Day of Reckoning

Every so often we need to list actions that are insane, inane, and inhumane.  Today, let’s do some accounting.

Hurricanes Harvey, Irma, Maria, and José are not just a part of hurricane season.  They are part of an ever more worrisome chain of cataclysmic events caused by climate change.  Yes, we should care about the people affected—those who have lost life, property, livelihood, and clean water—in every way we can, and we have to stop causing these events, then throwing up our hands as if we don’t understand their origin, and then calling upon people to clean up the messes.

Colin Kaepernick and dozens of other NFL players are not just well-paid professional athletes with a bone to pick.  They are brave individuals who are responding to a system of oppression that we white people have created and perpetuated.  We have all witnessed the excessive use of force on African Americans, resulting in death, incarceration, and entrenched patterns that we are only now starting to acknowledge.  We shouldn’t foment racism and then criticize those who protest it, those who have a legitimate cause to question allegiance to a flag whose country has never chosen to represent their interests.  Colin Kaepernick should have a solid Title VII case working, especially given the retaliation he has suffered for his important gesture of resistance, a gesture made in a context highly visible to white men, the group perhaps most in need of lessons about United States history and present-day realities.

The events of Charlottesville didn’t happen in a vacuum.  We have spent too long neglecting the evolution of the First Amendment and indulging a long outdated interpretation of the Second Amendment.  Jeff Sessions is busy accusing college and university campuses of serving as echo chambers for people with homogeneous opinions and fragile egos, hearkening back to some mythical good old days when tough people argued out tough opinions.  Whatever good old days he may be referring to were days when colleges and universities had not yet opened their doors to many people who weren’t white or male.  Not all white males have the same opinions, but an environment that welcomes them and them only also protects them from heterogeneity and challenges to their privilege.  It creates power systems for them and them only, power systems that manifest themselves in the very type of government that is not working for many of us at this moment.  The powerful weapons available to the common person give the Second Amendment a ferocious sway over the First, as we witnessed so clearly in Charlottesville.  Open-carry laws on campuses such as The University of Texas certainly chill free speech freedoms and impulses.

It is no coincidence that Betsy DeVos is unraveling all of the equality work done by President Obama.  We created Betsy DeVos, and her toady, Candice Jackson, by allowing attack after attack on the character and actions of the most qualified candidate for the presidency, demonstrating that we can’t stand women who have earned power, and giving power to someone wholly unqualified to be Secretary of Education just because she is (1) a billionaire and (2) willing to assume that women who have been raped are liars and to give alleged rapists (Brock Turner, for example) the overwhelming benefit of the doubt.  DeVos serves to dismantle Obama-era protections, yet another demonstration of the racist need to undo all the good work done by a black president.  Trump’s proposal to Congress to end the Deferred Action for Childhood Arrivals (DACA) again erases an Obama-era program and, according to this article from The Atlantic, reverses upward mobility for many of the nation’s young people.

The travel ban imposed upon Muslim-majority nations, a ban rearing its ugly head anew, now includes Chad, North Korea, and Venezuela, much to the confusion of most people who are experts in information-sharing among nations with an interest in eliminating state-sponsored terrorism.  Chad’s inclusion, even in a Trumpian worldview, is quite confusing. Trump has baited North Korea and then blamed the nation for its (admittedly) dangerous and (hopefully) unwarranted missile tests.  The ban of Venezuela, whose citizens are suffering in many ways, including vast food shortages, seems cruel and, to put it lightly, un-neighborly, especially for a nation that offered aid to the United States after Harvey and Irma. The inclusion of non-Muslim-majority nations represents a chess move on Trump’s part to attempt to make the ban appear less targeted at one religious group.

Despite recommendations from his top military advisers and servants, the “president” continues to insist that transgender individuals should not serve in the military.  We shouldn’t have to be in an uproar about having a president treat people as less than human for their race, religion, national origin, and gender identity.  These groups are supposed to be protected under the law (Title VII, 1964, and Title IX, 1972) of the United States and are now targeted by the government of the United States.

