Tuesday, April 18, 2017

It's All About Priorities

This started on my Facebook page. There I also tagged the Facebook pages of my Congressman and Senators. Feel free to share this yourself.

So, here's a thought. Instead of trying again to take healthcare away, or to address something as complex (and dicey) as the tax code, why not press forward on infrastructure.

  • First, it has bipartisan support. 
  • Second, it will create jobs, and jobs that can't be sent out of the country. 
  • Third, those jobs will be in the private sector (remember, the Government contracts those jobs out; they don't buy bulldozers or hire workers itself). ...
  • Fourth, there will be some significant multiplier effect, from the additional retail purchase of workers to the upgrading of heavy equipment to the investment in materials. 
  • Fifth, it will help with health insurance because these new employees will either be able to get employer-supported insurance or they'll be able to buy on the exchanges with fewer subsidies. 
  • Sixth, all that economic activity will increase tax receipts without increasing tax rates, for all levels of government.

So, why not pursue this instead of wasting time on the other issues?

Thursday, February 09, 2017

Insight into Supporting Those Who Have Served in, and All Too Close To, Combat

I am just young enough that I did not have to worry about being drafted in the Viet Nam era. This not to say that I did not worry: I had already thought through how I might try to have some choice in my service if I was drafted (I had rejected the thought of somehow not serving). I registered as I was supposed to, but it didn't turn out to be an issue. As many will remember, in those waning days of Viet Nam the draft was determined by lottery; and just before my 18th birthday the lottery was suspended. That was not a call I received.

That was not to say, however, that I wasn't touched. I have older cousins, most of them women; and among their husbands were several who served. One of them was a career officer, who had more than one combat deployment. In our family that was appreciated and welcomed, if not always understood; but I was also aware of just how hostile the world outside the family could be for those returning veterans.

This comes to mind today as I have been reading the article "Only God Can Judge Me": Faith, Trauma, and Combat. The author is Nathan Solomon, a U. S. Navy Chaplain. I recommend it highly.

Central to Solomon's thesis are the categories of the Sent, the Senders, and the Liminal Ones. It should register immediately that the Sent are the service members who experience combat, whether directly or in support services. The Senders are, really, all of us: the nation, the society whose goals the service members seek to serve. The Liminal Ones are the chaplains who support the Sent. They are themselves Sent, and at the same time they bring something of the rest of us, the Senders, as well. 

For each of these groups, Solomon examines the experience in three categories: "What It Means," "What It Costs," and "Living With It." The explorations are honest, and through the paper the differences among the experiences of Sent, Senders, and Liminal Ones are well laid out. There is particular attention to how the churches (sic), both denominations and congregations, might want to examine ministries. 

While the article is written primarily for congregational clergy, I think there is value here for healthcare chaplains as well. Around us are those who have experienced combat trauma, among our patients and their families, and among our professional colleagues. While few of us could claim the same experiences, we do have some experience of serving with violent trauma, and that might make us - and call us to be - better listeners, better pastors, for those around us. 

Saturday, January 14, 2017

On Keeping Healthcare Stable

Some of you may wonder why I haven't said too much about the threats to adequate healthcare for all Americans. Some of you may wonder why I have said "keep healthcare stable," instead of just defending the Affordable Care Act. I have done that because I actually work in healthcare, and want to be clear, including by when and where I'm logged in, that these are my opinions and not a reflection of or a reflection on my employer.
That said (and I can't imagine anyone will be surprised), I do have opinions. First and foremost, I think we have sold the Act incorrectly. The name of the act that is labeled Obamacare is "The Patient Protection and Affordable Care Act." We've spent so much time letting folks complain about what "affordable" might mean, and for whom, that we are now at risk for letting the "protection" get washed away. Pay close attention: it is the protections that are truly popular - no exclusions for pre-existing conditions; equity on preventive care for both men and women; equity for mental health with physical health; subsidies to allow the most vulnerable to afford insurance; insurability for folks whose employment and lack of income had left them out; coverage for children on a parent's policy until age 26; a set of minimum standards for what a policy should provide. It is also the protections that make this less "affordable;" and so it is the protections that are at risk. So, not just "Defend the ACA;" "Defend the Patient Protection Act."
So, I speak about "keep healthcare stable" because I can imagine improvements to the Patient Protection and Affordable Care Act; and even a replacement that might be better. At that point, I heard Paul Simon singing about "the myth of fingerprints:" I don't care much whose name is on the bill as long as the bill does the right things. Call it Romneycare instead. Call it the German Model, because this is basically how the Germans meet everyone's needs. Call it Trumpcare or Ryancare - I don't care, as long as it's a real replacement - you know, one that does at least what the old one did (EVERYTHING the old one did), and perhaps more, and perhaps more economically. One of our major auto insurance companies has this ad out, with a focus on their full replacement policy. The hook, proclaimed by the actor complaining about another company is, "Do they expect you to drive 3/4 of a car?" So, I am interested in stability more than the myth of fingerprints. I don't care whose name is one it; but 3/4 of a replacement for the Patient Protection and Affordable Care Act is not a true replacement.
I am also concerned about stability because healthcare is one of the largest employers, as a sector of the economy. These are good jobs, professional jobs, that can't be outsourced overseas. In my years in the business one of its hallmarks has been the many people who have started at the bottom and used employer-supported resources to have better jobs and better pay. One of the patient protections at risk if things aren't stable is an adequate workforce to care for them. Note that at this point I'm not talking about chaplains. We are so small a part of the industry already that we can't sway much. I'm talking about nurses, therapists, lab scientists, and pharmacists. To have them when we need them means we need to keep healthcare stable.
So, there I am: I'm willing to hear that there's a better way; but those who claim that need to actually offer something better. They need to offer it clearly, and they need to offer it before dismantling what is in place. For patient protection, affordability, and a stable economy - things that have actually been helped by the Patient Protection and Affordable Care Act - we need to keep healthcare stable.

