I sent my great idea about foreclosures and the homeless to my Districts' City Councilman and in return he invited me to a meeting! I'd hoped, naturally, that the meeting was to discuss innovative ideas and solutions to our community's economic situation. The invitation didn't say this, but that's been my thing, so - I'd hoped.
What the meeting was, actually, was the Councilman's Organizing Committee meeting. His idea is that neighborhoods that are organized are better equipped to respond to threats to the community's well-being. If, for example, the City Council was entertaining a notion to re-zone a certain neighborhood, organized neighbors would be positioned to immediately support or object to the notion (depending) "Organized response has an immediate and powerful effect," he said. And I've no doubt he is correct in this.
At a previous meeting, the group had divided the district into a dozen or so areas, and the Councilman's hope was that there would be an organizer - a leader - in charge of each area who would contact residents of the neighborhood, spearhead community projects like cleaning up trash and graffiti, provide communication about the needs of the neighborhood, and so forth. It reminded me very vividly of my brief, painful stint as a labor union organizer...and I knew I wasn't cut out for it myself. Trying to get Mental Health Workers to take actions for their own good (the first SEIU contract with MHCD) used up every fiber of organizational leadership impulse I'd ever had. Completely worked off whatever that Karma was. I have absolutely no desire to lead anyone anywhere like that again.
The Councilman's meeting was Grassroots Organizing in full flower. Grassroots Organizing is apparently what got President Obama elected. Any smart politician who wants to get reelected should be - and probably is - doing the same thing.
In our District, it was agreed that Internet Grass Roots Organizing was limited. Residents in our District are not, it was asserted, heavy Internet users. Yet, if the Obama election taught us one thing, it's that Internet Organizing is very effective....and will become more effective as time unfolds since every younger generation is more wired than the next.
Sometime later that week, there was an article in the News about a City Council meeting where everyone was all riled up about names for buildings. I thought again about how politicians spend their time. My Councilman is right that organized people can get things done....but I loose interest when what "gets done" is "name a building". I keep thinking of other things - bigger things - things I'd want to get done.....(like the foreclosure/homeless idea), things that might benefit me.
Here's one for the Councilman. Our district needs to get wired. You need it to get wired so that you can use it as an organizing tool. According to the Rocky Mountain News, Monday 2/23/09, The stimulus bill provides $7.2 billion for grants, loans and loan guarantees, primarily for areas that lack broadband or are "underserved," though the term is not defined. Some of that money is set aside to expand Internet access at public centers like community colleges and libraries. (Broadband funding questioned, by Peter Svensson).
The reason I like the idea of wiring the community is that I've been looking at the cost of my Broadband access. I've been paying almost $50/month for great speeds. I just called the company and agreed to less speed for $40/month, with half off for three months...I told them I wanted the cheapest possible Broadband service. So, I've got three months to see if I can find it cheaper elsewhere - keeping costs down is essential in these troubled times! But it could be free - community wireless broadband signals could be generated at our various libraries, blanketing the whole District with FREE Broadband. Now that's something I could get excited about! "That Councilman," I'd say, "Look what he did for our District! This is a guy that gets things done!"
After that, it's just getting those $200 laptops that are out there through various charities, and setting up some free classes so that everyone can learn how to send and receive email and the web - and bada-bing!, bada-boom!, the District is wired. You've contributed both to the health, well-being and future of the District and to your Grassroots Organization! Now you can organize just the way Obama did and really reach your constituents.
But Thanks! to the Councilman for inviting me! The meeting was interesting - gave me food for thought - and material for the blog. I wish the organizers well. If one comes by my house, I'll greet him warmly and give him my latest great idea.
Monday, February 23, 2009
Friday, February 13, 2009
The Ned Flanders Syndrome
I think I've discovered a new diagnostic category! I've seen this phenomenon more than once now. I have two vivid cases in my recent experience, and when I describe it to my coworkers, they recognize it immediately!
I'm counting on the NIMH to start up some studies....we could probably develop an "evidence based" treatment for the sufferers of this new diagnosis....think of the profit!!
Anyhow.
There are parents out there - mostly just turning 50 - who have children at home who are turning 20-something, and are a total mess. These are the kids who early-on displayed some distressing behaviors like running around wildly, not listening to their parents, hitting their playmates. They were promptly diagnosed as having ADHD, prescribed stimulants and provided therapy. These children have, with the inevitability of time, reached adulthood. They are drug addicted, accomodated by their long suffering parents, and totally dysfunctional as independent adults. They act out in dramatic, self destructive ways, and their parents support them at every step.