What happened to infrastructure and jobs?  Why have the “president” and Congress spent nine months trying to repeal and replace the Affordable Care Act, only to find that it is the best solution we have so far?  (They could have spent those nine months fixing certain elements of the ACA to make it even stronger.) Where are the “progress” and “greatness”?  What is beneficial, humane, kind, generous, or noble about the way the United States is conducting business these days, within the country and beyond it?

Even Forbes has a list of the ten most offensive tweets from our “president.”  A man who uses his Twitter account and the Oval Office as a policy machine, bully pulpit, and series of contradictions is running our country into the ground.

It’s Raining

 

 

 

 

 

The skies have been sobbing for several months.  Gray clouds, torrents of tears, occasional peaks of sun, more torrents of tears.  The rivers are overflowing, thick brown mud churning as the waters make their serpentine path through this beautiful area.  This is southwestern Virginia in a climate-change spring and summertime.  While skies are gray and rivers are brown, everything else is green, green, green.  It’s beautiful, if you’re in the mood, you don’t think too much about the doom of ignoring climate accords, and you don’t have arthritis.

I’m a bit of a “torrents of tears” person.  I’ve always cried easily—at sad stories, sentimental moments, and hilarious events.  The tears just flow.  I used to apologize for them but eventually learned not to.  Now I just keep tissues nearby.  At this point, too, after having plugs literally placed in my eyes’ tear ducts to slow corneal erosion, tears are always welled in my eyes, just physically sitting there to maintain the health of the windows to the soul. I also use dozens of small vials of artificial tears each week, just in case my own natural sentimentality and plugged tear ducts aren’t enough.  So, yes, it’s raining, and so am I.

Over the last several days, I have sat with my father and brothers in my mother’s hospital room in the ICU.  While the notion and reality of tears and sobbing play a part in this context, my focus here is not on my own or my family’s worry and sorrow.  I’m writing today to sort through, in a preliminary way, what there is to cry about as we consider our health systems.  I’m concerned about three main factors: decentralization of care, poor communication, and high costs.  The comments I make here are quite apart from my support for the Affordable Care Act, which still makes the most sense for most people in the United States.  (*See this post to learn more about my support for the ACA and opposition to the AHCA.)

Deep knowledge about and experience in treating specific conditions are important.  We need nurses, nurse practitioners, physician assistants, and doctors to specialize in treating specific systems and parts of the body and specific illnesses and ailments.  I don’t argue at all with specialization, but I am concerned that an extreme focus on specialization has made us forget about the whole person who becomes the medical (and “medicalized”) subject.  There are excellent medical personnel who are working long hours to take outstanding care of patients.  The complexity of the job they do must be much greater than I can imagine, as they combine intellectual smarts, physical skill and stamina, and emotional intelligence.  They interact with many patients (more and more, as pushed by a healthcare system overly hungry for greater profit), their co-workers, the insurance companies, their internal and external IT systems, and the pharmaceutical companies.  A gigantic population of the aging introduces even more needs and ethical considerations in the healthcare realm.  All the while, medical personnel are trying to take care of real, live human beings who are complicated bundles of the physical, emotional, and intellectual.  They’re also dealing with the families of their patients.  It sounds close to impossible to manage it all, doesn’t it?  But they do it, and they keep up the pace, and I respect this.

