Part I: Access

So, Obamacare is upon us, like it or not.

Why we just can't just have a single payer system, the only real system that makes any kind of sense, is beyond me. Well, not beyond me, I do understand that we live in a country where free market fundamentalist millionaires make all of the decisions and where any kind of logical, efficient centralization that might benefit the working class is a dirty word that makes conservatives hiss “that’s sssssssocialism!"

There's only one problem with this criticism. Obamacare is not socialism.  It’s corporate welfare, a handout to the insurance industry that may incidentally do some good for the average working person, but it's not socialism in any way.

That being said, I personally believe that socialism is the only sensible way to run a health care system, morally and economically. You can bitch about rationing if you want, but rationing is already the name of the game: some people have it and some people don’t. You can bitch about being told what to do by a higher authority, but you don't elect the CEO of an insurance company and you do elect the members of the government. You can bitch about choice, but in a socialized system all reasonable care is covered and all doctors are participating providers, so a patient has more choice. You can bitch about compensation, but in a socialized system doctors wouldn't have to buy malpractice insurance and could spend most of their time practicing their profession and less of their time fooling around with insurance companies. You can bitch about cost but a centralized system can be run cheaper and more efficiently. The list goes on.

Look, there is no perfect system, but health care is a basic need and a little more complicated than buying toothpaste, though if you have tried to buy toothpaste lately, that's getting pretty complicated as well. Socialize the hell out of it, I say. Just one kind of toothpaste that works is fine with me.

You see, I’m the socialist that your mother Anne Coulter and your daddy Glenn Beck warned you about.* I am not one of those crazy racist national socialists who worship Hitler, but a democratic socialist. In my interpretation this essentially means that I think that some things (basic needs) should be centrally managed by a democratically elected government that is transparent and actually concerns itself with the welfare of the people. By "the people" I mean the average people, the working people, the producers, the people who are not in control of the system and in fact pretty much get screwed by it and therefore require representation.

It's not that I think the government we have now is all of these things, but that is another issue for another day. It's not that I think everybody should dress the same way or even make the same income. It's not that I don't think people should take responsibility for their actions and it's not that I don't love liberty. However, the free market is not the answer to everything and it’s definitely not the answer to health care. If a guy is having a heart attack and he can't get to the hospital for treatment because he can't afford it, more likely because he works his tail off and doesn't get paid enough, not because he is a lazy bum, this is NOT liberty. However, even if the guy is a bum and his heart attack was his own fault because it was ultimately caused by eating too many cheeseburgers, I'm still not willing to tell his kid or his mother or his spouse or his best friend, "sorry, health care is a privilege, not a right", though I have to admit that my evil vegetarian brain does think that in this case the cows are getting their just revenge.

Are you going to tell a marathon runner that because her bad knee was caused by too much marathon running that it's her own fault and therefore she should just suffer the consequences and not get surgery? Find me one person who lives perfectly and dies without ever having a health issue. Even this person has at least one relative with congestive heart failure or a thyroid problem.

Anyone can go around shouting “Liberty! Liberty! Liberty!” and it sounds really good until one starts to actually think it through. Then one realizes that liberty becomes more complicated when there is more than one person involved, and the last time I looked there were several of us human being types stumbling around aimlessly on this planet.

There are always conflicting needs and conflicting values. There is freedom from and freedom to. There is the consideration that my liberty ends where yours begins. Laws and regulations are necessary unless one wants to live in a world run exclusively by bullies. You may have the right to drive a hummer, but I also have a right not to contract cancer from breathing your exhaust. You see how that works? It’s called civilization.

* Please, Anne, Glenn. Don't reproduce together.

Part II: Access to what?

Since Joe Lieberman killed the public option, I've decided there's no hope for this country. In fact, the day the public option died, I drove my Chevy to the levy and almost decided to throw myself into the raging river. Fortunately for my cats,  I instead decided to die a slow death and throw myself into art.

So I've given up on politics and just do art in my spare time, which I don't have much of, being a working person in America. Never-the-less, while toiling on a project one day I thought about how strange it was that in an indirect sort of way, Joe Lieberman was my inspiration. It was then that I started to think about health care again. What occurred to me was that back when I would run around with my forehead furrowed and my hands on my hips shouting about access, I forgot to examine the thing that I was insisting on access to.

"Access to what?" I thought.

You see, people, it became apparent to me that if we opened the proverbial door to the wild place called “health care in America” we would find a tangled web that is virtually impossible to navigate and even dangerous. In this world communication sucks, wasteful, unnecessary spending is rife, the big picture is often ignored, paperwork trumps people, patients are generally treated like shit, have most of their time wasted and are lucky if they leave the system better rather than more impaired, stressed out or addicted to pain medication. Sometimes they get well in spite of the system, not because of it.

