Proposal: New Civil Service Branch

Rural hospitals are closing. Family medicine in rural communities is disappearing. And the lack of accessible healthcare in any impoverished community is deplorable. Recently, I mentioned the proposal to begin reforming the ACA (Obamacare) with a buy-in option for people at age 55. I am becoming more convinced that a single-payer system, “medicare for all,” is the way to go.

Reforming the payment for services highlights the need to reform the delivery system. I’ve been thinking about our current training system of medical personnel. Is the possibility of being very rich the sole reason people endure med school and residencies and debt? I don’t believe so.

One solution is to create a fifth branch of service called the Civil Medical Corp. This is separate from the people who train to be military medics, nurses, and doctors trading military service for their education. This would be a civil service commitment.

In exchange for post-high school medical training focused solely on the medical requirements for the chosen course of professionalism, the graduates are deployed throughout this nation in every community.

Civil Medical Corp members fulfill a period of service commitments, receive pay through the single-payer system or salaries like any other medical office/hospitalist and are “stationed” according to needs of the people through a state-based assessment and application process.

These medical professionals would take only courses necessary to become degreed. Medical doctors and all levels of nursing as well as the technical specialties would each have tracks. Thus training and deployments include MDs, xray techs, CNAs, RNs, etc.

Training focuses solely on the knowledge required to become prodicient in the chosen track. Problem-solving, critical-thinking, psychology, and communication are part of the process throughout. Limited electives allow recruits to broaden their interests, thus reducing the education by 2, 3 or even 4 years depending on the initial concentration. Field training through Internships would be required before deployment.

All first level Civil Medical Corp practitioners remain in the “service” for 10 years. Thinking specifically about doctors, after 3 years as a family practice or pediatric generalist, a doctor may apply for a residency in a specialty and return to study for surgery, etc.

The major disruption to the educational process for MDs is the change in undergraduate degree elimination. So a qualifying process and 1 to 2 year program of basic requirements would have to be developed.

I envision a process that moves a doctor candidate into obtaining a Bachelor’s of General Medicine–then 3 year deployment. The Masters degree would be the specialties, such as Emergency and Trauma or General Surgery or Dermatology. And the Fellow and Diplomate would be in ever higher levels of specialized care.

Associates for non-doctor tracks and Bachelors degrees are paid like we do ROTC, Masters level would be jointly funded by the individual and the Medical Corp. And anything after that is paid by the individual. Educational partnerships with states, institutions, and private investors may provide subsidized funding through scholarships or internship/work-study programs.

The appeal for the CMC to potential students is debt-free training and guaranteed employment.

Every community would have local access to the foundations of good healthcare.

Sound impossible? Every day we take 18 year-olds and hand them multi-million dollar equipment, train them to make instantaneous decisions over life and death, require them to be killers in our name, then send them all over the world to do their job. Regularly conversations erupt about spending more for the improvement of our nation rather than sending money overseas. Given these two considerations, shouldn’t we compensate a little by turning some of our kids into life-givers here at home?

Run with it, you who are are smarter than me.

Together We Can 

Ever walk into a nursing home and think you’d rather die than live there? 

Ever hear a story about someone’s heroic fight against disease or injury and think how did they manage?

Both circumstances have to do with community support. One has it and the others don’t.

Ever wonder how to make a difference in the world and leave the world a little better than you found it? The healthcare debate has a chance to begin anew. 

Consider a foundation of everyone helping each other so impoverished nursing home residents have the same opportunity to become someone’s heroic fighter that better insured and wealthier people already have. No one needs to suffer alone. We can do this together. We can pull together and do a better job sharing resources. To those of us who have we may have to offer a little more. But the end profit for everyone will be greater than if we hoard. 

Healthier people — better economy. 

Time for the Dems to Put Up a Plan

A few ideas for a good healthcare plan

1. letting people over 55 years old buy into Medicare.