Friday, December 23, 2016

Once Again, Amahl - Once Again


I posted this for Christmas eight years ago. As I look back at it, somehow the tenor of the times call it back to me, make it seem particularly apt. I offer it again. Once again this Christmas there will be Amahl; and once again I will cry.

This morning I am once again practicing my last Advent (or first Christmas) ritual: I am listening to “Amahl and the Night Visitors.” As “Jesus Christ Superstar” has long been my Holy Week ritual, I can’t be quite ready for Christmas until I’ve heard Amahl.

If you haven’t heard it before, I commend it to you. Gian Carlo Menotti composed it for the first broadcast of the Hallmark Hall of Fame on NBC. It was first broadcast on Christmas Eve, 1951, and every Christmas Eve after until 1966. It is a memory from my childhood, before we had joined the Episcopal Church and I had discovered Midnight Mass. Wikipedia has a good synopsis, with the history of the production, here. I have written some earlier reflections on the opera here.

As I listened this morning, I was particularly struck at how timely the setting is for this opera. Amahl’s mother is in her own survival mode. She can see no value beyond the economic, whether in her son’s poetry or in her guests’ possessions. It isn’t because she’s unfeeling. She loves her son powerfully, and wants, with what little she has – another “widow’s mite” – she wants to show hospitality. She is enough of a known person in her community that those around her will turn out in the middle of the night to extend their hospitality with hers.

At the same time, she is defeated, or so nearly so as not to matter. She is ashamed to consider begging, however exciting it might seem to her son; but she sees no other option for his survival, much less her own.

And so she is driven to theft. She considers differences in class: “I wonder if rich people know what to do with their gold,” thinking not of great luxury, but of the simple pleasures now beyond her reach, beyond her hope. She considers a greater good to be done: “Oh, what I could do for my child with that gold!” She considers even whatever incipient relationship, even obligation, she might have with her guests: “Why should it all go to a child they don’t even know?” Finally, she gives in, not for herself but for her child; not for it all, but for just what she might need: “If I take some they’ll never miss it.”

Perhaps; but she is caught in the act. And when caught, her humiliation, and that of her son, are complete. She is seized, and her only defender is her crippled son, too weak to do more than appeal plaintively to the kings themselves.

It is then that she discovers mercy: for the kings know she and her son are more important than the gold itself:


Oh, woman, you can keep the gold.
The Child we seek doesn’t need our gold.
On love, on love alone
He will build His kingdom.
His pierced hand will hold no scepter.
His haloed head will wear no crown.
His might will not be built on your toil.
Swifter than lightning
He will soon walk among us.
He will bring us new life
and receive our death,
and the keys to His city
belong to the poor.

And in that moment, there is a miracle – indeed, there are two. We will all celebrate with the second, when Amahl can walk, blessed with healing in the moment of his own greatest generosity. But, neither do we want to miss the first: for it is indeed miraculous when his mother’s eyes are opened, her imagination expanded, and her hope renewed. Indeed, her miracle is not so different from his; for as his body his healed, so is her spirit. She can see possibilities again, possibilities that take her beyond herself, even beyond her son: “For such a king I’ve waited all my life. And if I weren’t so poor, I would send a gift of my own to such a child.”

We are surrounded these days with the same desperation Amahl’s mother felt. We see it of course in any Christmas, and will until we see the Kingdom in fullness: those who, beat down by their circumstances, unable to imagine alternatives, will steal. Some will be simply and solely greedy; but many, like Amahl’s mother, will be unable to bear the shame of what they cannot do for another, for children or spouse or those otherwise family. But this year I fear there will be so many more. The economic devastation around us, wrought in no small part by our own inability to see value beyond the economic, our own poverty of spirit, leaves many, and more than usual, literally with “nothing to eat, not a stick of wood for the fire, not a drop of oil in the jug.”

Give thanks for those who can say, to whatever extent and in whatever way, “Oh, woman, you can keep the gold [because] the Child we seek doesn’t need our gold.” Give thanks and praise when you can and I can say that, for when we do we open up possibilities for miracles. Cry aloud, “On love, on love alone will he build his kingdom… and the keys to his city belong to the poor.”

And pray, pray now and always, for those miracles, whether as visible as a dancing child, or as profound as a healed and opened heart. Pray that as our hearts are opened, so might theirs be; so that all of our eyes might be opened to the miracles wrought in the name of the Child.

Blessings for Christmas, and for all in this season of Light, from the Episcopal Chaplain.

Monday, December 19, 2016

Opportunity for Fun for Wonks and Geeks Like Me

This morning I received a link to a page that ought to be exciting - if you think knowing about published research is exciting. Take a look at the Top 100 Articles of 2016 as compiled by Altmetric. Altmetric is new to me, too. They say of themselves, "Altmetric is a Digital Science company based in London, UK. Our mission is to track and analyse the online activity around scholarly research outputs."

At any rate, their list of the most reviewed articles is interesting. They include at least one unexpected author. And, at least some of the articles are available for anyone to read (and, yes, for some you'll need to get the journal in which it was published).

So, take a quick look to see at least which was number 1. Take a quick scan, and you'll discover a number that are not only of broad interest, but also accessible to a broad audience. (And thanks to Becker's Hospital Review for the link.)