A Father's Thoughts

The Maraschino Cherry

This is an essay I wrote a few years ago narrating one experience during my work as a counselor intern in Atlanta Georgia.

Every time I eat a chocolate cake with cherries, I think of Robert. I met Robert in 1994 while working as a mental health intern providing counseling services and support to those who were either infected with the virus that causes AIDS or who were diagnosed with AIDS.

My interest in learning about AIDS began in November of 1991 when my daughter Cindy telephoned and said “Dad, I have AIDS.” In what Joan Didion describes as an ordinary moment when life changes, my life changed forever.  At the time, I was 55 years old, committed to beginning a new career, and a student in college studying psychology. After recovering from the distress and anguish that Cindy’s disclosure caused, I immersed myself in an effort to learn as much as I could about the disease. I welcomed the opportunity in 1994 to participate in an internship in Atlanta with Positive Impact, an agency providing mental health services to the HIV/AIDS community. I had faith that if I helped someone in Georgia, someone would help my daughter in Utah

Robert, a forty-two year old man living with Walter, his partner of a few years, was an early client during that internship. While Robert lived openly as a gay man for much of his adult life, Walter, a retired college professor, had foregone any open or serious intimate relationships until after completing his career. Neither of them was aware of Robert’s HIV status until Robert became ill.

Our early meetings took place in the agency counseling offices and then were continued in their home and eventually in the hospital as Robert’s health deteriorated. As we worked together over the months in this heavy emotionally laden atmosphere, gradually a meaningful three way therapeutic relationship developed.       

The treatment priority was to help Robert as he moved toward death experiencing many of the feelings described by Elizabeth Kubler-Ross in her landmark work, On Death and Dying. Since this was before the development of medications that transformed this illness into a more chronic disease thus prolonging the lives of those carrying the virus, there was a feeling of inevitability about Robert’s prognosis. We addressed many personal issues, not the least of which was Robert’s concern about his eternal well being and his relationship with God. He felt an affinity for the Catholic Church but was conflicted about the Church teachings regarding homosexuality. He also hungered for the acceptance from his family that they never offered him as a gay man.

Robert was grateful for the love and support he received from Walter, and over the weeks and months Robert gradually reached some resolution of his conflicts and moved toward a position of acceptance of his situation. On more than one occasion he had the wisdom and kindness to tolerate this beginning therapist’s awkwardness and even clumsiness. Belying the seriousness of his situation, he often displayed a sense of humor, allowing us to laugh at each other as we shared these few steps of our life’s journey. Of the many gifts Robert gave me, one was to permit me to be a witness to his courage, his vulnerability, and the strength of his human spirit, particularly during our last session together before his death.

By this time, the disease had taken its toll. Robert was in the hospital, sleeping lightly in his bed, when I arrived for our regular weekly session. He slowly woke as I entered his room and we chatted briefly about the day’s events, his physical weakness obvious. While lying on his back he would lift his knee in an attempt to ease the pain and find some comfort. Just the act of bending that knee was an exertion.

While we talked, an aide came in with a white bag containing a piece of maraschino cherry chocolate cake tightly encased in Saran wrap. Being the helper I was, I began to take the cake out of the bag with the intent of feeding him. Robert, as emphatically as his condition allowed, let me know he didn’t want my help. I gave him the bag and over the next 20 or 30 minutes he removed the cake from the bag and with great effort struggled to loosen the tightly clinging Saran wrap. As the cake became accessible he would break off little pieces and lift them to his mouth. Robert created a glorious mess as chocolate crumbs scattered over the previously white and spotless sheets and floor.

 While eating, Robert occasionally bit into a succulent maraschino cherry, a smile spreading across his face, his lips glistening as traces of juice from the cherry escaped his mouth. He savored the sweet flavor and moisture of the cherry pausing to enjoy the happiness and near joy he found in that precious moment! After resting to regain his strength, he continued his heroic task.

When finished, Robert lay back exhausted and fell into a light sleep. After I quietly cleaned up his bed, I held his hand for a few moments. Our visiting time up, I tapped him lightly on the shoulder and softly announced that I was leaving. He opened his eyes, looked intently into mine, smiled, and squeezed my hand affectionately. In a moment, reminiscent of the moment that I had during my last meeting with my terminally ill father years earlier, our eyes and our touch conveyed what I understood to be our last goodbye.        

 

Helping kids today pays dividends in the future

This is a column that appeared in my local newspaper The Spectrum on February 21.

In my last column I wrote about the vulnerability of the poor in these difficult economic times. Poverty rates have been increasing and today one in four children live at or below the poverty line in our country.

