Sunday, July 28, 2019

Hate, Diversity, and Assimilation




August 2019


As of 08/04/2019, there have been 250 mass killings in this country this year! Now, more than ever before, we need leaders who unite us. I urge everyone, especially our President, to stop all the divisive rhetoric. While it is true that the shooters are the ones to be blamed and that they may be 'sick,' there can be no excuse for people who embolden them and flame their violence. Unless a group purposely aims to harm another group, no one should ever fear or hate others because of their sex, race, nationality, religion, sexual orientation, disability, economic class, or political association.

History has shown that when people feel financial and/or socially threatened, they seek a strong leader and a common enemy. Our President has shown us how thoroughly frightened many people are today. People are frightened by the jobs they have lost or the lives they may soon need to change. These economic and social shifts are due to advances in technology and globalization. Instead of focusing on the positive side of how these advances can help everyone, both sides of the political spectrum are instilling fear and hatred. Instead of finding ways of using new technology to ensure that everyone has good food, health, and happiness, we focus on how new technology is taking away our jobs and privacy. Instead of seeing how globalization can supplement and complement our cultures, we choose to blame each other for the atrocities of the past.
 
Focusing on diversity and neglecting assimilation has led to a very ugly and dangerous tribal polarization in this country. It is critically essential that people in all ethnic, racial, national, and other cultures learn about their heritage and feel good about their group and good about who they are. It is equally essential that all people learn how to assimilate into the mainstream culture. Accusing 'the other group' of the horrors, pain and discriminating acts they and their ancestors have afflicted on 'our group,' regardless of the validity of the accusation, rarely lead to real change. Working and playing and focusing on how changes will help everyone is how actual progress happens.

I have an obvious and palpable disability. I use a powered wheelchair for my mobility. I cannot sit up straight. Cerebral Palsy causes involuntary body and facial movements. I have a significant speech impairment. I have always been a strong disability advocate. The Disability Movement has resulted in many great civil rights laws and a much more physically accessible nation and world. My disability advocacy successes have come from my active participation with my family, friends, and the Jewish and business communities. Here are 2 examples;

After working at Wells Fargo for a year, I needed something from the data center. At that time, the data center was just a few floors below where I worked. I called, and the person who answered the phone made fun of my speech and hung up. I tried again, and the same thing happened. I told my manager what happened. My manager was livid. He wanted to get the operator reprimanded and fired. I asked my manager to simply let me know the name of the operator. Knowing the operator's name, I went down to the data center. When I got there, several people who knew me came over to say hi and find out what I needed. After getting my question answered, I ask them to tell me who so-and-so was. They pointed to him. He turned and faced me. He turned pale. I said, “Hi, how are you?” and left, He became one of my best allies.

Often at Wells Fargo, I attended meetings where many of the attendees didn't know me. I was amused by seeing the fear on their faces as they saw me for the first time. The air in the room sometime was very thick due to their anxiety. If I led the meeting, I'd say something like, 'for the next few minutes, you probably won't understand what the hell I'm saying because of my New York accent – haha). As the meeting progressed and we started talking about work, I loved seeing faces relax and the air clear as they forgot about how different I looked and sounded.

I am extremely fortunate to have parents who knew the importance of assimilation. Being survivors of the holocaust, they worked very hard to assimilate into America's culture while always remembering their Jewish heritage and advancing their Jewish culture. They demonstrated how people can assimilate without conforming. Assimilation is fitting in by emphasizing commonalities and positivity. Conforming asks people to change who they are and what they believe. My parents
always told me that due to my disability, I had to be better and work harder than people without disabilities. The way people viewed and reacted to me was my problem and my responsibility to change. 

Blaming others for their feelings and sins of their heritage too often diminishes our ability to affect real change. Burdening marginalized individuals with continually having to combat negative stereotypes and discrimination is difficult and unfair. Diversity awareness training must continue. However, more emphasis needs to be made to ensure that people feel good about themselves, be proud of the group(s) they identify with and have the skills to assimilate with others. True diversity will happen as we work, play, and interact with each other.
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Monday, July 15, 2019

A Plan to Achieve Healthcare For All


July 2019

It's great to see that most people in this country recognize the necessity of having healthcare for all. This blog suggests that a Central Healthcare Agency and Marketplace (CHAM) is needed. Some of the goals and objectives of a CHAM include:
  1. Ensuring everyone has access to excellent and affordable healthcare, including Long Term Support Services.
  2. Setting standards and price ranges for healthcare products, services, and insurance plans that are subsidized.
  3. Ensuring that no one needs to pay more than a percentage(5%?) of their annual income for healthcare premiums and no more than an additional rate (5%?) for their total yearly healthcare costs.
  4. Enabling the private sector to provide healthcare products, services, and insurance plans that meet and surpasses standards set by CHAM. Anyone willing and able to pay healthcare costs that exceed CHAM's standards can do so.
  5. Ensuring that healthcare costs are sufficient to
    1. attract people to healthcare jobs and professions,
    2. continually improve products, services, and facilities, and
    3. promote innovation, research, and ever-increasing quality of care.
  6. Enabling employers and other third parties to offer healthcare plans either through their chosen vendor and/or by contributing to an individual's CHAM account.
  7. Confirming that most people all along the wealth spectrum see the system as equitable.
  8. Encouraging competition and healthcare investments.
  9. Ensuring that the system is economically self-sustainable.
The CHAM will set minimum standards for healthcare and long term support services. State and/or community CHAM boards will establish price ranges for all products, procedures, drugs, and other commodities associated with these services. Price ranges will also be set for healthcare plan expenses, including premiums, deductibles, copays, and out-of-pocket expense caps.