Notice that I'm blaming the system, not the people in it. There are all sorts of competent, knowledgeable, compassionate, hard working health care professionals . However, I have seen the innumerable examples of the inefficiencies, callousness and frustrating serendipity of the health care system in America first hand because A. I'm a nurse working in a hospital and B. for most of my adult life I have been sick.

What I suffer from is a mysterious roaming back/hip pain that is usually absent but can be so crippling that I am unable to get out of bed. Over the years these “flare-ups”, as I call them, have become more frequent, more intense, and last for longer periods. Most of the time, I just plow through it, taking good care of my body with exercise and a balanced diet, but occasionally it gets so bad that I have no choice but to go to the doctor. Usually, by a "doctor" I mean Dr. Jack Daniels, which works pretty well and only costs 16.99 for a 750 ml bottle,  but sometimes, this means an actual doctor in an emergency room or clinic, the only two options I had as an uninsured person, which is what I was for most of my adult life.

 

In any event, over the course of twenty years, and hundreds of tests I was finally diagnosed with “ankylosing spondylitis” and, more recently by a rheumatologist with "some kind of spondylitis but not the ankylosing kind” since my spine apparently slides around like it’s greased with butter. This rheumatologist who I was finally able to see now that I do have health insurance, listened to me for five minutes, examined me for three minutes and then handed me a prescription for what I now refer to as the “miracle drug”: meloxicam.

 

I swear I'm not getting any kick backs, but I’ve never felt better in my life. Meloxicam is just a measly old NSAID, not one of those expensive designer drugs that you hear about on TV. You know, the ones that come courtesy of our clever neuroadvertisers who know that the only thing more attractive to the human brain than a person dancing is a content, smiling person arranging flowers. 

 

So, this may sound like a success story, but it was a bumpy twenty year road to my little yellow pill. For example, a few times I waited around the emergency room in excruciating pain until being sent home half a day later with an information sheet on exercises and instructions to take Tylenol. One time a doctor told me “I think it’s some kind of rheumatoid thing, but you wouldn’t be able to afford the medication so there isn’t much I can do.” One trip brought on a four day stay in a hospital on a heparin drip with somebody telling me I had a pulmonary embolism and another person, four days later, telling me that whoever read the CT scan was “hallucinating”. Most of the time I was barely listened to and then treated like a liar or a drug seeker. Once, a doctor practically shoved me out of her office telling me that, according to my blood tests I was in perfect health and suggested an over-the-counter anti-inflammatory and warm compresses. This despite the fact that I had told her several times that I slept on a mattress made of Aleve and snacked regularly on warm compresses. I was still in crippling pain. 

 

One day, I was hopping around an empty waiting room after drinking copious quantities of water for an ultrasound (this during the era of the “ovarian cyst” hypothesis of my mysterious roaming back pain) and contemplating the closed opaque sliding window that the secretary who I'd spoken to briefly forty five minutes before presumably still sat behind. I thought either everybody had forgotten about me and gone home for the day or there had been a nuclear war and the opaque window was made of some special radiation proof plastic that protected me. This window, I thought, was the perfect metaphor for the system as I saw it. Then, though maybe it was the azotemia since I’m pretty sure that my urine was backing up into my blood stream, I started to fantasize about my perfect health care system.

 

There was no doubt, first, that my perfect health care system would be patient centered, holistic, and completely tax-payer financed. There would be no insurance companies at all. The system would contain health care entities that would operate pretty much the same way they do now but with the stated cultural changes.  What would be really different, and this is the part that would have me hammered and sickled if I ever decided to bring it up at the next Tea Party Rally, would be the annual  weekend “health retreat”.

 

This is how it would work in a nutshell. All citizens, from the time they were born until the time they died would be strongly encouraged/incentivized to go. During this retreat, the person would get a full check-up that would include quality time with physicians and a plethora of routine and customized tests. The record that resulted from the health retreat would be in a protected data base that could be provided to the other health care entities as needed, so that the patient’s history/baseline would be laid out, in an organized, linear fashion. In addition, and as an incentive, the retreats would be pleasant, with plenty of down time for people to attend cooking and or exercise classes, get a massage, take a dip in the pool, or hang out in the sauna. It would be a weekend getaway for the whole family, just with some needle sticks and x-rays and maybe a few mandatory classes. For instance, all diabetics might have to attend a refresher course on diabetes, updating them on the latest information. The possibilities for education on prevention and healthy living are endless.

 

I think the benefits of this system are quite obvious. It would save time and money, emphasize prevention, catch serious problems early, improve communication and remove waste generated by redundant testing and scattered health histories.

