Tag Archives: politics

Hurricane Katrina: Lessons Learned

The primary and causative failure of government, according to the U.S. House report (2006), was that officials did not develop an adequate or accurate situational picture in a timely fashion. This lead to minimal preparation, ineffective evacuation plans, and an slow logistical supply chains for moving needed assets into the area to aid with the response. The second mistake, according to the report, was officials distancing themselves from the failures politically. This sole act (by many in the leadership) served only to protract the response and recovery and confuse the populace. Understandably, however, the politicians certainly wanted to be removed from the situation, as they could have lessened the burden years earlier with use of specific appropriations. Funds designed to mitigate the exposure of the Gulf coast to hurricanes were not spent as intended, if at all.

Looking back on the situation, had each government activated their EOC and staffed it with reputable public safety officials to run the response, the situational picture would have been clearer, especially with the various EOCs communicating together (Walsh et al., 2012). The plan might have coalesced into the use of an area command with resources deployed in task force and strike team convention as needed. Certainly, though, the public message would have been singular, to the point, and helpful to the public (Walsh et al., 2012). This would have lead to an expedited response and coordinated evacuations prior to landfall of Hurricane Katrina, which was said to be “predicted with unprecedented timeliness and accuracy” (U.S. House of Representatives, 2006, ix).

References

U.S. House of Representatives. (2006). A failure of initiative: Final report of the select bipartisan committee to investigate the preparation for and response to Hurricane Katrina. Washington, DC: U.S. Government Printing Office.

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Critical Incident Response Plans

The possibility of a large-scale event threatening the health and safety of a large number of residents in Connecticut is sizable. Emergency response plans (ERPs) need to be in place to address concerns including epidemic/pandemic disease, the intentional or accidental release of a hazardous material, contamination of the food and/or water supply, and other incidents that might threaten the 3.4 million residents and could result in mass casualties. For this reason, the State of Connecticut Department of Public Health (DPH; 2005) has developed an ERP to guide the department in the event of a catastrophic threat the lives and safety of the residents of Connecticut. Additionally, the State of Connecticut has developed a State Response Framework, much like the National Response Framework, in order to allow for a modulation of an incident from a local level to a state or federal level (State of Connecticut, Department of Homeland Security, 2010; U.S. Department of Homeland Security, 2008). The ability of an incident response to grow and shrink as an incident dictates follows the natural progression of incidents starting and ending locally, whether involving state or local responses at any time during the response (Walsh et al., 2012).

The ERP (DPH, 2005) that guides the DPH allows for representation in the state EOC while forming a modular incident management team (IMT) to staff the DPH emergency command center. The DPH IMT is designed not only to support the state EOC when activated, but also supports the various local incident commands as a public health and medical service resource. In keeping with the modular aspects of the incident command philosophies and the state and national response framework, the DPS ERP becomes a valuable resource for both initiating a response to a significant threat to the public health and safety and allows for an expert resource when other incidents of magnitude, but not necessarily public health in nature, require or benefit from the availability of public health experts.

One criticism I do have, however, is that the plan (DPH, 2005) does not address the provision of emergency medical services (EMS). For some time, there has been much confusion as to where EMS falls in the realm of emergency service functions. EMS, for many jurisdictions, is a function of the fire department and may fall under the direction of ESF #4, firefighting, especially as many EMTs and paramedics are cross-trained to fight fire. However, ambulances are not firefighting apparatus. As ambulances do transport the ill and injured, perhaps EMS falls to ESF #1, transportation. This is unlikely, though, as the primary need is not the transportation provided but the care rendered. Public health and medical services, ESF #8, seems to me to be the logical category for EMS to fall under, but EMS has an expanded role that also fits ESFs #9, #10 & #13 (search & rescue, oil & hazmat response, and public safety & security, respectively), as well as the aforementioned ESFs #1 and 4. This lack of initial categorization may allow flexibility in the deployment of EMS personnel and equipment, but it could also lead to ineffective deployment strategies resulting in a shortage of EMS in one area and overutilization in another.

References

State of Connecticut, Department of Homeland Security. (2010, October). State response framework. Retrieved from http://www.ct.gov/demhs/lib/demhs/telecommunications/ct_state_response_framework_v1_oct_10.pdf

State of Connecticut, Department of Public Health. (2005, September). Public health emergency response plan: Emergency Support Function #8 Public health and medical services. Retrieved from http://www.ct.gov/ctfluwatch/lib/ctfluwatch/pherp.pdf

U.S. Department of Homeland Security. (2008, January). National response framework. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Physician-assisted Suicide

I have always maintained that the best thing that I have ever done for a patient was to hold their hand as they died; however, there are few scenarios that I can posit where I would ever cause the death of another, and I would never do it in my capacity as a medical professional. In the State of Connecticut, assisting a patient in their suicide is illegal (Kasprak, 2003; Saunders & Smith, 2010). Saunders and Smith (2010) describe the use of “semantic ploys” (para. 3) in arguing for physician-assisted suicide and how the court deemed the “issue rests with the legislature, not with the court” (para 4).

