27 July 2009

Personal Responsibility

5 Facts:
  1. You always have a choice. Even if your choices are only crappy ones, you still have a choice.
  2. Choices come with consequences.
  3. Not all consequences are good.
  4. Not choosing is still a choice.
  5. “No one can make you feel inferior without your consent.” Eleanor Roosevelt.
I didn’t learn about personal responsibility until well after I graduated from college. My father died when I was young and my mother wasn’t so good at it herself and thus not a great role model. My siblings were all older by many years, but to her credit, my sister (closest in age but still 4 years older) I think occasionally tried to point out responsibility for actions, but I think she tried more by example, and me being so much younger couldn’t quite make the leap without explicit instruction. Needless to say, it wasn’t until I was out on my own, defaulting on my student loans, drowning in credit card debt, losing my driver’s license, and almost getting evicted from my apartment did the whole idea of responsibility start seeming like something I should become familiar with.

Recognizing my inherent luck, I did actually start figuring it out. It wasn’t easy, and it wasn’t without humility. Explaining wage garnishment to your boss is never a pleasant conversation. Handing the BMV clerk your certificate from Traffic School and proof of payment for the outstanding speeding tickets is embarrassing. Getting lecture after lecture from credit card companies as you’re trying to work out affordable payment plans for overdue balances is tedious. You become very practiced at admitting your fault and negligence and promising that you are trying to fix your mistakes. But I did it. I admitted making mistakes and started making a plan to fix those mistakes and start taking responsibility for my actions.

It might be because of these hard lessons that I tend to have little sympathy for people when they refuse to hold themselves accountable for their actions. It’s one thing to not realize you made a mistake, and for that, I have all the sympathy in the world, because, well, see above. But when these mistakes become apparent and you leave them as such and prefer to wallow in misery and complaining or just keep the status quo, that is when my sympathy ends. You have a choice. You always have a choice.

Sometimes the consequences are hard. Yes. But sometimes choosing to not make decisions leads to harder consequences. And sometimes those consequences lead to more decisions and more consequences. But you always have the choice. There is no other force at work destroying your life. You make the decisions. You decide. You.

People make hard choices every day. People decide to turn off respirators. People decide to undergo chemotherapy. People decide to quit chemotherapy. People decide to take second or third jobs. People decide to get sober. People decide to take medication. People decide to abandon their families. People decide to get divorced. People decide to swindle others out of millions of dollars. People decide to cheat, steal, and murder. And people decide to listen, help, and heal. People choose to try. People choose to give up trying. People choose. You choose.
And the only person to blame for your mistakes is you, because you chose. Maybe you didn’t know it was a mistake when you made the choice, but you made it. But the best thing is that you can make more choices, choices to fix the mistake, choices to lead you somewhere better. You get to make that choice. And there are always choices.

A class on personal responsibility should be a requisite before graduating high school. We learn cause and effect in physics, bull and bear markets in economics, and good versus bad in philosophy. But we never get that explicit lesson in how that relates to us. Just words on a chalkboard or characters in a book. These don’t work because we are real people. Real people making real decisions, with real consequences.

No matter what it is, it’s always about our own choices. I hope America can remember that and preserve that.

20 July 2009

Job Performance

Most employers have some sort of standard job expectations and an appropriate performance review/management system. For example, I started my current job one year ago next week. I was told upfront that the first few months are a gradual ramping up process—even even though I was familiar with my actual job responsibilities, learning the new company’s preferred methods and standard operating procedures would take some time. After that, there were to be regular performance reviews to assess my ongoing performance. Unless you are hired for a specific task in a specific timeframe (such as consultants, contractors, freelancers, or designated “fixers”) you are given a reasonable amount of time to reach reasonable goals. However, even some of the aforementioned short-term project employees are still monitored throughout the performance. I expect my landscaper to be making sufficient progress on our new patio within the reasonable time he has estimated. If not, I’m allowed to consult with him to figure out what’s wrong and how we’re going to address it—and only if it’s not addressed appropriately (per our contract) can I start thinking about monetary repercussions or firing him if the work isn’t satisfactory.

