. We need to harness it. Use it to further our cause.

How do we do that? We stay mad. We stay engaged. We use this energy to propel us forward.

So, let me ask you, do you know who your county commissioner is? What about if judges are elected or appointed in your district? How are your libraries/schools/Medicaid/roads/parks and other local programs funded?

In the words of Tip O’Neill: all politics is local.

But sometimes we forget that. We think that everything happens in DC. In a far away land where there are lobbyists and no one looking out for us (this isn’t true, btw. The legislative branch is essentially run by millennials who moved to DC because they are passionate about something — most likely making a positive change in this world).

However, Republicans have LONG outplayed us at the local level. This was my number one take away from policy school. You want to know why we can’t make gun control happen? Because the NRA has organized at the state and local level and can ‘activate’ their base when needed. “This is why when tragic shootings happen, we see the same thing: collective outrage, followed by a momentary flurry of unorganized calls and letters and donations from thousands of individuals, and then a quick return to the status quo. In Congress and in state legislatures, a few elected officials invariably use the opportunity to advance gun control legislation. But most political leaders lie low, assuming that the public agitation will prove fleeting, just as it has so many times before. And prove fleeting it inevitably does.”

So don’t let this outrage pass. Don’t let our access to simply luxuries like iphones and alcohol or our small victories with weed and gay marriage lull us into complacency.

So how do you make a difference? You get involved and stay informed. It’s not glamorous to show up to your local county party headquarters. Some of the people will be radical. Some will look unkempt with Bernie-esq hair. But this is where change begins.

“The framers of the Constitution rigged the US political system to frustrate the ambitions of bold policy reformers and to reward those who build consent from the ground up. Their plan succeeds to this day.”

So embrace that design. Don’t start at the top, start at the bottom, and work to the top. Incrementalism is key. Change opinions, change regulations, change minds, change elected officials, change policy.

The glass that didn’t break

Turns out, that glass ceiling wasn’t ready to fall.

At the beginning of this campaign I said that Donald Trump wasn’t the problem, but rather a symptom of the problem. In the words of Isaac Asimov, “Anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that ‘my ignorance is just as good as your knowledge.'”

We live in a democratic society that depends on an educated and informed public. Thomas Jefferson believed this was required for a healthy democracy. And we are failing. We are leaving people behind through public education, we are leaving people behind through a lack of public services that care for our poorest, weakest and most disenfranchised. And people have noticed. They feel that the system is rigged against them and that people in the far away land of DC and government don’t care about their problems and struggles.

The private market isn’t going to fix poor rural communities, free trade doesn’t help bring dentists to under served communities, and people aren’t seeing equal economic gains despite improvements in the economy.

But, Republican policies don’t fix these things. Lower taxes don’t help the poorest, repealing the ACA won’t help those who can’t afford health insurance, and harkening back to the “good old days” with a slogan, isn’t a policy platform.

So what do we do? We press on. We know that progress happens in spite of trials and tribulations not because of their absence. We know that the fight isn’t over.

But we need to find a way to reach out to those who feel that the system is rigged. We need to help those who feel disenfranchised. And we need to invest in our future by improving public education.

The arc of the moral universe is long, but it bends toward justice.

Thoughts on DC

Today (when I drafted this) marks three years since I packed my bags and flew to DC to start graduate school. I planned to stay for 21 months and then return to Portland. But, that’s obviously not the path I’ve chosen. I still find myself conflicted about my my decision to live here and my desire to return to the PNW. But if I’m being honest, I actually find myself conflicted about a lot of things – sometimes it’s as if there are two people living inside of me.

One half of me is a rule follower. The half that got (almost) straight As in high school, makes sure instructions are executed correctly, can’t help but show up on time, has anxiety, is shy, disciplined and principled and thinks that a good, successful life can be achieved by making conventional choices. (This is the side I try to project to the world).

The other half of me is more tempestuous. The half that hurls myself at things I want and things I believe with a reckless fire. The half that is terrified of heights but somehow repels over cliffs, jumps into rivers, rides on the back of motorcycles through Mexico (sorry mom), embraces the opportunity to be a naked body double, and wants nothing less than to lead a conventional, safe life. (Maybe it’s immaturity but this half is where all my good stories come from).

I often try to rectify these two parts of my soul and just end up very confused. Should I be in DC, working with fantastic people, at a job that uses my mind (and degree) but also sometimes makes me feel like a hamster? Or should I be in the PNW where following convention doesn’t matter as much? Or should I be somewhere I haven’t even thought of yet doing something that isn’t even on my radar?