Debbie Justice, Executive Director of The Learning Center for Families (www.tlc4families.org/), responded to my article and invited me to tour the St. George facility of her organization. She frames her programs as workforce development programs to help the children “grow up to be productive and engaged citizens.”

I share with David Brooks, author and New York Times columnist, a passionate interest in human development and neuroscience. I am concerned about the seeming disconnect between what we understand about the pre and postnatal needs of infants and young children and the resources available to address those needs. Recently Brooks cited how early childhood education and development or lack thereof hugely effects later years in life. He bemoans the fact that nationally nobody seems to want to do anything about it. There is no debate on this issue during our perpetual political campaigns. He notes that the lobbying guns in Washington and the prestige is focused on K-12 and higher education.

Because of my previous work as a psychotherapist and in my role as a father and grandfather, I am profoundly aware of the criticality of adequate nutrition and active human and social interaction to healthy brain development. The American Academy of Pediatricians recently reported on the evidence of the link between childhood toxic stress and other deficiencies in the family and social environment during early life and lifelong impairments in learning, behavior, and both physical and mental health.

Because of the dedicated work of The Learning Center for Families and the support it receives from government and community resources, many young children conceived and born in challenging circumstances will have the opportunity to experience an enriching and healthy support system.

Family services can begin before and during pregnancy and continue for the first three years of life. The Center’s most recent annual report cites The Early Intervention Program that identities children who are “showing any kind of early developmental delay such as Down Syndrome, Cerebral Palsy or extreme prematurity.” The early intervention team of professionals and other staff members work with each family individually, structuring a program to meet that family’s specific needs.

The Early Head Start Program “is a comprehensive family development program that promotes the physical, cognitive, social and emotional growth of infants and toddlers while assisting their parents in achieving greater degrees of self sufficiency.”

I ended my tour heartened by the obvious commitment of so many focusing on the needs of young children and their families, but as with other social support programs, there is a bulging wait list of those needing these services.

As Frederick Douglas wrote in the 19^th century “It is easier to build strong children than repair broken men.”

 

 

Can we believe in helping the poor

This was my column for the writers' group in the Spectrum on January 24, 2012   

Last week I attended a ceremony at the St. George Tabernacle celebrating Martin Luther King Jr. Day helping me to reflect again on the life of Reverend King and the impact he had during the nation’s struggle to expand civil rights to the African-American community and the effort he was beginning, shortly before his tragic assassination, to bring attention to the plight of the poor.

More than forty years ago, along with the Southern Christian Leadership Convention, Dr. King was planning to dramatize the needs of the poor and bring national attention to jobs, income, and housing. He recognized the negative impact that long-term poverty has on the human soul. At the time, he felt that Congress was showing “hostility to the poor.”

Are we hearing voices of hostility to the poor today in this election year as attacks on “entitlements” are made by the same politicians who are intent on protecting the inordinate financial gains of the “job creators” from even the smallest of tax increases?

A recent study by Indiana University’s School of Public and Environmental Affairs titled At Risk: America’s Poor During and After the Great Recession focuses on the impact of the Great Recession on poverty in America. The full report can be found at: http://www.indiana.edu/~spea/pubs/white_paper_at_risk.pdf

Briefly the researchers found: “The Great Recession has left behind the largest number of long-term unemployed people since the records were first kept in 1948.” “Large numbers of Americans are already poor.” In 2010 about 46.2 million Americans or about 15.1% were living in poverty, the number having increased 27% between 2006 and 2010.

Other data show that the devastating impact of the financial decline has not been spread evenly throughout the economy. The net worth of white households has decreased by 16% while African-American and Latino household net worth dropped 53% and 66% respectively. The unemployment statistics show similar disparities with the official unemployment in Black communities approaching 20%.

The executive summary of the University’s report concludes: “Promoting sustained economic growth, while at the same time protecting the well-being of the poor, the near poor, and the new poor, is the central challenge for leaders of the United States.”

It takes no great economic wisdom to realize that the way out of our current fiscal morass has to include reductions in expenditures along with increases in revenues. Both entitlements and taxes need to be reformed. As we delay the hard decisions the pain being felt by the poor and near poor in the richest country in the world is real.

Inscribed on a stone panel at the King memorial in Washington are the following words of Dr. King: “I have the audacity to believe that peoples everywhere can have three meals a day for their bodies, education and culture for their minds, and dignity, equality and freedom for their spirits.”

Can we believe?

