Emergency rooms, magical thinking, and the poor

Emergency Room

To hear Mitt Romney (and many others) tell it, Emergency Rooms are the physical embodiment of Mother Theresa, treating indigents like Jesus treated the lepers. The great seas of health care are suddenly parted for the poor and ill, and outstanding bills just miraculously become absorbed into the ether of write-off’s and tax exemptions.

This type of magical health care thinking isn’t limited to multi-millionaire politicians. Many in the public also believe ER’s effectively fill the wide gap between sickness and insurance. It’s a fallacy that has become so engrained that its standard line — get sick, get treated by an ER, get the tab picked up by someone else — goes nearly undisputed by those on both the right and the left.

That’s simply not the way it works.

Setting aside the fact that ER’s are not mandated to treat what their doctors may consider a non-emergency — a subject which merits its own, separate discussion — many uninsured ER patients find themselves saddled with bills they can’t hope to pay. These bills are not just from the hospital, but from outside physicians, diagnostic services, and laboratories, none of whom are mandated to treat the indigent or uninsured for free.

Depending upon the state and the hospital, uninsured patients may meet with a hospital social worker who will have them fill out forms for state aid or other programs. There is no guarantee of approval, and even when someone does qualify, benefits may not extend to other services rendered in the course of care.

On a trip across the US, I spoke to several people in dire straights due to medical debt. One of them was a homeless man in his 30s. John M. was a single laborer who was working a temp job when he was hit with over $8,000 in medical bills for non-work related wound that had led to a staph infection. In the hospital, he met with a social worker who helped him apply for aid. Later, he received notice that he didn’t qualify due to his income and status as a single person. The bills started pouring in, not just from the hospital, but from doctors whose names he didn’t recognize and labs that had processed his tests.

When bills like John’s go unpaid, hospitals and other businesses may “write them off,” but contrary to what many people may believe, this does not mean that they disappear. Collection agencies buy such debts for pennies on the dollar and then may vigorously pursue the patient-debtor, through judgments, wage garnishments, and bank account liens. To add to the confusion, medical debts can be bought and sold many times over, involving an almost incomprehensible string of collection agencies.

Like many people with medical debt, John attempted to work with the collection agencies on a payment plan, but there were too many of them, each demanding that their bill take precedence. Desperate for relief, John went to an agency that specializes in helping debtors reach payment agreements and was told he didn’t make enough to carry the minimum monthly payment that would be required. At that point, John considered filing for bankruptcy, but he couldn’t afford the attorney’s fees.

Four years after his illness, with his credit ruined and with several court judgments against him, John’s low wages were garnished and he could no longer afford his rent. He applied for a second job as a cashier at a home goods store and was told that they’d run his credit report as a matter of practice. It was the same at other places he applied. While he was never told why he wasn’t hired, he suspected that his low score had something to do with the lack of call-backs, particularly since he’d never had such a problem finding a minimum wage job before.

John scrambled for a cheaper place to live, but none of them were cheap enough to make up for the loss of wages, and all of them required better credit than his. He was told he’d need a cosigner or a larger deposit, neither of which he had. Feeling he had no choice, John quit his job and found work with another temp agency, hoping to outrun his garnishment and at least catch up on his rent. Within two months, the collection agencies had found his new place of employment and set the wheels in motion to collect their pay. John was eventually evicted. Jobless, he lived out of his 14 year-old truck for a while, but then his truck died and he couldn’t afford repairs. He sold it for scrap so that he could eat. He showed up at the county day labor office every weekday, hoping to make enough money to rent a motel room. Sometimes there was work, sometimes there wasn’t. Sometimes he slept in shelters, but many times he slept in the streets. When winter got to be too much, he scraped together enough to take a bus to a warmer climate. When I met him, he was among many of Florida’s homeless and his prospects for crawling out of the hole were dimmer than ever.

Of course, not all stories are as extreme as John’s, but the fact that some are is a stark reminder of how easily a life can be unraveled, particularly when medical debt can bring a host of life-altering consequences.

Some people do end up qualifying for State programs, and there are some hospitals which have developed their own foundations to assist in care, but there’s no national uniformity to the system. While an uninsured person at one hospital may qualify to have their ER charges reduced or paid for by another entity, another person, at another hospital, may not.

In any case, medical debt is on the rise and collection agencies are becoming increasingly aggressive in pursuing debtors.