Two states have laws permitting physician-assisted suicide, Oregon and Washington (Death with Dignity Act, 1997; Death with Dignity Act, 2008). The other 48 states either have laws forbidding assisted suicide, such as Connecticut, rely on common law, or have no laws permitting or forbidding the practice (Kasprak, 2003). Personally, my thoughts on the matter are clearly reflected in my opening statement. More compelling, however, is a recent discussion on the discontinuation of implanted cardiac devices in patients with a desire to “refuse continued life-sustaining therapy” (Kapa, Mueller, Hayes, & Asirvatham, 2010, p. 989). Many of the respondants to this study viewed the discontinuation of pacemakers akin to physician-assisted suicide, whereas less felt the termination of cardioverter-defibrillator therapy was an ethical issue. Oddly, lawyers indicated less problems discontinuing therapy than did physicians.

There are conditions that are so intractably painful and wrought with suffering that I would not even consider thinking less of a person suffering such a malady who took their own life. Death, for many people, is a fear beyond fear, and for a person (of considerable sound mind) to choose death as a viable alternative to such suffering, I commend their bravery and choose not to judge them negatively. No physician or other health care provider should cause the death of a person directly, but acknowledging the patient’s will to die is another matter. In lieu of providing a chemical means of ending life, a physician could, in my mind, counsel a patient on the means and methods that might be viewed as more effective and humane than other means which might result in unwanted suffering. I do believe that a person has the right to choose an alternative to a surely painful and agonizing death, regardless of the presence of depression. If a person is suffering from depression because of a terminal illness that is causing physical suffering, it is hard to imagine this person will resolve the depression before succumbing to the causal disease process. In these cases, the person has the right to choose a more dignified death. For those cases where the person is incapacitated and cannot make health care decisions, I feel that any friend or family member, or a consensus of available friends and family members, should be able to make the decision to continue or discontinue life-sustaining measures. Even if the decision is wrong for the patient, most of the time the decision is for the benefit of the family and friends and lacks medical relevance aside from resource management, though there are spiritual, emotional, and moral considerations that the next of kin may face which are no less relevant.

Personally, I grant any person permission to end my life if they see me engulfed in flame or if taken on the battlefield by an enemy known for public torture. Beyond these two circumstances, I will always choose to live so long as I have my thoughts. I have heard some people intimate that they would wish to die if they were conscious but perpetually paralyzed (i.e. locked-in syndrome); however, I am not so sure that I would want to die just for lacking the ability to communicate with others. I would want to view the world, though, perhaps by television or radio. I am too curious as to what comes next for the world. As we interfere with the dying process, it does make sense that we address the morality in which we do this. It does not seem right to have brain dead patients connected to ventilators and feeding tubes forever. It’s Orwellian.

References

Death with Dignity Act of 1997, O.R.S. 127.800 et seq. (1997).

Death with Dignity Act of 2009, R.C.W. 70.245 (2008).

Kapa, S., Mueller, P. S., Hayes, D. L., & Asirvatham, S. J. (2010). Perspectives on withdrawing pacemaker and implantable cardioverter-defibrillator therapies at end of life: Results of a survey of medical and legal professionals and patients. Mayo Clinic Proceedings, 85(11), 981-990. doi:10.4065/mcp.2010.0431

Kasprak, J. (2003, July 9). Assisted suicide (OLR Research Report No. 2003-R-0515). Retrieved from http://www.cga.ct.gov/2003/olrdata/ph/rpt/2003-R-0515.htm

Saunders, W. L. & Smith, M. R. (2010, June 21). Assisted-suicide advocates fail in Connecticut. National Review Online. Retrieved from http://www.nationalreview.com

Drawn into Politics

When I reflect on my realization that I had to be more politically and economically fluent, I recall a number of campaigns designed to urge the younger generation of voters to the polls. The most prolific one was Rock The Vote! (RTV!). In the midst of the current debates, I draw a correlation to how the younger voters were urged to the polls and how today’s Tea Party movement is drawing political commentary from the older and younger generations, alike.

RTV!, created at the Ministry of Sound nightclub in London in early 1996, has advocated comprehensive voter registration focusing on the younger demographics (Cloonan & Street, 1998; Hoover & Orr, 2007). The result, in some minds, is a prevalence of uneducated and uninvolved voters; however, according to Hoover and Orr (2007), the Rock the Vote campaign did little to increase the voter turnout within the 18 to 24 year-old demographic. Though I did vote following the RTV! campaign, I cannot say that the campaign had any effect on my likelihood to visit the polls. Instead, RTV! appeared to revive party politics by appealing to popularity-driven politicians in an environment of “the affection and admiration which audiences give to their idols” (Cloonan & Street, 1998, p. 36). RTV! may have reached its goal of 20 million votes from the younger demographic, but it was still only 10% of all voters as every demographic turned out in higher numbers for both the 2000 and 2004 elections (Hoover & Orr, 2007).