One significant problem, nevertheless, is the decentralization of patient care.  From the patient and her family’s perspective, a medical emergency brings a foreign environment (the hospital, with its weird beds, beeping machines, loud entrances and exits, and frequent interruptions of rest and recovery), a host of visits from dozens of medical practitioners (the ones I listed above, plus the people who take meal orders, clean the rooms, and check on insurance policies), and a bewildering stream of disconnected explanations of the patient’s state (platelets here, crackly lungs there, the unexplained threat of “interventions,” whatever they are).  Oftentimes, the general practitioner, or primary care physician, is nowhere on the scene (busy as he or she may be with the hectic day-to-day of office and clinic visits).  This leaves the interpretation of the multiple explanations and medical pokes, prods, and procedures to the surrounding family members, who are often taking turns being in the room to nurture their loved one and understand the medical messages.  It ends up feeling like the patient who has a neurologist, cardiologist, ophthalmologist, oncologist, and hematologist becomes just a line item for each of these specialists, who is doing her or his darnedest to take good care of the patient, but who often seems unaware of the other doctors’ movements. In fact, my mother just spent three days in the hospital before being able to communicate to a medical staff member that she really wanted and needed her teeth brushed.  The little things for a patient’s care and daily well-being also matter and can be easily overlooked.

In my own case, I have a primary care physician who is wonderful.  Nevertheless, when I went to her to try to understand the big picture of my health (which doctors to trust; when to get a second opinion; how a drug for one chronic condition affects a different chronic condition; how certain forms of exercise are of harm or benefit; etc.), she asked quite bluntly (which I appreciated), “What do you want me to do?”  I heard myself answer, “Well, it would be great if you were to centralize my care.”  And that’s when I realized that the only people really centralizing care at this point are the patients themselves.  I realized, too, that this enormous burden, which I believe is a significant outcrop of the medical industry’s attempt to protect itself from risk, has dire implications for patients’ mental well-being.

The decentralization of care connects profoundly to the communication problems in the medical industry.  People who feel well could easily find it hard to track which doctor does what and why, and so imagine the increased difficulties for people who don’t feel well.  Most medical personnel do introduce themselves and identify their roles, but they frequently do not give an explanation for why they are poking, prodding, pouring, or popping.  It is even rarer for an explanation to be linked to the previous ministrations done to a patient.  While there are still many, many nurses and doctors who look at and really see the whole person/patient, many others are distracted by entering data into computers whose screens become the focus of attention.  They mumble to a screen, ask rapid-fire questions whose responses they don’t seem to register, and sometimes even ask why the patient is undertaking a course of treatment prescribed by that very doctor!  Sometimes they don’t even touch a patient, which certainly contradicts best practices from non-western medical traditions.

Some doctors charge patients for a missed or changed appointment, but the patient receives no recompense or reassurance when the doctor’s office changes or cancels an appointment.  Patients also often have to describe their symptoms on one single visit to numerous medical personnel, leading patients to believe that no one is actually listening.  One of my own sources of frustration is the perennial update of the medications list.  I bring an updated list to any doctor I ever go to, but the list is never updated by the next time I visit.  If this small example is extrapolated to the realm of urgent care, then we should have profound concerns about who is aware of a patient’s whole self and well-being.  Who is taking care of this communication?  Do they understand the uneasiness that poor communication sows?  Again, I believe the stresses on medical personnel are enormous, and so I am blaming the system, not its employees.

Not unlike the argument I made about the airlines in the “Who’s Sorry” post, I believe that many of the people on the frontlines of patients’ frustration with the big system are women—nurses, nurse practitioners, nurse aides, and insurance billing personnel.  While 2016 statistics show that CEOs of the biggest healthcare businesses (with pharmaceutical and insurance companies appearing to earn more than hospitals) are mostly men (the people on this list named Jody, Kelby, and Kerry are also men), we know the large majority of nurses and nurse aides to be women (here are old 2003 Bureau of Labor statistics that provide statistics on men and women nurses, African-American nurses, and Asian nurses in the United States; these 2015 statistics from Becker’s Hospital Review sort only by women-men).  Again, the people managing the healthcare industry and earning astronomical yearly salaries (in the tens of millions) are not the people dealing with the day-to-day frustrations of the problematic industry from which the ones in charge profit so greatly.

