#and it’s the most un-explainable feeling to articulate because it’s not ‘too fast’ to me | Explore Tumblr posts and blogs

glendavidgold-blog · 8 years ago

Text

When we rebuild it

In 1972, I was eight years old and the elections were coming. I asked my father what the differences between Republicans and Democrats were. He said that Democrats’ first question was “What is the individual’s duty to society?” And that the Republicans’ was “How do we protect the individual from society?”

There was a lot more -- he explained the extremes, from progressive to liberal to socialist to communist, and from conservative to reactionary to John Birch Society to fascist. He also confirmed that he was a Republican. A Jewish Republican from Chicago, technically the null set, but that’s a story for a different day.

For today, I wanted to start with the terms he laid out above. Both of those driving questions are good ones. And there are times where I would come down on one side of an issue or the other, depending on my own worldview. Should the government tell me how to love? Probably not. Should it tell me that, say, a year of national service is a way for me to pay back for infrastructure? Probably so. These are my answers, not necessarily yours. Yours could well be the the opposite.

My point is that the basic nature of the opposing sides made sense, not just to me (more of a progressive sort) and to my father. He’s been frustrated by presidential elections since about 2004, as his party has drifted away from him.

I get it. Beginning in 1980, my party drifted away from me -- and I wasn’t even able to vote yet! In my mind, Ronald Reagan successfully demonized the word “liberal,” and ever since then my Democratic party has been afraid of its own policies. They have been formed not in light, but in the shadow of the other party. “Hey, at least we’re not those guys” isn’t really much of a platform.

I’ve been thinking about this since the election, and as I’m typing this, it looks like all hell is about to break loose with the Russia investigations. Maybe it won’t. Maybe they’re planning a war with Iran or North Korea to try to distract us. Maybe something else. But let’s say for now that things go A to B to C, the way they always do when Bunker Time starts, and there’s about to be some serious, fast, shocking, destabilizing changes. I’d like us to prepare for them.

I have a message for everyone who is heart sick, everyone who has woken up every morning will a sense of ill-ease, as if we have just remembered there is a candle burning next to a stack of newspapers. Everyone who looks at the weather and wonders if the weather will ever be normal again. Everyone who is being priced out of housing and who is feeling like there is a rug about to be ripped out from under them, be it healthcare, pensions, job security, education. Everyone who feels that the parties in charge are no longer accountable to citizens. My message is that we’re all in this together. And that has to be the message that the party getting us back into the light will trumpet every place it can.

I have a recurrent fantasy about facing the few folks I know who are Trump voters. It has nothing to do with getting anyone to change their minds. It goes like this: I’m on a stage in a debate, and I am allowed to ask the first question. My question would be “Can you articulate my position?”

(In my fantasy, that always throws them.)

See, I ask that because each side (and we are down to sides now, tribal and unthinking, rather than people who bond together differently on different issues) sees the other as kinda dumb. And they’re right. My side is kind of dumb about stuff. Obama and drones, Obama and surveillance, Obama and the death of privacy, Obama and the bankers -- all of those things are horrible and I ignored them because, hey, Obama was an adult who backed up my point of view. I absolutely, positively realize I made some mistakes there.

Likewise I made a mistake in dismissing Reagan. Yes, he lied repeatedly, covering up crimes with folksy witticisms that drove me insane. But they weren’t just distractions. They gave people energy to go out and be Americans and work hard and have something to believe in. It drives me crazy that his bellicose Russian strategy paid off in some ways. Yes, I realize it’s more complicated than that, but I do see merit in the position: whatever else his flaws were, there’s a good argument that Reagan helped defeat our ideological opponent, and that’s got to at least be taken in and considered.

I would be curious if Trump supporters could say of me why I voted the way I did, at all times assuming that I’m not a complete idiot, but instead human and bound by my experience and perceptions. I would like to do the same for them. But there’s a lot of noise. I’m not sure why they voted for him beyond what the media reports, and the answers are so jumbled: economics, racism, wanting an authoritarian dad, not understanding cause and effect, a weak Democratic candidate, misogyny, delight in the LOLZ of it all -- I’m not sure i know anyone who votes like that.

I have a feeling, not supported by any evidence, that there’s an un-examined reason for all the rising authoritarianism in the world. The questions my father said the parties asked back in 1972 only have equal interest for voters in a world where the future looks limitless. If there is an infinite amount of resources, then figuring out our responsibilities to each other follows.