Though a bunch of individuals with their own ideologies, the Tea Party formed through a grass-roots movement to promote very simple founding principles of the American experiment: Constitutionally limited goverment, fiscal responsibility, individual liberty, and free markets (Tea Party Patriots, 2010). Discussing the impetus of the Tea Party, Marcuse (2010) counters that “if the displacement could be countered and redirected towards its actual causes, it might strengthen rather than conflict with progressive resistance” (para. 1). He seems to miss the mark.

In both instances, groups of individuals band together to promote a goal. For RTV! it is to maximize youthful voting. For the Tea Party, it is to underscore the purpose of our government. These are just two fine examples of individuals gathering together to have their voices heard in a way that might not be possible without the others. Whether you wish to change society or maintain its importance, groups are typically heard faster and louder than individuals, but integrity and honesty both demand that you act in accordance with your ideals, first, before rabble-rousing a group into action.

References

Cloonan, M. & Street, J. (1998). Rock The Vote: Popular culture and politics. Politics, 18(1), 33-38. doi:10.1111/1467-9256.00058.

Hoover, M. & Orr, S. (2007). Youth political engagement: why rock the vote hits the wrong note [Excerpt]. In D. M. Shea & J. C. Green (Eds.), Fountain of youth: strategies and tactics for mobilizing America’s young voters (pp. 141-162). Lanham, MD: Rowman & Littlefield. Retrieved from http://books.google.com

Marcuse, P. (2010). The need for critical theory in everyday life: Why the tea parties have popular support [Abstract]. City, 14(4), 355-369. doi:10.1080/13604813.2010.496229

Tea Party Patriots. (2010). Mission Statement. Retrieved from http://www.teapartypatriots.org/mission.aspx

Occupational Social Responsibility

According to Barendsen (2007), my profession is a caring one. I am a paramedic and I serve my community. I am also a firefighter who serves his community without compensation. It could be said that I blur the lines between my professional and personal life, but I enjoy great satisfaction doing so. I am by nature a very socially responsible person, but I extoll the virtues of taking personal responsibility. As a paramedic, I have a mantra: we combat stupidity.

As Barendsen (2007) points out, “workers in caring professions typically describe themselves as filling in or taking over a responsibility that others have abandoned” (p. 173). Everyone at some point in their lives makes stupid decisions. This is part of human learning, but some of these mistakes can unfortunately be lethal. This is where I feel that I make a difference in the lives of others. Driving too fast, smoking, eating too many fatty foods, or incidences of drunken abilities (in Texas, we had a saying that no good can from the statement: hey, hold my beer; watch this!). We all make these mistakes, thus we are all prone to stupidity from time to time. I enjoy the fact that many times I can help to allow others to learn from these mis-steps and reduce the lethality of their decision matrix.

There are times, however, that I have to get away from my occupation for my own sanity. I enjoy a number of hobbies and friends with varying interests that I can rely on to take my mind off of the worries of work. Also, attending school gives me added balance in the personal development side of life. Though attaining my degree will certainly better my professional outlook, I am seeking a degree solely for personal achievement. The prevalence of burnout in my profession is extremely high (Felton, 1998; Neale, 1991), so I make great efforts to balance and separate my personal life from my professional life. Admittedly, this is difficult at times because I am almost always on call.

References

Barendsen, L. (2007). Service at work. In H. Gardner (Ed.), Responsibility at work: How leading professionals act (or don’t act) responsibly (pp. 172-195). San Fancisco, CA: Josse-Bass.

Felton, J. S. (1998) Burnout as a clinical entity — its importance in health care workers. Occupational Medicine, 48(4), 237-250. doi:10.1093/occmed/48.4.237

Neale, A. V. (1991). Work stress in emergency medical technicians. Journal of Occupational and Environmental Medicine, 33(9), 991-997.

Addressing Health Disparities

It is troubling to many people to see any person suffering in our society. It is even more troubling to see inequality extend to whole ethnic and racial groups within our society. We certainly do not want to be an unjust society, and we certainly want every member of our society to benefit from the technological gains made in the last century.

One of the more troublesome areas that many view as unjust is health and health care. It is unfortunate that some members of our society suffer from disparities in health. For instance, immunizations and vaccines for most of the common deadly pathogens are readily available, yet many people fail to immunize themselves or their family.

Immunization and vaccination programs have eradicated smallpox and polio and have all but eliminated the threat of measles in the United States (U. S. Department of Health and Human Services [DHHS], 2000). With influenza and pneumonia causing 30,000 to 41,000 deaths in the U. S., annually, the importance of vaccinating against these diseases is quite evident. Obviously, lacking immunity to a deadly pathogen is a disparate condition of health status, and Hispanic and African American populations are vaccinated with less frequency than Whites. How are these issues being addressed?

On the international level, the United Nations (2009) is addressing health disparities by attempting to eradicate poverty on a global scale. Unfortunately, many of these global initiatives have created an environment rife with economic turmoil that we are just now starting to see and understand. Though the premise of helping people out of poverty is very noble, the reality seems to be that we can only offer means for people to help themselves. Otherwise, we risk thrusting whole populations into a world they know nothing about, setting them up for failure. Poverty is based on local economy, and I believe that these interrelated problems are best addressed on the local levels with assistance from states, nations, and global endeavors. The people must direct their own path for a successful transition. They must take responsibility for their own successes and failures.