An additional obvious element of healthcare costs is the impact they have on patients.  (Here’s a useful link from the Kaiser Family Foundation about costs in the healthcare industry.) High premiums and deductibles, reduced employer contributions, decreased job mobility due to limits on pre-existing conditions, and high hospital and drug costs all contribute to a health system that is suffering from extreme ill health.  We need leaders who are willing to have broad and open conversations about the gray clouds and storms of our nation’s healthcare industry.

AHCA B.S.

How many of you out there have a pre-existing condition or know someone who does?  Hmm, let me count, yes, that looks like, well, everyone.  Do you have a father with prostate concerns or diabetes or a weak heart?  Do you know women who have given birth? (I’m guessing you know a few.)  Have you ever heard of a newborn with a serious medical condition?  Do you have or know children with special needs? Are you someone or do you know someone who has limited funds for routine care and/or unexpected medical needs?  Do you live in a state that has rejected federal funds for Medicaid expansion?

As I write this, the roll call of House of Representatives votes on the American Health Care Act (AHCA) is in.  217 Republicans in the House voted to pass it.  Not one Democrat did.  Final tally: 217-213 (with 20 Republicans voting against and one no vote).  *See this link for the full list: http://clerk.house.gov/evs/2017/roll256.xml.  Excuse my French, but this is absolute bullshit.  Hyperpartisanship is killing the United States public.  I’m no longer just speaking metaphorically.  This health care act is killing us.  (Remember: The ACA was helping us.)

The representative from my district in Virginia, Bob Goodlatte, declares himself proud to appear on the list of “ayes.” He is, kindly put, a Trump lapdog.  Goodlatte, in the company of mostly white, male, and Christian Republicans (*see this slideshow for the demographic breakdown of the Congress: https://www.usnews.com/news/politics/slideshows/the-115th-congress-by-party-race-gender-and-religion), has again chosen to ignore the constituents of Virginia’s Sixth District in order to pander to national, damaging trends.  Why do the demographics of our members of Congress matter, you might ask?  They matter because Trump and the trumpkins continue to push a traditional supremacist agenda that benefits them and their cronies and deeply damages the lives of those who are not like them.

We know this to be true if we do our own sample roll call of executive orders given since January 20, 2017:

“Implementing an America First Offshore Energy Strategy” (4-29-17)

“Buy American Hire American” (4-18-17)

“Promoting Energy Independence and Economic Growth” (3-28-17)

“Revocation of Federal Contracting Executive Order” (undoes fair pay and workplace regulation work done under President Obama; 3-27-17)

“Comprehensive Plan for Reorganizing the Executive Branch” (seeks to give more power to the executive; 3-13-17)

“Preventing Violence Against Federal, State, Tribal, and Local Law Enforcement Officers” (ignores completely [and repackages in the reverse] violence against black people and black lives; 2-9-17)

“Protecting the Nation from Foreign Terrorist Entry into the United States” (1-27-17)

“Border Security and Immigration Enforcement Improvements” (1-25-17)

“Enhancing Public Safety in the Interior of the United States” (crackdown on sanctuary cities; 1-25-17).

Many of the executive orders emphasize an expansion of executive power.  Look at the words.  Pay attention to the rhetoric, which both discriminates and co-opts language from the left. If you’re not a trumpkin, you are less than human.  If you are black, LGBTQIA+, Muslim, a woman, Latinx, or from another nation, you don’t deserve to live here, work here, love here, or be cared for here.

Make sure to take a look at Alabama’s H.B. 24, which was signed into law two days ago.  The bill allows “some state-licensed adoption and foster care agencies to reject qualified prospective LGBTQ adoptive or foster parents based on the agency’s religious beliefs” (cited here on the Human Rights Campaign website).  It is challenging and soul-sucking to absorb this bald discrimination and hatred.  Furthermore, again, look at the words.  Pay attention to the rhetoric.  This bill is called the “Child Placing Agency Inclusion Act.”  The use of “inclusion” co-opts language from the left and can easily lead to false conclusions about the legislation itself.  There is nothing inclusive about this legislation.  It excludes LGBTQIA+ individuals and couples from adoption and fostering.  It reduces the pool of prospective parents and excellent caretakers for children in Alabama.  It is bullshit.

