I heart Consejo de Latinos Unidos

California based Consejo de Latinos Unidos brought the issue of 'price-gouging of uninsured patients by hospitals who receive millions in tax breaks' to national attention first. Now they're holdin' the catholic hospitals to their religion and mission. What happened to "thou shalt not price-gouge your neighbor?" It's simple -- nonprofit hospitals (under which Catholic hospitals fall) receive tons of tax breaks (on property, on income, etc) as compensation for providing low-cost and charity care to folks. Then they don't provide this service, and charge uninsured patients up to 7 times what they would charge Medicare or private insurance companies, and pocket millions to billions in tax-free profits.

Something wrong with this picture?

From today's Kaiser Daily Health Policy Report:

Catholic not-for-profit hospitals are reaping high profits while charging uninsured patients up to seven times as much as those covered by Medicare, according to a report by Consejo de Latinos Unidos, the Denver Post reports. The report, which is based on annual tax returns filed by seven large Catholic health systems, found that net income at the hospitals doubled between 2003 and 2004. The hospital systems also have amassed $20 billion in cash and investments. For example, Denver-based Catholic Health Initiatives reported revenues of $5.9 billion during the first nine months of fiscal year 2005, an increase of 5.6% from the same period last year. In addition, CHI's investment income increased to $203.4 million, compared with an $80 million loss in 2003. Revenues increased 10.5% to $7.4 billion in FY 2004. Catholic Healthcare West, which has $3 billion in nontaxable assets, made $249 million in tax-free profits in 2004, according to the report. Sister Carol Keehan, a spokesperson for the Catholic Health Association, said the nation's "turbulent health care system" requires Catholic hospitals to "maintain large financial reserves" to ensure continuous operation.

Reality news and entertaining politics

I Love the way Adrienne Marie Brown (a cool cat) answers the age old question: Why do you think youth are apathetic about political involvement?

I don’t want to point fingers, but media giveth and media taketh away. This past year media has really tapped youth away from politics. It was already such a blow when Bush the Lesser ended up president, and before we could catch our breath there was 9/11, and before we could heal there was war, and now it’s like, well what the hell can I do, throw my nubile young soul in front of that right radical? For the majority of young folk the answer is No! So instead, young people turn to TV and magazines and movies and video games and celebrities and all that. The Patriot Act passed under the veil of NBA Finals. Joe Millionaire’s battling ladies were engaged in the only ‘war’ given fair coverage. Hey, people need entertainment, I am not against reality shows, I watch them sometimes. But what about reality news? That would be so cool. And what about entertaining politics?

Save a Turkey?


Hope y'all had a wonderful thanksgiving, whether you spent it with family, friends, or working in the hospital (like some of my fellow interns), and whether you thanked God, yo'mama, or anyone else meaningful to you.

My bro and I ate some yummy enchiladas in our vegetarian way of celebrating thanksgiving. Both Nalin and I have chosen to remain vegetarian for the animals (I'll save the interesting story of how we became vegetarian for another day). Neither of us push this way of thinking and living on our friends, and yes, our friends do eat meat around us, but we chose this for ourselves. Turkey day does, however, present an opportunity to discuss the issue, and I've taken that opportunity in the past (for a writing assignment in 7th grade, I wrote a play on two school-age friends who went from meat-eating to convincing their families to not to turkey on thanksgiving -- but not quite in the way Huey did in the Boondocks cartoon above).

As many folks wished each other a "Happy Turkey Day" as they left work on Wednesday, 45 million turkeys in the US were experiencing the opposite of happy (or had already met their fate). The Free Press has a short piece on The Making of a Turkey -- it's not for the weak at heart, but hey, it answers the age old "how do you go from Turkey Birth to Turkey on My Plate?" question.

A friend forwarded me a link to the "Adopt-a-turkey" campaign. Sounds cheezy, yes, especially the part where you receive a (signed) photo of your turkey. But I love the idea. And I'm eager to check out the upcoming Los Angeles outdoor safehaven that Farm Sanctuary is creating.

In related news, those turkeys are beginning to think they're the bosses around here:

Last month, jogging on a back road in Massachusetts' Berkshire hills, Betsy Kosheff passed a farmers' field where farm-raised wild turkeys were pecking for grain. Suddenly about 30 of them took off after Ms. Kosheff, who has a public-relations firm in West Stockbridge, Mass.