The United States addresses these concerns on a federal level, offering guidance to states and municipalities in ways to address them. One of these methods is a report from the U. S. Department of Health and Human Services. Healthy People 2010 (DHHS, 2000) has two stated major goals: 1) to increase quality and years of healthy life, and 2) to eliminate major health disparities. There are also 467 objectives in 28 focus areas designed to further these two major goals. Immunization is one of these focus areas.

According to the CDC’s National Center for Disease Statistics (2010), the goal of achieving a 90% immunization rate for children 19-35 months of age is close to being reached. The combination diphtheria, tetanus, and pertussis (DTP) vaccine (85%) and pneumococcal conjugate vaccine (75%) are the only two recommended childhood vaccines that are not being administered at least 90% of the time. According to DHHS (2000), the goal for DTP vaccination was 80% in 2000. It appears that this goal has been reached and exceeded.

Conversely, older adults, age 65 and greater, are at an increased risk of contracting illnesses that could be prevented by vaccination. “In 1999 approximately 90 percent of all influenza and pneumonia-related deaths occurred in individuals aged 65 and older” (Centers for Disease Control and Prevention, Office of Minority Health and Health Disparities, 2007, para. 2). DHHS (2000) does not state a quantitative goal for vaccinating noninstitutionalized older adults, though it does mention a need to “increase the proportion of noninstitutionalized adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease” (p. 42). In 2000, 46% of the population in the U. S. were vaccinated against pneumococcal disease, and 64% were vaccinated against influenza (DHHS, 2000). In 2009, pneumococcal disease vaccinations increased by 15%, whereas influenza vaccinations increased by only 3% (Centers for Disease Control and Prevention, National Center for Health Statistics, 2010).

Striving to eliminating health disparities is a noble endeavor; however, the mere fact of attaining this goal contributes to the increase of health care disparity. By increasing the health care delivery model for one at-risk population, we must accept negative gains in the delivery of health care for all other populations. This is an example of the law of conservation describing the divisional nature of finite resources: when an isolated system undergoes change, its change in entropy will be zero or greater than zero (Negi & Anand, 1985). This concept is better stated as it applies to the zero-sum game of our economics today. Kathleen Madigan (2010), in a Wall Street Journal blog post, stated, “More spending in one area has to be financed by less purchases elsewhere” (para. 5).

Two conclusions can be drawn from observing this phenomena in health care. First, if people are spending their health care dollars on other staples, such as food, clothing, and shelter, then we should see a decline in the health of individuals that are making these choices. Second, within health care, in order to increase a focus on one population, an equal negative effect will be seen in all other population groups.

In all aspects of health care delivery, care should be taken to ensure just and equitable delivery of care regardless of socioeconomic factors, race, gender, religion, or creed. All people should have access to the minimum required care in order to maintain a healthy and productive life. We can counsel and educate our patients and clients to best health practices, but we cannot, however, force people to choose health over other facets of their lives.

References

Centers for Disease Control and Prevention, National Center for Health Statistics. (2010). Immunization. FastStats. Retrieved from http://www.cdc.gov/nchs/fastats/immunize.htm

Centers for Disease Control and Prevention, Office of Minority Health and Health Disparities. (2007). Eliminate disparities in adult & child immunization rates. Retrieved from http://www.cdc.gov/omhd/AMH/factsheets/immunization.htm

Madigan, K. (2010, August 3). With wallets thin, consumers face zero-sum game. Real time economics: Economic insight and analysis from the Wall Street Journal. Retrieved from http://blogs.wsj.com/economics/2010/08/03/with-wallets-thin-consumers-face-zero-sum-game/

Negi, A. S. & Anand, S. C. (1985). The second law of thermodynamics. A textbook of physical chemistry (pp. 241-289). Retrieved from http://books.google.com/

United Nations. (2009). The millenium development goals report: 2009. Retrieved from http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf

U.S. Department of Health and Human Services. (2000, November). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: U. S. Government Printing Office.

Conversations in the Back of the Ambulance

MS: So, we have about a half-hour ride to the other hospital. Would you be willing to help me out with a project for my anthropology class?

AP: Sure, we’ve been having quite a conversation so far.

MS: Okay, for the record and because of medical privacy concerns I will acknowledge your participation with the initials AP for Anonymous Participant. Also, I have to make sure that I note the generational differences between us.

AP: Well, that shouldn’t be too hard to do.

MS: No, certainly not. For documentation sake, let us say that you are in your 70’s, and we can leave it at that.

AP: I’m closer to eighty, though?!

MS: Wow, can’t even do a guy a favor!

AP: HA! So, what are these questions? I imagine it’s how to pick up the ladies, right?

MS: Yeah, sure, let’s start there! Actually, I wanted to ask more about your views growing up. Politics, religion, et cetera.

AP: Well, let’s start with religion. I think that will be the easiest.

MS: Okay, religion.

AP: Well, let’s see… I grew up in a fairly Protestant family. I mean, we went to church every Sunday and all, but we were never overly religious.

MS: Would you say that you were tolerant of other religions, or did you view your religion as the true religion of your god?

