Let's find real solutions to the impending doctor shortage

One of the most common arguments I see in opposition of healthcare reform is that there are "not enough doctors" if everyone in the USA were to gain access to health care.

This argument irritates the hell out of me. What this really boils down to is, if those who currently do not have health insurance are, by way of reforms, finally able to access affordable (for them) health care, then those who are currently privileged enough to have health insurance may have to wait longer to get an appointment with a doctor.

In other words, "I got mine, screw everyone else, and don't you dare try to inconvenience me so that others can receive care."

Instead of trying to address the actual problem of potential doctor shortages, these people would rather deny healthcare to less privileged people. They will also say things like, "They should get a job and get health insurance like I do, by working for it*," all the while blinding themselves to the obvious fact that if that happened, there would still be the problem of not enough doctors; how those doctors are paid--by insurance companies or by single payer--is not going to matter a whole lot when there still aren't enough of them to care for all of our country's citizens. But of course, the teabaggers are counting on a significant portion of US citizens remaining in the position of not having health insurance. They aren't forward thinking enough to try to work on ways for the doctor shortage issue to be addressed, they just want to make sure they keep the status quo.

So what are some real solutions to this impending shortage of health care professionals (and, actually, despite our having the oh-so-fabulous system we have now, we actually have shortages right now, especially of general practitioners)? Now that we've established that denying health care to a large portion of citizens is NOT an acceptable solution, I have a number of suggestions for both increasing the number of physicians, and for reducing the demand on them:

1. Medical school enrollment hit an all time high in 2008. Obviously, there isn't a lack of interest in the medical profession. However, this makes me wonder how many well-qualified candidates didn't get accepted. Somehow, we need to increase the capacity of our medical schools so that many more good students are able to attend. I feel that anyone who feels a true calling to the profession, and who is intellectually capable, should have access to a spot in a medical school.

2. We also need to de-privilege medical school enrollment. Applicants who show great promise should be admitted regardless of their socioeconomic status, and we need to find ways to help less privileged applicants fund their education.

3. Regions that are experiencing the most severe shortages could offer grants to help a local student pay for medical school, with an agreement that they will return to the region to practice family medicine for a specified time period.

4. These same regions could ease family practitioners' overhead expenses by providing a city- or county-owned clinic facility. They would have an incentive to make these facilities comfortable and attractive so that the physician(s) will want to work there. I have seen some of the incredibly ornate and beautiful public libraries in some places, so why not create similar places for public clinics?

5. Offer similar incentives and opportunities to educate and recruit more nurse practitioners and physician's assistants; they can take a huge load off the doctors by serving patients. For those who are not in the US, people in these two jobs are able to see patients and perform most of the things a family practice physician does, but must practice under a supervising physician.

6. Adopt a single payer healthcare system! Our doctors currently spend an obscene amount of time and money trying to get insurance companies to pay their bills. Insurance companies currently spend an obscene amount of time and money trying to avoid paying doctors what they are due. Between arguing on the phone, filling out and faxing a ludicrous number of forms, and writing a bunch of letters explaining WHY Mrs. Jones really DOES need her lifesaving medication, doctors are cheated out of time spent with their patients and families. They either find themselves rushing through a double-booked schedule and not getting the chance to really connect with their patients, or they are cheated out of the income they would get by booking more patients in the time wasted wrangling with insurance. Many doctors report that Medicare and Medicaid don't give them the same headaches and runaround as insurance companies, and doctors in the UK and Canada often say that the single payer systems in those countries leave them with more time for patients and less overhead spent on staff needed to sort out insurance snafus.

7. Improve our education system so that gifted and talented kids of all socioeconomic backgrounds have a good shot at becoming doctors if that is their dream. Find more ways for our best and brightest to get into college and on the right track to med school. It's ridiculous that we have college recruiters for sports teams, but not for academics. Why isn't there a recruiter sitting in the back row of a biology classroom to pick out the best and brightest, to offer them incentives to pursue a pre-med career? Isn't creating more health care professionals more important than winning a few ball games?

There are surely countless other ideas out there to ward off the physician shortage that don't involve telling 47 million US citizens to suffer and die. What are your ideas?

