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ObamacareThe continued rancor about Obamacare among some interest groups could provide an opportunity to improve a landmark law through subsequent lawmaking that refines elements that aren’t working as well as expected.  Even people who are diehard supporters of Obamacare recognize that it doesn’t cover all people in the U.S. and that it falls short on things like negotiated pricing of pharmaceuticals. But analyzing the successes and shortcomings of existing laws requires unbiased data and whole truths.

When Congresswoman Cathy McMorris Rodgers gave the Republican  response to President Obama’s State of the Union address, she spoke about a woman from her state of Washington who reported that her insurance premium increased by $700 a month under Obamacare. New York Times columnist Paul Krugman writes today that this is misleading, at best. He links to a report by The Spokesman-Review, a local paper in the state of Washington, that interviewed Ms. Rodgers and discovered that she did not use the state health insurance exchange, even though it would have provided her with less expensive coverage.  “I wouldn’t go on that Obama website at all,” she is quoted as saying. In addition, her prior plan was a catastrophic coverage plan with a low premium and $10,000 deductible. Her current insurance coverage is more comprehensive and must include free well women care–one of the important elements of the Affordable Care Act.

The Republicans have finally put forth an alternative to Obamacare. The Patient Choice, Affordability, Responsibility and Empowerment (or Patient CARE) Act would repeal Obamacare and replace it with a plan that would increase access to affordable, high quality care “by empowering individuals and their families to make their own health care decisions, rather than empowering the government to make those decisions for them.”  In reality, it reduces the ACA’s restrictions on insurance companies being able to charge more for people with pre-existing conditions, allows states to opt out of requiring insurers to cover dependents up to 26 years of age, eliminates the individual mandate for insurance coverage (something that economists and others have argued is essential to reduce the overall cost of insurance by having the pool of ‘covered lives’ include healthy people who are low-end users of health care), changes Medicaid into a capped state allotment and have block grant programs for special populations (such as pregnant women and low income families), and other elements.

Are any of these ideas worth considering?  Many are incompatible with the ACA, but the proposal may include some measures worth exploring.  Unfortunately, when there is no space for honest, factual conversations about refining the law, the alternative to Obamacare can easily be viewed as a ruse to continue to oppose the most significant single piece of legislation in decades. The opposition would have more credibility if they insisted on using data and anecdotes that are true and undistorted.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

The continued rancor about Obamacare among some

I have been a guest author each day this week at the Best American Poetry blog. The following is a repost of an interview I posted there yesterday. My thanks to Stacey Harwood and David Lehman at the BAP blog for permission to repost, and to Seema Reza, for taking the time to talk about her important work with veterans.–Joy Jacobson, CHMP senior fellow, @joyjaco

Seema Reza, photo by Willie Young

Seema Reza, photo by Willie Young

Seema Reza is a poet who coordinates recreational arts activities at Walter Reed National Military Medical Center and Fort Belvoir Community Hospital, where she works with veterans and active duty service members in the Washington, DC, area. I met Seema last fall at a conference of the Transformative Language Arts Network, a gathering of writers, musicians, health care professionals, and others using language for personal and social change. Seema, who is of Bangladeshi heritage, will turn 33 next week. She has two sons, ages 13 and seven, and holds a bachelor’s in fine arts from Goddard College, where she is set to begin the master’s program in Transformative Language Arts. I talked with her by phone this week about her work. What follows is a lightly edited transcript. And please make sure to scroll to the bottom of the page for a poem by a combat veteran participating in the arts program, Joe Merritt.