AP: Oh, no! We were very tolerant. We would never look down on anyone else because of their beliefs, especially their religious ties. The only problems that I have ever had with people were, well, the neighborly scuff – whose fence is on whose property – and, of course, mechanics. $1000 to install a $25 part… highway robbery for sure! And, I am sure I won’t like you too much after I get your bill!

MS: Obama will take of that, though, right? Actually, I do want to talk about your political views here in a minute, but let’s keep on religion for now. Do you think your views of religion have changed much over the years?

AP: Well, that’s tough to say. I’m pretty old, and I know that I’m gonna die pretty soon. It makes you think, you know? I mean, I know I want to make sure that I get a chance to tell the kids and the grandkids how proud I am of them, and I pray to God every day that I will get that chance. They all live in different States, so it’s tough to get them all together, lately. But, I find myself talking to God a lot more these days, but I am not sure if I believe in Him any more than I used to, as an adult, I mean. As a kid, he’s like Santa Claus or the Tooth-fairy; you believe in Him for no other reason than you were told to.

MS: Yeah, that’s kinda where I’ve been. I can understand that there might be a consciousness that is ultimately responsible for our creation, but I am not sure if I believe he knows what exactly he has created. Accidental or otherwise, we do exist, and it would only make sense that something put this in motion. Maybe I’m a theist, but mostly I don’t think about it. I’m usually agnostic or atheistic. Perhaps, I’m an agnostic theist?!

AP: Well, when you get as old as me, you want to make sure you are on the good-boy list.

MS: That’s Santa?!

AP: Close enough.

MS: Alright, let’s talk politics. I’ll keep it simple at first. George Washington, good or bad?

AP: Good, no great! He was a great man, Washington.

MS: Tyler?

AP: Who?

MS: Abraham Lincoln?

AP: Great!

MS: Wilson?

AP: What? Woodrow Wilson? Ungh… That was an evil man. Let me tell you about Wilson. Wilson is why this country is the way it is. I imagine that others before him wanted to do some of the things that he did, but sheesh, Wilson was the one that got it done. And, done, indeed, it is.

MS: What was so bad about Wilson?

AP: Have you ever heard of the Great Depression? That was Wilson’s work, there. Yeah, it happened a few years after he died, but the framework was his alone. Who were those other two guys? They came after Wilson…. I can’t think.

MS: Harding and Coolidge?

AP: That’s them. I remember my father telling me that if it weren’t for those two, Hoover wouldn’t have had a chance. Hoover was actually in office during the start of it, the depression. Lucky for me, I don’t remember it. In fact, don’t remember him. I think the first President that I can remember was F.D.R. He was the war President. As far as I recall, though, I think Hoover just ran with the Wilson plan, killing everything Harding and Coolidge did to fix the problems.

MS: So, I’m guessing you are a Conservative? A Republican, perhaps?

AP: I remember waving the flag for Roosevelt, so I guess I was a Democrat, then, you know, at twelve years old, or however old I was then… probably more like nine or ten. But, as I got older, especially from the time the war ended, I started paying attention to politics. I’ll tell you, it makes not one lick of difference if the guy is black, brown, yellow or white; if he’s a politician, he’s both a liar and a thief! We have had very few politicians that were honorable men, very few. And, these Progressives, well, they are the worst of them. This Obama is one of them.

MS: Yes, I believe Obama is a self-proclaimed Progressive.

AP: And, it shows. Wilson was a Progressive. Too many of them are. And, they don’t tell you! That’s the worst of them. They tell you what you want to hear, you elect them, then they do this about-face and spend, spend, spend us into oblivion. Looking back, this is certainly not my father’s country anymore. Ford was good, though. He never gets any recognition.

MS: So, Ford, good; Wilson, bad. Is that right?

AP: Yup!

MS: Interesting. I’m going to have to read up on Ford a bit more. You mentioned something about race a minute ago: “Brown, black, yellow, white”, something. What are your views on race relations in the United States?

AP: Oh, no… You aren’t gonna like me much after this conversation, but I’ll be honest. I always try to be honest.

MS: Okay, Ben Franklin, let me have it.

AP: Ha! Well, I can honestly… heh, honest… say that I have no problem doing business or maintaining friendships with anyone of any race, nationality, or creed. The problem that I have is the laziness and the sense of entitlement that many people have today. Fifty years ago, you didn’t see that, not like today, anyway. It’s just unfortunate that the minorities tend to have this attitude, this air of you’re not better than me, so give me money so I don’t have to work.

MS: Ahh, so the Progressives rear their ugly heads once again!

AP: Exactly! And, that’s what I was talking about. It’s this idea that if we give them money, they will use it to rise up and overcome poverty or something. Almost magical thoughts of levitation, if you will. One day, they will learn that if you keep giving people stuff, there will come a time when they forget how to earn it. Same with me. I’m sure that if the government sent me a check every week for not working, at some point, I would become complacent and not work. I doubt it, but it is possible I guess.

MS: Is it the government’s place to give out all of these entitlements?