2. Reduce out-of-pocket costs like copays and deductibles.

3. Reduce drug costs by 

  A. Stopping direct-to-consumer drug company advertising subsidies, and reinvest funds in research

  B. require pharmaceutical companies that benefit from federal support to invest a sufficient amount of their revenue in R&D, and if they do not meet targets, boost their investment or pay rebates to support basic research

  C. Require health insurance plans to place a monthly limit of $250 on covered out-of-pocket prescription drug costs for individuals

  D. Increase competition for specialty drugs including new “biologic” drugs – which are often the most expensive new treatments

  E. Prohibit “pay for delay” arrangements that keep generic competition off the market

  F. Allow Americans to import drugs from abroad – with careful protections for safety and quality.

 G. require drug manufacturers to provide rebates for low-income Medicare enrollees that are equivalent to rebates in the Medicaid program

  H. Allow Medicare to negotiate drug and biologic prices

3. Expand access to rural Americans, who often have difficulty finding quality, affordable health care.

4. Give authority to Secretary of Health and Human Services to block or modify unreasonable health insurance premium rate increases so that coverage is more affordable

This is not my thinking. It is part of the plan proposed by Hillary Clinton who actually worked for decades becoming expert in healthcare needs across the nation. This week the RNC tweeted a jibe against her, asked where her plan was, she gave them the link to her website and said “run with it. ”

I’m with her.

My Own Take on Medicare for 55 year olds

3 reasons to open Medicare for buy-in from 55 year-olds up to 65:

1. Healthier sub-group = more money in but less out = more money exchanged for other than healthcare goods = growing economy
2. More providers for preventative care = more steady guaranteed income for providers and negotiating power for Medicare = healthier middle-aged population entering older age = decreased expenses in later life = improved cash available for other purchases = growing economy.
3. Allows last of baby boomers to follow dream of entrepreneurial work without fear of insurance coverage loss = more good jobs for next generation = economic mobility = growing economy

Okay maybe just one reason: good for the economy.

This idea is a proposal from the healthcare plan of Hillary Clinton.  It’s time for the Democrats to put up their revisions for the ACA aka Obamacare.  This is a start.

I’m with her.  

Liberty and justice for all

My more usual rant.  

Dear America: 

Wake up! On the anniversary of this nation’s founding, Mad King George is back and ready to crush our democracy. Soliciting the voting registries of the states can have no purpose except intimidation and voter suppression. Colluding with a foreign nation or at least stating that foreign interference is irrelevant sows seeds of distrust in the system of our democracy. 

 This is not about policy differences.  This is not about attempts to develop a fiscally conservative direction in federal government. This is not about a social conservative movement to limit individual liberties around sex and reproduction. 

This is not about reforming healthcare. These are important debates and policies but the conflict is being used against us.  

All of this is designed to hide the fundamental attack on our founding right to self-government.

The Mad King wants to pit us against each other so he can reign. Even his own party refuses to stand up to him for our rights. Who knows when the manipulation of policy differences began but — we the people must unite across our differences and stop this before we lose the nation of “We the People” and find ourselves in the monarchy of Donald-Bannon. 

Who does it benefit to pollute the water and air while taking away healthcare options? Who benefits from sick and impoverished masses? 

Who benefits from class warfare?  Who benefits from sending our young people overseas to fight endless and unwinable wars? 

Who benefits from pitting poor whites against poor Latinos? Who benefits from putting Christians against Muslims?  

Who benefits from the absence of a free press? Who benefits from disempowering women?

Not we the people. 

We must unite for our democracy with liberty and justice for all.

Our country needs us. We must reclaim our principles. We must reclaim America as the nation of, by, and for the people.  

Not my pageant, not my president

John Lewis won’t be there. Jennifer Holliday will not sing after all. This year, I won’t “be there” either. It is not my pageant.

The pageantry of the inauguration of American presidents has come into sharp focus this year as entertainers weigh whether or not to perform; and, we are beginning to hear from government officials about their consideration of whether or not to attend.

Why do we have such an elaborate pageantry of speakers, pray-ers, poets and performers? Tradition. The US Constitution calls only for an oath prior to beginning presidential duties. Who is present is neither defined nor required.

We the people are not witnessing a coronation of a king to whom we must bow in obedience as to a god. Quite the opposite, we witness a person vowing to serve the nation and protect our nation as defined in the Constitution. That document describes the service our elected officials are to fulfill on our behalf. We witness the promise of the incoming president to serve us and our interests according to constitutional law.