You’re about to enter Goddard’s master’s program in Transformative Language Arts (TLA). Why as a poet did you decide to pursue that degree?
When I got my BFA, they were really kind to me at Goddard. They let me play with different forms of creative writing, essays and telling the stories of what I was experiencing. And then my father passed away, and I couldn’t bring myself to write complete sentences. He drowned while on vacation. It was very sudden, very far away. Our relationship was rocky. I was going through a divorce at the time, and hadn’t talked to my father in a while. It was a devastating loss. When you lose a parent, suddenly you feel a generation older, a little closer to that generation holding up the sky. It was a big identity shift. I decided at Goddard to learn the rules of poetry so I could reject them. I found in working with fixed-form poetry that the poems are not necessarily where I want to end, but I am able to discover things using fixed forms. I have to force myself to find the syllables and words and phrases, and I will go back to it often to try to figure out what I am trying to say.

So you were discovering as you wrote what you needed to say.
At Goddard I was exploring the relationship between form and content and how that connects with the primal brain. And to connect with an audience, to hit an emotional place, you have to go deep. With fixed form it’s harder to hide from the difficult stuff.

Could you give an example?
I had written this villanelle. I believe the refrain was, “Now we separate, divide, remove the groom, reclaim the bride.” I thought it would be a poem about the fierceness of reclaiming myself. But you’re reusing these lines, and the meaning is changing. You have to keep addressing it to find words that rhyme. And then you say “Oh, shit, that is not the poem I thought I was going to write.” The final poem was not something I loved, but I had to confront my mixed feelings, take some responsibility for my part.

Do you see a division between creating a work of art and the “transformative” aspects of writing? Why get a master’s degree in TLA?
I have mixed feelings about how expensive higher education is and how it changes the playing field. It changes the bar to things other than accomplishment, skill, and grit. This program in particular is based on the idea of building community and using the arts to do that. It’s a simple concept but it’s overlooked. Art therapy is a field that has its own beauty and importance in the continuum of care. But ultimately, the benefit of finding your voice and having your words validated by your peers or by a larger community is something you can’t do alone. You might want to say it doesn’t matter what anyone thinks of you, but that is not how humans are built. You have to have this opportunity to put yourself out there and see that no one runs away, to gather people together who say, Yes, I hear your story, I appreciate your truth, and I am still here.

When I attended the TLA conference last year I came away thinking about “radical acceptance” and how life changing that can be.
Radical acceptance is such a beautiful phrase. It is life changing. It causes me to have less patience for some of the more surface interactions that we tend to fill our lives with. It’s hard to come back from one of those experiences and say let’s go to happy hour.

Is the TLA study important to your career?
It is, in the sense that I hope to find the methods and language to answer: How do we survive in this work? I spend my day listening to some really rough stories. That’s my job. The goal is to create more people who are doing this work, especially veterans. There are stories that veterans tell other veterans that in some cases they wouldn’t tell me. So how do we maintain our own creative practice? That is an important part of the TLA program. When I’m working with veterans there’s mutual growth. We are together, both of us growing. How do we support the facilitators of this work, particularly when they have traumas of their own? It’s the kind of thing we need people all over the world doing, and they have to have safe outlets for processing it. Artists and veterans are leading these community-building workshops, and I’m interested in seeing that people are staying sane.

How is writing central to that?
Writing is what I believe in most of all. I paint as well. But I am able to hide more with painting than writing. At least two of the people who are a part of the research project I hope to do at Goddard are primarily visual artists and they bring some narrative to it as well. When I was burying my father, it took a long time to bring his body from India to Bangladesh. I was there before he arrived. It was traumatic, to say the least, the most difficult time in my life. I kept trying to write it and only could when I went to a writing retreat in Utah. I thought, if I break here I’ll be safe. I wrote the story in a workshop with Steve Almond. I use those words I wrote to speak about what I felt and saw. I tell it to people not because I want to tell this traumatic story but because it is who I am. I have to tell people who I am and why I am the way I am. The barrier created by the experience crumbles.

Why aren’t there more people taking about using writing in this way?
I am in a field where I feel a lot of people are talking about it—narration from a therapeutic perspective. But I think also it’s scary to do this work on yourself and with others. It’s super scary to take all the pieces of you and put them on the table and say I’m going to confront this. It’s hard work. People don’t know how to start. People don’t know how to enter into their story. I come across it a lot in people who don’t identify as writers and their experience in high school English does not prepare them.