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* There is the fact that many people have jobs that don't give them health insurance--to which the teabaggers will often respond that it's the person's own fault for not pulling themselves up by their bootstraps and getting a better job. There are countless problems with that, however, with just a few of them being:
- Not everyone has the ability to become an engineer, or a lawyer, or some other profession that has decent benefits

- Teabaggers are anti-union, so they're actually against workers gaining access to better benefits

- They also vote for the corporate whores who send jobs overseas and sacrifice lower level jobs for CEO and upper management bonuses and (temporary and unsustainable) inflation of stock prices (which often end up eventually gutting the corporations for the sake of making a quick buck for investment bankers--and by the way, studies show the seven percent rule is a myth; GE and P&G pulled it off, but they're the exception, and companies trying to emulate their layoff tactics are not getting the results they wanted)

- There are not enough of these health-insurance-providing jobs for everyone; if there were, we'd all be working them

- Regardless of anything else, SOMEONE has to do the "less desirable" work that currently doesn't provide health insurance, and you know these selfish teabaggers are going to be the first to whine when there aren't enough checkout lanes open at Wal*Mart for their liking

- It's inhumane for a person to have to choose to stay with an abusive employer (or an abusive spouse whose employer provides health insurance) because they've got a health condition that would be impossible to manage without insurance (and impossible to get insurance coverage for outside of employer-offered).

A labor of love

Janie L was in pain every single day. She had undergone a major back surgery that stood a chance of paralyzing her forever. She can't get out of bed some days, but she isn't paralyzed.

Janie was also deathly allergic to cats. A couple of hours visiting her sister, who had two cats, would often give her bronchitis and stuffed up sinuses for two days after. Still, she adored animals, especially cats. So when the weather was turning cooler, she felt she had to do something about the tiny black and white cat who had spent the summer in her neighborhood's lawns, chasing squirrels and avoiding humans. Janie got a hav-a-heart trap, and soon she had a very frightened little cat trying frantically to escape from it!

Janie's sister came over to help get the little one into a large kennel; the cat had never been touched by humans before, so this was a real challenge that got sis scratched up. But the cat was safely ensconced in the kennel, with a cozy bed, plenty of food and water, and a litterbox. The two sisters could not tell what gender the quivering furball was, but they did determine (correctly, it turned out) that kitty was deaf.

Janie called every rescue she could, but all were full to overflowing. Her sinuses grew more and more clogged, and she knew that she couldn't keep this up for long--but she could not bring herself to put the kitty back outside, especially now that she knew kitty was deaf.

As luck would have it, she called the rescue I volunteer for while a particularly soft-hearted volunteer was on phone duty. This volunteer felt drawn to the situation, both by the cat's desperate need and by the woman's kindness and courage in trying to help a creature that was making her physically ill.

So I, the volunteer, was able to somehow convince the foster coordinator to let me take on this challenge. I called Janie to arrange for us to come and meet the kitten. Brian and I arrived around 7pm with a carrier and towel. I had Brian hold the towel at first while I removed items from the kennel to get them out of the way. Once the way was cleared, I reached in to see how the cat would react to my trying to pick her up. Janie and her sister were amazed that I would just reach in like that, but I could tell from the cat's behavior that it was afraid, but not aggressive. After it pulled itself back into the corner, I took the towel from Brian and used that to wrap her up and pull her out.

I had Brian hold the wrapped, trembling kitty while I looked it--her!--over. Janie and her sister wanted to pet her before we put her in the carrier, so we let them stroke her head. It was a huge thrill for Janie to touch the scared little kitty she'd rescued! She told me that she had tried every rescue, and that she was crying and praying, asking her mother's spirit to help her find someone to intervene for the kitty. They'd been calling her Oscar, and she is about six months old, short haired, black and white, and POLYDACTYL! I'm a sucker for extra toes.

So we said goodbye and took Colette (we named her that night) home with us. Brian took her straight up to the bathroom while I put together my foster intake kit. Brian sat with her on his lap, a towel underneath her, while I sat on the floor in front of them to do the procedures. Colette was amazingly calm the whole time, and let us do whatever we needed without a peep or struggle. I think her being deaf helped; strange sounds seem to be the most stressful things for scared kitties.

