An open letter to The Secretary of Health (whomever that turns out to be!!)

H -- Hurry, people are suffering needlessly!
E -- Everyone – not just a few people deserve core services
A -- Accountability – no more shrugging shoulders on the part of payers/providers
L -- Leadership – on behalf of the greater good, not individual money niches
T -- Together – stop deciding FOR people, begin working WITH them for health
H -- Healthcare Vs. Illness care – let’s not wait ’til it breaks & try to cure

R -- Reality – what real people face; not the wishes of the wealthy & well heeled
E -- Evaluated – follow the data, focus on achieving the best outcomes
F -- Fit – one size doesn’t fit all. Address special needs of high risk people
O -- Orchestrated – but not MANAGED – work together to serve patient Vs. payer
R -- Reach – out to find community leaders who can engage the people
M --Money – too much waste, too many hands in the till, too few resources aimed at making a significant difference in the lives of patients and families who get lost in the money shuffle



Dear Secretary of HHS–

Above you can see my thoughts on health reform. As a nurse, I come with a professional bias on how healthcare should be designed and delivered. Some of the things I believe in and will describe for you here would upset my own nursing colleagues because they have begun to prosper on the status quo. For instance, where have all the nurses gone – they’re working for insurance companies! Rather than taking care of patients, they are taking care of the assets of the payers who would rather not spend money on the “covered lives” they’ve accepted the responsibility to serve. I offer that perspective so that you don’t think I paint my own kind with a softer brush than I do others in this broken system. We’ve all got room to examine and change our practices.

When are we going to see dollars spent on wellness in America? Those of us with adequate insurance and at least some disposable income take part in such things as fitness clubs, diet plans, annual physicals, having our teeth cleaned, using community walking paths, nutritious eating, wellness counseling, and holistic alternative care options.

We’re clear on the problem. Here are a few facts I gleaned while watching public television:
5% of the people use 55% of the healthcare resources.
75-80% of hospitalizations are for chronic disease episodes – why? It is too little, too late.
Source: http://www.mnchannel.org/video_archive.php?video_id=22

But what does the typical American do?
He or she ends up in the hospital because no one teaches or supports him or her with the tools to manage life and health, to recognize early warnings, to take initiatives on his or her own behalf. Sometimes technology is all that is needed so that early intervention (short of coming to the Emergency Room) can be provided to prevent the crisis from occurring.

The average American can’t name his of her healthcare provider. (You’ll note, I didn’t say physician because I think if we limit our thinking to physicians, we lose sight of the wide range of care services people need – including the services of nurses at all levels). Sometimes that is because that American doesn’t have a primary care provider. Sometimes it is because there is no provider accessible. Frequently it is because the inattentive American doesn’t “get it” that healthcare is a daily activity we each engage in, not something we finally attend to when the pain or the problem is too hard to bear.

The reluctant Americans wait to access healthcare until the problems are beyond control. And, they know that there is no money, in their government plan, their minimally funded insurance plan or in their own pockets to address the difficulty before it becomes catastrophic. Why aren’t all our payer sources (from CMS to the VA to nationally recognized health plans) putting their money into prevention, rather than protecting themselves from “big costs” when it all begins to unravel? It is as though we have the motto: “Pay now; get sick later; I told you so!” It is a “gotcha” mentality rather than one that serves the need of people.

What needs to happen?
Dismantle health insurance as we know it – just look at the salaries we pay to people at the top of these enterprises and you can see why an honest person would hardly find him or herself in such a job (remember Bill McGuire, former CEO of United Health?). Obama is on to something when he wants to get rid of the Medicare “Advantage” programs – my husband is 78 and manages his statements from Medicare just fine. Let’s help people learn to manage rather than convince them to let us manage their money and healthcare decisions for them!

Build on best practices -- Take the best of what we’ve learned from Medicare, Medicaid and the VA system, mix in whatever Massachusetts is up to and help citizens see how to live healthier lives (yes, even with chronic illness! Look what happened in AIDS care in middle-America, where we treat it as a chronic disease, not a death sentence!).

Challenge the heart of Americans – I know that in the 1980s we declared that “Greed is Good!” but every time I hear statistics about poverty, prematurity, hunger or seniors aging alone, I am touched that the GREATER GOOD is what matters, not my “need” for Tuesday tennis shoes to match my grey work-out sweats. We all have to sacrifice a little to get the American healthcare system we want and can be proud of.