But I think that’s no longer the case. I’ve said it before, but the world no longer sees the future as a renewable resource. We see limits where we didn’t before. It’s climate change. The earth is starting to treat us like an opportunistic infection and it’s starting to burn us off of it. That’s terrifying. We all know it’s coming, even the people who deny it. They deny it because it’s terrifying and because taking responsibility for our actions is not something Americans of any party have ever been good at.

They also deny it because the corporations that now control most discourse are looking for short term gains. Decreasing resources mean that the people who own them are getting richer. They will always put the thumb on the scale to make sure their agenda gets heard. Their agenda is “anything that regulates us, or promises to allow more people access to wealth is bad.” But they don’t phrase it like that. They instead make promises that are insupportable (”More jobs!”), but only if you know how to analyze them.

I am by the way a fan of capitalism. But I’m a fan of them they way I am of teenagers. See: the stock market has the emotional maturity of a teenage girl. OMG OMG OMG OMG, like that. And corporations have the ethics of 14 year old boys. I like 14 year old boys but I don’t think they should be allowed to drive, as badly as they want to. So: yes to your energetic natures, corporation and teenagers, but like a good parent -- and citizens of democracy are the parents of capitalism -- I need to reign that energy in to make sure it doesn’t drive the car into a ditch.

When we rise again, it is going to be chaotic. There will be competing voices. Some will be Democratic party fossils who think that trying to capture 50.1% of the vote is good enough. No. It’s got to be a new set of questions. It’s something like “What is the individual’s duty to society?” again, but taking in the current state of affairs. People who are smart at platforms should understand that it’s crucial to be positive and specific.

Start like this: it’s tough out there, so the way we’ll handle this is by banding together and figuring out 10 million new jobs building the boats that go into the ocean and clean up the plastic, which will we figure out, using science, how to use to build housing; we’ll rehabilitate the planet and we’ll do it using the world’s greatest workforce. Let’s do it as a joint force between business and government and figure out how the maximum number of people can benefit.

There’s more, but that’s the place I’d start.

This isn’t going to convince a lot of Trump voters. I don’t worry about it too much. One thing I’ve read repeatedly is that they think progressives look down on them, and guess what? That’s right. I’ve seen a lot of FB threads where people assume the only way someone voted for Trump was to momentarily dislodge themselves from their Lazyboys, then bring Pop-tart-sticky fingers to the ballot box, where they voted against their own interests and then farted and giggled about it.

That’s not helpful.

I have a different narrative about that.

My day job is that I write historical fiction, much of it about con men, much of it about the pursuit of power. Trump is an amazing character, purely American, exactly our Golem, our Anti-Golem, a creature into whom every poor American aspect, everything we’ve tried to sweep under the rug, every little awful thing we have done as Americans and yet still tried to argue that America is the greatest country on earth, all of that was poured into a mold and made into a President. Let’s ignore class and race and hereditary wealth and how the law buys different justice for the rich and Gerrymandering and the rights of people of color, and the problems of reality TV blending into reality, and the death of our educational system, and let’s no longer teach kids how to think, because thinking is hard, but revelation is extremely fulfilling, and when we do all of that, we have marked a chalk outline, and then dropped Trump right into it. It’s kind of amazing and it’s the kind of thing that makes me think he really is our own special kind of doom.

But he’s not. He’s a con man and a serial domestic abuser and a sexual assailant and a bully. What all of these characters have in common is that they are weak. Trump is a small, weak coward who will fold when a rolled up newspaper gets near his nose. That’s not so much the point as this: the victims of con men, abusers and bullies internalize shame to an extent that evades logic and reason. When you realize you’ve been betrayed it’s awfully hard to admit it, and you want to defend your bully even more. So: I’m not on board with shaming anyone for having voted for him, nor still defending him. That’s going to last for a while, and I’d just let that happen and have some sympathy for it.

Instead, this: we’ll just be over here, listening. We are all in this together. And to be honest, there’s something that everyone who is liberal, conservative, or at some different part of the politcal spectrum can agree upon is that we’re all kind of a bunch of jerks. Yep, we’re really assholes a lot of the them. And that makes sticking it out hard. But what choices do we have? I would rather team up with other people in my neighborhood and work on something to turn back that feeling of dread that’s been in my soul than use the fear of the future to barricade my precious, dwindling resources away from them.

Step one: have a pathway for all of those people who are about to realize they’re fucked. Step two: see if you can articulate their points of view. My campaign slogan: “Sure we’re jerks, but we’re all jerks together.”

This post will update as coffee and time allow.