Enough is Enough

David Frum has a blog entry attempting to understand the people who might support Donald Trump. He describes the feelings of a mythical 62 year old white guy who has been battered by recent events. I clearly don't fit that description but I am a bit riled up.

I'm a 75-year-old white guy who worked for a company for 28 years before it went bankrupt in 1991. The bankruptcy was a mess and a significant part of my retirement resources went down the drain. At 55 I had skills that were not marketable. My wife went back to work and I returned to college finishing my Bachelor's degree and earning a Masters and post-Masters while training for a new late life career. We survived the .com bust and the housing bust, but we both still work in our own small business.

Throughout this time, we were demeaned and stigmatized by the radio talk show hosts who made millions making liberal a dirty word. And now we have a Republican party home to the advocates of war (two of my grandsons are in the military), advocates of guns in every home, believers in the mantra that government is the problem, defenders of the resources of the wealthy, and generally macho guys and gals who with a few exceptions dare not challenge the inanities of the faux conservative talk show millionaires who feed the Tea Party patriots’ anger.

Now along comes the Republican Party passing the Ryan budget. Should I feel grateful that the Social Security and health care my wife and I benefit from is protected at a significant cost to younger generations? Pray tell, what do I say to my adult offspring, my 14 grandchildren and my two great-grandchildren? “Sorry, I’ve got mine you’ll have to fend for yourselves.” How could I justify supporting a program that does away with Medicare without any serious attempt to reduce health care costs, putting in jeopardy their senior years?

As importantly, what do I say to myself, nearing the end of my life as I wrestle with what Erik Erikson identified as the eight crises? Do I look back and believe that I lived a life of integrity or do I despair because my generation and I squandered the money that has been borrowed for the last 30 or more years as we selfishly took care of ourselves with little regard for the future of our progeny?

Or, do I continue raising at least one small voice supporting policies that may help create a better future for those that I love?

 

Senator Coburn on the Health Care Law

Senator Tom Coburn (R-OK) was at a Town Hall Meeting covered by C-Span recently. When asked about the health care reform law he commented that we have the best health care system in the world and he told of his successful treatments for cancer. He also advocated the use of free market principles to reduce the cost of health care by introducing competition. His audience consisted of senior citizens, probably on Medicare, and they seemed to generally approve of his remarks or at least no one challenged him. 

Certainly if you are a member of Congress or very wealthy, our non-system can provide the best health care in the world. Even those of us on employer provided insurance, private insurance, Medicaid, or Medicare have access to reasonable health care. But, how about the the 33 million uninsured, not presently covered, who will have access to insurance when the health care law is fully implemented. 

During the year long public debate leading up to passage, no Republican ever proposed an alternative that would extend coverage to 33 million uninsured and none are being proposed now. No one offered an example where free market principles were effective in delivering health care to the general population. T.R. Reid, author of The Healing of America after surveying the health care provided in a number of nations around the world noted that systems based on free market principle provided quality care only to those with adequate financial resources. 

Rather that spending more time trying to deny coverage to our fellow citizens, why not begin to seriously focus on difficult challenge of reducing our health care costs that are nearly double those in other nations that provide more comprehensive coverage? Why not develop proposals to reduce additional costs imposed on the system by our imperfect tort system? Why not begin to constructively find solutions to the uneven delivery of health care in this nation? We are at the beginning of the process of reforming our health care system. The challenges are great, but we are a resourceful people. 

It is time to move forward on health care reform.

Obama administrations accomplishments

President Obama has been in office 15 months. To listen to the media driven political drivel heard in the political fantasy world in which many citizens apparently live one would think his presidency is already a failure. This fantasy world is replete with what Steven Colbert labels as truthiness, a world in which feelings rule unimpeded by rational thought or reality.

Reality. It is helpful to recall the situation that existed in January 2009 when the president was inaugurated. In addition to the wars in Iraq and Afghanistan, the GDP was declining more than 6%, more that 700,000 jobs were being lost each month, General Motors and Chrysler were on the verge of bankruptcy and their failure would have added tens of thousands to the rolls of the unemployed. We were in the most serious economic decline since the Great Depression.

Recitation of these facts is not intended to blame previous administrations but to establish a conceptual framework on which to judge the performance of the Obama administration.

Robert P. Watson, Coordinator of American Studies at Lynn University compiled a list of 90 accomplishments of the Obama administration and the Democratic Congress since the inauguration. To cite just a few:

 

·       Instituted enforcement for equal pay for women

·       Provided families of our fallen soldiers funds to cover expenses if they choose to travel to Dover to witness the return of their loved one. The media is now permitted to cover the return pending the adherence to respectful rules and the approval of the family.