I’ve always been a girl with a plan. Working towards “the next thing” motivates me. I don’t know how I’ve done this, but anything I’ve ever REALLY wanted, I’ve somehow made happen – grad school, moving to DC, boys, a scooter, traveling, a marathon (while injured) etc. But the funny thing about life is that you can only plan so much. Now that school is done, I’ve struggled to find purpose in the everyday and find myself wanting to “plan my next step” in order to give my life more structure. I assume I’m not alone in this.

But I’m trying, for the next little bit (see, a plan) to actually embrace where I’m at in life – here in DC with a lot of questions. I don’t know if I’ll stay here or if I’ll return to the PNW or if I’ll end up somewhere else entirely. Rather than constantly having one foot out the door onto my next “goal,” I’m trying to embrace this moment – here, right now.

My initials are “ask” and  my middle name means wisdom. I remember my dad telling me at some point that “smart people challenge things and ask questions.” I’ve always had a lot of questions about what it means to live a “good life” and how I can make it happen. I strive to be a good person, keep a good job, hang out with good people, and invest in good things and I hope that those things together will help me live a good life – even if I don’t know where it will be or what it looks like exactly.

DC people, thanks for making this choice a good one. Portland people, thanks for making this decision a hard one. Cheers to three years and having many, many questions about life!

Live your wisdom

“Live your wisdom” she whispered in that calm soothing voice that yoga instructors and therapists seem to have patented as she bowed to the class, hands clasped in the prayer position above her head.

I had just spent another $23 on a candlelight yoga class in an effort to bring a little zen into my end-of-the-week decompression. I felt good – calm, stretched out, and open.

But what the hell does “open” even mean? And have yoga instructors patented that voice yet? Because in my corner of the, yuppie club, it seems that everything we do to try and live a good life is now a part of someone else’s plan to make money – and be original. The constant quest to be original – and slightly more “zen” and “enlightened” than our neighbor.

But back to the money thing. Have you noticed that all your friends, yoga instructors, acquaintances, coffee shop patrons and lululemon associates are getting online certifications in “wellness.” I googled “online wellness certification” and this is what came up:

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Did you know you could get a degree in “wellness”? Because I didn’t.

But that seems to be the world we are living in. Where friends are using their social media presence to advertise a lifestyle and then they sell the services required to obtain it. In an article that I read, a woman credited her good looks to her “nonalcoholic, mediative, yogic, vegan lifestyle.” And you better believe the article was about her new vegan cookbook.

No longer are we laughing at the pretentiousness of Gwyneth Paltrow’s GOOP because we are all trying to see how many people we can get to subscribe to our own version. (For the record, I’ve always loved Gwyneth and admired her unabashed pretentiousness. At least she recognizes her place of privilege). I have friends selling “wellness” services that include finding a balanced lifestyle, guided meditation, nutrition counseling, and “mental health.”

I’m not meaning to express opposition to the goal of these services – I embrace wellness, attempt to lead a balanced lifestyle, love working out and an occasional meditative yoga class – but I’m merely questioning the saturation of the selling of these services. Who know that selling “wellness” was such competitive business.

Friends are now competing for the “best” yoga trainings, most original blog content, and grappling for the same client networks. What is sold as a way to find “zen” involves as much advertising as Coke, PR as the Ice Bucket Challenge, and authenticity as buying a pink water bottle to support breast cancer research.

In a world of privilege – where we shop at Whole Foods, buy organic, and exhale as we downward dog – we are all attempting to find balance. We want careers that make money and do good. But do we need to pay our friends and “wellness coaches” to find this?

What happened to communities? Friendships? Can’t we all just form a book club, talk about these ideas and then attempt to put them into practice? Why do we need to pay someone who has a blog and is an expert in “balance” in order find this for ourselves?

I believe in therapy, I believe in counseling, mentoring and all sorts of ways that people can help support others in need. I question the expertise of a person on online certification in “wellness” to answer my ongoing questions about purpose, work-life balance, and health. These are questions I need to answer myself, through living.

Once I’ve found that “wisdom” hopefully I’ll live it, not sell it.

February

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February blues. They happen.

When it’s cold. When you have midterms. When your favorite person is diagnosed with a very bad C word. When you’re craving sunshine and adventure. When you miss living with just the two of you. When boys are confusing. When you’ve been “good” for weeks – just studying, running and no funny late night shenanigans.

That’s when it’s time for something new.