"It was like that scene in 'The Birds' except there was no phone booth," says Ms. Kosheff, referring to the famous refuge in the Alfred Hitchcock movie. A passing friend stopped her pickup truck and Ms. Kosheff ran around it several times. The turkeys kept up the chase, although she says "they were too stupid to split up or change directions" to trap her. Finally, Ms. Kosheff got in the truck, where, she says, her friend "was laughing so hard she almost choked on her Dunkin' Donut."

Payback time! (yikes!) But of note: We're not reducing the wild turkey population by eating them on thanksgiving and christmas and other occasions -- most turkeys born in the US for human consumption arise from artificial insemination, as the turkeys who are raised on factory farms ain't healthy enough to breed).

And for those of you who thought Tofurkey was weird (I'd rather not eat something in the shape of a turkey, or made completely out of tofu, if it were up to me), well, there's always jello-turkey . I'll, um, go for the homemade enchiladas...the ones that look like...well, enchiladas.

(cross posted on LosAnjalis)

Language is Power.

Alright folks, gather 'round. I've got to tell you something: I'm on a mission. I'm on a mission to break down some of the language we use that's absolutely loaded with stereotypes, judgments, and institutionalized racism in our society, and more specifically, in the casual and serious discussions that occur around medicine and health.

Some may call me touchy or politically correct. First of all, "PC" is so 1990's. It's trite, overused conservative soundbite that has, in the past, put thinking people back into shut-up mode. Likewise, the words "touchy" or "sensitive" are attack words used to effectively shut down any rational discussion of anything.

SO, i'm beginning an installment on this blog, of things I come across, in daily conversations and in the press, related to these issues. Placing blame ain't my thing, my aim is not to say that x or y person is stupid, racist, or otherwise piglike. But I'm trying to encourage folks to become more aware of the use of their words, and I'm doing the same in the process (as I'm becoming more aware of my use of words, judgments, etc, I'd think *I* was a smelly pig. I don't want to think that of myself, so I won't think that of others, unless they truly are smelly pigs).

A first quick example is below -- a paragraph from an article on doctors fighting medicare payment cuts:

Dr. Cyril M. Hetsko, a trustee of the association, said paying doctors for their
performance might be a desirable goal. But he added, "Depending on how the
program is set up, it could have the unintended effect of reducing payments to
doctors with black and Hispanic patients in inner-city neighborhoods, while
rewarding doctors with healthy, better-motivated patients in affluent suburbs."

Now even though Dr. Hetsko is a trustee of the American Medical Association, and I have openly stated some of my strong opinions about the AMA in this blog, I'm not attacking Dr. Hetsko nor am I attacking the AMA in my remarks on his paragraph. In fact, I commend Dr. Hetsko for looking out for the docs who work in resource-poor inner-city neighborhoods. If a program is set up to document the decrease in patients' Hemoglobin A1C (a marker of longer term control of diabetes) over time, as a quality indicator of a physician's effectiveness, there are a ton more barriers to lowering this marker in resource-poor, economically poor neighborhoods. A discussion for another day and time would entail what should and shouldn't count as good quality indicators in health provider-care.

My issue with the good doctor's statement is the fully loaded term "better-motivated". What's the opposite of better-motivated? Lazy, of course. Again, I'm not saying that Dr. Hetsko intends to call some folks not-lazy and other lazy. We all get the gist of what he's getting at with "better motivated" (people in affluent communities can focus more on improving their health and have other advantages such as being able to pay for their medications with more ease) but perhaps there's a different way to say it. Because I sure know that the patients I see in my county hospital and clinic are super-highly motivated -- often balancing two jobs, sometimes with school, sometimes with families of their own, and often dealing with life stressors that folks in affluent neighborhoods may never face.

Alright, enough of this. Next time I post on this topic, I'll try to share a more personal experience than something I read in the paper (perhaps an overheard conversation or *gasp* something I caught myself saying.

Language is power. Word.