 

So, this is what I imagined as I hobbled around in the empty waiting room, leaking urine into my panties and having no idea when or if somebody was ever going to come through the door to get me. After an hour and a half I ended up rushing to the restroom and just letting it all out. When I knocked timidly on the opaque sliding door to inform the secretary she shook her head scathingly, clicked her tongue and told me I had to reschedule for another day. 

 

 At least there hadn't been a nuclear war.

 

My three minute fiction essay that didn't win

She closed the book, placed it on the table, and finally decided to walk through the door.

“I can’t take it any more,” she grumbled, as the door slammed firmly behind her: heavy and air tight, like the lid of a coffin.  

The now deserted chamber was hardly empty. Buried beneath the clutter and dust, Blattie perched upon the edge of a stool finishing off the last of his supper. Churning his head mechanically and crushing macadamia nut between his jaws, he pondered her departure with a mixture of curiosity and dread. Though it was true that she often left the apartment, there was something about this particular incident that felt portentous.

Blattie went over the sequence of events in his mind. First, of course, there was the piqued expression on her face followed by a horrified shriek. Second, there was the book:  larger and flimsier than others he had seen. Third, there was the ominous phrase “I can’t take it anymore”.  These words seemed prophetic. These words summoned doom.

Blattie attempted to quiet his ganglia. He told himself he was overreacting and appeased himself with gratifying memories. In fact, in most cases when she left the apartment Blattie was delighted, since when she returned, her arms were laden with a variety of colorful, crinkly containers. These packages would eventually be opened with a fresh, liberating pop followed closely afterwards by an indulgent deluge of food. He had become accustomed to the rich, sweet crumbs that gushed bountifully from these bags and her fingers like succulent rain.

For most of his life, as if enchanted, Blattie had trailed her through the well-worn paths of the cramped apartment. He scurried over stacks of papers, books, clothing, and electronics. He disguised himself among crates of toys, boxes of pens and skeins of yarn. While she slept, the gentle rise and fall of her body felt soothing as Blattie meandered and foraged for delicious treasures along the vast folds of her bed sheets.

Still, he could not suppress the visceral chill that originated from deep within his hemolymph and radiated along the ridges of his exoskeleton. “From plenty follows danger,” he knew the presage well, but since he had been born into prosperous times, the significance of these words had never fully resonated until this moment. There was an eerie connection between this event and the stories he had heard around the colony, harrowing stories of chemical Armageddon and scarcity that made the hair on the back of his legs stand up.

He knew, for example, that before his hatching there was nothing around the house to eat but wet newspaper, soap scum and, if one was fortunate, a little piece of fetid fruit. Once, his uncle Arthro had lived for months on a sliver of dried crust and a small cardboard box. Previously, there had been someone in the apartment who had similarly provided his ancestors with abundant sustenance. When she left for the last time she had uttered the same words: “I can’t take it anymore”.

Blattie flicked his antennae contemplatively. He had to uncover the truth and warn the colony. To confirm his suspicions, Blattie decided he needed more proof. Now confident and without hesitation, he darted to the table and mounted the book.  Peering over the edge, he apprehensively fixed his two-thousand eyes on a slip of yellow paper that had been torn from its pages: “Exterminator” had been marked with a thick red circle.

Blattie’s spiracles tightened. Just then, the lock clicked open. Blattie dashed into the corner as a fine, deadly mist filled the room.

From the bottom: a simple solution to the education crisis

“Ping.”

The first time I heard it I ignored the sound and enthusiastically returned to giving instructions for the day’s project to my generally apathetic ninth grade class.

“Ping. Ping. Ping.”

This time the sound was accompanied by giggles and snickers. I identified it immediately. Someone had lifted the beads that I used to illustrate how alleles separate during the process of mitosis and meiosis and was now playfully flinging them around the room.

“Ping. Ping. Ping. Ping. Ping.”

 Not wanting to appear too alarmed, my first reaction was to pause long enough to let the class simmer down. I then calmly requested that the “alleles” be returned. I waited. A few students shuffled reluctantly over to the supply table, deposited their booty, and shuffled back. I waited some more.

“Sorry for chucking the beads,” one student mumbled.

“You mean alleles,” I corrected.

When I felt like the distraction had been satisfactorily extinguished, I jovially began to address the day’s project, again. We had already wasted ten precious minutes, and I had spent all night planning and preparing. I was excited to get started.

“Ping.”

This was my first period class.

By third period it felt like an epidemic. I locked up the beads. I admonished myself for leaving them out in the first place. It was too late; there were already hundreds of them circulating. I tried humor, anger, even begging to get it to stop. At the end of my last period class, amidst beads whizzing through the air, ricocheting off of every surface, I crawled back to my desk, put my head in my hands and cried.

The bell rang. A few of the kids came up to me and said they were sorry. A few gave me lectures on laying down the law. Most of them hurried out the door, giddy with mischievous excitement. One student stayed after and helped me sweep up the beads.

