Shortly after I left the full time practice of law to run a chemical dependency treatment center in 2001, a friend asked me if treatment works. I observed that it seemed like 20% of the patients who went through treatment succeeded in staying in recovery after a single rehab experience. 20% of the patients would never recover from their chemical dependencies no matter how many times they went through a treatment program (the so-called "Lost"). The remaining 60% were an unknown. Their likelihood of success depended on the treatment experience, the appropriateness of the program, the skill of their counselors, the support of their families and their ability to deal with their unique personal struggles and willingness to give sobriety a try. For the entire six years I worked in the field as an administrator, the 20/40/20 ratio continued to ring true.
I've been thinking a lot about the lost 20% lately because if we accept the premise as true, i.e., the Lost are never going to benefit from chemical dependency treatment and learn to live normal, productive lives, then we have to acknowledge in this era of hope with increasingly limited resources that the costs of supporting the Lost are expensive, long term propositions. We also need to acknowledge that it may not be appropriate to allocate resources as we have historically to care, and coddle, the Lost, while so many members of society are, as a result, denied access to remedial resources.
I am mindful of, and have long admired, Hubert Humphrey's observation that the true measure of a society is how it treats its most vulnerable citizens. To be clear, I am not speaking of persons with mental or physical infirmities that make successful chemical dependency treatment or to otherwise function productively in society impossible.
Rather, I am talking about the segment of society that consciously chooses to play the "treatment game", bouncing from program to program as an alternative to accepting the responsibilities of employment, parenting, self-betterment and other indicia of adulthood. Too often, these Lost fly below the radar of societal scrutiny, relying on commonly held perceptions of the challenges of chemical dependency to avoid being held accountable.
In the past, taxpayers just paid for the Lost to attend one treatment program after another, often with a short hiatus between episodes of shelter in well-intentioned licensed facilities. The financial impact was enormous, but it was a price society quietly paid to warehouse the Lost. Three years ago, my employer received about $2,500 a month for counseling services rendered to each client. Using my 20% rule, at any one time, the treatment center was home to 15 clients who I'd consider part of the Lost. On an annual basis, that amounts to providing treatment for 180 of the Lost. At $2,500 apiece, it cost taxpayers $450,000 a year, effectively wasted, to treat the Lost. $450,000. One treatment center in the "Land of 10,000 Treatment Centers". Wasted.
So, what do we do as a society? How do we justify wasting such vast sums of taxpayer money with minimal likelihood of success when so many programs are being cut or eliminated and so many of the vulnerable adults championed by Vice President Humphrey are going wanting?
I recently posed this question over lunch to a friend who is a former officer of the local N.A.A.C.P. I'll call him "Jeff". His answer was startling, probably because it was not the usual "society cannot give up on those who struggle". Jeff responded that it was like clearing garbage from one's home when its accumulation impairs the living environment: "We have to take out the trash".
The scope of the topic of our concern went beyond the chemically dependent who were incapable of sobriety. It included generations of what are typically thought of as underprivileged residents of the community who are perpetually un- or under educated, employed and/or engaged in self-betterment. Focusing on the Black community, my friend observed that the election of our new president offers a positive role model for today's youth and that the ongoing race card blame game used as an excuse by many of their elders lacks credibility. Jeff suggested that it is time to move on from the chronically chemically dependent Lost and from those unwilling to make any effort to reside in society as lawful, productive members.
But, of course, moving on has its consequences. To use Jeff's analogy, you still have to deal with the trash left behind. From Jeff's point of view, this requires establishing residential campuses where persons otherwise intent on disrupting society are required by court order to live. Residents would be responsible for maintaining their living quarters, assuring a drug-free environment and not tolerating lawlessness. Residents unable to abide by these guidelines would face jail time as a consequence of whatever conduct landed them in the residential campus in the first place. Eventually, the scufflaws would age to the point that they are not a threat to society as a whole or to themselves, and society will have survived to a clean start.
I cannot conceive of any cooperative effort by law enforcement, the judiciary, civil libertarians, social services and willing taxpayers that would allow the creation of such a system. The liberal in me fights the idea that we've sunk so far that intelligent men like Jeff, long involved in the Black community, see no viable alternative to the current situation or to the residential campus concept besides building more jails.
I am back to my original dilemma. I believe that we have a responsibility as a society to help those who cannot help themselves. But, what do we do with those who choose not to seek to partake in economic recovery? What do we do with those who have given up on themselves and choose the comfort of an artificial high to making the effort to live drug-free? As with the classic philosophical debate about the lifeboat carrying 7 people that can only sustain 6, we have some choices to make.
Government and philanthropic financial resources are increasingly precious at the same time they are in increasing demand. It simply makes no sense to deny services and support to persons with legitimate needs because we continue to throw money at others who are making a conscious decision to be wards of the state. Maybe cutting the latter group from support is a form of "tough love". But what then?
I have no answers today. I merely pose the question and ask that we keep in mind the billions of dollars that are wasted as governments and charities are being played for chumps. There are so many worthwhile programs that have done so much good for so many people. I witnessed the successes repeatedly during my six year stint in the social service community. The dilemma is not with the program participants who strive to achieve success. The problem is with the faux participants who park themselves at the public and philanthropic trough with no real desire to use the opportunity to make a difference in their lives.
What do we do? I welcome your comments.
Thursday, April 30, 2009
Thursday, April 23, 2009
Answer the Damn Question!
I spend most Sunday mornings catching up on the week’s issues and events by watching several news shows that I’ve recorded on the satellite’s digital video recorder. I usually start with TPT 2’s Almanac and Washington Week and move on to ABC’s This Week with George Stephanopolous and NBC’s Meet the Press. I ignore Fox. If I skip the music and matters that don’t interest me on Almanac and skip the commercials on This Week, I can be up to date in a little over 90 minutes.