AP: Again, I’m old, but I’ve made a pretty decent living for myself over the years. Medicare is a horrible system, but between that and my other insurance, at least you’ll get paid!

MS: Well, I’m not too worried about that. You sign my form, and that’s all I care about for payment. We have people!

AP: Yeah, tough guys always have people. But, community… community and family is what we need to get back to. That used to be enough. Granted, there were times that were really tough, especially for my family when I was born and right before. We had tough times, but we got through them. We were smart about it. We trusted that it couldn’t last too long, and it never did.

MS: Well, one thing that I’ve noticed is the propensity of my generation to move away from family. I think we rely on the internet for communication and planes, trains, and automobiles to visit from time to time.

AP: Well, we had a farm. When the family has a farm, you help run it. Actually, I think it was the farm that kept our heads above water all those years.

MS: I always wanted a farm. Is it still in the family?

AP: Nah. None of the kids wanted to keep it up. It is hard work running that farm, but we sold it off, paid our debts, and invested the rest. Pretty much been living on that after we retired.

MS: So, what was life like on the farm? I mean, family life specifically.

AP: Well, our farm was a part-time venture, so to speak. I would wake up, do some chores, have breakfast, go to work, come home, do some chores, eat dinner, do some chores, go to bed, and repeat. Don’t get me wrong, I enjoyed the hell out of it. The kids helped out when they were old enough, but the wife kept the whole ship running smooth. If it weren’t for her… well, let’s just say I wouldn’t still be here.

MS: Television and movies about years ago seemed to marginalize women. The wives cooked, cleaned, did the laundry, had babies… you’re laughing?

AP: My wife cooked, cleaned, did the laundry, had babies, sure, but I cooked, I cleaned, I did laundry, and I was very involved in the raising of our children. Don’t let those programs fool you. Family was family. We did it all. In fact, we both left for work at about the same time, though she would get home sooner than me. She only worked around the corner.

MS: You are describing a very concerted effort at keeping house and home.

AP: If you find a young woman to love, you take good care of her, and she will take good care of you. I remember a few guys that would mistreat their ladies, but back then, well, back then, we took care of things like that. Times get tough, but don’t mistreat your lady.

MS: Speaking of your wife, she said that she would meet us up here. So, I should give her all the respect in the world?

AP: Anything less, and I’ll smack you one!

MS: It seems chivalry ain’t dead!

AP: Not as long as I’m around, and I ain’t going anywhere, yet!

MS: No, it seems that you will be around to cause her grief for a little while longer, at least, but not with me. It seems like we’ve arrived. It was absolutely great hearing your story. I am honored. Is there anything that you would like to add?

AP: Yeah, tell the driver not to hit so many bumps next time!

MS: He’ll be opening the doors here in a minute. You can tell him yourself. Thank you again.

AP: Anytime, but next time, come by the house. I don’t need another ambulance bill!

MS: Understood.


As a paramedic, I enjoy many benefits. The single best benefit is certainly the ability to meet new people and talk to them. For this assignment, I felt it best to rely on the random nature of my job to gain the perspective of someone I have never met before. There are limitations, though, to this method of choosing a potential informant for this interview. Paramedics are bound by confidentiality, and though the informant granted express permission to use his words and his story, I could not ask him to waive his rights under the Health Insurance Portability and Accountability Act (1996). I felt that the limitation was not an undue hardship, and the benefits of gaining such a random perspective far outweighed the benefits of identification of the informant.

The informant that I interviewed was a 70-something year-old gentleman who was more than eager to share his story with someone so interested in listening. The most important discovery of the entire interview was that we all have interesting life lessons to share. If only more people would stop to listen, important lessons could be taught.

It is very important to note that this interview was conducted during a time when the informants mortality was in question. I feel that this opportunity is unique in the honesty and conviction of the responses to my questions. We started the interview by talking about religion.

The informant and I feel that we have quite the same religious background and beliefs (personal communication, June 2010). When I approached the topic of religious tolerance, he seemed to be more cognizant of character and overall morals separate from specific religious practices. This thought reinforced some of my core beliefs about the human condition, about how we are moral creatures.

Discussing politics gave me some real insight into how earlier Americans might have viewed the progressive versus conservative debate originally (Anonymous, personal communication, June 2010). I am sure that the informant is not an exemplar of all twentieth century American political thought, but he was able to draw some parallels with the current political environment. Tough times arise and people tend to get nervous about economic survival. It is easy to conceive that an incomplete understanding of politics and economics fuels the debate on both sides of the issues.

From politics, we moved on to discuss his view of race relations in the United States. Interestingly, it seems as though my informant might have been resigned to accept that he might have some racist tendencies until I asked him his thoughts and understanding of race (personal communication, June 2010). It turns out that he was slightly mistaken. My informant realized, during our conversation, that it was not racial differences that he was upset about but a general lack of motivation seen in many people over the years. It is just an unfortunate twist that he associated this laziness with racial stereotypes. Though we changed the subject quite abruptly, I could sense a rebuilding of his understanding of racial differences. It was good to see such a thing take place.