The Commonwealth Fund, a private foundation that sponsors health care research, estimates that 22 million Americans were contacted by collection agencies for unpaid medical bills in 2005. That increased to 30 million Americans in 2010. – March 2012, USA Today

As the article in USA Today points out, credit may be wrecked even when medical debt is paid. Slow and late payments can stay on records for seven years, and as much as ten if there is a judgment involved. There is also a valid and growing concern that collection agencies are misusing the court system to have debtors thrown in jail, adding the element of warrants and jail time to people’s background checks which, like poor credit, may diminish their future employment and housing opportunities. Poverty by itself is a vicious cycle that is difficult to escape. Adding collections, garnishments, judgments, bad credit, and arrests to the list of obstacles can make it nearly impossible. In the bigger picture, it would seem to do more harm to our economy and social structure to keep people locked in the cycle of medical debt for years on end, rather than to offer them a real solution.

Despite receiving tax exemptions to care for the uninsured and poor, some hospitals have gone so far as to sue these patients for what they are owed. Others, as noted, turn their debts over to collection agencies. In the mix are the outside services which are not given the same exemptions, and which aren’t subject to the same guidelines.

The result of all of this is that both patients and the medical care industry are suffering, while collection agencies are growing richer. By 2007, the number of collection agents had doubled from the early 1990s, while industry revenue tripled to $15 billion (on $40 billion in collected debt).

So, no, emergency rooms are not the answer for America’s sick and uninsured. The illness that’s treated today should not result in years of financial consequences, which not only affects individuals, but society as a whole. To what end is a culture that binds people to medical debt in ways that may cost them their homes, jobs, and futures? To what end is a medical system that only increases the need for shelters, welfare, and other social services — while burdening the healthcare industry with millions of dollars in extra costs? An America that grows poverty is not as valuable as an America that grows potential. Anyone who would argue against that is as short-sighted as they are unreasonable.

The Dad Who Shot His Daughters Laptop: 7 Reasons The Majority Are Wrong

Today’s post is a guest post by the novelist and essayist, Jane Devin. We’re delighted she stopped by to bark and walk in our back yard and welcome her any time she wants to wander in. If you haven’t already, buy her book, Elephant Girl. It is nothing short of amazing.

Earlier this month, a YouTube video of a fed-up father who shot up his daughter’s laptop after she posted a disrespectful letter about her parents on Facebook went viral on the internet. This is the video:

On YouTube

A few words up front: I was not a perfect parent and sometimes not even an adequate one. I don’t know Mr. Jordan or his daughter well enough to speak to their true characters, intentions, or their family dynamics.

What I do know is what Mr. Jordan chose to make public. First, his 15 year old daughter wrote a scathing post against her parents which many people, including me, thought made her sound like an entitled brat. She posted it on Facebook and her dad found it through their dog’s account (seriously). Second, Mr. Jordan decided to teach Hannah a lesson by posting a video to her Facebook wall. After going off on his own diatribe, which I found not too horrible (hey, parents are people, too — our feelings get hurt and we don’t appreciate being disrespected,) Mr. Jordan decided to put several rounds of bullets into his daughter’s computer. That’s where his family drama became ugly for me.

A majority of parents (and by my count mostly women), lauded Mr. Jordan with praises like, “It’s great to see someone actually parent” and “The brat got what she deserved – I bet she won’t dare act that way again”. It takes a lot to shock me, but these kind of comments did. Here’s why:

1) If it was any other authoritarian relationship — say, employee/employer, teacher/student — people would have been up in arms over the destruction of property in order to teach a lesson, not applauding the act. If someone provided a computer to their employee or student and then shot it up when they found them abusing it, most of us would think they were nuts, even if they did pay for what they destroyed. We wouldn’t be praising the “lesson” they were teaching.

2) The “lesson” that it’s somehow okay to destroy someone’s property when you feel disrespected, even if it’s something you bought as a gift, teaches that destruction and revenge are appropriate responses. It seems to me that a lot of people who grow up with that lesson are the same ones who do things like slash the tires of their boyfriend’s car when they find out he wasn’t faithful.

3) The definition of vandalism is “deliberate, mischievous, or malicious destruction of public or private property.” The law may have given the father the right to control his daughter’s use of property, and he could argue that the property was ultimately a gift he bought and then reclaimed, but the spirit of vandalism remains. He deliberately and maliciously destroyed something even he admitted was his daughter’s.