First, I had to trim her nails so she wouldn't shred us if she resisted. She calmly let me trim each claw. When I got to her right rear foot, I was appalled to find that the extra toe, which was halfway up the foot (if it were on your foot, it would be on the inside of your foot, right at the point where the arch is at its highest point), had overgrown the claw all the way into the pad. Cat claws grow in a curve, and regular wear and shedding usually keeps them from overgrowth. On a toe that does not touch the ground, the outer layers don't shed, and the claw doesn't wear down, so it keeps curving around until it grows into the flesh of the toe. I've seen it on polydactyls before; in Colette's case, it was a matter of being a stray who'd never had anyone to groom her, whereas the previous case was a person who was not diligent about nail trimming. Colette did not react at all as I trimmed the overgrown nail, removed the bit from her paw pad, which started to bleed, and then cleaned and disinfected the wound. Luckily, it was not full of pus or necrotic tissue; she will be just fine as long as we keep her claws trimmed!

After the claws, I had to dredge an appalling amount of clotted black goop out of her ears. I was pulling chunks out of her poor ears, and she just sat there and let me do it. It took a long time to get them cleaned; I flushed, I rubbed with cotton balls, and I pulled bits out with swabs. I treated both ears for mites as well; I'll probably have to repeat the whole process in a week or two.

Then came the easy stuff; worming medicine down the hatch, a quick distemper vaccination (she didn't even notice), flea treatment, eye drops for her conjunctivitis, and the first dose of Doxycycline for her URI. She's a bit snuffly, but she's alert, bright eyed, inquisitive, and energetic, so I think we got to her just in time. After that, we just petted her and let her get to know us for a bit before putting her out on the front porch with food, water, and litter box. The front porch is our "extra" foster room when we have a cat that needs to be quarantined.

Janie is going to sponsor Colette's spay, which is scheduled for Tuesday, 9/22. Colette will be tested for FIV and FeLV as well, and I am hoping that she is negative for both. She will be socialized here, and then when we feel she is adoptable, she will go on the rescue's website so we can find her a home.

I don't know what drew me to this cat, but I am grateful to have the opportunity to help her.

Revisiting the "Lucky Ducky" mindset

"Lucky Duckies" may seem like old news, since the term came about in 2002, but I think it's vital that we revisit it at this very moment, because we need to be reminded exactly what we are up against. We need to always keep in mind that the neocon point of view is horrifically sociopathic, and that we are dealing with people who are so mentally ill that they believe people who live below the poverty line are fortunate to be doing so. This may seem ludicrous to you, but it is not a joke, and it is terribly, disturbingly unfunny--made even more so by the fact that this point of view actually instigated policy changes.

http://en.wikipedia.org/wiki/Lucky_duckies - Lucky duckies is a term that was used in Wall Street Journal editorials starting on 20 November 2002 to refer to Americans who pay no federal income tax because they are at an income level that is below the tax line (after deductions and credits). The term has outlived its original use to become a part of the informal terminology used in the tax reform debate in the United States.

Here are some excerpts from articles about the "Lucky Duckies" discussion that came about when the term was coined:

http://www.gregsopinion.com/archives/002640.html

Carping critics of the conservative movement have been known to say that its economic program consists of little more than tax cuts, tax cuts and more tax cuts. I may even have said that myself. If so, I apologize. Emboldened by the midterm election, key conservative ideologues have now declared their support for tax increases ? but only for people with low incomes.

The public debut of this idea came, as such things often do, on the editorial page of The Wall Street Journal. The page's editors, it seems, are upset that some low-income people pay little or nothing in income taxes. Not, mind you, because of the lost revenue, but because these "lucky duckies" ? The Journal's term, not mine ? might not be feeling a proper hatred for the government.
The Journal considers a hypothetical ducky who earns only $12,000 a year ? some guys have all the luck! ? and therefore, according to the editorial, "pays a little less than 4% of income in taxes." Not surprisingly, that statement is a deliberate misrepresentation; the calculation refers only to income taxes. If you include payroll and sales taxes, a worker earning $12,000 probably pays well over 20 percent of income in taxes. But who's counting?