Family was strong throughout my informants life (personal communication, June 2010). Whether we were speaking of being raised by post-depression era parents or farm life with his own family, there was always cooperation to make the family structure work. I took exceptional notice during this portion of the interview. In the contemporary United States, I have noticed a disintegration of family and community. In childhood, I recognized the meaningfulness of family bonds and community spirit. I wonder how this changed. My informant describes a time that was not particularly easy on him or his wife, but they remained loyal to each other and to the family, specifically. Today, it outwardly appears to makes more sense for some to seek a better alternative at the first hint of difficulty or trouble. This is not what family means to either of us, and I am glad to see an example of how things work out pleasantly in the end.

Our interview ended with a particularly entertaining joke about him protecting his wife from any irresponsible comments that I might make (Anonymous, personal communication, June 2010). I am sure that he did not feel that he had to actually protect her from me, but I think he felt that he needed to make me understand how much he cared for his wife. Man to man, an idle threat seems to convey a universal understanding between men, whether serious or joking. I am glad to have witnessed this show of strength. I am sure that he is contemplating the fact that he will not be around much longer. I hope that he understands that he would leave his wife with good people in the world. I believe that this discussion was the impetus for my patient to realize that the world outside of [his neighborhood] is not a hostile or unfriendly world. I also think he realized that he will not be here forever, and his wife will be taken care of by the community that he supported for so long. I am glad to be a part of that community.

References

Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, §1177, 110 Stat. 2029 (1996).

Reducing Philanthropy to Political Commentary

In searching the typical news outlets for stories related to health care reform, be it local or national, I cannot help but notice that health care reform is the news. The factions are split, and the bias is evident. As the news outlets lean more to the left of the political spectrum than ever before, it is almost impossible to research the real issues at hand. Wading through the political views to glimpse a meaningful patient-focused agenda is quite difficult lately.

An article written by Randall Beach (2009) of the New Haven Register focuses on a group of doctors that rely on charity to provide health care to a select adult population who do not qualify for Medicaid and make less than $20,000 per year. Unfortunately, this article, like so many others, reduces philanthropy to political commentary.

Our current health care system is fragmented, and many people believe health care reform is needed (“54% Say Major Changes Needed”, 2009). As Dr. Peter Ellis is quoted, “Our motto is: ‘Health care reform starts at home'” (Beach, 2009, p. 3). It does not make sense, however, to provide Universal Health Care at the cost of our failing economy. Dr. Ellis’ group, Project Access, has secured funding from private sources, including the Hospital of St. Raphael and Yale-New Haven Hospital staff, the Aetna Group, the Community Foundation for Greater New Haven, and the New Haven County Medical Association Foundation. Additionally, 350 local care providers are associated with the project. This is a grassroots effort at helping to care for our neighbors, and as far as I have read, it seems to be a reasonable and responsible attempt to mend some of the local disparities to health care access.

Though I commend Mr. Beach for covering such a newsworthy story, it serves no one to inflame the current health care debates with political posturing by the media. I believe that the recent passing of health care reform will do nothing but create more clutter and complication for us to untangle when we finally have the financial stability to address the issue responsibly and realistically. In the meantime, I, like Project Access, will continue to volunteer my time and medical services to my community.

References

Beach, R. (2009, December 28). Doctors giving health care reform a head start. New Haven Register. Retrieved from http://www.nhregister.com/articles/2009/12/28/news/new_haven/a1_mon_nedoctors_art.prt

54% Say Major Changes Needed in Health Care System, 45% Disagree. (2009, October 2). Rasmussen Reports. Retrieved from http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/october_2009/54_say_major_changes_needed_in_health_care_system_45_disagree

Health Care Reform

In beginning this endeavor, I found it initially difficult to find anything related to health care legislation that I would be inclined to support or oppose in a letter to my Congressman. I tend to rely on the elections in order to convey my political positions. After studying some of the recent legislation, I found that the only premise that interested me was the adoption of The Patient Protection and Affordable Care Act of 2010 and the related Health Care and Education Reconciliation Act of 2010. Unfortunately, attempting to find credible dialogue on the internet regarding these laws is both impractical and near impossible. The special interest groups are leaning to their respective extremes. With commentary not proving trustworthy for factual insight, I relied on the Congressional Budget Office and the full text of the laws to cement my position. Using the aforementioned information in conjunction with Senator Lieberman’s contact information from the U. S. Senate website (http://www.senate.gov), I formulated a letter to him outlining my economic concerns (see Appendix).

I understand the grandeur of the idea of universal health care. I applaud the debates of how best to offer affordable or free health care to ever citizen of the United States. Unfortunately, as a nation, we are not fit in our financial means to proffer such an expensive entitlement. As Goodson (2010) reports, many of the initiatives outlined within the law are not guaranteed to be successful. This at an increased cost of $390 billion over the first 10 years (Elmendorf, 2010).

To ensure that my points were valid, I researched the approval ratings of these laws. According to WashingtonWatch.com (2010), approximately 80% of respondants do not favor the passing of these laws. More scientifically, however, a consistent range of 54 – 58% of Americans favor repeal of the laws, while 63% of senior citizens agree (Rasmussen Reports, 2010).