This past Sunday was no exception, except (sorry) it gave me an idea for this blog: Politicians do not like to answer direct questions. This Week started out with two interviews. White House Chief of Staff Rahm Emanuel was first up. He was brilliant in his portrayal of the work of the Obama Administration and successfully defended its efforts from partisan attacks. He was necessarily vague about some aspects of the President’s policies. I accepted everything he said without pause or concern. ;-)
George Stephanopolous’ next guest was Republican Congressman John Boehner from Ohio. Congressman Boehner serves as the House Minority Leader in Congress and often serves as the spokesperson for the Republican Party. I was so startled by his exchange with Mr. Stephanopolous on the subject of carbon emissions and climate change that I had to watch the interview again to make sure I had heard it right over my hamburger/onion omelet (cooking is another part of my Sunday morning ritual).
Here’s the transcript of the exchange (with my comments in parentheses):
George Stephanopolous: Describing Congressman Boehner’s reaction to the decision to allow the E.P.A. to regulate carbon dioxide as means of controlling greenhouse gasses.
Congressman John Boehner: This decision is nothing more than a backdoor attempt to enact a national energy tax that will have a crushing impact on consumers, jobs and our economy. The Administration is abusing the regulatory process to establish this tax because it knows there are not enough votes in Congress to force Americans to pay it. (In 2006, more than 2 years before the election of Barack Obama, the U.S. Supreme Court ruled that Congress had given the E.P.A. authority to regulate carbon dioxide in the Clean Air Act. The economic consequences of regulating carbon dioxide emissions are not a “national energy tax”. They are the wages of our sinful ignoring of the problem for decades and now being forced to implement extraordinary measures to try to save the planet. Repeat for effect: to try to save the planet.).
GS: Let me ask you then about energy. You’ve come out against the president’s plan to cap and trade emissions. So what is the Republican answer to climate change? Is it a problem? Do you have a plan to address it? (N.B. THESE are the "pending questions" referred to throughout below.)
JB: George, we believe in our “all of the above” energy strategy from last year continues to be the right approach on energy. We’ve got to make sure we have resources of energy, green energy, but we need nuclear energy. We need other types of alternatives and, yes, we need American made oil and gas. (Technically, Congressman Boehner did not answer the question. It comes close only if we parse the answer to assume that Congressman Boehner believes that reduced reliance on fossil fuels will reduce overall carbon dioxide emissions.)
GS: But that doesn’t do anything when it comes to emissions, Sir – (Interrupted)
JB: When it comes to the issue of climate change, George, it's pretty clear that if we don’t work with other industrial nations around the world, what’s gonna happen is that we’re going to ship millions of jobs overseas. We have to deal with this in a responsible way. (Still not answering the pending question, Congressman Boehner deflects the inquiry and moves to the politically expedient soundbite of focusing on American jobs.)
GS: What is the responsible way? That’s my question. What is the Republican plan to deal with carbon emissions, which every major scientific organization has said is contributing to climate change?
JB: George, the idea that carbon dioxide is a carcinogen that is harmful to our environment is almost comical. Every time we exhale, we exhale carbon dioxide. Every cow in the world, you know when they do what they do, you’ve got more carbon dioxide. And so I think it’s clear . . .[Interrupted] (This was the response that triggered this pondering. “Carcinogen”? Breathing? Blame the cows? Again, Congressman Boehner does not answer the pending questions. The House Minority Leader, prominent spokesperson for the national Republican party, is more comfortable belittling the threat of climate change from excessive carbon dioxide put into the atmosphere by human endeavors than he is admitting there is a problem and offering a specific alternative to the E.P.A.’s regulation of carbon dioxide emissions.)
GS: So you don’t believe greenhouse gasses are a problem in creating climate change?
JB:... we've had climate change over the last 100 years -- listen, The question is, how much does Man have to do with it and what is the proper way to deal with this? We can’t do it alone as one nation. If we got India, China and other industrial countries not working with us, all we’re going to do is ship millions of American jobs overseas. (Still no answer to the pending questions. Rather, Congressman Boehner again deflects by rewording and posing the same question back to Stephanopolous and, again, wrapping himself in the American flag.)
GS: But it sounds like what you’re saying is that you don’t believe the Republicans need to come up with a plan to control carbon emissions. You’re suggesting it’s not that big of a problem even though the scientific consensus is that it is contributing to climate change.
JB: I think it is, I think it is an issue. The question is, what is the proper answer and the responsible answer? (Ditto, absent the American flag.)
GS: And what is the answer? That’s what I’m trying to get at. (Thank you Mr. S.)
JB: George, I think everyone in America is looking for the proper answer. (At least since the beginning of this interview.) They don’t want to raise taxes one and a half to two trillion dollars like the Administration is proposing and they don’t want to ship millions of American jobs overseas. (Deflection. God Bless America.) And so, we’ve got to find ways to work towards the solution to this problem without risking the future of our kids and grandkids. (Think about this. Most folks lacking the intelligence to serve in Congress [I’m making a BIG leap of faith here] discovered sometime before Al Gore’s 2006 An Inconvenient Truth that man-made carbon dioxide emissions contribute to the problem of global warming. So why, on April 19, 2009, is the House Minority Leader still in the “we’ve got to find ways to work towards the solution” stage? Because, of course, the House Minority Leader would rather play politics with the issue and use it to attack the Obama administration by engaging in economic fear-mongering than get on board a meaningful plan to save the planet and the future of his kids and grandkids.)
GS: So you are committed to coming up with a plan?