Where am I going with this? The White House, that’s where. Seven months in and I’ve already heard several people exclaim about Obama being the “worst president this nation has ever had.” One person, who I thought was actually a bit more moderate, even said about Obama, “I used to say this country wouldn't see a Prez worse than Clinton - wish I'd been right….” Now I get that opinions are going to be skewed by core beliefs, but if your boss came to you after only seven months on the job and told you that you were the worst person he’s ever seen doing your job ever? Especially if it’s a job you’ve never held before? Don’t you think you’d want a chance to say, “Hey, boss, I’m new at this, let’s talk about it and maybe give me some more time to figure it out?”

All that aside, wouldn’t you also want your performance to be based on what you were actually hired for? Whether or not you agree with the policies, Obama was elected to do a specific job based on his campaign. Based on actual job performance standards on accomplishing the task he was elected to do, he’s still above 50% in overall approval rating (and according to Dick Cheney in 2004, anything over 51% is a "mandate"). I absolutely loathe George W. Bush, but looking at his first 6 months in his first term, he did exactly what he was elected to do, I will never argue that. Do I hate that he was elected by people with diametrically opposite opinions and values than me, of course. But he at least followed through with his goals. Unlike, say, Arlen Specter.

So, ask yourselves, oh people pissed off at Obama… would you be happier if Obama turns out to lie to more than half the nation and begins acting on a more conservative agenda? Because when Clinton lied about the Lewinsky issue (an issue that had absolutely nothing to do with his responsibilities as president), conservatives felt that was an impeachable offense. After all, if he lied about this, what was to stop him from lying about important matters concerning The Country?!?! But, well, now, when liberals complained about how the Bush administration lied to the country about reasons for going to war—a matter actually affecting the entire country—the the conservatives figured that was OK because Saddam was bad anyway, so it didn’t matter that the nation’s leader lied. Maybe lying isn’t really that clear-cut an issue for the conservatives after all?

I wish they would admit it, what really pisses them off is not that Obama is “bad” president it’s that people who believe differently are now getting their way. Clearly they aren’t concerned with his actual performance as commander-in-chief, because 1) he’s doing what he was actually elected to do, and b) because he’s only been in office for seven months, not near long enough to see what his actual presidential legacy will be. He hasn’t even had time lie about anything, for crying out loud!

I remember when people complained about George Bush, they were told “love it or leave it!” Basically, if one couldn’t embrace the policies, then they should pack up and move to another country. My boyfriend responded once that he’d rather have Option C: Work within the system to affect a desired change. Of course, what the liberals didn’t realize back then was that “leave it” could refer to entire states. Though, we all know how that turns out. And because you can’t force anyone to love something, that only leaves my boyfriend’s Option C. How do you think that turned out?

13 July 2009

In Support of “Universal” Healthcare

5 Facts

  1. People with emergency medical needs get medical care, regardless of their ability to pay.
  2. The government is already involved in healthcare – individuals and families that are at a certain income level or meet other requirements are eligible for Medicaid, and people over 65 and with certain medical conditions or disabilities are eligible for Medicare – systems paid for with taxpayer money through income taxes. You cannot “opt out” of paying this tax.
  3. Health insurance coverage is not federally regulated, it’s left to the states to determine what, if any, regulation is placed on health insurance companies.
  4. Health insurance companies are private, for-profit businesses.
  5. The US government is made up of people elected by the people, for the people.

My political beliefs trend toward the constitutionalist/libertarian track. I feel government – local, state, or federal – should have an extremely limited role in my life and only focus on the matters affecting the group of people as a whole. I firmly believe that your rights end where mine begin and vice versa. Your ethics and morals should have no bearing on my ethics and morals except when it comes to affecting our collective rights. That said, I do believe one of the roles of government should be to uphold the Constitution in providing – for all citizens – the basics of life, liberty, and the pursuit of happiness. And pursuant to that right to life, medical care is essential. The Constitution of the United States makes no direct guarantees to the freedom of healthcare, but it does uphold the right to “life” as stated in Amendment 14 (bold for emphasis mine):

1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

To the point – no one can prevent someone else’s right to life. The AMA Code of Ethics also says, “A physician shall support access to medical care for all people.” From the Constitution and the AMA Code of Ethics, it is clear that the right to medical care is granted to all people – and there is no restriction or clarification regarding the ability to pay for such services. Hence, the argument for the government and physicians to provide, at a minimum, access to healthcare for all citizens is in place.

