politics

Affordable Care -- Just a first step


The myth of informed consent

In all this back and forth about the Affordable Care Act we are missing what is an equally important issue. -- the cost of health care in general.  There is excellent and detailed writing by Steven Brill on the topic, but it was hard to get through it without an elevation of my own blood pressure. Most remarkable in his reporting is the fact that the cost of most medical procedures is a well-guarded mystery. From one hospital to another the costs vary greatly and the amount that our insurance company covers is also done by some mysterious formula for procedures and medication.
 This brings me to my current shock about the cost of medication. After a persistent cough  following a cold, my doctor prescribed a steroid inhaler. When I picked it up the young pharm tech said apologetically that it was $135.00. It was probably the startled look on my face that caused her to say, “Wait, let me make sure that insurance covered its part.”
When she returned from the computer she looked even more startled than I and reported that the “out-of-pocket” cost was actually $1,017.00. Yikes! I didn’t know whether to be grateful that the insurance (theoretically) covered $882 or still be outraged by what the cost to me was going to be. In addition was concern over someone without insurance who might need such a medication and be unable to pay the “out-of-pocket.”
I support the Affordable Care Act and I urged my twenty something offspring to sign up through the health care exchange. They are not invulnerable and huge bills could come to haunt them and maybe their parents. The situation with existing plans could possibly end up, as it did for our daughter.  She had a minor bike accident and even after two years was still paying off the large part of her bill not covered by insurance.
Even after the exchange works and the benefits are in place, everything is not settled. We must continue to look for more transparency in the pricing of medical care and prescription drugs. Since the ACA is in part a full employment act for insurers, they might become our partners in this quest -- once they start getting more bills for inhalers costing $1,017. People should be compensated for their work and for the product they create, but behind this veil of mystery the consumer has no way of making decisions about the better choices in the medical field.
For every little medical procedure we are asked to sign a form indicating our informed consent. At this point in dealing with the medical system in general we are all operating with uninformed consent. Having health insurance is not going to completely address this and the battles over the ACA are unfortunately taking attention away from some of the real issues in medical care in this country. It’s possible for legislators on both sides of the ACA to work to create a more transparent system of medical costs, if they can resist the pressure and checkbooks of lobbyists. Then, we citizens will finally have the luxury of real informed consent.

"Mistakes were made" -- the art of deflecting blame.


My original title was "When the passive voice is active." Amazing how often this article  from the Christian Science Monitor is relevant.

Mistakes were made in owning up to mistakes

By  / March 16, 2007
BERKELEY, CALIF.
"I acknowledge that mistakes were made here." With those words Tuesday, Attorney General Alberto Gonzales became the latest public figure to rely on the nonapology apology's best friend: the passive voice.
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"Mistakes were made" is the consummate case in point. It has become a contemporary mantra. Why won't those pesky mistakes quit making themselves!
Writers are cautioned – sorry, let me begin again: editors caution writers to eschew the passive voice. It's needed sometimes, but too much of it is considered bad form. And in public life, it almost always has the effect of avoiding accountability. But in government hearings and statements these days it seems to be the norm.
This trend and the common use of the generic "They" – as in "They just can't seem to get along in Washington" – lead us to mask the reality that actual individual human beings have power and accountability in creating positive or negative outcomes. Anyone who works in a large organization has also observed the trend to attribute most problems to management.
When I hear such vague blame, I have started asking, "What specific person?" and "What specific action?"
When I confront my own teenagers with their mistakes, they sometimes protest, "You're trying to make me feel guilty." Darn right I am! Sometimes that is the right response to a bad choice. Blame is not always a game; it can be an appropriate reaction.
Passive voice has so cheapened the concept of a mea culpa that various officials in government hearings and press conferences actually seem to be proud of themselves when they acknowledge that "mistakes were made."
And the really brave ones admit that the buck stops at their desk. With a grave tone they state: "I take responsibility. I was ultimately the one in charge."
What they usually mean is this: "Some jerk under me messed up, and I'm being gracious by pretending that I think it was my fault. But of course you realize I am blameless."
Wouldn't it be refreshing to hear an official say, "I made a big mistake by appointing a friend (or a relative or someone who contributed to my campaign). I should have hired someone with the knowledge and skills to do the job." After fainting from shock, most people would admire that candor and maybe trust that the same mistakes would not be made again.
I try to fight this pattern of accountability phobia in my own work by quickly acknowledging errors and getting on with solutions. I'm consistently surprised at how forgiving people are; they are generally equally ready to move on to solutions.
As a psychologist, I am often asked to work with children who have difficulty accepting responsibility. I try to help them see that when we give away blame, we give away power. If we don't recognize that we messed up, then we don't realize that from that same source of power we can generate solutions.
In counseling, I assign children homework: Each week, they have to share a mistake they've made so we can figure out a better course next time. It's amazing how quickly they learn to say, "I made a mistake when I ...." Remarkably, I never hear the children say, "Mistakes were made."
• Susan DeMersseman is a psychologist and parent educator.

Politics and Polarization




Given what's going on now this oped published 9 years ago seems worth revisiting. My point in the article was not being "left out",  but more being so dedicated to a "group" that truth and facts lose their power. But I've always been so happy to be published in the Christian Science Monitor that I never quibbled about titles.