4) Discipline and revenge are not the same thing. That’s why comments like “finally, a parent acting like a parent” stunned me. Since when is an act of vengeance the same as discipline? While I understand people’s frustration with kids who are spoiled or act “entitled” I fail to see how shooting up a child’s possessions can, in any way, be considered good parenting or intelligent discipline.

5) The public doesn’t know, can’t know, both sides of the story. The dad said his daughter was grounded for three months before for doing something “similar” and “stupid.” To those who say the girl was previously spoiled and therefore needed a harsh reminder of her place, I’d counter that a three month restriction seems pretty drastic and not lax at all. A quarter of a year is a long time in the life of a teen — and there are few teenagers who don’t repeat their mistakes. And that list of chores? How long did they take in reality? Did the girl also work at her stepmom’s business, as she claimed? Was she given adequate time outside of school to be a kid? We don’t know. While the girl’s letter was nasty — I especially took exception to the “cleaning lady” bit — maybe she had her own and possibly legitimate reasons for being frustrated.

6) Like Hannah’s father, I also left home at 16. I was mostly self-supporting by the age of 14. I don’t think it made me a better or more responsible person, and I would not wish that kind of necessary but early independence on any teenager. I have no problem with a 15 year old having a part-time job, but unlike Hannah’s dad I don’t view it as a requirement. I think a child’s primary job is to go to school. I think learning social skills and having friends and activities is also important. There’s plenty of time and occasions in life to go to work at Burger King for minimum wage. At 15, I think a job should be a choice, not a condition of living happily under your parent’s roof.

7) Another viral YouTube video was that of a judge who was shown spanking and yelling at his then-teenage daughter for being disobedient. He had told her not to download music from the internet and she did. The majority of parents condemned the judge for his abuse, which was blatant and easy to see. Almost no one in that case called the girl a spoiled brat or praised the judge for his parenting skills. Yet Mr. Jordan was lauded for shaming his daughter publicly by posting his video on Facebook and YouTube — an act that will have consequences for her years into the future — and for taking a gun to his daughter’s property in order to prove that he was the man in charge. The hallmarks of domestic violence are not always physical. The six signs of an abuser are: Dominance, Humiliation, Isolation, Threats, Intimidation, Denial and Blame. Again, I do not know Mr. Jordan outside of what he has made public, but I see all six signs in the behavior exhibited in his video. He asserted his dominance, humiliated his daughter, promised to isolate her through restriction, threatened her with promises that her life was about to get “a whole lot harder,” intimidated her by showing her his power, denied that she had any right to complain, and then blamed her for his own overreaction, which was to put several rounds of ammunition into her property. I do not see much of a moral difference between the physical abuse of the judge and what Mr. Jordan did. Both men showed a lack of self-control and used their power wrongly. To condemn one while praising the other is, to me, hypocritical at best.

I believe in discipline. I don’t believe in destruction. I believe that good parents have a right to demand respect. I don’t believe respect is achieved through acts of violence. I believe children should know that their parents are human and can get angry and have hurt feelings just like anyone else — but I think it’s a parent’s job to model an appropriate way to deal with frustration. The use of a gun to make a point is never appropriate. Ever. That many people think it is — that the majority of comments praise Mr. Jordan — doesn’t make him, or the majority, right.

PS I just took your picture

Today’s post is a guest post by the novelist and essayist, Jane Devin. We’re delighted she stopped by to bark and walk in our back yard and welcome her any time she wants to wander in. If you haven’t already, buy her book, Elephant Girl. It is nothing short of amazing.

I have social media friends who would be appalled if someone reposted one of their tweets and didn’t give them credit as the original author—even if the tweet was mindless and casual. They’d be outraged if another blogger lifted a picture from their site and republished it without permission—even if it was a picture that required no particular skill or time to take.

Yet when it comes to taking stealth pictures of other people’s faces or bodies for the purpose of putting them online, these same bloggers rigorously defend the practice. It’s not theft, they claim, but art. Their subjects tacitly agreed to the invasion by being in public.

People in public shouldn’t expect any level of privacy.
If people want privacy they should stay home.
It’s not illegal.
I have the right.
But photographers have been getting crowd shots for years.
It doesn’t harm anyone.
Asking permission before the fact would be embarrassing.
If I ask permission after the fact they might tell me no.
I might not get the candid shot I want.
The government and businesses videotape us. What about that?
It’s art.
It’s fun.
It’s funny.
Everyone’s doing it.