http://archive.salon.com/news/feature/2002/12/21/duckies/print.html

Chait and countless others pointed out that the Journal's argument was both factually wrong -- it considered only the federal income tax, not all the taxes that poor and middle-class people pay, in particular hefty payroll taxes like Social Security -- and culturally out of touch. Had the editors ever met a person of little means? Did they realize that being poor, while perhaps an attractive tax shelter, tended to come with such hard-to-bear downsides as not knowing where your next meal will come from?

http://writ.news.findlaw.com/commentary/20070423_buchanan.html
Buchanan makes a GREAT point here:

Unfortunately, because tax issues are all about numbers, it is far too easy to introduce confusion into the debate. And conversely, it takes a bit of effort to unsnarl the arguments. But when the facts are laid bare, the brazenness of this new attack on fundamental American notions of fairness is simply stunning.

Indeed, the proponents of "Lucky Duckies" will hurl numbers right and left, but can we honestly say that we need to "unsnarl" those numbers to understand that it sucks to be poor? That having food security and shelter is better than not knowing if you'll have enough to eat today, or whether you'll be evicted from your home at the end of the month? That Joe being able to keep his modest roof over his head is more important than George buying a fifth Mercedes? And, probably even more importantly, that George's fifth Mercedes was paid for by laying Joe (and fifty of Joe's coworkers) off?

Buchanan continues:

The zero bracket is simply a matter of humanity. If someone is working but unable to earn above a basic minimum, then they should not pay income taxes.

EXACTLY. Humanity--the keyword here, and what the neocons seem to be sorely lacking.

He continues, with some more common sense:

in reality, are we anywhere close to such a situation? In 2005, total income reported to the IRS rose by nine percent, but all of the gains went to the richest 10% of the population. Incomes for the remaining 90% actually declined. Every day brings news of ever-greater income inequality, with measured inequality reaching levels not seen since the Roaring Twenties and the Gilded Age.

If we have a redistributive system, therefore, it is not having any noticeable effect on the party in the penthouse. Any concern that our political system is somehow excessively responsive to the poor, and deaf to the cries of the rich is, moreover, hard to take seriously.

Finally, this Ruben Bolling cartoon is an eloquent illustration of the neocon point of view regarding how "lucky" people living in poverty are. I just wish there were some way for Bolling to illustrate how long Ducky had to stand in line at government offices and agencies to receive the meager benefits he got.

Bad Benches

I'm looking at these benches...

And I have to say, the slanted one? Pisses me off. The Nike "wet paint" ones are also dickish, but at least they're usable.

For those who don't want to click the link, basically a gym company advertised by putting these benches in public places. The benches were designed so that the seat was tilted so far forward that no one could actually sit on them, the implication being that you shouldn't be sitting down, you should be omg exercising.

The Nike benches had fake wet paint stickers on them to "promote running"...basically to remind us all that we shouldn't be wasting precious exercise time sitting down and relaxing.

Another advertiser placed decals of bathroom scales so that when someone sat on the bench, their feet would be right on the scale. The decals said, "Burn Calories" and were advertising a gym in India. Oh, and the scale's dial registered a horrifyingly OMGFAAAAAAAAAAAAT weight of 95 pounds. You know, if I'm tired and need to sit down for a moment? I don't need eating disorder triggers shoved up my ass for the horrible crime of sitting down.

The latter two suck, but the first one is a kick in the teeth to those of us who have disabilities. If I'm out walking somewhere, and I have a real, sudden need to sit down for a little bit (often my back will be spasming, which is excruciating), encountering one of these useless, mean-spirited benches would probably make me dissolve into tears of pain and frustration. And then I'd probably have to sit down on the ground...which may be muddy or wet, and is not as easy to get up from as a working bench.

I am so damn tired of the neverending "Burn more calories" propaganda. We are cajoled and coerced into engaging in more and more strenuous physical activity, and guilt tripped if we do not. The gym companies barely even need to do their work in this anymore, because they've now got plenty of exercise zealots who LOVE showing off how morally superior they are to people who choose to spend their free time doing other things, or to those of us whose bodies are not able to engage in strenuous exercise.

The marketing weenie responsible for the slanted bench? I'd love to see that jerk get a badly sprained ankle, or come down with mono, and then be forced to replace all his furniture with slanted crap so he can't sit down or even sleep in his bed.