This was one day of my first and last year attempting to teach ninth grade biology. There were days that were better. There were days that were worse. As the year wore on, disillusionment began to set in. Gradually, I was less likely to stay up all night designing and preparing some magnificent lesson and more likely to hand out a work sheet.

Half way through the year I alerted the administration that I was failing as a teacher and quite possibly having a nervous break down. They promised to visit my classroom more often. This happened for a few weeks, but the visits tapered off and chaos was eventually restored. I began to despise going to work. Everyday, I felt as though I was at war and had been shot full of holes. I made up my mind that I was going to quit.

About a month before the year ended the students had all heard the news.

“Why are you quitting?” they would ask, entirely bewildered, apparently ignorant of the extent of my torment. “You just started!”

“Because I suck at this job,” I replied, committing myself to the principle of complete honesty. “I want to teach you biology. I want you to love it as much as I do, or at least understand it. I want you all to be successful. The truth is, however, that I am unable to make those things happen, because, quite frankly, I don’t know how to handle your behavior.”

“Well,” one student said sarcastically, “they are just going to replace you with some earth hater.”

Okay, so sometimes they were funny, too.

I share this riveting story of downfall and defeat in order to raise a point that I find is omitted from every discussion I hear or read about education reform. Most experts seem to agree that “good” teachers are the most important factor in improving education. Therefore, much of the debate seems to center on how to attract “good” teachers and remove “bad” ones. However, what I believe goes unrecognized in this ongoing dialogue is the dual nature of the teaching profession. In order to be an effective teacher, one must be adept at two very disparate, sometimes irreconcilable, skills. The first is being able to teach and the second is being able to manage.

To illustrate this point, I am now going to brag that I am an excellent teacher. I am creative, interactive, enthusiastic, passionate, patient, and knowledgeable. Teaching biology is more than a job for me, it is a mission. I had been teaching for several years at the community college level, a job that I loved, but I needed full-time work and benefits, and felt I would be “good” with this age group. I, myself, had been a defiant kid who had been highly disenchanted with the prison-like, uninspiring atmosphere of public school. I remembered how this felt and was determined to make my classroom different.

On the other hand, as I believe the story above clearly exemplifies, I am not an effective manager. My disciplinary skills are pitiful. I am easily manipulated. I am a transparent pushover who hands out second chances like candy. Some of these kids scared me; they knew it and took advantage of it. Every day I would write up scores of students, only to find myself ripping these documents to shreds, telling myself that the kid really was not that bad, convinced that I would solve the problem “in house”.

Obviously, without these management skills, my teaching abilities were rendered irrelevant.  Despite my sincere efforts, very little biology was learned that semester. Though it is worth noting that it was only a few students who were regularly causing me trouble, I devoted the majority of my time attempting to address behavioral issues that were disrupting the classroom, and very little time actually teaching. Some days I was lucky if one full sentence escaped from my mouth.

So, the question is, where do I fall? Was I a “good” teacher or a “bad” one?

While we are oversimplifying, I would like to address this question by calling for a slightly more complex descriptive model. Instead of the good/bad dichotomy, I would divide up the profession into four categories: those who are good at managing and teaching, those who are good managers but bad teachers, those, like me, who are good teachers, but bad managers, and those that are terrible at both.

The first category is rare. These are incredible, superhero like people. The second category, unfortunately, is more common. I think it is obvious why this must be the case. It is a pretty good gig to get paid to play around on face-book while students sit quietly filling out work sheets all day. There may be a few teachers who fall into the fourth category, but most of them would probably never enter the profession to begin with. It is the third category that concerns me. There must be a lot of us, and I think that we are the ones that leave the profession in droves.

Could good teachers learn how to be good managers? Maybe…or maybe there is something inherently incompatible about these two roles. If a teacher is engaging her students she must be moving around the classroom. She must be physically next to them, conversing with them, asking them questions, keeping them on task. A good teacher rarely sits down to survey her classroom. She cannot always be aware of the spiteful little monsters in the corner, quietly dismantling her microscopes.

It is for these reasons that I propose my very simply solution to the education crisis. For those teachers who want it, I think all classrooms should have two adult figures: one who handles the teaching, and one who handles the managing.

Though there is not the space to lay out the details, I can think of many ways this could be achieved. Somewhat facetiously, my favorite would be paying fully vetted ex-prison inmates, former gang members, or other menacing characters to do the job. We could call them “bouncers”, though I would never advocate grabbing students by their collars and tossing them unceremoniously out into the hallway.

In any event, there is one thing I am absolutely certain of. I am certain that if discipline had been taken entirely out of my inept hands that year, all of my students would have learned…a lot. In addition, I would have loved my job. I would have gone back. I would still be teaching.

There must be a lot of us out there.