I’ve disagreed, sometimes hotly, with my blogging friends about the phenomena of covertly taken cell phone pictures being posted online. I’m not likely to change my mind and neither are they, but for those sitting on the fence about the issue I’d like to offer up a few thoughts on the subject.

The essential question is: To whom does a person’s face and body belong? The logical answer would seem to be that these things belong to the individual who possesses them—and if we believe that, then we should also believe that people have some rights as to when and how their own image is used.

Being out in public shouldn’t negate all reasonable expectations of personal space and privacy. As a matter of social decorum, most of us don’t purposely brush up against strangers or stand too close to them in a line or an elevator. We consider it rude to purposely eavesdrop. Very few of us would think that it was okay to record and podcast the intimate dinner conversations of others without their consent. Most of us would agree that an up-skirt shot would be less likely to identify a woman than a picture of her face, but as a matter of social propriety (and in some states the law) it’s considered the aberrant act of a Peeping Tom.

So why do some cell phone users believe it’s okay to secretly photograph strangers and post their pictures online?

The argument that there’s no expectation of personal privacy in public comes from the same faulty reasoning of the underwear snappers: The shot was available and they took it. People in public shouldn’t expect others to respect their bodies, particularly if they’re dressed in a way or engaged in an activity that piques a photographer’s interest. If the photo-snapper asked permission, they would probably be told no. If some states don’t have a specific law against cell phone owners using other people’s faces and bodies for their amusement, then it’s legal and therefore a right.

There are a host of unpleasant things people could legally do in public, but that we don’t do as a matter of courtesy and respect for others. Most people don’t step outside their door in the morning wondering how they can make the world a more uncomfortable and invasive place for others, yet for many a cell phone camera seems to be a license to do just that.

It doesn’t matter if the picture is bitter, sweet, repulsive or beautiful. The pretty woman dining with her lover probably may not feel any better about her picture being posted online than the unattractive young woman with the pockmarked face who’s dining alone. The well-dressed elderly man taking his dog for a walk may feel as uncomfortable about a stranger taking his picture as the toothless old man who’s asleep on a park bench. The point is, without asking permission, the photographer doesn’t know. Without asking permission, the integrity of the photographer is already questionable. Whether they post a picture for people to laugh at (look at this overweight woman in Lycra shorts!), cry at (see how thin and frail this homeless man looks), or ooh and ahh over (isn’t this young couple cute?), the fact is that they’ve invaded someone else’s life in order to get their shot. They’ve unapologetically stolen someone else’s image for their own purposes. They’ve put their own impulsive wants above any consideration and respect they might have for other human beings.

There’s a world of difference between accidentally capturing the faces of strangers while snapping photos of your kids at Disneyland and purposely whipping your cell phone out to take a picture of the 400 pound man in a scooter so you can post it online and rouse the disgust of your friends and readers. There’s a difference between historical event photography, like taking crowd shots of the #OWS movement, and sneaking a picture of someone who’s quietly shedding tears as she talks with a friend inside of a Starbucks.

As for those who insist that what they’re doing with cell phone cameras is no different than what photographers of bygone eras did when they captured scenes from their generation, I’d remind them that in those days cameras were a lot more noticeable. Photographers couldn’t pretend they were doing something else while snapping pictures. In those days, cameras didn’t fit into the palm of one hand — journalists and artists alike would have found it hard to take stealth photos while carrying around a tripod and twenty pounds of photo gear. The Internet also didn’t exist then. Photographers were lucky if their photos made it to the pages of a local newspaper. Today, anyone can post photos online, where they can be seen worldwide, by a potential audience of millions after being blogged, commented on, reposted, shared, catalogued in Google images, Facebooked, Tumbld and re-tweeted.

In general, the video cameras at the mall or on city streets don’t publicize the pictures they take unless there is a genuine public interest at stake, such as catching a suspected child abductor. To suggest that because some city police departments and businesses use video cameras without the explicit consent of each person filmed somehow makes it ethically “okay” for citizens to do the same is the worst kind of slippery slope excuse. Taking pictures of strangers slurping their spaghetti, kissing their partners, or wearing hideous shoes has nothing in common with protecting the public or a store from criminals.