Stop paying for poor productivity – and yes, I mean everyone with their fingers in the healthcare till! What are we doing subsidizing vacations and cruises for prescribers, golf trips for healthcare executives, ginormous salaries for physicians who don’t see patients and nurses who don’t practice nursing care? (and don’t get me started on lobbyists!) Let’s pay for outcomes that improve patient’s lives, programs that change the health of whole communities, ideas that squeeze the nickel ’til the buffalo brays in an effort to get the most out of every dollar we spend on healthcare!

You, Ms. or Mr. Secretary, may be our last, best hope. Obama may build the only federal administration in my lifetime that could actually be responsive and accountable to the people rather than to special interests. Now is the time. Healthcare is the issue. Do not let this moment pass without enacting change.

Sincerely,


Paula S. Forté, PhD, RN

What does this inauguration mean to you?

I’m one of those middle-aged, American women who was hoping that in my lifetime, I would be able to celebrate the election of a woman with enough chutzpa to really do the job of president, not just declare candidacy. We got one hell of a contest but, in the end, something even more amazing unfolded, the election of our first Afro-American president who has the diversity of Kansas and Kenya all wrapped up in a Hawaiian mindset. Who could have ever imagined that?

This inauguration, this history-making, stereotype-busting, oh-m’God-can you-believe what-just-happened inauguration means to me a fresh appreciation for what liberty is all about. I am white, female, middle-class, middle-income, well-educated and boringly “ordinary” in the statistics of this amazing country of ours. I have enjoyed every freedom known to man in the latter half of the 20th century. But what this inauguration brings is the fresh, new opportunity to say out loud, in the hearing of politicians and policy-makers alike, the America I know and love, “has no clothes on!”

We, common, ordinary Americans now have a champion about to be sworn into office who doesn’t need to paint himself or his America as perfect. He admits he’ll make mistakes, even before he’s seated and given the chance. He’s seen America’s warts from the shenanigans of Washington to the mean streets of Chicago to the littered beaches of Honolulu. He knows what America is, where America’s been and (thank heaven) where he wants America to go. The liberty to speak the truth is an astounding thing. We finally will have an administration that isn’t all about saving face, but about naming the problems America is facing and getting them solved.

My career spans over 30 years in healthcare. I am full of opinions and ideas about what might make that one sector of America’s troubles better. To date, I have never been moved to speak any of these ideas to anyone in any political party. This reluctance is not born of fear, but of the confidence that no one in office really cared what I thought. Now, I do see myself writing to the former senator, Tom Daschle about what I think, what I know from inside the belly of the beast, and what I think we can do to make Americans safer, healthier and more engaged in protecting their own health. I do see myself standing up in community forums and speaking what is on my mind. I do see myself encouraging others, especially physicians and nurses, to say what we’ve seen and stop pretending we don’t know what’s wrong with the most expensive healthcare system in the world. We do. And now, in this administration, we can say it with confidence that something may be done about it.

After all, what is liberty if it is not the freedom of speech? But liberty with hope is a powerful thing and more Americans than ever before in my lifetime are eager to speak what they know, to speak truth to power and influence the re-emergence of the great American country by the people, for the people; the one we all grew up believing could prevail.

Finals week and I am tired!

On Thursday I took an online final that was a mere 35 questions long. Fortunately I knew my way through the content and got an A (94.5 %) on that particular test. This weekend I have another one to take and on this content, I am not so self-assured. I’d settle for a C, just to get it over with!

Why do tests make us crazy? I know I’m not alone in this. Some folks have test anxiety so severe that they actually need medication to simply get through an exam. I’m not anxious, I just don’t like taking tests – and, maybe I’m just old, because now that most tests are electronic, I feel a little more handicapped when taking them.

I have two or perhaps three certification exams looming in my future and in today’s world those tests are all online as well. You generally have to go to a testing center to have the privilege of sitting for them (after you pay several hundred dollars) and they are timed by a proctor. The first one comes up this spring and I am not looking forward to it. The second one will occur when I complete my coursework for the Family Nurse Practitioner certification. Hopefully, that will be in the summer of 2010. Then, if I have any endurance left in me, I am considering the pursuit of a Child/Family Psychiatric Mental Health NP certification (this could take another 2 years), so I don’t expect the test will be on my calendar until 2012. Maybe if I spread them out (one every 2 years or so) they won’t seem so overwhelming!

