I want to preface my accident with this. A couple weeks ago, I was with my son in Moab, we went canyoneering and repelling, mountain climbing, rafted and kayaked and swam the Colorado River, 3 hours of horseback at the bottom of monument valley, hiked Hovenweep, climbed in the Abajo mountains, explored ancient ruins, even pilgrimaged to Four Corners, all in a weeks time, I did not get hurt. Granted for a guy crowding fifty, I had my opportunities, my fourteen year old son did fine of course. Mountain biking on the red rock, slick rock I crashed into a pricker bush, on the edge of a canyon cliff, but other than embarrassment and a few scrapes-no big deal.
So I come home and a feel later, have a nice dinner with my wife at a friends house, and he shows me his toys in his garage. One of them was a motorized scooter. Now I have only driven motorcycles a couple times in my life in college, and I figured this thing is more like a bicycle. How hard can it be?
I went around his driveway, as he lives in the country, and still not knowing what I was doing, thought I had it sort of figured out, I came back and told my wife to hope on and we took off, and that's about all I remember.
We were in gravel and these things don't do so well on gravel. I don't know if I was trying to turn, or hit a rock, but somehow ended up landing on the left side of my face. No helmet-everything we teach our children not to do- it was only his driveway,
Friday, September 18, 2009
Scooter Accident-Accessing Health Care
It only takes about a millisecond for things to go wrong and have a bad accident, facing death or severe injury. We do live in the moment, we can not really control the future and the past has already happened. Despite all this "pseudo-intimacy" or the Internet, which is really immediacy and not intimacy, we are still human beings who feel pain and joy, and there is simply no way the immediacy of the Internet can ever replace the support, compassion and nurturance one human being provides to another. I think the connectedness and the decrease in the feeling of isolation the Internet gives us is phenomenal, I think when we expect something else out of it, that is when it leads to problems. It is hard for me still to grasp how the generation under age thirty approaches the Internet as such an intimate thing, with all the social networking and such. We don't have to shake hands anymore, or look someone in the eye, or be in the same space as someone, and yet kids under age thirty consider this social networking intimate. My wife and I are reading a book by the founder of google, it talks about this a lot, generally putting a positive spin on everything. The bottom line is the Internet is changing society probably for better and worse.
Through all the immediacy and attention and exposure and support people crave, we are more exposed than ever. Yet paradoxically we are more invisible than ever, since everyone will be on the Internet and networking eventually, who will notice?
I am reminded of all this, as I was recently lambasted by my niece for "using her" to forward my blog address to people on a an email forward she sent me with 30 people, whom I did not know, who were in her address book. I thought I would just publicize the blog if anyone was interested. I was not making money, hurting or exploiting anyone. But apparently this is an emotional and Internet attrocity . I never really knew. Of course I apologized to her, but for the life of me, I still don't understand the new age of all this. In doing this blog I am still learning.
What does all this have to do with a recent scooter accident?
Well last weekend, I got really hurt. I have had to access much health care over the last week, and it has not been pretty. It is extremely personal and intimate. I debated all week whether or not to blog about it. What would be the point? Interesting read? Catharsis? It is hard for me to do any major action without considering the utility and if it would help anyone else.
Well as I see it, AD is related to health care, health care is a hot immediate topic, I had a head injury, etc. Anyways I think I will talk about it. ...
Through all the immediacy and attention and exposure and support people crave, we are more exposed than ever. Yet paradoxically we are more invisible than ever, since everyone will be on the Internet and networking eventually, who will notice?
I am reminded of all this, as I was recently lambasted by my niece for "using her" to forward my blog address to people on a an email forward she sent me with 30 people, whom I did not know, who were in her address book. I thought I would just publicize the blog if anyone was interested. I was not making money, hurting or exploiting anyone. But apparently this is an emotional and Internet attrocity . I never really knew. Of course I apologized to her, but for the life of me, I still don't understand the new age of all this. In doing this blog I am still learning.
What does all this have to do with a recent scooter accident?
Well last weekend, I got really hurt. I have had to access much health care over the last week, and it has not been pretty. It is extremely personal and intimate. I debated all week whether or not to blog about it. What would be the point? Interesting read? Catharsis? It is hard for me to do any major action without considering the utility and if it would help anyone else.
Well as I see it, AD is related to health care, health care is a hot immediate topic, I had a head injury, etc. Anyways I think I will talk about it. ...
Thursday, September 17, 2009
Blog Content
When you have a blog, it is basically an expression of free speech. A mind journal if you will, to share over the world wide web. The title of the blog, determines the content. The title would help people looking for Alzheimer's Caregiver Support, if they find the actual blog.
I have no daily AD journal to share with readers, many caregivers are struggling with the day to day existence, caring for a mother or father, or grandparent or spouse.