2 notes · View notes

realselfblog · 6 years ago

Text

The Consumer and the Payor, Bingo and Trust: My Day At Medecision Liberator Bootcamp

To succeed in the business of health information technology (HIT), a company has to be very clear on the problems it’s trying to address. Now that EHRs are well-adopted in physicians’ practices and hospitals, patient data have gone digital, and can be aggregated and mined for better diagnosis, treatment, and intelligent decision making. There’s surely lots of data to mine. And there are also lots of opportunities to design tools that aren’t very useful for the core problems we need to solve, for the clinicians on the front-lines trying to solve them, and for the patients and people whom we ultimately serve.

At the end of each day, the HIT company has to remember that at the end of a digital transaction, there’s a person. That individual could be a member of a health plan, a nurse, a physician, a grandparent-caregiver tapping into her grandchild’s medical portal…all people, with different abilities to read and comprehend data, values, and incentives.

Earlier this week, I spent a day with Medecision’s digital health team, aka ‘the Liberators.’ My role in the event was to provide a through-line from introductions to trend-weaving what I heard and learned at the end of the day. In the middle of the day, I spoke about trends in health care focusing on the patient: as a payor, as im-patient, as digital, as a consumer, and as political.

As a payor, the insured patient in 2019 is likely to be managing a high-deductible health plan, responsible for first-dollar costs until s/he reaches that threshold. As such, health care spending feels like a retail event, prompting the patient-as-payor to ask, “what’s the price?” “What’s the value?” “What’s the product?” “What are the alternatives?” Even though price transparency has gone live online among more hospitals, this start-up phase is still heavy-lifting and confounding for people to understand. Health care costs continue to be the top pocketbook issue for most families in the U.S. across income cohorts.

As that payor, expecting retail service, patients are im-patient. Why can’t appointments be made online like I do with restaurants on OpenTable? What’s so hard about getting me my lab test on the day or next-day after I provide my sample? Health care surely doesn’t feel like the best retail experience, and that’s especially true for health plans. I shared the Temkin Group’s data on customer experience (shown here), where our favorites are found in grocery stores, fast food joints, and retailers. Health insurance plans? Not so much.

Patients are also digital: smartphones are fairly ubiquitous (although we must remember that not all people can afford data plans – my mantra, that connectivity and broadband are a social determinant of health). This means people (with connectivity) want work-flows for health care the way they conduct their financial affairs, social networking, travel planning, and way-finding. People are omni-channel, too, so health care must think like a retailer in reaching people wherever and however they want to be reached: online, via email, via text, phone call, and even via snail mail for some (albeit increasingly fewer) patients.

Patients are consumers, at the end of the day. As payors, digital beings, im-patient people demanding service levels they experience elsewhere — outside of healthcare.

Finally, patients are political. Health care was the top issue driving voters to the 2018 mid-term elections. Health care will also be top-of-mind among voters in 2020, who are becoming more aware of the risks of losing coverage. This week, the level of uninsured people in America rose to a four-year high, with the erosion of support for the Affordable Care Act by President Trump and Congress over the past two years. Growing concern for losing coverage for pre-existing conditions has become mainstream across political parties.

Politics underpin what’s happening in health plans in the public sector, and I spoke a bit about Medicare and Medicaid. The latter is the place to look, across the fifty State Governors, for Medicaid expansion (or not); growing integration of behavioral health to deal with depression, anxiety, and the opioid crisis; and greater attention to the social determinants of health and long term social supports (LTSS). You can see the latest Medicaid demonstration waiver data from a Kaiser Family Foundation analysis done January 9, 2019 shown in the bar chart.

To that point, during the day, two Medecision Liberators played out a scenario for complex cardio management. In the role play, a patient-persona was speaking with a call center associate. In the conversation, the plan member asked how the associate knew so much about them. Further into the conversation, the member said she needed to hurry off the call to get to her bingo game in time.

That conversation raised two important points and opportunities to drive health outcomes: first, on the issue of privacy and trust, as the member questioned just how the associate knew so much about her. That’s an opportunity to forge a bond of trust between the member and the health plan or provider, to discuss how bringing various data together can help paint a picture of her whole life and help her achieve better health.

The second item — the bingo game — presented an opportunity to discuss social supports, transportation to the event, and what the member might be snacking on during bingo. If it turns out she loves the salty snacks or M&Ms, the health coach has an opportunity to counsel the member on the impact of salt on her heart health, and suggestions for some healthier snacking.

This kind of conversation is inherent in the values that Health New England’s Lisa Holland discussed in the context of HNE’s customer promises for the organization: quality, thoughtfulness, and humanity.