Life is full of tests. Most of them don’t occur online, however. They happen when you make a presentation at work and everyone is judging your project, examining your worth to the organization and either feeling very supportive and proud to have you as their colleague or jealous as hell if you did a good job! Other tests are more subtle –

• What did you do with that Christmas gift Aunt Catherine sent you (you know, the one you hated!)? Because, after all, she is coming for New Year’s dinner!
• Where did you put your copies of those trip receipts you’d never thought you’d need? Well you need them now, because there was a small fire in the accounting department and all the work in Cynthia’s in-basket (your expense report included) is in ashes!
• “How old are you grandma?” seems like an innocent enough question unless it is going into a report for school that notifies a whole portion of the disbelieving world that you are indeed over the age of “senior citizen” and deserving of a discount on nearly everything retail.

What tests are facing you? Will you worry that you look “fatter” when you see your friends and family over the holidays? Will you still be in love with the fellow you met at that conference last year, but haven’t seen (except in e-mail photos) in over 9 months? Will your Red Velvet Cake hold up to grandma’s standards at the holiday dinner you’re hosting this year?

We all have tests. My advice? Take a deep breath, give it your best effort, and realize, in a few years (maybe just weeks or months) no one will even care how you did on your test!

The Joys of Travel

This weekend I get to venture to one of my favorite parts of the country, North Carolina. It is not that I’ve spent a great deal of time there, but that one of my very best girlfriends lives there and I will get to spend time with her!

As I get ready for this trip I notice that preparation in mid-life is different than it was just a decade or so ago. This week, in getting ready for my trip, I saw my physician, made appointments for two steroid injections (knee & spine), renewed my prescriptions and got a new one for those “power surges” that hit you in mid-life. Hopefully, on this new drug, I will be able to sleep through the night without having to “cool the fire within” every hour or so.

Also in getting ready to leave, I had to clear my desks – yes two desks, one at work and one at home. With work projects in fairly safe array (or in good hands while I’ll be gone) and school projects on track for appropriate completion for the end of the semester, I believe I will be able to get on that plane worry-free.

The trip comes in the form of a conference for work. The best news was that it would be in my girlfriend’s home-town. Two days with her, two days for work-related business and I should be ready to return to both my desks refreshed and renewed.

Travel is an interesting thing. It is always on my “wish list” when I tabulate the things I want to do in life yet, when it comes to actually taking a trip, a million headaches come to mind. Many of them airport related: Do I have all my liquids in less than 3-ounce bottles? Remember to wear shoes that are easy to slip off and on! Shall I pay to check my bag or schlep it on the plane in the hopes that some tall person will help me heft it up into the over-head storage compartment?

Then there are the ordinary woes of just being away from home: Should I take a bathing suit for the pool (do I want to be seen by strangers looking like a beached whale?)? Do I have the right clothes for the activities; will I need a dressy outfit; is there a banquet; can I wear jeans?

And finally, there is the question that arises anytime we go to see an old friend, especially one we don’t get to visit very often – what will she think of me? Will she care that I’ve put on a few pounds (Few is a delicate word!)? Will she hate my punky, spiky hair? Will we have enough in common to even hold an interesting conversation?

All these things roam through my head, but as I zip up my suitcase and scoop up my trench coat, I remember how every other visit with her has been (visits that go back nearly 40 years) and all I feel is warmth because she and I never care about each other’s looks, we always have enough to talk about – usually well into the night! We are old friends, in the most generous definition of the term, and I am so very excited to get to see her again.

Boomer Women, Finding Our Way in Retirement

Harvard researchers recently report that we boomer women are less married, more divorced, more childless and more alone than any prior generation of women. These worrisome facts add financial and healthcare challenges to an already expanded life expectancy for all of us born in the baby boom that ran from 1946 to 1964.

Boomer women are at risk for having inadequate retirement savings, mainly because, like most women, we’ve been in and out of the workforce managing family life while we juggled career milestones along the way. Women also are notorious for being slow to take advantage of the 401 (k or b) retirement savings products when they were introduced, so our net savings in IRAs, work retirement accounts and pensions are generally inadequate.