That's where the "Ned Flanders" comes in. The parents strike me, each time, as totally innocent...only concerned about the welfare of their disabled child. Each one is a very concerned and giving parent, who has sheltered and protected her child - as any loving parent would do - for years....and just can't stop now. The bright innocence of Simpson's neighbor, the disaster of Flanders' children....
Except, of course, in real life (as opposed to life on the Simpsons) the children seem much more dangerous - and nobody knows how to change the channel. They do things like overdose in the basement, refuse to buy food and do laundry, refuse to contribute anything to anyone for any reason period. ... and the parents just continue to fill in all the gaps....until, frantic at 50, they start to say...I need to be free of this...I want a life....EEEEEEKK!
That's when I see them.
They want the state to pick up some of the tab.
And it will....but it is a very small portion of the tab that the kid - sorry, young adult - has become used to. Forget health insurance (and with it, mental health care and medications....which this young adult is completely addicted to by now...). I had one kid with a Ned Flanders mother in my office, filling out a disability questionnaire. The questions was "do you have any trouble with ADL's - taking care of your hygiene and so forth". His answer was that, "yes, sometimes I forget to bathe for weeks." "Really?!", I said. "How do your girlfriends like that?" "Oh, they don't," he said. "Sometimes they just put me in the tub and bathe me." "Wow", I said. "You've got it made. Why would you change a thing?" He just smiled. His mother, who paid his rent, phone, guitar lessons, everything...looked stricken.
Social Security Disability is probably two years off, minimum - if ever.
Subsidized housing? Ha!
So - under the bridge or in Mom's basement (unless Mom still has enough money to fund two separate households) - Really....those are the choices. And Mom is such a nice person...how could she banish this disabled child to under the bridge? She can't.
But she's needing some Mental Health Care of her own...and she's asking me about what benefits her son might be entitled to...should she finally have the strength to opt for the bridge housing.
I believe that after long and careful study the NIMH will determine that the best treatment for children with ADHD is farm work. Energetic children need physical work and lots of it. Problem is that there aren't the number of farms there used to be - and you can't just drop your too active child off with some random farmer....unfortunately. I'm sure a summer of bucking bales would settle most kids down - at least for that summer. So I don't know what they'll come up with. Perhaps the focus has to be on the desperate parent. The parent has to be toughened up enough to toss the brat out and let him fend for himself.
I, for one, don't know how to do it - except to give them the application for food stamps and explain that "Food Stamps" and "Aid to the Needly and Disabled", will provide maybe $300 - $350 dollars worth of food stamps and money to an individual each month for a while- if the individual can keep up with the paperwork requirements - which most people can't, let alone a kid like this. I tell them how to apply for Social Security Disability - and what to expect, and how long it will take. I let them know that, really, there's not a place to put their child to either "retrain" him or to "keep him safe", at least not that I know of. A Psych hospital wouldn't keep him, although jail might someday. The military wouldn't take him on a bet.
It's not a pretty picture for these innocent, well intentioned parents. I hope the NIMH comes up with something.
Here's what I think. Those poor Ned Flanders parents, who mean well and are so very gullible, bought the pharmaceutical industry's line that most, if not all, problems can be solved with the right medication. Sorry. Not true. In fact, health is the ability to avoid all pharma products for as long as possible. If you are dying, then accept the pain meds. Otherwise, stay away. Absolutely avoid psychoactive drugs for children. Never. Do not do it. Send them to a farmer first, and let their brains grow unhindered. That's what I think.
I'm counting on the NIMH to start up some studies....we could probably develop an "evidence based" treatment for the sufferers of this new diagnosis....think of the profit!!
Anyhow.
There are parents out there - mostly just turning 50 - who have children at home who are turning 20-something, and are a total mess. These are the kids who early-on displayed some distressing behaviors like running around wildly, not listening to their parents, hitting their playmates. They were promptly diagnosed as having ADHD, prescribed stimulants and provided therapy. These children have, with the inevitability of time, reached adulthood. They are drug addicted, accomodated by their long suffering parents, and totally dysfunctional as independent adults. They act out in dramatic, self destructive ways, and their parents support them at every step.
That's where the "Ned Flanders" comes in. The parents strike me, each time, as totally innocent...only concerned about the welfare of their disabled child. Each one is a very concerned and giving parent, who has sheltered and protected her child - as any loving parent would do - for years....and just can't stop now. The bright innocence of Simpson's neighbor, the disaster of Flanders' children....
Except, of course, in real life (as opposed to life on the Simpsons) the children seem much more dangerous - and nobody knows how to change the channel. They do things like overdose in the basement, refuse to buy food and do laundry, refuse to contribute anything to anyone for any reason period. ... and the parents just continue to fill in all the gaps....until, frantic at 50, they start to say...I need to be free of this...I want a life....EEEEEEKK!