I will pray for the president-elect. But I will not watch.

I do not harbor any illusions that he has our interests at heart, nor that his oath will be kept. Neither do I believe that he knows what the Constitution requires of him. I do not believe he has considered beyond his own bank account what the power of the Presidency means and requires. He has never acted on behalf of others or sacrificed for the good of someone else. His rhetoric and behavior has demonstrated that we the people are his playthings.

As an American citizen, I evidently pay more taxes than he does, am obligated to ethical standards regarding conflict of interest though he prefers to be above ethics. My citizenship is worth less to him than his celebration of an enemy of the American vision and government. As a worker, I am at his disposal and may not be paid if contracted by him.  As a family member to military personnel, their sacrifices have been dishonored by his trashing of a Gold Star family because of their constitutionally protected free speech opposing his election.As a woman, I am meaningless to him unless I meet his grade and receive his shameful advances.  As a queer woman in a same-sex marriage, his nominees are a threat to my life and livelihood. The list goes on.

In a week, he may legally, though illegitimately, become the US President.

But until he earns it, he is not my president.




Here I am

Time passes. Grief changes. A lot has happened and been said since November 8 and the election. Many opinions, reflections, news items – both fake and factual – have been penned and pondered. I have occasionally reposted or “liked” someone else’s comments.

But I have struggled to articulate a nuanced understanding of my own about the election of a man who has celebrated his sexual assault of women, encouraged Americans to fight publically when police are striving mightily to become partners in their communities; behaved as a child on a playground about a disabled man, pitted white against black, brown, red and yellow, and completely obliterated the meaning of freedom of religion.

I struggled to understand my uncharacteristic stillness. Until President Obama’s farewell speech from Chicago…

I paused the speech before it began. I had to record it and save it for later. Because of the pain and sorrow that caught in my throat and ran down my cheeks as I began to say goodbye.

I finally realized the depth of my grief. Not just a disappointment at my candidate’s loss. Not just anger like a petty, sore loser. Not just embarrassment that people I thought I knew … yet too painful to articulate even now….

I realized as the President took the stage that something I held dear had died.

And suddenly I thought of the generation who watched in horror and silence as President Kennedy was taken away from us. That day, for that generation, their hope died and people remember details about that moment, that day, that week and tell those stories to this day. This was my Kennedy.

As President Obama entered, I understood that my country died on November 8. The hope and change and dream and “yes, we can,” America I knew was dead. And I have been with an unspeakable grief. The USA I thought I lived in was not just vanquished, but perhaps had always been non-existent.

The arc of the moral universe broke. The wings of freedom fell from the sky in a garbage heap of hopeless feathers. The light of the promise that all Americans may pursue life, liberty and happiness, went out.

America was dead.

…   …   … then the President spoke.

Then….I cried and began to say goodbye.

And as I let go, opened my hand and unclenched the tight grasp of what I thought might still be salvageable, my tears bathed me in truth. Truth always brings new light.

…………………………..“You are not alone.” said Lawrence O’Donnell speaking  about a new poll.

For that knowledge, I am grateful. For as I come about, and the trauma of this present darkness lifts, I will need you—

You– who believe that death will never have the last word.

You who believe we can be stronger in the broken places when we attend and heal them.

You who believe that we have a moral obligation to one another as human beings to be good neighbors in spite of the ways we may disagree.

You who believe we are to be good stewards of this gift called Earth.

I need you—

who believe,

who act for justice, love mercy and walk in humility.

What will be the United States of America is yet to be known. But it is already rising in the hands of those around us. And I don’t intend to watch from the sidelines of a garbage heap. Nor will I leave it to those who killed the founders’ dream.

May the darkness become kindling for new firelight of freedom,

The feathers sharpen into quills to pen the language of a new hope and vision,

That arc, an arrow pointing the way, lining a path, and bridging the divide.

To you who had to grieve publically so as to hold space until others began awakening, I am sorry I’ve taken so long. Thank you for listening in the night, catching fears, collecting tears, opening doors, cracking windows, calling out, whispering names, until I heard and at last say, “Here I am, send me.”

Deo Valenti,