JB: I think you’ll see a plan from us, just like you’ve seen a plan from us on the stimulus bill and a better plan on the budget. (If you say it enough times, people will believe anything. And, by the way, Congressman Boehner never answered the pending questions.).
The bad news is that many politicians, including Congressman Boehner, cannot get past party politics to do the right thing for our society. The good news is that Americans seem more willing to publicly disapprove of such recalcitrance. We learned something during the eight years of the Bush Administration. We learned that when the pronouncements of our elected officials defy common sense, it is okay to say so and to react as we would to any other idiotic verbal diarrhea.
If the Republican party is unwilling to distinguish its environmental viewpoint from that of the coal lobby in a meaningful way, so be it. The party’s adherents are entitled to their opinions. But they ought to have enough respect for our democratic way of life to openly proclaim their position, by answering the questions, and let the electorate decide whether they belong in positions of leadership. Absent such respect, the Republicans are just a bunch of clowns trying to fool all of the people all of the time.
This past Sunday was no exception, except (sorry) it gave me an idea for this blog: Politicians do not like to answer direct questions. This Week started out with two interviews. White House Chief of Staff Rahm Emanuel was first up. He was brilliant in his portrayal of the work of the Obama Administration and successfully defended its efforts from partisan attacks. He was necessarily vague about some aspects of the President’s policies. I accepted everything he said without pause or concern. ;-)
George Stephanopolous’ next guest was Republican Congressman John Boehner from Ohio. Congressman Boehner serves as the House Minority Leader in Congress and often serves as the spokesperson for the Republican Party. I was so startled by his exchange with Mr. Stephanopolous on the subject of carbon emissions and climate change that I had to watch the interview again to make sure I had heard it right over my hamburger/onion omelet (cooking is another part of my Sunday morning ritual).
Here’s the transcript of the exchange (with my comments in parentheses):
George Stephanopolous: Describing Congressman Boehner’s reaction to the decision to allow the E.P.A. to regulate carbon dioxide as means of controlling greenhouse gasses.
Congressman John Boehner: This decision is nothing more than a backdoor attempt to enact a national energy tax that will have a crushing impact on consumers, jobs and our economy. The Administration is abusing the regulatory process to establish this tax because it knows there are not enough votes in Congress to force Americans to pay it. (In 2006, more than 2 years before the election of Barack Obama, the U.S. Supreme Court ruled that Congress had given the E.P.A. authority to regulate carbon dioxide in the Clean Air Act. The economic consequences of regulating carbon dioxide emissions are not a “national energy tax”. They are the wages of our sinful ignoring of the problem for decades and now being forced to implement extraordinary measures to try to save the planet. Repeat for effect: to try to save the planet.).
GS: Let me ask you then about energy. You’ve come out against the president’s plan to cap and trade emissions. So what is the Republican answer to climate change? Is it a problem? Do you have a plan to address it? (N.B. THESE are the "pending questions" referred to throughout below.)
JB: George, we believe in our “all of the above” energy strategy from last year continues to be the right approach on energy. We’ve got to make sure we have resources of energy, green energy, but we need nuclear energy. We need other types of alternatives and, yes, we need American made oil and gas. (Technically, Congressman Boehner did not answer the question. It comes close only if we parse the answer to assume that Congressman Boehner believes that reduced reliance on fossil fuels will reduce overall carbon dioxide emissions.)
GS: But that doesn’t do anything when it comes to emissions, Sir – (Interrupted)
JB: When it comes to the issue of climate change, George, it's pretty clear that if we don’t work with other industrial nations around the world, what’s gonna happen is that we’re going to ship millions of jobs overseas. We have to deal with this in a responsible way. (Still not answering the pending question, Congressman Boehner deflects the inquiry and moves to the politically expedient soundbite of focusing on American jobs.)
GS: What is the responsible way? That’s my question. What is the Republican plan to deal with carbon emissions, which every major scientific organization has said is contributing to climate change?
JB: George, the idea that carbon dioxide is a carcinogen that is harmful to our environment is almost comical. Every time we exhale, we exhale carbon dioxide. Every cow in the world, you know when they do what they do, you’ve got more carbon dioxide. And so I think it’s clear . . .[Interrupted] (This was the response that triggered this pondering. “Carcinogen”? Breathing? Blame the cows? Again, Congressman Boehner does not answer the pending questions. The House Minority Leader, prominent spokesperson for the national Republican party, is more comfortable belittling the threat of climate change from excessive carbon dioxide put into the atmosphere by human endeavors than he is admitting there is a problem and offering a specific alternative to the E.P.A.’s regulation of carbon dioxide emissions.)
GS: So you don’t believe greenhouse gasses are a problem in creating climate change?
JB:... we've had climate change over the last 100 years -- listen, The question is, how much does Man have to do with it and what is the proper way to deal with this? We can’t do it alone as one nation. If we got India, China and other industrial countries not working with us, all we’re going to do is ship millions of American jobs overseas. (Still no answer to the pending questions. Rather, Congressman Boehner again deflects by rewording and posing the same question back to Stephanopolous and, again, wrapping himself in the American flag.)
GS: But it sounds like what you’re saying is that you don’t believe the Republicans need to come up with a plan to control carbon emissions. You’re suggesting it’s not that big of a problem even though the scientific consensus is that it is contributing to climate change.
JB: I think it is, I think it is an issue. The question is, what is the proper answer and the responsible answer? (Ditto, absent the American flag.)
GS: And what is the answer? That’s what I’m trying to get at. (Thank you Mr. S.)
