Archive for the ‘Uncategorized’ Category
Is this what it takes?
We have all been captivated in the aftermath of Brian Thompson’s brazen murder in New York. As the news was announced, many speculated that the gunman was either a frustrated United Healthcare customer or hired by one. As we have seen in the last few days, the apprehended suspect did, indeed, face debilitating pain, though the details of his medical journey have not been made public.
Beyond the reckless gun violence that seems to define our country, we like to think of our society as a morally ethical one. We are a democracy, with laws in place to punish crimes like this, including the vigilante crimes that to some seem justifiable. In the end, this was a murder, the premeditated killing of a human being, and this is without a question wrong.
Some have called the murderer a hero. By this argument, United Healthcare is an evil corporation, and killing the CEO is a statement against all that the insurer has done to harm its customers.
The murderer is no hero.
Whatever the outcome of a trial, however, we cannot deny that the murder has brightened the spotlight on much that is wrong with healthcare in the United States. Despite the high premiums we pay for health insurance, the process of getting medical care approved and funded can seem nearly impossible, especially for those who need it the most.
I have read many arguments in response to discussions lately that insurance is not intended to cover normal care… and in fact, I remember a time, years ago, when this was true. When I was little, my mom wrote a check to the doctor for ordinary visits. Ha! So long ago! Private pay feels quaint now–or exclusive, limited to the private care psychiatrists, med-spas, membership concierge practices. In reality, ordinary healthcare, even one office visit, is largely unaffordable without insurance, and still unpredictable despite pricing transparency laws that have gone into effect since 2021. Reduced prices negotiated for health insurance plans create a two- (or more) tier system with much higher prices for those who want to pay out of pocket.
Insurance or not, the research and study involved in making predictions about costs for care are overwhelming, and harder still to navigate while sick or injured. People are talking about this loudly again, with media coverage and attention from Congress. Anger today is palpable, as if we just realized that the countless hours we spend on hold with our insurers are the experience of nearly everyone, and not isolated incidents. Protests, strikes, marches all seem overdue, but demonstrations have seemed so ineffective to the monstrosity of a system where the decision-makers seem so cut off from ordinary people.
For the last fifteen years, I have seen firsthand that for most people, often very sick people, it is not the illness or condition that is the primary point of suffering; it is the maneuvering necessary to secure treatment and payment for that treatment. How horrible is that?
Worry about payment shocks and all too often, bankrupts people who get sick. Many of us have delayed or deferred care that was not urgent, often due to cost, either defined or potential, and most of us now have fought at least one battle to have our care approved. Copays for ongoing treatment often are a barrier, though some ongoing therapies may cost far less in the long run–and improve quality of life overall. Ordinary devices and services could improve life for so many, but think of all that is rarely covered by insurance: dental care, hearing aids, any sort of long-term care support services (community-based or institutional)… If the human condition includes a certain amount of physical disability throughout a lifetime, a morally ethical society would take our likely need for healthcare into account within the framework of human rights. I am not the only professional who has seen jaws drop as people who have paid for years into a system figure out that the gold-standard plans they paid into for years are more like lead: heavy, impenetrable, and toxic.
Back in 2012, Robert Wood Johnson Foundation, Harvard School of Public Health, and NPR released a study called “Sick in America” (https://www.kff.org/wp-content/uploads/sites/2/2012/05/charts.pdf). It was not the first study of the issue, but it struck me at the time because of what I was seeing, and because the study compared perceptions of medical care and health insurance based on the illnesses and conditions people had experienced. For those who had chronic conditions requiring care for over a year, favorable responses dropped enormously.