American political polarization amounts to fear of being left out

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By Susan DeMersseman / July 15, 2004
BERKELEY, CALIF.
I'm starting to wonder if entertainment television, talk radio, and sports have all had a negative influence on political discourse in this country. I watch a lot of political discussion on TV and a fair amount of sports, and in a disturbing way these two contexts seem to be morphing into each other.
It now feels as if someone is keeping score in the political arena. And unfortunately, in my own mind, when I hear of a gaffe or embarrassment for the party I don't prefer, I think, "Oh good, a point for my side."
When "my side" is called for a foul, I think that the officiating might be biased.
So many recent events highlight the polarized context we are now operating in. Whether it is reaction to the Michael Moore film or to an interview with a candidate, there seem to be so few people willing or able to see anything positive in an opposing side or any negative in their own. Perhaps it requires a level of effort and analysis that doesn't fit with the sports metaphor.
I wonder if there was a time in political discourse when people listened to each other and occasionally said, "Hmm, that's a good point, how can we incorporate that into the solution?"
"Solution?" Now there's a novel concept.
But it may also be one that doesn't make for entertaining television talk shows.
One morning I read the regular oped columnists known for their political perspectives. I was in agreement with the one on "my side" and opposed to the other.
Then I had this wild idea: What if, on April Fool's day, the paper switched bylines on columnists who are well known for their political perspective? Would content we normally oppose all of a sudden make some sense if it appeared to have been written by a commentator we usually agree with? Would the tendency to accept input from "our own team" trump our normal belief structure?
The columnists seem to be participating in this sports metaphor and their contributions are often "scoring a point" in style. Or perhaps readers have come to be more entertained by a contentious, bombastic style. So that is what "sells."
I wish we could find a moral or even a common-sense compass that hasn't been distorted by the sports metaphor for politics. In the sports context, saying "I see your point" would be like stepping aside for the other team to score a goal or handing them the ball at their 10-yard line.
I believe that Americans are looking for the truth, for common sense, and for solutions. But there is something seductive about the bond that comes from cheering for the same team. Sadly, it requires that there be an opposing team.
Trying to understand what in our human nature as well as our environment has brought us to this point, I recalled conflict resolution interventions I'd conducted in various organizations. At one large high school the situation was classic. Faculty factions had come together based on what other faculty factions they disliked. They shared almost nothing except their opposition to the "other team." The need to belong was so powerful that members of one "team" disregarded significant issues among themselves and simply focused on the common enemy, the other team.
Once when I was interviewed after a violent incident at a school, I was asked what was the greatest fear of children. The journalist was thinking in terms of weapons.
But, after listening for years to the concerns of youngsters, I answered without hesitation, "Being left out."
Looking at what is taking place in the polarized nature of politics these days, I think that maybe we never outgrow that fear. Perhaps this polarization is less about ideology than about belonging. By backing "our team" we share a bond with others - we are not left out.
• Susan DeMersseman is a psychologist and parent educator.

NOT MY FATHER'S GOP

The address below will take you to one of my rare political pieces. The piece is titled,"Not my Father's GOP." It was printed in the Chicago Tribune May 27.
(So that you don't have to search the web-- here it is)



Not my father's Grand Old Party 
By Susan DeMersseman
May 27, 2012

I miss the GOP, the Grand Old Party. I grew up in a Republican household in a Republican state. My dad was an adviser to the governor; my brother was a Republican state legislator. When I was little I wore an "I Like Ike" button. I'm registered in the Democratic Party now, but I miss the GOP, the grandness of the GOP. I am sometimes embarrassed for my family and friends who are Republicans in the old way, the thoughtful, principled way — the grand way. They were people who paid attention in history class, in science class and to the well-being of their neighbors.
It sometimes seems as if the party has been hijacked by groups of narrow-interest voters or ones so angry they would sacrifice their countrymen to beat an opponent. The natural and healthy differences within the party seem to be forbidden.
Some leaders in the party behave as if their job as legislators is to make sure that the rich stay rich or get richer. I know many people of exceptional wealth and very few have backed politicians to make sure that they are protected from paying their fair share. Many appreciate the system that has allowed them to maintain or gain their wealth and they realize (those with enlightened self-interest) that a society in which all have opportunity benefits them as well. They see it as a bubble-up rather than a trickle-down economy.
Some political leaders and commentators like to call it "class warfare" when those on the lower rungs want a better chance, but I do not see most at the top wanting to engage in that mythic battle. For a small group financial domination has become a sort of sport, but in the corporations and government there are thoughtful people who want all to do better. I want them to step up and to speak up.
I miss the days when I could watch a debate based upon thoughtful differences, rather than one in which debaters are simply trying to score points or pander. The Democrats are by no means perfect. I believe even their discourse could be elevated if the worthy opposition were indeed worthy. Currently, the extreme behavior of some in the GOP makes the Democrats look more dignified and sensible. But I would sacrifice that for sensible dialogue.
I once wrote about how politics has morphed into a sport where we cheer for our team and celebrate the fouls and missteps of the other. Now, I think the sport has descended into mud wrestling. I miss the grand part of the GOP. If there is a silent majority, I hope it is those who will soon step up, speak up and take it back.
When my brother gave into the cajoling of his children and opened a Facebook page, he described himself as a "Big Tent Republican" and the "me too" responses poured in. Those thoughtful, generous, dignified members of the GOP still exist in my family and I believe in other families too. Our country will be better when their voices are heard again.
Susan DeMersseman is a psychologist who lives in Oakland, Calif. She grew up in South Dakota.
Copyright © 2012, Chicago Tribune
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