The problems develop when we try to figure out how to implement and pay for that that healthcare. Right now, the debate is between the current privately-funded insurance industry versus a government-run healthcare plan. So let’s take a peek at them side by side. Remember, though, that the US has never had a government-run plan, so that side of the equation is still based on other countrys’ models with a healthy dose of supposition.

Table 1. Stacking Up: Private vs. Government Healthcare Plans
ConcernPrivate IndustryGovernment-Funded
Decision MakersPrivate citizens who are elected board members by shareholders (also private citizens); no influence on these roles by individual patients unless patients happen to be shareholders.Public officials, elected by the voting public or appointed by elected officials elected by the voting public.
EligibilityVariable. In some states, companies that provide insurance are required to provide it for all employees regardless of their health status or ability to pay. In other states, only those who can afford it can purchase it. For individuals without access to a company plan, coverage can depend on health status despite ability to pay, etc.Everyone.
CoverageVariable. Each insurance company decides what services will be covered for which plan and which people can be covered under which plan.Fixed. The government can set the minimum services covered for all US citizens.
CostVariable. Premiums are dependent on a multitude of factors varying from company to company, plan to plan, and service to service.Fixed. The government can set a single standard price for all services for all people.
Responsibility of PaymentIndividuals with health insurance pay premiums, co-pays, and deductibles per their specific plan. Individuals who pay taxes also cover the cost of the current government-funded healthcare programs covering those who cannot pay themselves. Essentially, individuals with health insurance are paying twice – once for their own coverage and a second time for the government programs. Those who pay taxes but cannot afford health insurance are still paying for the government-funded programs – for which they might not even be eligible, thus paying for healthcare they themselves can’t even access.All taxpaying individuals will pay only once for healthcare – covering themselves and those who cannot pay. All people, however, will have access to care, period.

Am I oversimplifying? Maybe a bit, but even in trying to simplify, look at how complex the explanations are in the Private Industry column. Almost every answer can be “it depends.” Because everything is variable, there are not standards or regulations. In doing research, I found a site that lays out the pros and cons for government healthcare and it provides a good summary of the “con” arguments. Go read 15 reasons to NOT support government healthcare. But read them carefully. Then, go back and re-read the list and ask yourself this, “Is this already happening within the private healthcare insurance industry?”

Argument against (and this one is so good I’m quoting directly): “Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.” Seriously? With the oft-reported “soaring costs of healthcare” people are going to argue that the current system leads to “greater cost control?” And where, exactly, is the competition when people need emergency healthcare? Or in fact, when their choices are limited based on their “network?” I can’t believe this argument even makes the list.

Argument against: “Government” will decide what is elective and what is necessary; or restrict drug access. Private insurance companies already do this. Ask women who have need breast reduction for health reasons – some get it, others don’t. Or IVF, some companies cover it, some don’t. There’s even a push to legislate that all companies be required to provide IVF coverage. If we’re trying to legislate that already, why not just legislate it all? As for drug access or availability, maybe you should look closer at your insurance materials. I’m certain you will find a “formulary” – a list of what drugs are covered by your insurance and which ones aren’t.

Argument against: Government runs slowly, it could take months to get anything done. How long does it take for the average health insurance reimbursement? How long does it take to go through the red tape with your insurance provider to have a procedure approved? Health insurance companies often delay processing claims and requests on purpose, hoping you’ll forget about it or get fed up and give up fighting so they can save money. And don’t forget that some insurance companies – even after approving a procedure – can change their mind and force you to pay after all.