JB: George, I think everyone in America is looking for the proper answer. (At least since the beginning of this interview.) They don’t want to raise taxes one and a half to two trillion dollars like the Administration is proposing and they don’t want to ship millions of American jobs overseas. (Deflection. God Bless America.) And so, we’ve got to find ways to work towards the solution to this problem without risking the future of our kids and grandkids. (Think about this. Most folks lacking the intelligence to serve in Congress [I’m making a BIG leap of faith here] discovered sometime before Al Gore’s 2006 An Inconvenient Truth that man-made carbon dioxide emissions contribute to the problem of global warming. So why, on April 19, 2009, is the House Minority Leader still in the “we’ve got to find ways to work towards the solution” stage? Because, of course, the House Minority Leader would rather play politics with the issue and use it to attack the Obama administration by engaging in economic fear-mongering than get on board a meaningful plan to save the planet and the future of his kids and grandkids.)
GS: So you are committed to coming up with a plan?
JB: I think you’ll see a plan from us, just like you’ve seen a plan from us on the stimulus bill and a better plan on the budget. (If you say it enough times, people will believe anything. And, by the way, Congressman Boehner never answered the pending questions.).
The bad news is that many politicians, including Congressman Boehner, cannot get past party politics to do the right thing for our society. The good news is that Americans seem more willing to publicly disapprove of such recalcitrance. We learned something during the eight years of the Bush Administration. We learned that when the pronouncements of our elected officials defy common sense, it is okay to say so and to react as we would to any other idiotic verbal diarrhea.
If the Republican party is unwilling to distinguish its environmental viewpoint from that of the coal lobby in a meaningful way, so be it. The party’s adherents are entitled to their opinions. But they ought to have enough respect for our democratic way of life to openly proclaim their position, by answering the questions, and let the electorate decide whether they belong in positions of leadership. Absent such respect, the Republicans are just a bunch of clowns trying to fool all of the people all of the time.
Saturday, April 18, 2009
A New Beginning (No Ewoks)
What a day! Spring has finally arrived on the prairie and I celebrated by getting out my bike, dusting it off, putting on my helmet (as promised) and riding on the adjacent bike trail for nearly an hour at about an 8 m.p.h. average clip.
I went further west on the Luce Line than ever before, making it a mile or so past Charlie Leck's farm, and plan on pushing the envelope a little further each time. The bike trail runs for 63 miles from start to finish. Meadow Breeze Farm is just off Mile 12, giving me 51 miles to explore under Horace Mann's directive.
I feel great, having accomplished something I've been merely yakking about for two long, i.e., getting off my fat butt and enjoying the outdoors. Frankly, it's a nice change of pace. I've felt rather paralyzed emotionally lately and forcing myself to get out may prove to be the breakthrough I've needed. Haven't we all been there?
The forest of anxieties constricting my ability to function normally consisted of the final illness and death of my good friend Tom Silver, the need to forumlate a defense for another good friend and client and file my first pleadings on his behalf using a confusing electronic filing system in Federal Court, the need to respond to a pile of discovery requests in another matter, organizing 2008's financial information to meet the government's April 15th deadline, keeping abreast of details in Minnesota's U.S. Senate election contest, deal with client issues as they get called in, handle new files with gratefulness and enthusiasm, and, as always, internalize all emotions and stresses.
Haven't we all been there? It is not the first time the volume of demands has seemed overwhelming. We know, intellectually, that we will eventually push forward, perform the necessary tasks, and feel the pressure relieved. The hard part is believing that the relief will come to pass when in the middle of that forest of anxieties.
Some people rely on faith to get them through these emotional roadblocks. Whatever works. I rely on the lessons of James Clavell. In Noble House, Clavell wrote of the trials and tribulations of Ian Dunross, the 20th Century taipan of the House of Struan. Having previously read Tai-Pan, Clavell's brilliant portrayals of the same Scottish trading family in the 19th Centuries, I closely identified with the Tai-Pan's struggles when I read Noble House in the early 1980's.
Ian Dunross probably did not worry about the electronic filing system instituted and mandated by the Federal Courts. Rather, according to the Wikipedia entry on Noble House: "(I)n 1963, the tai-pan, Ian Dunross, struggles to rescue Struan's from the precarious financial position left over from his predecessor. To do this, he seeks partnership with an American millionaire, while trying to ward off his arch-rival Quillan Gornt, who seeks to destroy Struan's once and for all. Meanwhile, Chinese communists, Taiwanese nationalists, and Soviet spies illegally vie for influence in Hong Kong while the British government seeks to prevent this. And nobody, it seems, can get anything done without enlisting the aid of Hong Kong's criminal underworld. Other obstacles include water shortages, landslides, bank runs and stock market crashes."
Clavell's books are worth reading and I won't give away the ending of Noble House. Suffice it to say that Dunross addresses his challenges aggressively and individually, rather than allow the number and scope of the problems he faces overwhelm him. That is the lesson I regularly take from Noble House and that is the manner in which I can achieve my emotional freedom, break the shackles of anxiety-induced depression and, not incidentally, return to blogging.
By tackling each tree individually, you find yourself in a clearing. The forest that seemed impossible to deal with becomes separate piles of stacked firewood. My discovery responses are complete, I picked up two major new clients this week, the Federal court Answer and Counterclaim are filed, taxes were paid, Al Franken will be seated before Independence Day, Tommy lives on as a stellar example of what it means to be a mensch in the collective memories of all who knew and loved him and I went further west on the Luce Line than ever before, making it a mile or so past Charlie Leck's farm, and plan on pushing the envelope a little further each time.
I went further west on the Luce Line than ever before, making it a mile or so past Charlie Leck's farm, and plan on pushing the envelope a little further each time. The bike trail runs for 63 miles from start to finish. Meadow Breeze Farm is just off Mile 12, giving me 51 miles to explore under Horace Mann's directive.