Many blogs are to help raise awareness and get the word out, to advertise an Alzheimer's walk. Some are more scientifically and research oriented. Some are written by people who are themselves diagnosed with and dealing with the disease in themselves.
My mother died from AD 22 years ago. Why write a blog now? What does Minnesota provider tax and lighthouses have to do with AD?
Is this therapeutic for me to write this blog 22 years after my mother's death? Is this blog spreading any valuable information about the disease?
Just about every aspect of my life has been shaped and affected by my mother. Her AD robbed her of herself and her personality. It was a part of my childhood and adolescent process and my experience with my mother.
I went from being a caregiver to her to becoming a doctor. That's how I got my start with empathy and comparison and perhaps most commonly overlooked: that sense of responsibility for others.
Any AD caregiver knows that 'you are it' , the buck stops with you, you are in charge and it is your responsibility. It is a lot of responsibility. There are sometimes feelings like:
"I should have done this," "I could have done this", "What if?" "I'm not trying hard enough." "Why is this so hard?" "I feel guilty". "I should try harder". "I hate how caring sucks the life out of me some days, but more or dad needs me....except the harder I try the worse the disease is getting. "
"I do or did everything I can, but it still is not enough."
Some caregivers will identify with these feelings, it is not unlike a lot of the feelings a physician deals with - completely taboo to talk about of course.
So just about anything I talk about on this blog is connected in some way to my mother and her AD. It affected my whole life forever, personally and professionally.
I have no daily AD journal to share with readers, many caregivers are struggling with the day to day existence, caring for a mother or father, or grandparent or spouse.
Many blogs are to help raise awareness and get the word out, to advertise an Alzheimer's walk. Some are more scientifically and research oriented. Some are written by people who are themselves diagnosed with and dealing with the disease in themselves.
My mother died from AD 22 years ago. Why write a blog now? What does Minnesota provider tax and lighthouses have to do with AD?
Is this therapeutic for me to write this blog 22 years after my mother's death? Is this blog spreading any valuable information about the disease?
Just about every aspect of my life has been shaped and affected by my mother. Her AD robbed her of herself and her personality. It was a part of my childhood and adolescent process and my experience with my mother.
I went from being a caregiver to her to becoming a doctor. That's how I got my start with empathy and comparison and perhaps most commonly overlooked: that sense of responsibility for others.
Any AD caregiver knows that 'you are it' , the buck stops with you, you are in charge and it is your responsibility. It is a lot of responsibility. There are sometimes feelings like:
"I should have done this," "I could have done this", "What if?" "I'm not trying hard enough." "Why is this so hard?" "I feel guilty". "I should try harder". "I hate how caring sucks the life out of me some days, but more or dad needs me....except the harder I try the worse the disease is getting. "
"I do or did everything I can, but it still is not enough."
Some caregivers will identify with these feelings, it is not unlike a lot of the feelings a physician deals with - completely taboo to talk about of course.
So just about anything I talk about on this blog is connected in some way to my mother and her AD. It affected my whole life forever, personally and professionally.
Tuesday, September 15, 2009
Provider Tax
Well, I don't want to complain about things too much, for the sake of not sounding too negative.
This tax is 2% tax, for me it is an income tax paid every quarter, just like my estimated state income tax of 7%. It is called the provider tax, because only medical providers pay it on revenue generated directly from treating patients. So if you are a Doctor and you work for yourself and all you do is take care of patients all day and that is your only source of income, it is another income tax. It does not exist in any other State. They tried it in a couple other States but it did not work out. It was repealed.
The revenue generated is supposed to go into the fund called the Health Care Access Fund. That fund is supposed to cover the uninsured. Some years that revenue from the Health Care access fund has gone into the General Fund, and been used to cover other debts at the state budget level.
It would not feel so bad paying the provider tax if everyone in Minnesota had health insurance. averaging 2005-07 stats from the Census Bureau, about 8.5% of people in MN do not have health coverage at all. Mass. and Hawaii cover more percentage wise-they do not have a provider tax.
Some legislators like to say with the access fund we do pretty good at covering our uninsured. 21 other States are within 4% points of MN according to the Census. They do not have a provider tax.
It has been challenged at the level of the Constitution- the Minnesota Constitution and been found perfectly legal. No one with any interest, time and money has ever had the fortitude to take it to the level of the United States Constitution.
I have been told in a public forum by one state legislator that, "Well its an unfair tax, but what else can we do?"
The set up is this= as physicians when someone says what else are we supposed to do, as physicians we want to help and fix things, so instead of saying "we are not lawmakers figure it out" we start trying to help the legislature solve their problems. Basically docs believe in social justice, in fairness. Most want to do the right thing. When you back is against the wall, and some legislator says don't you want to cover the uninsured, almost all doctors are going to care and say yes.
The issue is further divisive of the few physicians working in private clinics and practices and those many salaried by huge and smaller corporations be it for-profit, non-profit, foundation etc. You don't really see or feel the provider tax. The institution pays it.