Boomer women are at risk for requiring a disproportionate amount of long-term care since women routinely outlive men, and boomer women will be no different, our numbers as we reach our 80s may overwhelm the healthcare resources we have come to depend upon in the USA. We’ll take up more long-term care beds and, because many of us did not marry and even among those who did, many did not produce children, we may be lacking a family caregiver who will oversee our health needs as we age.

What’s a woman to do? Harvard researchers recommend several strategies that I, for one, have begun to take to heart. They remind women now approaching retirement to consider:

• Know what your Social Security income projections. Each year, the government sends an update indicating what your retirement benefits from Social Security are likely to be. Remember those (downward) income adjustments for being widowed or divorced women can be significant. Women need to educate ourselves and plan accordingly
• Work a few years longer. Extending worked years by even five years can push up Social Security benefits, increase your time for making considerable retirement contributions and sustain health insurance coverage until Medicare is available.
• Save more retirement money. Utilize the generous retirement contribution rules for those over 50. Put away as much as your income will allow while there is no penalty for doing so and while your funds can still gain interest.
• Own your home. By adding just one additional payment each year, you can shave a decade off the length of your mortgage. Whether you purchased early or late in life, this one asset can provide housing, much needed capital or simply equity for a reverse mortgage as you age.
  

For more information on what you can do to protect your financial future, see this report available on line:

Baby Boomer Women Secure Futures or Not?
Edited By Paul Hodge, Chair, Global Generations Policy InstituteDirector, Harvard Generations Policy Programhttp://www.genpolicy.com/
Available at: http://www.genpolicy.com/freecopy/

Reinventing myself in mid-life. . .

Researchers tell us that this is what we do; we reinvent ourselves because naturally life changes after mid-life. Not only do we get old, but we loose roles we’ve had for a long time (Mom or Dad) and gain new ones we may or may not be prepared for (Mother-in-law, Grandmother).

Some of us do this very well and a great deal of interest (along with several articles) is emerging about how we “boomers” will reinvent not only ourselves but the meaning of retirement.

In my case, I will strive to be as creative as possible, but I have a sense that the economic realities of life will play a much greater part in the direction I take than will my sense of adventure, freedom or wanderlust.

So far, I’ve been going about my reinvention in a very pragmatic way.

• I came back to pediatrics (where I really have not practiced in over 25 years). This returning to my practice “roots” is not something I ever intended to do but the opportunity that presented itself was too good to resist.
• I went back to school. Learning has been a life-long endeavor and something I truly love. That said learning in mid-life and in a new century is not so easy. I am surrounded by fellow students who are far more energetic who and have well honed skills for the technological demands of higher education today! I alas, do not.
• I married (again), something I thought I would never do. But his son was about to have a son and I simply didn’t want to be known as “Grandpa’s squeeze” – I wanted the title, Grandma.
• I bought a new house! Something I have not done in nearly 30 years. I’ve lived in all kinds of homes but I wanted a new house and in mid-life I found one, customized just for me. I expect I will be there for quite a while!
• I consolidated my retirement monies and now only have two main financial repositories for my IRAs and my 401 K. Naturally, when you’re as old as I am there are bound to be little bits of money here and there (I think I have a pension with about $200 in it!), but now, two phone calls or a visit to two websites and I know where I stand (or perhaps, fall).
• I started to write. Not that I have not always had a love for words and some hopes about writing, but now I set aside time to do it. I go to classes and discussion groups to improve my writing. I look for opportunities to have my work critiqued.

However, I know I’m not done. There are things I need to do that I haven’t gotten to yet. Certainly, a portion of that is procrastination. Another portion is surely a choice about where I will spend my time and with whom.

So what’s left? These things for sure:

• I must commit to regular exercise. I need both strength training and cardio if I am to head into old age with a sense of wellness and wellbeing.
• I must de-clutter. Everywhere I turn I see the burden of postponed decisions – debris in every corner of my life and space. It is time to really clean house (physically and metaphorically).
• I must live consciously. I have no more time for the anesthesia of hurry and over-booking. I want no more running from hither to yon, I want to walk, listen to the breeze in the trees, smell the flowers, and hear the birds. I want to revel in the richness of life and relationships, not merely rush on by. I want to enjoy the journey – whether I get to the destination or not!