·       Placed limits on lobbyist’s access to the White House.

·       Began modifying military procurement procedures.

·       Expanded the SCHIP program to cover health care for 4 million more children.

·       Implemented significant changes in credit card regulations banning unfair rate increases, preventing unfair fee traps, and requiring plain language in plain sight for disclosures.

Politifact.com, a source for objective political information, compiled and is tracking a list of 502 campaign promises made by candidate Obama. At the end of 2009 the president had fulfilled 91 of his promises and he received a partial success grade on another 33. In addition he is making progress on more that half of his campaign commitments.

Early in his term the president provided the leadership that led to the passage of the Recovery Act or $787 million stimulus program to arrest the economic decline. The program was divided into 3 parts.

One third provided tax relief for 95% of working families and small businesses.

One third provided emergency relief to help folks bearing the brunt of the recession. Unemployment benefits were extended and health insurance premiums for families relying on COBRA were reduced by 65%. Aid was also provided to state and local governments. Utah has been allocated $1.6 billion of stimulus funds and the Deseret News reported last Saturday that the stimulus program brought 25,000 jobs to Utah in the first quarter of this year.

One third was allocated for investments to put Americans to work doing the work that America needs done. Investments focusing on energy programs, computerizing medical records, medical research, education and infrastructure were given priority.

It cannot be denied that the much-maligned stimulus program has been a factor in our economic recovery. The GDP grew by 5.6% in the fourth quarter of 2009 a significant reversal of the 6% decline in the last quarter of 2008. Rather than losing 700,000 jobs a month, we are creating jobs, not enough yet to reduce the unemployment statistics, but the direction is clear. The stock market is recovering with the DOW now above $11,000. We have a ways to go, but he economy is like an ocean liner not a speedboat and it takes time to change direction but economic progress is obvious.

Also important to our long-term fiscal health was the passage of Health Care Reform last month. We, as a nation, have now established in law a moral principle that has eluded us for decades. We have taken an important step toward health reform by extending coverage to 32 million uninsured Americans. No longer will we accept the deaths of thousands of our citizens because of the lack of access to adequate health care. Enactment of this law is the beginning of what will be a decades long effort to increase the efficiency of health care in our country by modifying the delivery systems and reducing costs.

Finally, a few words about our wars and foreign relations. The president is committed to ending the wars in Iraq and Afghanistan, perhaps not as quickly as many of us would prefer. Our troop levels in Iraq continue to decline and we are refocusing our effort in Afghanistan while supporting Pakistan as its army attacks the terrorists in that nation. As with the other challenges we face, ending these wars will not be easy but the president has a plan and the support of our military establishment.

At the same time we are making efforts in the international community to lay the groundwork for a future with fewer military conflicts. The president recently signed a new START treaty with Russia that will continue us along the path set out by President Reagan toward a nuclear free world. The president organized the meeting of 47 nations in Washington DC that focused on the

problem of terrorist access to nuclear materials. He is reframing the 21^st century nuclear threat and mobilizing the international community to confront it.

There is a warming of our relationships with many of our allies as the president actively engages in effective personal diplomacy while supporting his foreign policy establishment. Can we agree that Hillary Clinton leads a competent State Department team?

So, positive and significant change is happening. Change that is exciting for some and threatening to others. Change that is necessary if we are to continue to be a nation able to influence world events while advancing our national interests.

Encouraging employment report

Tom Schaller has a post on the FiveThirtyEight blog this morning about the March labor numbers including a chart that clearly shows the progress the economy is making in creating jobs with net new non-farm jobs coming in at 162,000. Unemployment remains at 9.7%. Schaller, commenting on the data, notes that the chart depicting the jobs lost and gained "resembles an inverted bell curve during the year leading up to Obama's inauguration  and the year after his inauguration." The 162,000 new jobs are the most added since three years ago. He points out that while this is encouraging the data also highlights some continuing concerns about the shape of our economy.

Reading his post, reminded me of some comments made on one of the morning entertainment news shows by an opponent of the Obama administration. She was expressing concerns about the worries in the small business community about the uncertain future and how that uncertainty is limiting job growth in that sector. It strikes me as a bit ironic that while many conservative commentators are proclaiming the need to establish government policies that can create some predictability for the future, these same people are refusing to accept the will of the electorate that led to the passage of our new health care reform law. 

Rather than accepting the reality that the nation has made a fundamental moral decision to extend reasonable health care to most legal residents, and focusing on how to implement the law, the Republicans want to continue the uncertainty and their opposition to the president, vowing to repeal and replace the law. 