I feel great, having accomplished something I've been merely yakking about for two long, i.e., getting off my fat butt and enjoying the outdoors. Frankly, it's a nice change of pace. I've felt rather paralyzed emotionally lately and forcing myself to get out may prove to be the breakthrough I've needed. Haven't we all been there?
The forest of anxieties constricting my ability to function normally consisted of the final illness and death of my good friend Tom Silver, the need to forumlate a defense for another good friend and client and file my first pleadings on his behalf using a confusing electronic filing system in Federal Court, the need to respond to a pile of discovery requests in another matter, organizing 2008's financial information to meet the government's April 15th deadline, keeping abreast of details in Minnesota's U.S. Senate election contest, deal with client issues as they get called in, handle new files with gratefulness and enthusiasm, and, as always, internalize all emotions and stresses.
Haven't we all been there? It is not the first time the volume of demands has seemed overwhelming. We know, intellectually, that we will eventually push forward, perform the necessary tasks, and feel the pressure relieved. The hard part is believing that the relief will come to pass when in the middle of that forest of anxieties.
Some people rely on faith to get them through these emotional roadblocks. Whatever works. I rely on the lessons of James Clavell. In Noble House, Clavell wrote of the trials and tribulations of Ian Dunross, the 20th Century taipan of the House of Struan. Having previously read Tai-Pan, Clavell's brilliant portrayals of the same Scottish trading family in the 19th Centuries, I closely identified with the Tai-Pan's struggles when I read Noble House in the early 1980's.
Ian Dunross probably did not worry about the electronic filing system instituted and mandated by the Federal Courts. Rather, according to the Wikipedia entry on Noble House: "(I)n 1963, the tai-pan, Ian Dunross, struggles to rescue Struan's from the precarious financial position left over from his predecessor. To do this, he seeks partnership with an American millionaire, while trying to ward off his arch-rival Quillan Gornt, who seeks to destroy Struan's once and for all. Meanwhile, Chinese communists, Taiwanese nationalists, and Soviet spies illegally vie for influence in Hong Kong while the British government seeks to prevent this. And nobody, it seems, can get anything done without enlisting the aid of Hong Kong's criminal underworld. Other obstacles include water shortages, landslides, bank runs and stock market crashes."
Clavell's books are worth reading and I won't give away the ending of Noble House. Suffice it to say that Dunross addresses his challenges aggressively and individually, rather than allow the number and scope of the problems he faces overwhelm him. That is the lesson I regularly take from Noble House and that is the manner in which I can achieve my emotional freedom, break the shackles of anxiety-induced depression and, not incidentally, return to blogging.
By tackling each tree individually, you find yourself in a clearing. The forest that seemed impossible to deal with becomes separate piles of stacked firewood. My discovery responses are complete, I picked up two major new clients this week, the Federal court Answer and Counterclaim are filed, taxes were paid, Al Franken will be seated before Independence Day, Tommy lives on as a stellar example of what it means to be a mensch in the collective memories of all who knew and loved him and I went further west on the Luce Line than ever before, making it a mile or so past Charlie Leck's farm, and plan on pushing the envelope a little further each time.
Thursday, March 26, 2009
The Lessons of Natasha
The tragic death of Natasha Richardson last week gave us all much to think about. In sitting down to write this installment of Prairie Pondering (again), I am (again) hit with a stream of consciousness of subject matter: the fragility of life, bad things happening to good people, privacy rights of celebrities, cherishing the time we have with friends and loved ones, sweating the small stuff, "if only ____", karma, taking advice, refusing advice, health care, the irrelevance of social status in matters of fate, etc., etc., etc.
No doubt I will revisit the event from time to time to make a point or two, but today I intend to focus on just a couple of the things I have been pondering.
My first reaction to hearing the news was that I would need no further urging from my bride to wear a helmet when bike riding. A few years ago, I spent one summer as an avid cyclist and, supported by a client in the business, loaded up with fancy riding equipment, including a tear-drop shaped helmet that I was instructed never to ride without. Once we moved to the country one farm over from a bike trail I used to drive a half hour to get to, I decided that it was more important to look "cool" than ride safe. I believed that since I was limiting my cycling to carefree jaunts down car-free gravel paths, I could leave the helmet behind and rely only on a baseball cap to shield my balding head from the sun. Deb protested; I chose vanity over safety.
That will not be the case in the future. The fluke of Ms. Richardson's death made me realize that it was stupid to unnecessarily risk my life on the hope that my baseball cap and enclosed head would not suddenly hit the gravel roadway (less forgiving than snow) as a result of a blown bike tire, unleashed dog, unnoticed rear-approaching cyclist or inability to timely remove my feet from toe clips.
Undoubtedly, many cyclists, skiers, snowboarders and other outdoor enthusiasts will similarly take the lesson of Ms. Richardson's death to heart and head. Her senseless sacrifice will save lives. That is not much of a silver lining, but it satisfies our collective desire to find something positive come from a shared horrific experience.
The second item I keep returning to is the lesson to be taken from Ms. Richardson's death with respect to the allocation of health care. Allow me the assumption that an identical fall and resulting injury sustained by any other visitor to that ski resort last week would not have made front page news all over the world.
After the event, I suggested to my wife, an R.N. with 30+ years of experience, that the public's awareness of the dangers of subdural hematomas publicized by Ms. Richardson's death would result in more accident victims obtaining treatment, as Ms. Richardson had been encouraged to to, and, correspondingly, many lives being saved.