The partisan Indivisible guide provides information here about the AHCA, or Trumpcare.  They state starkly that there are 10 principal reasons for which we should worry about the AHCA.  I am copying and pasting them here because we need to see the numbers and read the discrimination, and we’re going to need to keep bringing this proposed (and half-passed) devastation to the attention of people in the United States:

IF YOUR REPRESENTATIVE VOTED FOR TRUMPCARE, THEY VOTED TO:

  1. Take away health care from 24 million Americans. This is according to nonpartisan estimates by the Congressional Budget Office (CBO). This will result in 24,000 – 44,000 more Americans dying every year from lack of insurance. Not to mention medical bankruptcies, lost wages, untreated illnesses…
  2. Hike deductibles by $1500 on average. TrumpCare pushes Americans into low-quality, high cost-sharing health insurance by providing meager tax credits compared to the Affordable Care Act. This is the opposite of what Trump promised in his campaign.
  3. End the federal protections for people with pre-existing conditions. TrumpCare incentivizes states to drop consumer protections, meaning insurance companies will be able to charge people more if they have a pre-existing condition. 130 million Americans have a pre-existing condition. People could face premiums well over $100,000 a year.
  4. Allow insurance companies to charge older Americans significantly more for their health care. A single, 64 year old adult making $26,500/year would have to pay $14,600 in annual premiums—a 750% increase from current law.
  5. Cut $880 billion from Medicaid, a program that more than 70 million Americans, half of which are children, rely on. TrumpCare cuts federal funding for the program, which will result in states having to ration care and cut the quality of services.
  6. Put lifetime and annual benefit caps back on the table for even those with employer coverage. This means a baby with a serious medical condition could use up its lifetime limits in the first month of life under TrumpCare.
  7. Make women pay more for health insurance than men. Because insurance companies could charge more for pre-existing conditions like breast cancer or assault survival and because pregnancy care no longer would be a required benefit, women would once again pay morefor health care than men.
  8. Defund Planned Parenthood. Nearly 3 million Americans, especially women and families, receive affordable health care services annually at Planned Parenthood facilities. TrumpCare prohibits any funding from going to these clinics.
  9. Harm children with special needs by cutting Special Education funds for schools. Medicaid funds a large portion of education for students with a variety of disabilities. Buried in the bill is a provision that no longer recognizes schools as required Medicaid providers, on top of the massive cuts to the program.
  10. And, it does all of this in order to pay for $600 billion in tax breaks for the wealthy and corporations. I’ve said this several times in this post.  Look at the words. Pay attention to the rhetoric.  And then call out the bullshit for what it is.  We must stop moving dangerously backwards.

Stag-Nation

Here is just a smattering of recent battering headlines:

“The Rise, Then Shame, of Baylor Nation” (The New York Times, 3-9-17)

“Sexual harassment:  Records show how University of California faculty target students” (The Guardian, 3-8-17)

“Inquiry Opens into How a Network of Marines Shared Illicit Images of Female Peers” (The New York Times, 3-6-17)

“Why So Few Women in State Politics?” (The New York Times, 2-25-17)

“Donald Trump remains silent as white men continue to terrorize America” (New York Daily News, 2-17-17)

“How a Fractious Women’s Movement Came to Lead the Left” (The New York Times, 2-7-17)

“Report that Trump Wants Female Staff to “dress like women” Sparks Movement on Social Media” (The New York Times Live, 2-3-17; reported by MSN here)

“The Trump Administration’s Dark View of Immigrants” (The New Yorker, 2-2-17)

These are national headlines that clearly speak to the white supremacist heteropatriarchy in charge of our nation.  I usually soft-pedal my language a little more, avoiding such charged terms as “white supremacist heteropatriarchy,” but let’s call things as we see them.  The photo above, from Samantha Bee’s “Full Frontal,” speaks more than a thousand words.  The “president” has effectively created a boys’ club (almost all white) of men between the ages of 55 and 80.  He has sent the message that all people who aren’t part of this group are unworthy.  We know, though, that this group only survives through its attempt to appear strong by making others weak.  Groups like these are doomed to fail.