Since that time, the COVID epidemic has brought healthcare concerns to the forefront. Several years past then, we have faced the burnout of medical staff, inflation, hospital closings, and an aging population that needs medical care more than ever. We are in trouble, and it has hit nearly all of us close to home. None of what I am saying here is new. The Affordable Care Act may well have eliminated exclusion to payment for pre-existing conditions, for example, but we never managed to remove the greed from the equation. Critics of single-payer systems have long pointed to the evil elements of a supposedly socialist health payment system, named them death panels who would restrict our care. The death panels are the insurers we have now. We all know this, and yet we remain complacent in our swallowing of what capitalism allows to trickle down to us.
I hate the fact that a man was murdered, and hate even more that a man was likely murdered to make a point about greed and the injustices in our healthcare system. Vengeful violence only perpetuates the system.
Many people feel completely helpless to faceless corporations and their enablers. Our country is suffering. The murder of Brian Thompson has highlighted the worst aspects of our country: gun violence and corporate greed. I hope that this time will be different, that changes will come to bring back a system that nurtures its citizens instead of perpetuating a class struggle.
We condemn human rights violations abroad so often, and we have so many freedoms and advantages in the United States. And still, more and more people find themselves locked out of rights because of financial struggles stemming from nothing more than the human condition. What more will it take for us to restore our humanity?
What the Hal?
Over the summer, I took on the task of editing a quarterly newsletter for the New England Translators Association. I was honored by the request and have wanted to get more involved, so I started collecting articles that I thought might interest the members. As I was doing this, I received some surprising news at work. My job, and the job of two others in my small office, were being eliminated by the end of summer. I started job hunting, and two trends became quickly evident to me. One, there are many unaccompanied minor children who have ended up in a new country alone. This alone was not news, but I was surprised by the number of recruiters offering opportunities to language professionals and case managers (also preferably bilingual). The jobs paid fairly well, but sounded grueling and required long stays away from home.
The second trend was also nothing new in our brave new world of smart phones and smart televisions and smart cars and smart houses and lives. Artificial Intelligence needs teachers, too, it seems, and recruiters are out all over the place rounding up subject-matter experts, preferably bilingual, to train large language models to sound more normal.
It occurs to me as I write this that I could have just asked my browser to write up something cute for my blog about the new jobs around this, but I didn’t. I hold tight to the talents that bring me pleasure, especially, but also, I would rather not work for $20 per hour in a job that is intended exactly to eliminate people like me.
So many years ago, I remember sitting in high school Latin class listening to my often-off-topic teacher. His ponderings were an enormous part of what made him a great teacher, and one day he was musing about the future. In the early 1980s, he told us that the next revolution, an unimaginable change, he said, would be a cybernetic revolution. We had a little lesson in Greek that day, learning a word that has, indeed, changed everything.
Many things will happen this year. I am sure of this, as we face an election and the steady march into this world where machines seem more and more capable of thinking for us. I wonder sometimes if we have a responsibility to train these machines well and not leave them to the subject matter non-experts who need a job. Would it make a difference? I have tried to understand the technology and the changes coming for years now, but it remains fuzzy to me. I suspect that much as I long for newsprint and vinyl, we may all soon long for the tangible, and for the warmth of humanity to replace the machine-generated mask of pure imagination.
User Experience
I needed milk and ran into our local Stop & Shop today. Of course, we needed more than just milk, so I also picked up coffee, the cherries that are on sale, and several other things. This is the closest non-specialty grocery store to me, and even though my son once worked here, I am not a huge fan of the chain. Overpriced and rude more or less sums up my general experience at this particular location in the past several years. Because of this, though, the store is rarely crowded, and prices are not as high as they once were, at least not for everything. They do have a few things I like, so it was a good chance to run out for a break from my job search.
I made my way around the store with few problems. I think they have finally gotten rid of the terrifying robot that roamed the aisles, or at least I didn’t see it today. On a past visit, the beeping android startled me, and I slipped on a wet floor, cracking my knee right by the checkout. In case you are wondering, no one from Stop & Shop asked if I was all right, although they plainly saw me fall. But I didn’t sue. I also didn’t go back for over two years. I returned once on a whim last year when they were the only store without a long line to enter. It can be nice to go into a store with so few customers in a pandemic.