There are times when cell phone pictures do serve the public interest. Citizens have caught police brutality and even murder on film. Citizens with cell phone cameras have filmed historical events, like the tragedy of 9-11 and the capture of Gaddafi, and have opened up a cross-cultural exchange of images that might never make it to the network news, such as the early protests in Egypt or the treatment of women in Afghanistan by the Taliban. Images like these aren’t taken for amusement, though, nor are they being posted without regard for their subjects under the guise of “art”. There’s an inherent value to pictures that relate to news and events that is not shared by sites like PeopleofWalmart.com or, unfortunately, most of the stealth pictures being posted online today.

What are your thoughts? Do you feel that being out in public suspends your right to privacy? Have cell phone cameras and the Internet made everyone a public figure? Would you be surprised to find a candid photo of yourself online? Do you think common courtesy should prevail or do we actually need laws that cover new technology?

The I Could Do it Better Syndrome

InvisiblePeople.tv

You know them.

They’re the people who yell at the television on Monday nights, insisting that they could have caught that pass or avoided that tackle. They’re the ones who can’t attend a conference or event without telling other people how they would have made it more interesting. They’re the people who believe they can do everything better than anyone else, whether it’s blogging, forging a career, making choices, having a relationship, or even serving a charitable cause.

The I Could Do It Better Syndrome seems to affect only a small percentage of the population, but they’re a persistent and vocal minority that demands not only to be heard, but somehow validated. It’s not enough to address their criticisms — they want nothing less than complete capitulation. Yes, you are right and I am wrong. How may I serve you? What can I do to make you happy? Until they get the attention and agreement they want, the I Could Do It Betters won’t let up, at least until they find a new outlet for their hostilities.

There’s a man online who has been doing a remarkable job of bringing light to the issue of homelessness. It was his vision, his idea and his efforts that resulted in a mission that has gathered steam, sponsors and many, many supporters. And while I’ve been neutral in the past about social programs that “raise awareness” — believing that direct, one-on-on support is more critical — Mark Horvath’s InvisiblePeople.tv has gained my respect. His pinpoint focus and tireless travels across the United States and Canada have resulted in more than just awareness and sympathy. His interviews with homeless people have spurred real offers of help and assistance. Further, in giving the homeless a direct opportunity to tell their stories to the world — to look into the camera and in their own words talk about their situations and feelings — Mark has given a powerful voice to those “invisible” people whom society has often ignored or dismissed.

I’ve followed Mark’s journey online for about a year. While it doesn’t surprise me that his mission has been attacked recently by a group of I Could Do It Betters, what I do find disturbing is how far they’ve been willing to go to get other people to jump on their hateful (and I must say, seemingly jealousy-driven, bandwagon). They’ve tweeted his sponsors and threatened to never do business with them. They’ve made YouTube videos questioning his ethics. They’ve accused Mark of exploiting the homeless for his own gain, of being a limelight seeker, of not answering questions to their satisfaction — even of passing out the wrong kind of donated food. Their claims have gotten ridiculous and out of hand — they’ll criticize anything from Pop Tarts to socks — but they seem to delight in any opportunity to assail Mark’s “motives”, his tactics and his character.

Having followed Mark’s mission for over a year, I know that not even one of the accusations are even partially true. This is a simply a bold case of I Could Do It Better by people who, hypocritically, are seeking attention for themselves. They seem to resent the (well-deserved) praise InvisiblePeople.tv has received and believe they could do a better job with the resources Mark has gathered.

My question to the armchair critics would be — if you believe you could do better, why don’t you? Instead of all that energy spent denigrating one person’s efforts, why not build your own mission from scratch? What’s stopping you from rallying support for your own better ideas and solutions?

The answers are, of course, apparent. Lacking their own will, drive and ideas to actually affect change and improve the world around them, the I Could Do It Betters would rather imagine that they could — if only they were Mark. If only they had had the idea and put the work in. If only they had spent the great amount of time and care that Mark has gathering support. If only they were given the opportunity.

However, the I Could Do It Betters have to know that Mark wasn’t given his mission — he created it out of his own vision and ideals and then worked very hard to make it a reality. There’s nothing to stop others from doing the same (or even better) should they ever choose to leave the comfort of their armchairs and take the real-world actions they believe would be an improvement.

You can learn more about Mark Horvath and his mission to help homeless people by visiting InvisiblePeople.tv, or by following @hardlynormal and @invisiblepeople on Twitter.

Today’s post is a guest post by the novelist and essayist, Jane Devin. We’re delighted she stopped by to bark and walk in our back yard and welcome her any time she wants to wander in. If you haven’t already, buy her book, Elephant Girl. It is nothing short of amazing.