References

Elmendorf, D. W. (2010, March 20). Manager’s amendment to reconciliation proposal [Letter to the Honorable Nancy Pelosi]. U. S. Congress, Washington, D. C. Retrieved from the Congressional Budget Office website: http://www.cbo.gov/ftpdocs/113xx/doc11379/ Manager%27sAmendmenttoReconciliationProposal.pdf

Goodson, J. D. (2010). Patient Protection and Affordable Care Act: Promise and peril for primary care. Annals of Internal Medicine. Advance online publication. Retrieved from http://www.annals.org/content/early/2010/04/15/0003-4819-152-11-201006010-00249.full

Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152 (2010).

Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148 (2010).

Rasmussen Reports. (2010, May 17). Health care law: 56% Still Want to Repeal Health Care Law, Political Class Disagrees. Retrieved on May 22, 2010, from http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/march_2010/health_care_law

WashingtonWatch.com. (2010). P.L. 111-148, The Patient Protection and Affordable Care Act. Retrieved on May, 22, 2010 from http://www.washingtonwatch.com/bills/show/111_PL_111-148.html

Appendix

Michael F. Schadone
[REDACTED]
Woodstock, CT 06282

The Honorable Joseph I. Lieberman
706 Hart Office Building
United States Senate
Washington, DC 20510

May 22, 2010

Re: The Patient Protection and Affordable Care Act of 2010

 Dear Senator:

 My name is Michael Schadone and I am a nationally registered critical care paramedic working in Northeast Connecticut. I am writing you today because I do not support the recent legislation referred to as The Patient Protection and Affordable Care Act of 2010. I urge you and your colleagues in Congress to repeal this law. I believe that our efforts aimed at improving the economy will, in itself, dramatically reduce the disparities in access to health care.

Under the auspices of a progressive government, our country has seen many times of woe. Bigger government and higher rates of spending have driven our economy into the ground. It was only the idea of smaller government and trust in the American entrepreneur that ever caused unemployment rates to drop to less than five percent. More people gainfully employed means more people with access to affordable health care. Is this not our goal? In Europe, economic systems are collapsing. Many of the countries with universal health care have tax rates approaching 70 percent (including ‘value-added tax’). It is commonly held that suppressing the spending power of the citizenry will surely lead to a collapse of the free market, the basis of our economy. I certainly do not want the United States of America to resemble Greece, Portugal, Spain, or Cuba. We are the Great Experiment, and so far, it is working. I fear, though, not for much longer.

I favor universal health care just as I favor universal education and other entitlements but not at the expense of our country. Improvements to the economy will put us in a position to gain strength and enable us to afford such a sweeping paradigm shift in health care. More importantly, a better economy will allow us to do it properly. I urge you to focus on the economy and repeal this dangerous law.

 Sincerely,

Michael F. Schadone

Freedom vs. Health Care Reform

In the United States, we believe in individual rights, some of which are enumerated in the U. S. Constitution. The right to health care is not one of these. As our country prospers or declines, we may amend our Constitution to ensure more rights or take them away. The question, now, is can we afford health care for all? At this moment, I believe we cannot. Other countries have attempted to provide health care for all of its citizens but are facing economic troubles in spite of 70% tax rates (Clark & Dilnot, 2002). I believe that high tax rates are dangerous to the economy because the people and the government compete in mobilizing the economy; whereas with lower tax rates, the small businesses can drive the economy (U.S. Small Business Administration, Office of Advocacy, 2006).

It is my experience that those who overutilize health care are those who are under-insured (e.g. Medicare and Medicaid) and uneducated about the health care system. Further, it seems that the underpayment of costs by the Medicare and Medicaid programs are driving up the recoverable costs to other payors (Brennan & Mello, 2009). This is why I believe that our health care system is as expensive and inefficient as it is. “The U.S. health care system also spends more on administrative or overhead costs related to health care,” says Garber and Skinner (2008, p. 32), but they attribute this to administrative waste where I conclude that the over-administration is needed to meet the demands of an over-regulated and inefficient payment system.

In conclusion, our health care system is linked to our economy, and improving the economy is the only way to ensure that our health care system improves. By adding entitlements, we are forcing the American people to minimize their financial growth and, thereby, their financial freedom to choose affordable health care.

References

Brennan, T. A. & Mello, M. M. (2009). Incremental health care reform. Journal of the American Medical Association, 301(17), 1814-1816. doi:10.1001/jama.2009.610

Clark, T. & Dilnot, A. (2002). Long-term trends in British taxation and spending (IFS Briefing Note No. 25). London, UK: The Institute for Fiscal Studies. Retrieved from http://www.ifs.org.uk/bns/bn25.pdf

Garber, A. M. & Skinner, J. (2008). Is American health care uniquely inefficient? Journal of Economic Perspective, 22(4), 27–50. doi:10.1257/jep.22.4.27.

U.S. Small Business Administration, Office of Advocacy. (2006, September 28). Small business drives the U.S. economy — represent 99.7 percent of all businesses, employ 57.4 million (SBA No. 06-17 ADVO). Retrieved from http://www.sba.gov/advo/press/06-17.html