Today, I made it all the way through my visitt, and opted for self checkout, as I saw only one regular register open, with a few customers already waiting. Framingham has a new ordinance to encourage bringing our own bags, which I was already doing, anyway, so I lined up my bags in the designated area past the scanner. As it should happen, this doesn’t work well, because the bagging area has a scale for items that are scanned. My bags had not been scanned, so they set off the alarm that “assistance is needed.” The employee then told me that I can’t put bags from home in that area, so I would have to load my purchases after I finished.
I had a couple of heavy items that I would normally put right back into the cart, but the scanner will not work unless the most recently scanned item is in the bagging area. A large bag of bird seed would not fit there. This required assistance.
I scanned an avocado, which again set off the alarm, and the employee scolded me not to scan produce. There is nothing to indicate this at the checkout, but the barcodes on produce do not work; you have to look up each item on a directory instead.
I accidentally scanned the cherries as grapes, and the employee came back and scolded me again, and also grabbed a bag of pistachios from my cart, right next to my purse. She was abrupt, and seemed angry, which I guess I can understand if she has to provide assistance four to five times for each customer in self checkout. Other than a few people who had only one item, it seemed that alarms were going off all around. She was alone handling six self checkout registers, while only one regular register was open. It seems such a short time ago that there were only two self check registers, and four or five registers with a checker and bagger for each, and not even that long ago that there were six or seven registers with one express line.
As I said at the beginning, I have encountered rudeness before at this store, but today I had my limit. The system is broken, and I’m not going back there. I have had problems at every store with self checkout, and this is not limited to Stop & Shop. At first, I resisted using it, because I felt it gave the stores excuses not to hire workers, but in many places, it is hard to find a register that is not self checkout.
I used to see more people working in stores, people I chatted with and liked to see. I don’t want to push back against improvements and technologies, but customers seemed fed up; I know I am. In a few stores, I have realized that I am the odd person shopping for myself while most people in the store are Instacart shoppers rushing through aisles. This is an amazing convenience, and I have used it a few times, too. But I really prefer to choose my own produce, and meats, and sometimes, in the right place, I am delighted by something I find. Is the shopping experience becoming a frustration intentionally? Are we being pushed to order everything from home? The convenience is undeniable, but I don’t like a world where we stay in our own huts and never encounter a stranger.
I suspect that the frustrations we face are not so intentional, though. My guess is that it is just cheaper to have more self checkout aisles, to avoid hiring workers. The store profits, and customers may grumble, but they adapt. They leave the stores in a bad mood, though, and over time, some realize that there are better experiences elsewhere.
I wrote some time ago about the Target dressing room, and the frustration that could have been avoided by providing a sign telling customers to check in with the store employee before trying things on. I have seen hospital staff fed up with baffled patients and their families. It is easy to forget that visitors to stores and hospitals do not know what the employee knows and experiences all day, everyday. And vice versa; it is easy for customers and patients and consumers of all sorts to forget that employees are (usually) doing the best they can.
Designing systems that work well for both employees and visitors takes planning and care. It matters, and it can make someone’s day.
Essential
The hospital across the street from my house has had a white tent in front of the emergency room for the last few weeks. A strange sight in normal times, but these are not normal times, of course.
If all of this had happened five years ago, I might still be going in to visit people, as I did at least two or three days a week back then, but I doubt I would have had that sort of access. I would instead be trying to telephone, or skype, if possible, and otherwise I would be worrying about the nurses and social workers I knew there, as well as all the people I could no longer visit. A phone call never took the place of going in person back then, and I imagine it still feels lacking in a world of people who often suffer as much from loneliness as from the illness they are fighting. I am sure that the barrier to touch is one of the most difficult parts of this evil virus that has taken us now, the necessary disconnection.
Someone has put up a sign in the parking lot: “Heroes park here.” And indeed, they do. I see them walking back and forth from their jobs as they always have, and they have always been heroes, long before they were deemed “essential employees” in the corona-lexicon.