What do you do as an arts coordinator at Walter Reed and Fort Belvoir?
The program has three major components. First, we have the in-treatment groups, which are part of two intensive, partial-hospitalization programs. They’re in treatment for psychiatric disorders, substance abuse, and it’s required that they participate in their recreational afternoon time. They have to be there whether they like it or not—and they do not at first, but eventually they do. There are between eight and 16 people in the room. We read a piece of writing and respond to it. I give them really specific directives, almost like Mad Libs. I give them the phrases they’re going to use. Free writing can be terrifying, especially to people used to being given orders. We do some visual arts groups within these populations.

The second piece is the open session, held on the hospital campus and open to anyone. It’s not treatment-directed, so you come if you want to come. We use visual arts and writing. Yesterday we had people doing self-portraits, soapstone carving, knitting. Somebody was painting with acrylic, somebody in watercolors. It’s loud and fun and we’re all making things. Sometimes we’ll have patients from oncology or inpatients, sometimes hospital staff, family members. It’s a flattened hierarchy, all first names, laughing, drinking coffee. Many are graduates of the programs. The open group has less structure, and they’re learning how to stay safe with less and less structure.

The third piece is a weeklong workshop—art, writing, music, or a combination—and ends with a performance that’s open to the public.

Open to public—that’s nice.
It’s incredible. We collaborate with local artists or veteran artists and work through the week to create this exhibit or performance. It’s an individual effort but they’re working together to support each other and propel each other forward to make their own work of art. They’ll have a recorded track of music and the performance is an opportunity to really step out and do this thing, to say, This is who I am, on a stage.

You’re working with people with PTSD, posttraumatic stress disorder. Do you guide them to open up to a particular trauma?
I keep it open. I am not a therapist. I don’t want them to open up more than they’re ready to share. Whatever your story is, I tell them, be specific; I want to hear your story. People have different things they need to work with. You might have deployed to combat but you have this childhood stuff and that’s the story you’ve kept hidden. We work with Combat Paper NJ and Warrior Writers—two nonprofits that are fantastic. They will be in the DC area 12 times this year. Because that’s a veteran-led initiative, the work tends to very much be about the military experience. Those two groups come together and do writing and paper making and then there is an exhibit and performance. This year has an open-mic component, which has been wildly successful.

What’s it like to work with veterans?
These folks are some of the most generous and responsible people in the world. We’re all born into the culture were born in to. But across the board they have chosen this military culture. It has its own language and dress code and history. It’s a community in a really beautiful way—where people choose a culture and are so committed to it.

Speaking of culture, I found a short piece online you wrote about your relationship with your mother, who was born in Bangladesh. I laughed out loud when I read that she “did not enroll me in music and art lessons to uncover my potential. She didn’t tell me to never give up—giving up is one of her key strategies for coping with life.”
My mother just doesn’t get ambition. You know when you have a friend who’s in a bad relationship and you think you can’t listen to it anymore? That’s how my mother is about me. “Dude, if you were just a librarian and you’ d stayed in that marriage you’d be all right. Why do you have to write too? Just stop. Just do one thing.” We have our moments, as every mother and daughter do. But her love for me is still boundless. It’s not fierce. She’ll never apologize for having done something wrong when I was a kid. She’s not protective, but she’s kind to me. As you get older you value people who are kind to you.

You sound older than someone who’s 32.
Well, I became a mom when I was 19. But honestly I think it’s because of writing. I navigate the world really consciously, since my writing process has become such a central piece of my survival. I think a lot about why I feel the way I feel. The poet Cynthia Oka said a poem or a piece of writing isn’t done until it’s transformed you and your perspective. As a writer I’m always waiting for something to become clearer.