Rather than working to implement improvements to the law and addressing the complex challenges underlying the increasing costs, the Republicans want to continue what most legal scholars believe are fruitless legal challenges. What is their plan for replacing the law? Tort reform is still an option that can be considered within the current legal framework. 

Rather than working constructively on the substance of the issue and focusing on creating a better future for our children and grandchildren, they promise to remain mired in the political thickets in the hopes of winning a huge victory in November. That of course begs the question: What did they do when they had the power to create effective health care policy? 

Pass the bill

The yearlong, admittedly messy, health care reform process nears its end on Sunday and passage of the president’s proposal now seems more likely.

The Republicans continue their unified opposition to any significant reform of our health care non-system. What is their record on this issue? They successfully defeated the efforts by the Clinton administration in 1993 to pass reform. During the 8 years when they controlled the executive branch, what did they accomplish?

Did they reduce the growing number of uninsured Americans or propose any programs to effectively reduce health care costs? Of course not. Then as now they were not concerned about those who lacked access to reasonable heath care. The Senate majority leader and his colleagues continue to claim that ours is the best health care system in the world. That is obviously true for the wealthy or those who have health insurance policies that haven’t been cancelled when they get sick. But, by any comprehensive assessment, we do significantly worse than other developed nations in providing health care to our residents while spending nearly twice as much money.

The Democrats will make a historic decision in the next few days. If health care reform passes, we will extend insurance to 32 million more Americans and begin the difficult process of trying to rationalize our non-system. The Congressional Budget Office affirms that reform can reduce the deficit slightly in the first decade, followed by significant cost savings exceeding $1 trillion in the second. We can begin the exceedingly difficult process of improving the efficiency and effectiveness of health care delivery. We will explore through multiple pilot programs alternative solutions to the myriad problems that plague our non-system. Success is not guaranteed, but continued failure is certain if we don’t begin the effort.

The events of recent months foreshadow the future if the Democrats do not honor their 2008 campaign commitment. Insurance companies raised rates for the insured while acknowledging losing policyholders because of the higher premiums and the recession. They will continue the current policies of excluding people because of preexisting conditions, placing annual or lifetime limits on coverage, canceling policies of the sick when possible, and denying access to preferred physicians. It is estimated that the number of uninsured will grow to more than 55 million in the next ten years in the absence of meaningful reform.

Passing the president’s proposal is just a beginning and does not preclude future action on issues that remain unresolved. Meaningful tort reform, a public option and other policy changes that continue to improve our health care delivery and reduce costs can still be adopted separately.

Pass the bill.

Finally a decisive vote on health care reform

Is it possible? We may finally get a decisive vote on health care reform in the House this week and the President will be able to sign the bill before he leaves on his trip to Indonesia and Australia. What if the House approval of the Senate bill fails? As financial advisors caution, past performance doesn't necessarily equate with similar future results. But, the Commonwealth Fund published a blog in December 2009 The Costs of Failure: Economic Consequences of Failure to Enact Nixon, Carter, and Clinton Health Reforms. They reviewed the history of rising health care costs since 1960 and projected what the costs would have been if previous health care reform efforts had been successful.

If the reforms proposed by Nixon had been enacted and had reduced costs by just 1.5% annually, our expenditures now would be 10.7% of our Gross Domestic Product instead of the current 17.7% or a savings of $1 trillion annually. Similar projections are made for the reforms proposed by Carter and Clinton in which cases our annual expenses would now be 11.5% and 14.2% of GDP respectively.

We are now closer than at any time in the past to beginning the process of serious health care reform. If we fail this time does anyone doubt that costs will continue to grow and millions more will be added to the rolls of the uninsured in the coming decades? Let there be no illusions about what passage of the President's proposal will mean; this is just the beginning of a decade or longer very difficult challenge of "bending the cost curve" that will necessitate significant structural changes in how we provide health care affecting many stakeholders.

But begin we must.

Decision Time on Health Care

It's decision time for health care reform. Obscured by all of the political rhetoric and misinformation that has characterized what passes for public debate over the last year is the core moral issue that we have been struggling with for six decades. On this critical issue there is a fundamental difference between the political parties. The President's plan extends coverage to 31 million while the Republican plan only covers 3 million additional Americans.

It is time for the Democratic Party to honor the 2008 election and pass health care reform now and then face the electorate in November.

There are life events more serious than risking the loss of a future election or ending a political career. The consequences of bankruptcy because of lack of access to health insurance are severe for individuals, families, and communities. Allowing thousands of Americans to die each year because of lack of reasonable health care is immoral and a national disgrace.