We are short of primary care doctors in rural areas, all things considered if you were a young doctor and you wanted to start a rural private family practice on your own, all other things being equal, and you could go to MN or Iowa, or Missouri, or ND, and you could pay 2% more tax in Minnesota to cover the uninsured, yet lots of you patients would not have health insurance,- it is sort of a disincentive. It is not a way to attract primary cares.
It is analogous to teacher's paying a 2% tax on the income they derive on the teaching they do with each student. Then putting that money back into education, except some years doing whatever you want with that money to pay the state budget.
Protecting the Health Care Access Fund and not use it for other debts besides health care becomes the partisan issue every year within the state government. There are threats to raise it every year, and that 2% has fluctuated a bit over the years.
Yet even with this progressive tax, (its not like a penalty tax or anything) we still don't cover 45,000 or so people in the state, about 8.5 %.
Yet it has been around for some seventeen years.
As doctors we are NOT allowed to complain about it. It is just unacceptable and makes you a bad person and a bad doctor if you even bring it up. What is the first thing the public would say and think if physicians actually got the intitiative and faculty to bring this to societies awarness? I think we all know hwat the public would say and think if physicians complained,
The legislators know this and key on physicians weakness, which is actually self-punitiveness, that is why the tax goes on.
I wonder how people would feel in the United States if everyone's income tax went up 2% to cover the medically uninsured, yet we still didn't cover the uninsured.
It works really well in Minnesota, (or does it?) yet you don't here much about it nationally.
This tax is 2% tax, for me it is an income tax paid every quarter, just like my estimated state income tax of 7%. It is called the provider tax, because only medical providers pay it on revenue generated directly from treating patients. So if you are a Doctor and you work for yourself and all you do is take care of patients all day and that is your only source of income, it is another income tax. It does not exist in any other State. They tried it in a couple other States but it did not work out. It was repealed.
The revenue generated is supposed to go into the fund called the Health Care Access Fund. That fund is supposed to cover the uninsured. Some years that revenue from the Health Care access fund has gone into the General Fund, and been used to cover other debts at the state budget level.
It would not feel so bad paying the provider tax if everyone in Minnesota had health insurance. averaging 2005-07 stats from the Census Bureau, about 8.5% of people in MN do not have health coverage at all. Mass. and Hawaii cover more percentage wise-they do not have a provider tax.
Some legislators like to say with the access fund we do pretty good at covering our uninsured. 21 other States are within 4% points of MN according to the Census. They do not have a provider tax.
It has been challenged at the level of the Constitution- the Minnesota Constitution and been found perfectly legal. No one with any interest, time and money has ever had the fortitude to take it to the level of the United States Constitution.
I have been told in a public forum by one state legislator that, "Well its an unfair tax, but what else can we do?"
The set up is this= as physicians when someone says what else are we supposed to do, as physicians we want to help and fix things, so instead of saying "we are not lawmakers figure it out" we start trying to help the legislature solve their problems. Basically docs believe in social justice, in fairness. Most want to do the right thing. When you back is against the wall, and some legislator says don't you want to cover the uninsured, almost all doctors are going to care and say yes.
The issue is further divisive of the few physicians working in private clinics and practices and those many salaried by huge and smaller corporations be it for-profit, non-profit, foundation etc. You don't really see or feel the provider tax. The institution pays it.
We are short of primary care doctors in rural areas, all things considered if you were a young doctor and you wanted to start a rural private family practice on your own, all other things being equal, and you could go to MN or Iowa, or Missouri, or ND, and you could pay 2% more tax in Minnesota to cover the uninsured, yet lots of you patients would not have health insurance,- it is sort of a disincentive. It is not a way to attract primary cares.
It is analogous to teacher's paying a 2% tax on the income they derive on the teaching they do with each student. Then putting that money back into education, except some years doing whatever you want with that money to pay the state budget.
Protecting the Health Care Access Fund and not use it for other debts besides health care becomes the partisan issue every year within the state government. There are threats to raise it every year, and that 2% has fluctuated a bit over the years.
Yet even with this progressive tax, (its not like a penalty tax or anything) we still don't cover 45,000 or so people in the state, about 8.5 %.
Yet it has been around for some seventeen years.
As doctors we are NOT allowed to complain about it. It is just unacceptable and makes you a bad person and a bad doctor if you even bring it up. What is the first thing the public would say and think if physicians actually got the intitiative and faculty to bring this to societies awarness? I think we all know hwat the public would say and think if physicians complained,
The legislators know this and key on physicians weakness, which is actually self-punitiveness, that is why the tax goes on.
I wonder how people would feel in the United States if everyone's income tax went up 2% to cover the medically uninsured, yet we still didn't cover the uninsured.
It works really well in Minnesota, (or does it?) yet you don't here much about it nationally.
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