I’ve become more aware lately of how writing can transform a memory. Sometimes I even intend it to change a memory.
One of my staples is talking about your past self, even who you were yesterday. So much of what we suffer from is not forgiving ourselves, and it eats us up in the present. That person who did that didn’t know what you know now. We do a lot of rewriting. I use Jeanann Verlee’s video “Unsolicited Advice for Girls with Crooked Teeth and Pink Hair,” her directions for how to survive. “When your mother hits you do not strike back,” she says. We’ll play that piece and I’ll say, Tell that person you were at the time what to do. It’s all about writing letters to yourself.

Do you teach poetic forms with these groups?
Not as much with the groups that are treatment directed, but with my graduate groups, absolutely. We’ll go to the villanelle and we’ll take it toward meter and get a little more technical, engage the mathematical side of the brain. My senior thesis was an autoethnography: how I grew, where I was willing to go in certain pieces of my writing, how it affected the aesthetic value of the piece. When you’re dishonest in your writing it shows. That was one of my key discoveries. There is a formulaic short prose essay thing, and it’s cute, but its not always what you need when you’re really looking for the truth. It’s important to understand musicality and repetition and what it does for your work—what it does for your audience as well as you.

Louise DeSalvo says that in order for a piece of writing to be “healing,” having an audience is not optional.
It is not optional. The open mics are incredible. After they do that the next stage is to go to a local poetry venue and read. There, you might have antiwar poems being read right after a combat veteran reads about his or her experience. We don’t create enough space for gray. But it’s really important to make room for that.

The following poem is by Joe Merritt, a combat veteran who deployed to Afghanistan and participated in one of Seema Reza’s writing groups.

Pray

When your Egyptian cotton sheets
hold the comfort of rusted metal teeth
you find yourself contorting to sleep,
squeezing your bones into the irony
of an empty love seat.

The bird lands, kicking up a storm of sand
that settles in the deepest parts of you,
leaves an uneven deckled edge in your mind.
Nothing will ever fit perfectly with it again.

They have been gone for some years,
these dog-eared pages are their ghosts
the worn out shoes you won’t let go of.

Watch them, yes you.
Watch them loaded onto the bird
again.
Watch them.

A mind reloading images like your
gas-operated,
belt-fed,
air-cooled,
fully automatic
crew-served weapon.

Those bunk beds are
what became the smashed clock
of where you imagined your twenties
its gears and springs
lay across cluttered floors.
Childhood toys are no longer memories.
They are the priorities that lead to
a sink full of dishes, a mind full of trains
a bedside coffee pot gives you an extra five minutes

before waking them
wake from it
skin like a wet bar of soap.
Roll over and see the only one there
staring back from a dirty vanity mirror.

The dresser that held the linen is empty.
Lay in the metal teeth.

Pray to the gods of warrior fathers.

 

I have been a guest author each

pete_seeger_1986__800x600_q85_cropSinger, songwriter, and activist Pete Seeger died this week at the age of 94. Social media immediately lit up with the news of his passing, with everyone – including the President – sharing memories of what this kind, gentle man meant to them.

So why is he the topic of a health care blog post? Easy.

Seeger was a champion of the underdog – those underserved, under-represented, exploited, common folks who do the work that makes America go. He did it through song, with sagas about railroad workers, unions and hard times. He did it through his presence at rallies and benefit concerts, encouraging passage of health care for all, better living and working conditions for immigrants, unskilled, or low-paid workers, including those who support our health system day in and day out.

Like those working overnight shifts to clean and disinfect hospitals and nursing homes but can’t afford health care themselves. Or the immigrant home health aide that changes your mother’s diapers and feeds her lunch – but who can’t take a paid sick day to care for her own mother. Or the Meals on Wheels delivery person, who may be the only social contact a homebound senior has all week.

Seeger understood that it’s the underpaid, under-appreciated workers who are the vital gears in our system. He gave them a voice, made their voices heard, and in his unique way, made their lives better. Better health, better working conditions, better outcomes.

Thanks Pete.

Singer, songwriter, and activist Pete Seeger died