Kitty pee problems

I recently had a friend ask me for help with a cat issue. It's a pretty common one, so I want to post this to help out others with the same problems.

Hey, I'm writing for my roommate who's having cat pee issues to see if you have any ideas. He has an 8-year-old male cat that's peeing on my friend's bed constantly. He never did this at my friend's old apartment, but he didn't start until 6 months after we moved, so it's not moving stress. He has a history of liver problems (doubt that's relevant). We brought him to the vet, who prescribed antibiotics for a bladder infection (10 days of something) but that didn't take care of it, so not sure it's that. He only pees in the one spot on my friend's bed and he obviously washes the comforter every time it happens. He's had it with this cat, so I'm trying to see what it could possibly be! Thanks. :/

My response:
First: Rule out physical causes
Get the vet to take a urine sample (with a needle) and check it for bacteria, blood cells, and/or crystals. Rule out physical causes. Sometimes a cat will urinate inappropriately because they do not feel physically well, and engage in litterbox avoidance. Once the urine is checked, the vet will be able to prescribe special foods or medications to help; kitty may still pee on the comforter while he isn't feeling well. (Note: If he DOES have bladder/urinary tract issues, get some Glycoflex to give him daily, as it has helped my ex's cat immensely with her interstitial cystitis).

Second: Get that odor OUT.
Cats can smell even the faintest traces of urine. Get your hands on Simple Solution Cat Odor Remover--not the regular stuff, but the cat specific kind. And then:
1. Launder the comforter, then spray the peed on area with the Simple Solution, let it sit for about half an hour, and launder again (don't bother drying inbetween washes)

2. Do the same for the sheet beneath the comforter.

3. Use the spray on the MATTRESS too, liberally on and around the spot. The odor penetrates through, so he's probably still smelling it there. Let it sit for about fifteen minutes, and then blot as much as you can with a towel. Repeat once, and then set a fan blowing over the top of the mattress to dry it out. IF you have a steam cleaner (they are indispensable here), use the upholstery attachment to clean the mattress area both before AND after the Simple Solution treatments. If you don't have one, see if you can borrow one, or rent one.

Third: Replace the "territory" pheromone with a "calming" one
Get your paws on a bottle of Feliway spray. It's expensive, but it WORKS. Spray the mattress with ONE squirt on the spot where kitty pees. Then spray the comforter as well, again ONE squirt. Do this once every day for a week, then space it out to every other day, then two days in between...then go down to once a week.

Fourth: Figure out non-physical causes
Now, if kitty does not have any physical issues? Try to sort out what may be stressing him. What's changed? Is there a new smell or sound in the house? New animal? New person coming over? If you need help figuring this out, after physical health problems are ruled out, we can chat and come up with what it might be. If you think you know what it is, let me know and I'll tell you the strategies I know for dealing with different stressors. If the cat is experiencing anxiety issues, and the cause cannot be found or eliminated, anxiety medications are actually very useful in helping with inappropriate urination behaviors.

I also recommend, for strategies in solving cat behavior problems, the following book by Dr. Nicholas Dodman:
The Cat Who Cried for Help: Attitudes, Emotions, and the Psychology of Cats

Some thoughts on bullying

Edited to add:
It's interesting to note that the bullies who inspired this post have actually come here and left hateful comments filled with abusive language. Of course, they are outraged that I just reject their comments--how dare I "censor" them! They are even more outraged that the incidents that led to this blog entry culminated with their actions being reversed by those in charge; what was stolen from me and the other person involved was restored to us. If you steal something from someone, and then the authorities take it away from you and give it back to the original owner? You're not being oppressed.

Someone in a livejournal community I'm in noted that bullies almost always have a persecution complex. When their victims protest, or fight back, the bully reacts with extreme outrage that would be out of proportion even if they'd just been attacked without provocation.

I've come to believe that at least some of them are bullying because they *want* someone to fight back and put them in their place. Perhaps they had absentee or ineffective parents that gave them no structure, or an unstable structure, and they are seeking someone, anyone, that will teach them some boundaries. They constantly test boundaries until they find someone fearless or fed up enough to draw a line and push them away and back over it.