Deb's response illustrated the stark realities of health care today. She explained, accurately, that medical facilities lack the hardware and staff resources, and insurance companies lack the funds, to allow everyone who takes a tumble on a ski hill to obtain an M.R.I. or a CAT Scan. For the most part, the wounded will be advised to watch for symptoms of head trauma and seek medical attention only in the event symptoms develop.*
I can imagine some contentious debates over course of treatment while the Richardson tragedy is fresh in our minds. The forthcoming demands for expensive procedures to rule out undetected, potentially fatal trauma, are consistent with the level of care we have come to expect and which have resulted in health care costs that have created the current health care crisis. In reality, entitlement to basic health care, including access to preventive medicine, must be distinguished from universal entitlement to the best possible health care that science can deliver.
This reality constitutes the flash point in any discussion about what kind of universal health care system we can and should adopt. Accepting it means that we acknowledge that some people will suffer health consequences medically avoidable. On the other hand, accepting it means we also acknowledge that the greater good, i.e., the ability to deliver affordable basic health care services to the largest number of recipients, trumps the alternative of spending the same finite amount of funds on premium levels of care for far fewer recipients.
Whoever is funding universal health care, be it insurance companies or the government, absent an increase in premiums or taxes, there will always be a limited amount of money to spend on all the medical services that will be delivered to all the beneficiaries of the funding entity. Therefore, as a matter of fundamental fairness, the pool of shared available funds should not be depleted by the purchase of extraordinary services by the most demanding. Rather, it must be left to individuals to purchase extraordinary services, like an immediate M.R.I. in response to a seemingly innocuous bump on the head, either directly, or with supplemental insurance coverage priced accordingly.
Again, this approach means that patients with better financial resources will receive "better" health care. There is no viable alternative. The hope, of course, is that by bringing costs down through the implementation of universal coverage, everyone's basic health needs will be met and higher levels of care will become more affordable and therefore available to more and more patients. In the mean time, we have to accept the fact that we are not, and will likely never be, a prosperous enough society to offer unlimited, on demand, state of the art, high technology medical services to everyone regardless of their ability to pay.
The Natasha Richardsons of the world will, of course, always have the offer of such services available to them. Hopefully, when needed, they will take advantage of the privileges they enjoy, continue to thrive and, use their privileged status to support philanthropic endeavors, as did Ms. Richardson, that care for the rest of us. I'll be thinking about that while riding down the neighborhood bike path wearing my geeky helmet.
*P.S. The morning after I posted this blog, there was a related story on ABC's Good Morning America. Here's a link to the news coverage of the story. May God bless you, Natasha.
My first reaction to hearing the news was that I would need no further urging from my bride to wear a helmet when bike riding. A few years ago, I spent one summer as an avid cyclist and, supported by a client in the business, loaded up with fancy riding equipment, including a tear-drop shaped helmet that I was instructed never to ride without. Once we moved to the country one farm over from a bike trail I used to drive a half hour to get to, I decided that it was more important to look "cool" than ride safe. I believed that since I was limiting my cycling to carefree jaunts down car-free gravel paths, I could leave the helmet behind and rely only on a baseball cap to shield my balding head from the sun. Deb protested; I chose vanity over safety.
That will not be the case in the future. The fluke of Ms. Richardson's death made me realize that it was stupid to unnecessarily risk my life on the hope that my baseball cap and enclosed head would not suddenly hit the gravel roadway (less forgiving than snow) as a result of a blown bike tire, unleashed dog, unnoticed rear-approaching cyclist or inability to timely remove my feet from toe clips.
Undoubtedly, many cyclists, skiers, snowboarders and other outdoor enthusiasts will similarly take the lesson of Ms. Richardson's death to heart and head. Her senseless sacrifice will save lives. That is not much of a silver lining, but it satisfies our collective desire to find something positive come from a shared horrific experience.
The second item I keep returning to is the lesson to be taken from Ms. Richardson's death with respect to the allocation of health care. Allow me the assumption that an identical fall and resulting injury sustained by any other visitor to that ski resort last week would not have made front page news all over the world.
After the event, I suggested to my wife, an R.N. with 30+ years of experience, that the public's awareness of the dangers of subdural hematomas publicized by Ms. Richardson's death would result in more accident victims obtaining treatment, as Ms. Richardson had been encouraged to to, and, correspondingly, many lives being saved.
Deb's response illustrated the stark realities of health care today. She explained, accurately, that medical facilities lack the hardware and staff resources, and insurance companies lack the funds, to allow everyone who takes a tumble on a ski hill to obtain an M.R.I. or a CAT Scan. For the most part, the wounded will be advised to watch for symptoms of head trauma and seek medical attention only in the event symptoms develop.*
I can imagine some contentious debates over course of treatment while the Richardson tragedy is fresh in our minds. The forthcoming demands for expensive procedures to rule out undetected, potentially fatal trauma, are consistent with the level of care we have come to expect and which have resulted in health care costs that have created the current health care crisis. In reality, entitlement to basic health care, including access to preventive medicine, must be distinguished from universal entitlement to the best possible health care that science can deliver.
This reality constitutes the flash point in any discussion about what kind of universal health care system we can and should adopt. Accepting it means that we acknowledge that some people will suffer health consequences medically avoidable. On the other hand, accepting it means we also acknowledge that the greater good, i.e., the ability to deliver affordable basic health care services to the largest number of recipients, trumps the alternative of spending the same finite amount of funds on premium levels of care for far fewer recipients.
Whoever is funding universal health care, be it insurance companies or the government, absent an increase in premiums or taxes, there will always be a limited amount of money to spend on all the medical services that will be delivered to all the beneficiaries of the funding entity. Therefore, as a matter of fundamental fairness, the pool of shared available funds should not be depleted by the purchase of extraordinary services by the most demanding. Rather, it must be left to individuals to purchase extraordinary services, like an immediate M.R.I. in response to a seemingly innocuous bump on the head, either directly, or with supplemental insurance coverage priced accordingly.