Private and public enterprises will sell their healthcare plans through CHAM. Each plan must offer all of the minimum set of healthcare products and services set forth by CHAM. Enterprises that currently don't provide the complete set should collaborate with other enterprises to ensure comprehensive healthcare and long term support services are available to everyone.

Individuals and households will sign up to be members of CHAM. Members will be charged monthly premiums that are a percentage (5%?) of their taxable income. Members total annual out-of-pocket healthcare expense will be capped at an additional rate (5%?) of their taxable income. Members choose any healthcare plan they want. CHAM pays all healthcare charges that meet CHAM standards and are within CHAM's price ranges. Members can select programs whose healthcare plans expenses exceed CHAM's ranges by waiving CHAM's responsibility to subside any of the member's healthcare charges for that enrollment period. Members will be charged for deductibles and copays up to their annual out-of-pocket expense cap. Members will also be charged for products and services that are not covered by CHAM standards or exceed CHAM's price ranges. See examples below.

This proposed plan needs to be vetted by healthcare professionals, the general public, economists, healthcare plan managers, healthcare insurance carriers, and legislators to ensure that the goals and objectives listed above are met.

I look forward to your feedback.
Examples
Re Healthcare Premium

CHAM's member's premium cap = 5% of taxable income
CHAM's price range for premiums = $0 - $400

  1. Example 1
    1. Characteristics
      1. Member taxable income = $10,000
      2. Healthcare premium = $200
      3. Member does not waive CHAM subsidy
    2. Member Pays $500 for premium (5% of $10,000)
    3. CHAM Pays $0 subsidy for premium

  1. Example 2
    1. Characteristics
      1. Member taxable income = $1,000
      2. Healthcare premium = $200
      3. Member does not waive CHAM subsidy
    2. Member Pays $50 for premium (5% of $1,000)
    3. CHAM Pays $150 subsidy for premium

  1. Example 3
    1. Characteristics
      1. Member taxable income = $10,000
      2. Healthcare premium = $550
      3. Member has to waive CHAM subsidy or choose a different plan
    2. Member Pays $550 for premium
    3. CHAM Pays $0 subsidy for premiums

  1. Example 4
    1. Characteristics
      1. Member taxable income = $10,000
      2. Member does not waive CHAM subsidy
      3. Healthcare premium = $550
    2. Member Pays $550 for premium
    3. CHAM Pays $0 subsidy for premiums

Thursday, July 11, 2019

The Need for Long Term Support Services


The Need for Long Term Support Services

      Any healthcare plan that purports to be available and affordable for everyone should include provisions for long-term medical expenses, aka Long Term Support Services. These services include such things as personal assistant services, durable medical equipment, long term therapies, and maintenance drugs. The California Regional Center System can serve as a model for this.

      For many people with disabilities, Long Term Support Services can be very costly. In recent years, personal assistant services expenses for me, and my wife exceeded $100,000 annually.

      Currently, Medicaid is the only healthcare plan that funds long-term medical expenses that are expected to be needed more than a few years. Medicaid is only available to people living at or near poverty levels. Many people with disabilities don't work for fear of losing healthcare and Long Term Support Services they need to survive. They remain beneficiaries of the Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) Programs primarily to qualify for Medicare and Medicaid. 

      Many programs aim to assist people with disabilities to attain employment and receive the services they need. They differ by state, county, and city. They are administered by different public and private agencies. They depend on many factors, including beneficiaries' age, disability, income, assets, onset age of impairment, the reason for disability, military status, etc. These programs are very interdependent and often are too complicated for people to understand. There are many experts, websites, and businesses that try to help people through these 'disability benefits' labyrinths.

      Unfortunately, there is no comprehensive process for people with disabilities to ensure our financial health and get the Long Term Support Services we need. As an example, it was only 5 years ago that one of my attendants pointed out that my wife and I, who both have Cerebral Palsy, qualify to be California Regional Center System clients. This agency funds Long Term Support Services for people with developmental disabilities, regardless of income or assets, if no other agency does so. Cerebral Palsy is a developmental disability.  I think I am well connected in the disability community and pretty knowledgeable about disability-related programs. Not realizing the advantages the Regional Center System offers illustrates the need for a simple-to-understand universal healthcare system that includes Long Term Support Services.

       Annually, millions of dollars are spent trying to improve employment opportunities and the financial health of people with disabilities. It would be interesting to understand what affect simply enabling this cohort to keep their Medicare and Medicaid regardless of the income or assets they garnered. Given the dismally low number of people who leave Social Security Disability Programs due to finding gainful employment, it is surmised that any increase in Medicare and Medicaid cost may be offset by increased tax revenue and savings in other government programs. 

      It is encouraging to see that most people in this nation now recognize the need for universal healthcare. Long-term medical expenses must be an integral part of any healthcare system.


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July 2019