Myofascial Memories

last week i was treated to an interesting insight. a young woman entered the clinic, complaining of bilateral breast tenderness with a small amount of milky discharge over the past few weeks. she had been seen at another clinic three weeks prior and some hormone levels were drawn. she didn't have the results and didn't remember which clinic she had been seen at.

upon examination, her breasts were non-tender. there was no liquid discharge. she was very tender at the juncture of her 10th rib and her sternum on the left side. there was minor tenderness at a few other points along her lower sternum on both sides with no other chest or abdomenal pain.

for those who haven't experienced or learned accupressure, it can be help relieve point tenderness. i applied mild pressure on the worst spot and held it for about 30 seconds. to my surprise, the patient began crying. at first i thought it was too much pressure but i realized looking at the patient that they weren't tears of pain, they were emotional tears. the naturopathic doctor who had accompanied me for the exam retrieved some tissues for the young woman and we stepped out to let her get dressed.

when i returned the patient was still tearful. she started sharing with me her story. she had emigrated to the united states from mexico 8 months prior, leaving her two small children (4yo and 8yo) behind. she was missing them tremendously and on top of it, she was not succeeding in her goal to find work in this new country. the realization had been building within her for the past month that she would have to decide if it was time to return home to whatever financial and social situation she had left there.

i offered her counseling services but she looked up at me out of clear eyes and stated that she was sure she had to go home now to her family and continue the struggle of life back in mexico.

we don't learn in conventional medicine that muscles hold emotional tension, memories and trauma. think of your own clenched jaw or tense belly when bad things are happening. this is the basis of "energy" healing, massage, reflexology... nothing more than the body's language if one can relax enough to really hear it.

30 seconds of focused pressure on a tender spot on the chest of a person and a critical life decision comes into focus for them. i am humbled by the human body once again.

andru ziwasimon

Getting lost is a beautiful thing

Some inspiring thoughts from an interesting article on James West, inventors, patents, and where the US stands in the future of innovation:

"When inventors work independently, the invention itself is seen as an opportunity, whereas in the corporate world accidents are seen as failures," said Peter Arnell, a marketing consultant who coaches companies about innovation. "When people exist outside of the corporate model and have vision and passion, then accidents and getting lost are beautiful things."

And thoughts on failure and success by an accomplished inventor:

"I think I've had more failures than successes, but I don't see the failures as mistakes because I always learned something from those experiences," Mr. West said. "I see them as having not achieved the initial goal, nothing more than that."

(cross-posted at Los Anjalis)

The California Special Election, or simply, "I'm voting with her"

I've always voted in New Jersey or NYC, so transferring my voting to California was a big step for me. I procrastinated on doing the transfer, but i'm so glad that I did. This special election tomorrow is BIG. As a healthcare provider, I'm extra interested in a few of the propositions (proposition 73 and 78 are especially frightening), but as a citizen of the United States i'm interested in ALL of them, because they all have serious repercussions.

I'm voting with Shari (who writes at An Old Soul), and thousands of other voters in this election -- NIX on the first SIX, and Yes on Proposition 79. Shari's posted a great deal on the special election, and all her posts are really worth reading, but I've gotta link to this must read one from a few days ago. Definitely check it out if you'll be voting, for the in-staters, or watching from the stands, for you out-o-towners (can i say that now?)

I thought her newly dubbed titles of the propositions were hilarious, so i'll rewrite the titles here, but check out her full post.

Prop. 73: The Secret Weapon to Get Out the Conservative Base Initiative.

Prop. 74: The Confuse the Issue by Blaming and Punishing New Teachers Initiative.

Prop. 75: The Let's Make Sure Corporations Destroy the People's Voice in Sacramento Initiative.

Prop. 76: The Destroy Public Schools and Make the Governor an Emperor Initiative.

Prop. 77: Let's get Three Retired Judges Appointed by Republican Governors to Redistrict California Initiative.

Prop. 78: The Big Pharma's Weak Effort to Look Good Initiative.

Prop. 79: The Big Pharma Hates This One So There Must Be Something Interesting Going On Initiative.

When I moved to California, I thought nothing could be crazier than New Jersey politics...

(cross-posted at Los Anjalis, Anjali's new personal blog for posts serious AND silly).

let's talk about what it means to be an ALLY.