Argument against: Slippery slope – the government will implement “sin” taxes or limit our personal freedoms. Health insurance companies already do this. People can be denied coverage for smoking or for being obese. And the government has already instituted taxes on cigarettes and alcohol. The thing is, if it’s legislature, citizens have the right to voice their concerns and vote against such measures – and elect officials who will vote no on those measures. If your health insurance company tells you that if you gain more than 10 pounds in a year they’ll drop your coverage, you don’t get to vote “no” on that.

Argument against: Soaring costs – with one system paying for everyone’s care, my taxes will go through the roof! Maybe. Maybe not. Remember that you elect officials who decide those tax issues. Unlike with private insurance, if your rates go up, you have no recourse (you can try to change plans, of course, but you are still at the mercy of the companies). With the government system, you do have a say in the rates and who decides those rates. And yes, consider that your current taxes for Medicaid, Medicare, and your private insurance premiums would then go away and become one single healthcare payment. And because the government officials are elected by you and represent you, if that cost is excessively prohibitive, you *do* have a say in getting it changed.

And let’s not forget my favorite argument, the one I hear constantly – “I don’t want to have to pay for other people’s care. They should have to take care of it themselves.” Well, sorry to break it to you, but you already ARE paying for other people’s care. Your taxes pay for Medicaid and Medicare. Your premiums go up every time someone else in your health insurance group incurs too much cost. You are already subsidizing other people’s care, period, both through the government AND through your health insurance company. Under this argument, at least with government-controlled care, you’re only getting screwed once instead of twice.

And those are just a selected few of the arguments. Almost every single one of the 15 reasons can be refuted with “it’s already happening (either in the private industry or government already)” or “if government controls it, citizens will at least have a say.” Opponents to government-run healthcare like to assume that the government acts as a “private” industry and that they can just institute rules and make decisions in a vacuum. Even though that is exactly what the health insurance companies are doing right now. The real argument is that the healthcare industry employs thousands of people, and those people don’t want to lose money, and politicians don’t want to lose campaign contributions. I’m sorry, but my healthcare is a heck of a lot more important than an insurance company fat cat’s greed. People also don’t want to be held responsible for their own choices and become active in government to help shape those healthcare policies. It’s easier to say you “have no choice, the insurance company does things their own way” than step up and take responsibility yourself. After all, if you don’t make your voice heard and Congress acts against your wishes, you only have yourself to blame. But if you do vote and Congress still acts against your wishes, you still have recourse to keep trying to change things.

I am suffering no delusions that there is a single “magical” answer to the problem. But I also know that the current system is not working. The CDC recently published a report on the increase of people without health insurance coverage. When the current system is not meeting our needs, and in many cases is abusing our freedoms already, we have no choice but to take action. We are guaranteed life by the Constitution. And our government is set up “by the people; for the people.” I think it’s high time the people started demanding what is their right and start taking care of it ourselves.

06 July 2009

Less Cowbell

The world seems to have gotten awfully complicated lately. There’s just so much more than there used to be. More people. More entertainment. More places. More food. More music. More news. More More More More. Sometimes, it’s hard to find the truly meaningful things in that sea of “so much.” That’s what I want to do here on this blog, sift through that noise and see if I can find the simple – the kernel in the melee that is solid. (I'm not immune to the irony of adding more noise to the world by adding this blog.)

I’m not saying there isn’t a place for the complicated, because there is. In a country of more than 300 million, there are just some things that aren’t simple no matter what. But even the complicated things can still have simplicity, a simple goal, simple idea, or a simple result or feeling. A simple truth. Sometimes people get carried away with the complicated and it becomes overwhelming and stressful. And simple doesn’t always mean easy, either. Sometimes, a simple choice can lead to very complicated results. But the simplicity itself holds something mysterious and beautiful and even terrifying at the same time.

And also, my “spousal equivalent” already agrees with about 90% of my beliefs and though he is 100% supportive of me and will listen to me justify my beliefs repeatedly, it would be nice to give him a break occasionally.