That's when I see them.
They want the state to pick up some of the tab.
And it will....but it is a very small portion of the tab that the kid - sorry, young adult - has become used to. Forget health insurance (and with it, mental health care and medications....which this young adult is completely addicted to by now...). I had one kid with a Ned Flanders mother in my office, filling out a disability questionnaire. The questions was "do you have any trouble with ADL's - taking care of your hygiene and so forth". His answer was that, "yes, sometimes I forget to bathe for weeks." "Really?!", I said. "How do your girlfriends like that?" "Oh, they don't," he said. "Sometimes they just put me in the tub and bathe me." "Wow", I said. "You've got it made. Why would you change a thing?" He just smiled. His mother, who paid his rent, phone, guitar lessons, everything...looked stricken.
Social Security Disability is probably two years off, minimum - if ever.
Subsidized housing? Ha!
So - under the bridge or in Mom's basement (unless Mom still has enough money to fund two separate households) - Really....those are the choices. And Mom is such a nice person...how could she banish this disabled child to under the bridge? She can't.
But she's needing some Mental Health Care of her own...and she's asking me about what benefits her son might be entitled to...should she finally have the strength to opt for the bridge housing.
I believe that after long and careful study the NIMH will determine that the best treatment for children with ADHD is farm work. Energetic children need physical work and lots of it. Problem is that there aren't the number of farms there used to be - and you can't just drop your too active child off with some random farmer....unfortunately. I'm sure a summer of bucking bales would settle most kids down - at least for that summer. So I don't know what they'll come up with. Perhaps the focus has to be on the desperate parent. The parent has to be toughened up enough to toss the brat out and let him fend for himself.
I, for one, don't know how to do it - except to give them the application for food stamps and explain that "Food Stamps" and "Aid to the Needly and Disabled", will provide maybe $300 - $350 dollars worth of food stamps and money to an individual each month for a while- if the individual can keep up with the paperwork requirements - which most people can't, let alone a kid like this. I tell them how to apply for Social Security Disability - and what to expect, and how long it will take. I let them know that, really, there's not a place to put their child to either "retrain" him or to "keep him safe", at least not that I know of. A Psych hospital wouldn't keep him, although jail might someday. The military wouldn't take him on a bet.
It's not a pretty picture for these innocent, well intentioned parents. I hope the NIMH comes up with something.
Here's what I think. Those poor Ned Flanders parents, who mean well and are so very gullible, bought the pharmaceutical industry's line that most, if not all, problems can be solved with the right medication. Sorry. Not true. In fact, health is the ability to avoid all pharma products for as long as possible. If you are dying, then accept the pain meds. Otherwise, stay away. Absolutely avoid psychoactive drugs for children. Never. Do not do it. Send them to a farmer first, and let their brains grow unhindered. That's what I think.
Saturday, February 07, 2009
Helping Healthcare Investors
I was watching Mad Money the other day and Cramer was interviewing some guy who was talking about Medco, which, I gathered as the talk progressed, is a "Part D" insurance plan. Part D plans, for readers who don't know, are the Medicare insurance plans for prescription drugs. There are a lot of them - 55 in this region, this year. Each year everyone has to go reassess their Part D plan, because each year all the plans have permission to change their formularies and their reimbursement rates and if you just stay with the one you liked last year, you're likely to find that this year, your life-saving medication now costs $600 a month...and you can't change until the next "open enrollment" period a year from now.
The reason why Medco was doing so well, this guy was saying, was that Medco "knows the protocol" for complex health conditions - it knows just what medications someone with a "complex" problem should be taking. Since it knows this, it can make sure that the patient is taking the right medications (by denying payment for the wrong ones) and this saves the company money. Lots of money, apparently. It was a strong "buy", according to Cramer - great profit margin, dividends flowing and all that -lots of folks making nice returns on your complex health condition.
Hmm. Since I work in a community mental health organization, I have occasion to be involved with many persons who have "complex" health conditions that require lots of medication. And since my role in that organization involves "benefits", I see a lot of "Part D" plans one way and another. What happens in the actual world when "complex health conditions" meet Part D plans is this: the Doctor prescribes a medication; the patient tries to get it at the pharmacy and is told that his Part D plan won't pay for it without "prior authorization"; and then the nurses spend a couple of hours filling out forms in an attempt to get the Part D insurer to pay for the medication the Doctor prescribed. Sometimes they get it, sometimes they don't. Without the authorization, the drug costs way too much for the patient to take it, and that's that. The Nurses wish those darned Doctors could memorize the various Part D formularies and save everyone a whole lot of trouble.