It is obvious that the people on the front line of illness are essential now, but the rest of the world that keeps those of us safe and fed at home share the badge of essential in these days. Suddenly, gas station attendants, delivery workers, and grocery store cashiers have become important, as it dawns on each and every one of us just how lost we would be if they all just stopped doing their job. In my neighborhood, it is not just the hospital that keep the traffic flowing; it is the many workers, whose landscaping, painting, and construction trucks still leave every morning and come back late. They are essential, and they are busy.
This is not to say that we are always treating them so well. This morning, as my daughter approached the early morning checkout line after a triumphant quest for toilet paper, the man in front of her could not stop himself from screaming at an employee, who had been working hours before the early-morning senior hours, I am sure. What good did it do for him to curse loudly about the inadequate supply of hand sanitizer?
Ah yes, we can vent our frustration at this whole situation. We will probably snap once in a while at someone who does not deserve it. We may drive a little rudely, despite the relative lack of traffic. And we can still demean those who manage the tasks that we just do not want to do. I dare say that this sort of entitlement is a bad habit that took root in the heart of many people long before this current crisis.
Of course, many rise to the crisis, and remember to be thankful. We can order take-out and hope the neighborhood restaurant can stay afloat, and we can tip the Uber Eats driver a little extra for his willingness to risk his life in an attempt to maintain some income. We can have our kids draw pictures for the staff at Grandma’s assisted living. It is nice to do these things, to be generous, and to teach our children to be kind. But will we still remember when all this is over? Will we remember that these so-called “unskilled” workers were once so essential?
An Outing to the Zoo
As I have been watching the families at the border, I have remembered also that I spent several years in St. Louis volunteering at the International Institute. The refugee organization was generous to me, and I gained far more than I gave in assisting people in English classes, and in working with a social program for Amerasian teens from Vietnam. It was the early 90s, and most of the refugees then were from Vietnam, the former Soviet Union, and Ethiopia.
I remember in St. Louis that the area around South Grand was an area where many of the families I met lived. For most of my life, I knew these areas as German (though my own family lived in North St. Louis), but the change was good. My family came under some hardship, but nothing like the trauma that the families I met at the International Institute.
Once, I helped a man to translate course certificates from an IBM course. The certificate was in French, and the man told me that he once spoke French as much as he spoke Vietnamese, but he could not remember now, and hardly remembering the programming had learned in those early days, a different time. But still, a certificate could make a difference for him.
A couple worked with me on conversation. They were former Soviets, and the man–an engineer–drove a taxi and complained, and resented that his wife (a patient woman) was learning English far faster than he was.
I worked with the teen program, but it was hard. The kids did not want to do “refugee things”, and preferred hanging out and enjoying normal American teenage life. I couldn’t blame them. And because all of them were their families’ tickets to refugee status–children of Vietnamese woman and American soldiers–they had even more reason to grasp tightly to their new country.
One day, a very cold day, I went to pick up my teen partner for a trip to the St. Louis Zoo. When I arrived, though, she was gone. Instead, I found her mother and four-year-old half sister bundled to the best of their abilities, and ready to go.
So we went. It was incredibly cold, though, but in the trunk of my car I had two extra pairs of mittens that my mom had knitted for me. We were warm enough now, and crossed past the bears (only a polar bear was out where we could see him). We looked to some of the enclosed exhibits, still, the reptiles. As we wandered, the mother began to see animals she remembered from Vietnam, and she started to talk about her country, and her past.
She told me that she could not remember her daughter’s father’s name. She tried and tried, but so much had happened. She told me of her house in the mountains, and of her other child, the one she begged not to cry, so they would not be found. She told me of the fire they set to her house in the mountains, and running, running with nowhere to go. She told me of the kind Vietnamese man who accepted her–he came to the US with her, and he was the father of the little girl who went to the zoo with us that day.