Again, this approach means that patients with better financial resources will receive "better" health care. There is no viable alternative. The hope, of course, is that by bringing costs down through the implementation of universal coverage, everyone's basic health needs will be met and higher levels of care will become more affordable and therefore available to more and more patients. In the mean time, we have to accept the fact that we are not, and will likely never be, a prosperous enough society to offer unlimited, on demand, state of the art, high technology medical services to everyone regardless of their ability to pay.
The Natasha Richardsons of the world will, of course, always have the offer of such services available to them. Hopefully, when needed, they will take advantage of the privileges they enjoy, continue to thrive and, use their privileged status to support philanthropic endeavors, as did Ms. Richardson, that care for the rest of us. I'll be thinking about that while riding down the neighborhood bike path wearing my geeky helmet.
*P.S. The morning after I posted this blog, there was a related story on ABC's Good Morning America. Here's a link to the news coverage of the story. May God bless you, Natasha.
Saturday, March 21, 2009
The Mom Song. [Lyrics on Screen+Download]
While I'm pondering my blog on Natasha Richardson and the lives she saved, I offer you this video which sums up the relationship between all mothers and their children. Enjoy!
Sunday, March 15, 2009
The Ides of March (Plus One)
Spoiler Alert: I admit to fallibility in this edition of Prairie Pondering. Stop reading now if that is a problem.
Tomorrow is my 57th birthday. I've been joking that these are the last of my pre-Heinz days. I started celebrating a couple of days ago when I hit two downtown bars during happy hour with friends from work. I continued on Saturday at a wonderful dinner with Dana and Greg (b. March 15) Kellenberger. This morning, I was joined by three dozen friends and family members at Jun Bo, the town's best dim sum restuarant, for brunch. The owners' presented me with the frozen whipped cream cake pictured here in appreciation for my business generation on their behalf.
I am always grateful to reach another birthday. I never feel as old as the calendar makes me out to be. 57 used to seem ancient. Now it must be the new 37. I certainly do not feel close to retirement age, either chronologically or financially. I have survived on Earth nearly twice as long without my mother as I was blessed to live on it with her. But, as usual, my father contrasts her early passing with his youthful exuberance at 80. It was fun to watch him hold court at brunch this morning as long time friends discussed their parents settling into the local Jewish assisted living facility. He reminded me, again, that he was never going to "end up" there, too.
There are a few indications that the new 37 is not exactly the same as the old 37. Last year, my dentist fitted me with a mouth guard so I would not grind my teeth at night. When she asked me if I was self conscious about how I looked wearing it, I just laughed. As I told her, I'm 30 pounds overweight, I'm balding, I sleep with a CPAP so I look like a scuba diver in bed, and when my sciatica acts up, I walk with a cane. No, I assured her, I was okay with a mouth guard.
My memory is probably not what it was when I hit 37 for the first time. I'm not worried about it, yet, but there are times when I'm an idiot. Last Wednesday I left the office in Minneapolis at about 4 p.m. to drive 120 miles to Brainerd. I had a meeting Thursday morning as a member of an advisory group to the Minnesota Department of Natural Resources and didn't want to have to drive up at 6:30 a.m. to make it on time. I made plans to have an early evening dinner with some clients to prepare for Thursday's meeting.
After driving for about 45 minutes and 40 miles, it occurred to me that I did not remember putting my overnight bag in the car when I left the house Wednesday morning. I pulled over on the freeway, looked in the back of the car, and spoke sailor. Taking the next exit, I returned to the farm on snowy, icy back roads, trusting my GPS rather than my memory, picked up my bag and headed out towards a planned shortcut to get me to my destination in a reasonable time. I forgot about the detour around the road construction on U.S. 12.
By the time I arrived in Brainerd with an extra 50 miles on the odometer, I was 80 minutes late. The clients were waiting for me in the hotel bar and we had a nice dinner. But it was not an early evening. It would have been nice to relax in the hotel's indoor pool as I did before last month's meeting, except I forgot to bring a bathing suit or shorts. Anxious to get a decent night's sleep, I plugged in the CPAP and grabbed my iPod, which I fall asleep to each night. Except that I had forgotten a component of the CPAP that I had removed to dry out, rendering it useless, and I had forgotten my headphones to use with the iPod. Without my mechanical aids, I did not get much sleep.
In the morning, I dragged myself out of bed to get ready for my meeting. I wanted to look my best, but I had forgotten my razor. I went out to the car, which, of course, had been parked outside all night. It had warmed up to -12 F by 9 a.m. The windshield was covered in frost. I needed to scrape it because I was running out of time waiting for the vehicle to heat up. I had my scraper but I had forgotten my gloves in the office.
The good news is that I have acquired wisdom from aging and don't sweat the small stuff. The world did not end by being 80 minutes late or by having to spend an extra $5 on gasoline. My hands warmed up once inside for my meeting. I slept well the next night. I'll be more careful when leaving home next time. Until I drop some weight, it's probably best that I don't go out in public in a swimsuit. My stubble while meeting with the D.N.R. was notable only in its inadequacy. And not having headphones for the iPod Wednesday night just meant I had more podcasts to listen to on the drive home.
March 16th. A birthday I've shared for 57 years with James Madison, our similarly short 4th President, and with Jerry Lewis, our similarly bloated cultural ambassador to France. Tomorrow I turn 57 and, as I've often noted to others fretting about their age, it beats the alternative. "Thank you" to all my well-wishers. I do love celebrating birthdays, whether mine or yours, in large part because it reunites me annually with so many great friends.From memory (mostly):Fairy tales can come true,
It can happen to you, if you're young at heart;
For it's hard, you will find
To be narrow of mind, if you're young at heart;
You can go to extremes with impossible schemes,
You can laugh when your dreams fall apart at the seams;
And life gets more exciting with each passing day;
And love is either in your heart or on the way;
Don't you know that it's worth
Every treasure on earth to be young at heart;
For as rich as you are,
It's much better by far to be young at heart
And if you should survive to a hundred and five,
Look at all you'll derive out of being alive;
And here is the best part, you have a head start,
If you are among the very young at heart!