I'm wondering if some of the severe acting out and bullying I see online, including those who engage in a great deal of trolling, are the result of the "self esteem" style of parenting, when many parents failed to teach boundaries and respect to kids because they were fearful of stifling their children's happiness. (Please note that I don't think you should beat your kids, or break their spirit--but kids need reasonable rules and structure.)

Boundaries are very important to self-esteem. They give you a map of where you end and others begin, and vice versa. Without knowing this, it is difficult for a person to have a sense of self without constantly seeking that line by testing boundaries. Unfortunately, the testing usually consists of striking out at other people and seeing what you hit. The seeker then starts to create an identity based almost entirely on the reactions of other people to them; their identity cannot stand alone, but instead is reminiscent of sonar--they send out signals, and get a picture of who they are based on what comes back to them. A healthier person is more able to be comfortable with who they are without needing constant feedback from other people.

A decent person who needs feedback (I will not comment on whether or not this makes them healthy or not, because it's of course variable from case to case) seeks positive feedback from others by doing nice things and helping people. If I cook you a nice meal, and you thank me for it and tell me how good it was, we both feel good and derive benefit. A bully will insult or hurt someone, and derive benefit from their negative response. It's easy to see which way is better--and not just better for the recipient, but for the giver. The question is, what makes a person choose bullying over kindness in their attention seeking behavior? And then, what can be done to get them to choose the latter when they have spent so long doing the former?

Living with Deaf Cats

Varjak Paw* was one of our foster cats. He was a kitten while he was here, and we had his mom, sister, aunts, uncle, and grandmother as well. His mother and sister, like him, are white with blue eyes, but being female, did not develop the deafness associated with that color combination (link goes to excellent article about cat genetics). Varjak, however, is deaf, and that makes him a bit more challenging to live with.

While he was here, he was a kitten, and he was no more a handful than any other kitten of the same age. We had to be careful not to step on him while he was sleeping, since he couldn't hear us coming, and he did scream his fool head off at the spay/neuter clinic (the vet said he drove them all NUTS--he woke up from the anesthesia almost immediately), but he was small and stumbly and still learning about his world.

Last week, my friend asked me to catsit for him for a little while, and she brought me this huge white cat that couldn't possibly be Varjak! He looks just like his beautiful mother, Cyrene (formerly Snowflake, adopted by my friends Catt and Ken), but he's got that big, strong male cat body. He's also got a new name, Max. Max was stressed out by the new surroundings, and by the fact that there were over a dozen unfamiliar cats all around him. So there has been a lot of yowling and hissing coming from him. For their part, my own cats are all saying, "Meh, so what, another cat."

One of the things about having a deaf cat is that they can be VERY LOUD. They don't have any feedback to tell them they are being loud, so they make their sounds without knowing they're being obnoxious. Having to pick Max up and remove him from, say, the counter, the refrigerator, and other situations, I realized that I might have to go tell my neighbor that no, we are not torturing cats here. The blood-curdling shrieks are very much like the ones we've gotten out of feral or abused cats. He isn't THAT mad, but he has no idea he's being that loud.

Another thing about him is that, when he IS being a troublemaker, I have to physically remove him from the situation. Almost all of my cats respond to verbal commands, which is very useful when I'm not feeling well. Max is usually visually focused on the trouble he's causing, so the only thing we can do is make physical contact to get his attention.

And he does like to get into stuff. Most cats would knock stuff over, and then scare themselves off with the crashing sounds. Max is currently pawing at a spoon that is next to a glass object, and making a racket; I don't think any of my cats could stand the noise he is making, and would quit because of it. So he just keeps doing noisy things because it doesn't affect him. He's also more easily bored because he needs more visual and tactile input than a hearing cat, so he seems to go looking for stuff to do.

Having him here has been an educational experience, and while he has been a handful, he is also a very loving, snuggly boy who is a pleasure to cuddle. I hope that as our limited time with him goes on, I will understand his needs better, and be better able to serve a future deaf cat's needs.

* Named for the title character of the books by S. F. Said. His sister was Sally Bones, and his aunt (who passed away) and uncle of the same age were Holly and Jalal, all characters from the Varjak Paw books. Varjak's mom renamed him Max, but Sally's adopter kept the name and actually got interested in the books!