So, that’s enough. I think if I live long enough to do all that, I’ll be able to sit down and craft a new list. I can’t imaging running out of “things to do” but I want very much to make my focus not just what I do, but who I am being and becoming for this second half of life!

When did I first know I was a Democrat?

The other day, a comentator on Public Radio asked a group attending the Democratic National Convention, “when did you first know you were a democrat?” and the question got me thinking, when did I first know I was a democrat?

I hate now, to admit that I voted Republican as many times as I did, but my excuse is that I was raised in a Republican home, and until I was about 30, I didn’t understand much about politics. My parents were very involved in politics when I was very small. I actually remember Eisenhower’s second run for office in 1956 and I was only four at the time. We had a TV and it was on every day from dawn until late into the night if the campaign was being televised.

My father worked as a lobbyist for the Pennsylvania Tavern Association and as a result he knew his way around state politics. I remember events at pubs and corner bars when I was very young where my parents were working to get someone elected to some local post. For me, it was always a chance to hear the music, dance, throw confetti and drink those “kid cocktails” that the bartender would keep handing to me. It was exciting and fun and I was part of the action – even if I didn’t know what all the action was about.

In my early voting years, I think I must have voted for the names I knew and, I confess, I knew more about the Republican names than the Democratic names. I even voted for Regan, probably twice, and that would have been what, 1980 and 1984? This was probaby where my disillusionment hit me. I was working with the AIDS community at the time (1986 through 1992) and I realized that we had a president who not only couldn’t deal with the healthcare crisis of the day, he couldn’t even say the word AIDS. It was as though, if he didn’t acknowledge it, it didn’t exist. As a result, neither did any significant funding.

So, that’s when I knew I had to be a democrat. Clinton made that easy – he was young and charismatic. Gore made it logical, after all, he’d served with Clinton. Kerry was harder to vote for – so I voted against Bush. And in this year’s election, I admit, I was a Clinton advocate, but I can and will vote for Obama.

A word about wishing, wanting and hoping for Hillary… I doubt that in my lifetime there will be another woman candidate as gutsy as Hillary. She can stand up to the boys, she can even stand up to Bill, and that’s saying something! She made her marriage stick (something I couldn’t do in my first marriage) against enormous odds and horrible public commentary. She raised an amazing daughter (remember those early pictures of Chelsea?) who has grown to be beautiful, focused and ready to take on her own world. I may not always like Hillary, but I admire her and would have happily voted for her to be our president.

Oh well, water under the bridge. Let’s consider Barack Obama…

First, he was born in Honolulu, Hawaii – right away, he gets extra points for that! He’s 9 years younger than I, but that’s good. He’ll be 47 when elected and 55 when he leaves office (surely we’ll give him two terms) which is very young, and if he’s even half as charasmatic as Bill Cliniton, he’ll be headed for important work even as a “former president.”

Also, he’s the product of a single-parent home. Well, Clinton was too, so he’s not the first, but I like the idea that women can produce a presidential offece-worthy son even when up against the hardships of doing it alone. Perhaps it will make us take a longer, national look at the plight of the single mother and the (way too) many fatherless sons in our communities!

His mom, Ann Dunham, a White American from Kansas, died in 1995 of ovarian cancer. She was 52. That also endeared this man to me. Having worked for the Women’s Cancer Center at the Univerisity of Minnesota, I know this disease (ovarian cancer is the most covert of killers). Perhpaps this will also focus Obama’s attention on women’s cancer and add to the NIH’s coffers for the research on these diseases.

Barack Obama went to Occidental College, one of the oldest liberal arts colleges on the West Coast, kown for its academic rigor and its diverse student body; to Columbia University in New York where he emerged with a B.A. in political science with a focus in international relations; and to Yale University where he studied law. I like a man of letters. I also appreciate that he has put his education to good use, doing good work for people far less fortunate than he.

Has he made some mis-steps? Sure, but when I think of my own mistakes, I know it is good I will never run for office – the scrutiny of our candidates’ early choices is merciless, and done by pundits who, if their own histories were explored would be embarassed beyond belief, I’m sure!

Okay, enough soap-boxing for this morning.
Am I voting democratic? You bet.
Do I hope Barack is smart enough to put Hillary in a cabinet position that permits her to use her talents nationally and not just for New York? Yes, I do.
Will I be working locally to get him elected.? I will.
What will you be doing this fall?