In the meantime, I wish I could say that the United States were just stagnating.  The unfortunate fact, however, is that we are moving rapidly backwards.  The world can see it, we know it, and only the little Trump pumpkins continue to prop up our stupid dictator.  *Check out Mexican surrealist painter Antonio Ruiz’s painting “El líder/orador” to understand this reference to the people I would like to officially dub the “trumpkins.”  Take note, too, that Ruiz painted “El orador” in 1939, a significant year in dictator history.

(http://www.artnet.com/artists/antonio-ruiz/past-auction-results)

There is no room to breathe now as we play defense on behalf of the First Amendment, the Civil Rights Act of 1964, Title IX, and the Affordable Care Act.  At the same time, we are reasserting what we thought were core values, such as welcoming individuals and groups from other nations, understanding that often it is better to keep families together, rather than wrench them apart, body autonomy, and loving our neighbors.  As the stags run (and ruin) our nation, they eliminate from their path anyone and everyone who is unlike them.  Those who are unlike them is a large and ever-growing subset of people.

Nevertheless, high-level business people know that well-run organizations encourage expression of divergent opinions and the cultivation of healthy debate.  These elements keep the organizations on their proverbial toes—innovative, collaborative, comprehensive.  (See Section III of Gender Shrapnel in the Academic Workplace for data and practical solutions on this issue.)  Isn’t democracy at its very core the idea that the people—in all of our differences and commonalities—will learn about the issues, educate others to be part of a well-informed citizenry, debate wholeheartedly, and then make decisions together about the best courses of action for all?

The national examples of stag-nation that I’ve provided here are replicated at the state and local levels.  In my state, Bob Goodlatte for decades has honed a dictatorial machine fed by national, white, male supremacist machinations.  (See previous posts in the Gender Shrapnel blog for examples of Goodlatte’s scary-ass brand of government.  Also check out Chris Gavaler’s Dear Bob Blog and Gene Zitver’s Goodlatte Watch.)  At the regional level, Ben Cline has consistently supported policies that are dangerous to all women.  (See last week’s blog post for more information.)

At the University of Virginia, where women comprise 56% of the student population, less than 30% of the presidential search committee is comprised of women, with two of those women being students.  In daily life, I watch my children perform in concert after concert whose playlist includes only male composers (some of whom, at least, are of color).  They participate on an official school academic team, for whose competitions they are asked questions primarily about Western civilization up to the year 1800 (i.e. not many women included, unless they are mythological figures or real-life muses).  They play on sports teams for which the girls teams are still playing in the smaller gyms or swimming in the shallower lanes.  They learn at school that transgender people will be forced into a bathroom not of their choosing.  In other words, we as a culture are not even moving forward on the smallest of everyday issues that affect us all (or many of us, at least).  We are seeing and experiencing how draconian governmental restrictions are severely limiting self- and group-definition and freedoms at the national, regional, and local levels.  This will affect our culture for decades to come.

What are Donald Trump, Mike Pence, Paul Ryan, Mitch McConnell, Bob Goodlatte, and Ben Cline so afraid of? Why must we who live in this country cater to their bizarre fears?  If they’re afraid of nothing and simply want unquestioned power, then why are we letting them have it?  We need fewer trumpkins and more resistance.  After “Willly Wonka”’s Veruca Salt, we need more resistance, and we need it NOW.