At the end, I didn’t know what to do. I drove the family home, and they left–wearing my mom’s mittens. I never asked for them back, and I never told my mom, either. But I think that she would have been happy to know that they had them now.
I’m not sure what happened to the family, but the last time I was with them, they were working hard, and had moved to a nicer apartment.
That day changed my life.
I have thought about many of the people I met then, people who had fled horrific hardships to come to our country, to have a better chance. We all must know many of the immigrants who come here with their dreams and their ambitions, who give up everything for the sake of their families. I think of the incredibly educated, sage scholars who worked in ordinary jobs in car plants (like my sister-in-law’s father, an art history professor working for GM).
I think of my own friends, literature students who came because coming to the US was the way to succeed. I think of the richness of our diversity, the music and food and art and texture of cultures, and I admit to falling silent in despair in the face of hatred to all these things that I love. I have not always been proud of the aggressions of the US–hard to argue that many of the refugees I met suffered in their own countries because of us. But in my life, I was often also encouraged as I saw us change, grow, love.
I want to think we can find this in our hearts again. Our biggest danger comes as we harden souls by torturing children, by pushing away those who need our shelter, by giving even more power to greed.
Flower and Stem
I was in my car listening to the radio, as I do quite a lot, and heard another story about increasing opportunities for women in STEM education and career paths.
The reason this is important is obvious: there should be no room for gender considerations in any field. But there is another consideration that comes up time and time again in these sorts of discussions, and this is that jobs in STEM pay more. Is the exclusion of women from STEM-related jobs part of the reason for salary inequality?
No doubt it is. But then, I wonder why we do not hear the same sort of push for men to enter fields that are traditionally held by women. I have known a handful of male nurses and social workers, for example, a few administrative assistants. Go to an elder service agency or a preschool, and count the men. Not many, in my experience.
I personally was not drawn to any STEM-related career track, though I liked math. I understood more science than I realized, but never wanted that life. Was it culture? Undoubtedly I was discouraged by an atmosphere that may have seemed overtly hostile to women, but more than this, I was more drawn to other areas: writing, languages, translating, interviewing and making connections, teaching. I invented my own way, to a great extent, and I saw my STEM-oriented brother leap far beyond me in salary at a very young age. I remember the heavy sighs from my family as I pursued my interest in literature, social work, advocacy–sighs undoubtedly at the thought of my inevitable poverty. But more than this, the sighs indicated a fear–a fear stemming from our society’s utter lack of serious respect for the fields where I excelled, for the career path that I–and many others–really wanted.
And this is what baffles me, really, not so much just that women don’t get an equal chance in STEM, but why we look down on those non-science, non-technical, non-engineering, non-math career paths and demonstrate our disdain by paying them so little money? Who determines the worth of work? I know the official answer to this question, but I ask this at a societal level. In a world that truly meets the needs of all of its citizens, shouldn’t we be encouraging people to explore many interests, and to pursue fearlessly and boldly those in which they truly excel–not abandoning talents we need in a rich world for the sake of work that has been artificially deemed worthy of a livable wage?
Ch…ch…changes
Funny how it is so true.. the more things change, the more they stay the same.
I should explain, at least briefly. I have not posted here in a year–not because I have no stories to tell, but because at the end of the day, 99% of the time, I can hand the clients I see now the thing they need. (And… yes, I no longer call them consumers–removed from one world, I have decided that client IS an empowering word–they hire me, really; I am a public servant, if a local one).
What this his has meant, personally, is that I sleep at night. I get thank you notes–not always joyful outcomes, but resolved ones. It is rather amazing to me, now, that I have the power to hand someone a document that opens a door, that breaks a boundary. I still see crises, but people come to me, and I can usually get them where they need to go. Sometimes the stories are not happy. More than once, clients have come to my little booth in a time of grief–a last moment, a funeral, a goodbye. But what they need from me is specific. And I can usually get it for them.