So when I heard this guy on Mad Money describing how much money Medco is making by only authorizing the drug regimen they approve, and not paying for other combinations or quantities of medications, I had another (yes! Another!) great idea! Clearly, we do not need Doctors to be prescribing anything! Insurance companies already know what you should be taking for your complex condition - all they need from the Doctor is the diagnosis! After that, the insurance company can take over! They'll tell you what you can take! Isn't that great?! Think of the savings! Doctors will only need to learn diagnostic skills! Once the diagnosis is made, the appropriate medications follow automatically! This is so great - talk about cutting down on medical errors resulting from bad handwriting! There will BE no bad handwriting! There will be no prescribing!
The Doctor can just provide you with a card imprinted with your particular diagnosis, which you take to the pharmacy, which then dispenses the correct (according to the insurance company) drugs in the correct dosages and off you go! You'll have something like an 87% chance you're getting the right stuff, since their studies show that 87% of persons with that diagnosis should do well on their designated combination. Talk about efficiency!!
I can see the day when Doctors will be really "extras" that no right minded insurance company will pay for at all. Soon, patients will be able to just 'click the boxes' next to their symptoms at their "virtual Doctor" website, the computer program will provide the diagnosis, allow you to print out the diagnosis card on the spot - and you can take that to your pharmacist who will give you what your insurer will pay for! It's beautiful! It's almost what Kaiser has now.
It could be the next evolution of the digital health records project! If we do it right, none of us may ever need to see a Doctor again - when our digital record indicates that we are having a "medical condition", perhaps our insurance company can just send us the right medications automatically...this could cut down on the number of Pharmacists, too! Think of the savings! Think of the stock returns!
Don't you love "for profit" healthcare?! I know I do.
The reason why Medco was doing so well, this guy was saying, was that Medco "knows the protocol" for complex health conditions - it knows just what medications someone with a "complex" problem should be taking. Since it knows this, it can make sure that the patient is taking the right medications (by denying payment for the wrong ones) and this saves the company money. Lots of money, apparently. It was a strong "buy", according to Cramer - great profit margin, dividends flowing and all that -lots of folks making nice returns on your complex health condition.
Hmm. Since I work in a community mental health organization, I have occasion to be involved with many persons who have "complex" health conditions that require lots of medication. And since my role in that organization involves "benefits", I see a lot of "Part D" plans one way and another. What happens in the actual world when "complex health conditions" meet Part D plans is this: the Doctor prescribes a medication; the patient tries to get it at the pharmacy and is told that his Part D plan won't pay for it without "prior authorization"; and then the nurses spend a couple of hours filling out forms in an attempt to get the Part D insurer to pay for the medication the Doctor prescribed. Sometimes they get it, sometimes they don't. Without the authorization, the drug costs way too much for the patient to take it, and that's that. The Nurses wish those darned Doctors could memorize the various Part D formularies and save everyone a whole lot of trouble.
So when I heard this guy on Mad Money describing how much money Medco is making by only authorizing the drug regimen they approve, and not paying for other combinations or quantities of medications, I had another (yes! Another!) great idea! Clearly, we do not need Doctors to be prescribing anything! Insurance companies already know what you should be taking for your complex condition - all they need from the Doctor is the diagnosis! After that, the insurance company can take over! They'll tell you what you can take! Isn't that great?! Think of the savings! Doctors will only need to learn diagnostic skills! Once the diagnosis is made, the appropriate medications follow automatically! This is so great - talk about cutting down on medical errors resulting from bad handwriting! There will BE no bad handwriting! There will be no prescribing!
The Doctor can just provide you with a card imprinted with your particular diagnosis, which you take to the pharmacy, which then dispenses the correct (according to the insurance company) drugs in the correct dosages and off you go! You'll have something like an 87% chance you're getting the right stuff, since their studies show that 87% of persons with that diagnosis should do well on their designated combination. Talk about efficiency!!
I can see the day when Doctors will be really "extras" that no right minded insurance company will pay for at all. Soon, patients will be able to just 'click the boxes' next to their symptoms at their "virtual Doctor" website, the computer program will provide the diagnosis, allow you to print out the diagnosis card on the spot - and you can take that to your pharmacist who will give you what your insurer will pay for! It's beautiful! It's almost what Kaiser has now.
It could be the next evolution of the digital health records project! If we do it right, none of us may ever need to see a Doctor again - when our digital record indicates that we are having a "medical condition", perhaps our insurance company can just send us the right medications automatically...this could cut down on the number of Pharmacists, too! Think of the savings! Think of the stock returns!
Don't you love "for profit" healthcare?! I know I do.
Subscribe to:
Comments (Atom)