Wednesday, March 4, 2009
Georgia's Mind on my Mind
Last weekend was rough. I know I have to write about it, but it has taken some time to compose my thoughts and start writing.
Deb and I drove to the South Dakota/Minnesota border to visit her parents. My father-in-law Ken is in a nursing home in Ortonville, Minnesota, where his Parkinson's disease and Myasthenia Gravis can be properly dealt with. Dad still spends most of his days at the family home overlooking Big Stone Lake a few miles north of Big Stone City, South Dakota, where Georgia, his bride of 55 years, still resides. Dad returns to the nursing home each evening; Mom is under the care of various family members, including her son, daughter-in-law and grandson. Mom is only 72 years old. But she has Alzheimer's.
Dad's Parkinson's has been getting gradually worse over the past 20 some years. Dad still insists on doing yard work around the house. The fact that the "yard" encompasses several acres does not slow him, or his Hover-round. Joking about how well he'd be able to jig for fish seemed funny when he was diagnosed. Not so much today. Although his tremors are fairly well under control through medications, it's heartbreaking watching the deterioration of the body of the former high school basketball star and all around athlete who loved recalling his swims across Big Stone Lake. Dad's mind is still sharp, probably exacerbating his frustration with his inability to live independently and certainly exacerbating the helplessness he feels as he watches Mom slip away.
When we arrived home on Saturday morning, I was a bit taken aback to see my nephew Shawn coloring in a children's coloring book. Shawn has taken on the responsibility of caring for his grandmother. I took the coloring to be a form of relaxation on the weekend since he had other family members around to relieve him of the constant obligation. Nonetheless, it struck me that, at 18, he should be spending time reading, not coloring pictures of kittens and bunnies.
Unfortunately, the coloring books were not for Shawn. As if a pointed demonstration of Mom's mental decline just since Christmas, the coloring books serve as a way for her to pass time. Shawn was not coloring for his own account. He was starting a page as a guide for his grandmother. During the 30 hours or so that we shared with Mom and Dad last weekend, I experienced a number of such doses of reality and realized, sadly, that an important era in my life as all but over.
The two parental in-laws presented a stark contrast to one another. Dad is healthy of mind; weak of body. Mom is physically fit but slipping away mentally. Both strive to overcome the lousy cards they've been dealt. Dad insists on staying active beyond the dictates of common sense. Mom repeats snippets of conversation as exchanged in order to appear as if she is fully following and participating in the discussion. She still seems to recognize everyone around her. But she makes allusions to events that never happened and places that don't exist.
Dad, Ken, has an amazing spirit and he will continue to fight against the physical limits his illnesses impose. I expect him to dance at MY funeral. Today, I find myself pondering Georgia's transformation from the doyenne of Big Stone Lake, whose accomplishments are memorialized in granite tributes on the Minnesota/South Dakota border, to the vulnerable and frightened recluse facing a loss of all she has known.
I remember being told 26 years ago that there was no experience like becoming a parent, that no amount of detailed, image evoking description beforehand could prepare you for the emotional tsunami that arrives with the birth of your first child. I believe it is the same way with watching a loved one succumb to Alzheimer's disease. There is simply no way to prepare for having someone with whom you've shared your entire life carry on in front of you as if you had never met and without any memory of everything that went into weaving a family fabric.
Mom is not yet at the point where she cannot relate to her family members. In some ways, living three hours away is a blessing. We are not confronted daily with the face to face evidence that Mom is slipping away. On the other hand, there is a desire to spend as much time as possible before we are strangers to her.
As I hugged her last weekend and, even more sadly, as I watched Deb hug her, I had to wonder if this would be the last time where there would be mutuality in the recognition. Given the progression in just the past two months, I have no assurance that Mom will continue to know us in the months ahead.
The scourge of memory loss disease runs in Mom's family. She conveyed a blessing on my wife some years ago while visiting Mom's ailing sister when she directed Deb not to take anything personally once Mom faced her own challenges with Alzheimer's. Her past thoughtfulness has helped. There have been instances when Deb has had to take charge of financial matters, business matters and health care matters for her parents. Dad understands; Mom pushed back, unsuccessfully, wanting to maintain her independence as a badge of competency.
But now, after a few months have passed, there seems to be an emotional surrender and a willingness to let others care for Mom's needs. She has transitioned from hiding her smoking, to smoking openly (including, very temporarily, in the family fireworks store), to not caring about smoking. Her days of exercising her mind with crossword puzzles are long gone. Now, she struggles to follow Shawn's lead and color in the line drawings of cute little animals.
I know we are not alone in this. I am blessed that my father seems abundantly healthy in mind and body. But I have so many contemporaries going through the same struggles that Deb and I face with Mom. Modern Medicine has bestowed the blessing of long life; Mother Nature taketh away some of that blessing for some of us. Years ago, we would joke about grandma or grandpa "getting senile". Now that our lifespans have increased, we are forced to deal with the progression of senility over an additional ten years or so.
Like the newborn that filled us with wonder, and as with the responsibilities that we gladly accepted when we joined the ranks of parenthood, we now begin to cope with equally dependent loved ones at the other end of the life cycle and, like it or not, must again take on responsibilities of care and nurturing as we would wish to be cared for and nurtured.
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