But it is so much more than this. I realize now the level of burnout that comes from crisis situations. I still see crises. But I am not burned out.
I was thinking of this earlier this week when I was scrolling through the Kaiser Health News. I used to read this daily, along with the local obituaries, and it is a habit I have not yet broken. The story that caught my eye told of emergency workers–no doubt far more apt to burn out than I ever have been. But I did know the numbness from seeing such difficulties, the nursing homes, the recent diagnoses, the bills…
The story told of Jonathan Bartels, a nurse at the University of Virginia Medical Center. He described the moments following a patient death, a moment when a tired trauma team may well feel defeated, and the chaplain who asked the team to stay in the room for a moment, to honor the life that was.
This moment made a difference. It is attention to a life, to the person, to the work to save that person’s life. It is a moment that gives permission to that trauma team to care, and to feel supported in that decision to care.
It also is a moment, I think, that a team can step back and see just how much the work that they do matters.
I can imagine the bureaucratic nightmare that could be the daily routine of my work now.. It’s not, though it can be, some places, sometimes, as we see on a daily basis across the world. Border crossings can prompt all sorts of demands, and I realize that I am lucky now to be able to do what I do.
But what is the difference, really?
I also think of the world of long-term care that I used to see daily. As I think through the problems around the critical moment of an accident or diagnosis, people were not always sure what it was that they needed. But after a bit of reflection, this was rarely the real problem–most people could name many things that would make an enormous difference in their quality of life. They needed help with housework. Transportation. A hearing aid. An accessible place to live. A new wheelchair cushion. A new wheelchair. Food. Not to lose everything they owned due to the exorbitant cost of their medical care.
Can it really be so difficult to solve?
Expensive, yes. With resources, though… not so incredibly difficult.
Expensive to solve, yes, in a world that has not considered that people do fall down and break things, that they get sick, and sometimes cannot climb stairs that they used to climb, cannot see things they used to see, cannot say things they used to say.
But in the end, it is far more expensive still to leave people isolated, impoverished, and depressed. In the long run, I know it is.
I felt this frustration often, despite the many people I worked with who did want to make a difference.
But there is an underlying message that is sent when resources are cut, when employees don’t have the tools they need, when there is not enough office space, when there is no time given to reflect for a moment… The message comes through loudly: this does not matter so much.
But it does. It matters a lot.
The world sees things it could ignore so easily in the past. As the tech-savvy get older, and tweet and post and video-chat their frustrations more and more, I cannot imagine that the rage at “the system” will remain so easily contained in this realm for much longer.
I have pinched myself sometimes over the last year, riding the train to the big city, protected by the glass of my booth and the reliability of the systems I depend on to do my work. It is amazing, really. Nice. Not extravagant. But it enables us to provide the excellence our clients deserve.
I used to go into the trenches… a word I do not use lightly, nor with disrespect. I loved seeing people where they were, where they lived, where they could show me firsthand the life they experienced. It was generous. It was often tough. It was real. It was sometimes lovely. More often, though, it was tragic, and could have nearly always been better.
As I always saw, though, we can make a difference, even in small ways. The things we must always give to people who come seeking help are these: listening–we cannot know if we do not hear and remain patient in the process, clarity–what we can and cannot do, truth–when we know it (not passing the buck to another messenger when truth is hard), and competence–and this is completely on us. We owe it to ourselves and to the public we serve to do our work well and to care about it.
I have thought over and over about systems, how things work, infrastructures, how an inefficient database can throw everything off. how everything needs to work well at every level, how giving good employees good tools–and putting trust in them–makes employees work better, not less, I do think that most people do want to do good work… but without the support and trust, the crises do quickly burn people out.
The trust, then, is also giving permission–expecting–people to care, to take it personally. A pause to say it all matters, that we should care. Caring is really what makes all the difference, in everything, at every level. It is what creates the changes when they need to happen.
Only Anecdotal 