PART 1 – Privilege and Internalized Superiority

i'm not talking about war-time alliances, i'm talking about the role of professionals and white people in social justice work.

you have to start with the truism - "the road to hell is paved with good intentions." sit with that for a bit because it will come back to bite you hard if you ignore it, to the point where your dreams and desires will implode on themselves and you will think it the result of incompetence or the petty frustrations of the people you are working with. I can guarantee that it is only the reflection of your own ego projection being rejected by intelligent, experienced human beings who are seeking what you claimed to be seeking – a world where we are all equally valuable.

to avoid such a quandary, along with good intentions, you need consciousness of your “privileges” and of your (likely unconscious) “internalized superiority complex.” if you haven’t studied racism and how racism works, this might be confusing vocabulary. take an “undoing racism” training to learn more.

here are some not-so-subtle symptoms of internalized superiority as they are expressed in social justice movements.

1. every document produced and every tactic chosen has to be approved by you down to the syntax and grammar. likely you consider that everything produced by your team is a direct reflection of you, and you want to carefully control your public image.

2. you take every negotiation and creation opportunity offered to you by the opposition even if you are too busy/overwhelmed. likely you don’t feel that anyone else has the skill to do the job correctly.

3. group decision-making is fine as long as you agree but if the group makes a decision different from your own you have the (perceived) ability not only to ignore the decision but to ignore the group as you continue to create reality with the opposition. note that anyone can disagree with a decision, but not just anyone would think that they had the power to move an organizing process forward by themselves. likely you think that the group is misguided, unsophisticated or out of touch and you don’t want to waste the opportunity to make some important changes. consider perhaps that those changes might really be compromises or less important than other factors that you are ignorant of, or simply that folks can see you better than you see yourself and aren’t about to endorse your role as the great white man coming to save the poor indigenous people. that pattern of history is old, too old to recreate again.

4. you participate in more meetings and "donate" more time to the cause. be careful with this one. you can start to feel like you care more or are more dedicated. likely the reality is that other non-professionals in the group have pressing home and/or financial situations that preclude them from putting in as much time. from a surface perspective it can start to create guilt in those who cannot participate as much (we all love to feel guilty, especially those involved in social justice) and give undue voice to the person who is "over-participating." this is a tricky one because the goal is not to work less or do less than you can. people are dying out there, do what you can. but the group, and especially you, the privileged one, needs to be conscious of this as privilege. pure and simple.

these fairly benign looking symptoms portent serious conflict and can fracture years of work at critical stress points when success seems like it is just a breath away. I know these symptoms because they have existed in me to some degree and I’ve seen them play out in other white professionals over the years. the contrast of styles is striking. the antidote is either an empowered team that has clear boundaries and roles so that us white professionals don’t fall trap to our own foibles (that’s the human model) or it is an individual who can continue to see the difference between personal power/privilege and personal liberation/service (the humble model).

let me try to explain a bit more.

what is privilege? it is advantage. given an equal world, there would still be privilege. I’m tone deaf, I don’t have a single musical privilege afforded to me by the creator. but I’m fairly good at understanding patterns of behavior that help me help my patients with their illnesses, which is a good step up on the road to being a doctor.

what is privilege in an unequal world? privilege is the accumulated advantages (over centuries) given to certain people based on where they were born and what their skin looks like. privileges are fiercely guarded and often, most of us take them for granted as gifts of god. they are gifts of man. how many fairly smart white people are doctors and brilliant Native Americans instead are spending their lives refuting prejudice and protecting their communities from further assault? I’ve met too many talented people of color whose career decisions are shaped not by a neutral assessment of job satisfaction but by the stark awareness of perpetuated injustice and their dedication to the transformation of social power relationships – a much more challenging job than becoming a doctor.

in conclusion, there is a line that we, as professionals (white or otherwise), should never cross – do not take control of an organizing process. participate, grow and learn, challenge those around you, be an ALLY. do not put yourself into a position where every decision has to flow thru you, where you feel personally affected by each word in every document or action created by your team. it is not about you. each person will have an area of expertise. limit your “micro-control” to the aspects of the work where your input in vital. if you believe that everything needs your input, then examine that belief. it’s the place to start to understand your unconscious superiority complex, and that is then another step along the way to liberation.

Andru Ziwasimon