The Medecision Liberators collaborated in a brainstorming exercise about social determinants of health, generating important insightful questions they would ask people about their lives to un-earth opportunities to address social supports. A few of these questions were:

What’s your most challenging daily activity?

Walk me through your typical day.

Do you have someone you can rely on if you need help?

What does living independently look like to you?

Do you have access to healthy food?

What did you do for entertainment today that gave you pleasure?

Can you read?

That led me to end the day’s trend-weaving quoting one of my favorite JAMA columns from the recent past: that Value-based payments require valuing what matters to patients, co-written by Dr. Joann Lynn, Dr. Aaron McKethan, and Dr. Ashish Jha. This has become a pillar in my thinking about the role of respect and trust in health care between patients (as payors, consumers, self-carers and caregivers) and health care organizations. They ask and answer: “How can a care system be structured to deeply respect the myriad differences among patients when disabilities or advanced age makes those differences especially important? The answer is that the delivery system must proactively help affected people articulate their priorities and goals.”

Health Populi’s Hot Points: The theme of trust was mentioned throughout the day, across a wide range of discussion topics. I noted in closing that this week also convened the World Economic Forum in Davos, during which Edelman annually updates their Trust Barometer. This year’s survey found that globally in 2019, the most trusted institution for consumers is the employer: both for ensuring a job for “me,” as well as for being a good corporate citizen in the community locally and in the larger world, in sustainability and responsibility.

This behavior drives trust, which we learned is the most important driver behind peoples’ engagement in health — a key finding in the first Edelman Health Engagement Barometer conducted in 2008. Eleven years later, trust as a health engagement requirement is even more important in light of our AI-enabled health care world.

We remember that at the end of every health IT transaction, there’s a person: a plan member, a consumer, a doctor, a caregiver.

“We are all the same,” a doctor’s essay in JAMA noted this week. Dr. Mandy Maneval, a family practitioner in Mifflintown, PA, wrote:

It strikes me that so many of life’s moments are dichotomies of health and disease, life and death, joy and sorrow. As a family medicine physician, this mirrors my everyday life. I often leave one patient’s room after giving bad news and immediately enter the next room to see the happy parents of a newborn. Navigating the full spectrum of human emotion is simultaneously exhilarating and exhausting. There are days when I feel like a hero and others when I cannot do a thing right…Connecting deeply through our shared humanity, no matter our differences, is one of the most precious gifts we offer and receive as physicians. We are all the same.

That works for physicians, and it works for all of us in the health care ecosystem. I thank Medecision for the opportunity to participate in this day of insights, team-building, and real human connection.

That last sentence was going to be the conclusion of this post. But just in time, on cue as this post was being scheduled on WordPress, an article titled A Framework for Increasing Trust Between Patients and the Organizations That Care for Them arrived in my inbox from JAMA published on 24th January 2019. Dr. Thomas Lee and colleagues explained:

Trust matters in health care. It makes patients feel less vulnerable, clinicians feel more effective, and reduces the imbalances of information by improving the flow of information. Trust is so fundamental to the patient-physician relationship that it is easy to assume it exists. But because of changes in health care and society at large, trust is increasingly understood to be at risk and in need of attention.

The authors outline potential approaches to increase trust between patients and health care organizations, which include:

As a first step, leadership should acknowledge that trust is foundational and a trusting environment essential for good health care

Measuring trust should be a standard part of evaluating patient care experiences, including those with health plans

Transparency of patient care experiences should be part of measuring, monitoring and continually improving quality and safety

Boards and leadership should routinely examine data that reflect on patient and staff trust, and include these in reward plans

Standards, training and accountability systems should be developed for clinicians and for teams

Relationships between patients and clinicians should be structured such that patients can make choices reflecting their personal preferences: this recognizes that patients know more about what matters to them and how they are doing

Health systems should insure needs of patients for a navigator or translator are met

Finally, patients should be actively engaged in designing solutions to the erosion of trust.

This article is free from JAMA’s usual paywall, so please click on the link above to access the entire discussion. These doctors who crowdsourced the recommendations really understand that it’s good to know about patient’s love of bingo, taste for salty snacks, and social support systems…and patients really do want to be part of their own planning and care.

The post The Consumer and the Payor, Bingo and Trust: My Day At Medecision Liberator Bootcamp appeared first on HealthPopuli.com.

The Consumer and the Payor, Bingo and Trust: My Day At Medecision Liberator Bootcamp posted first on http://dentistfortworth.blogspot.com

0 notes

maxihealth · 6 years ago