Trying to Find the Gray

This is a question that I wonder if people ever consider. I had recently posed the question on FB “What has been the general motivator in your life? (What has been your source of drive?)” I didn’t ask the question in the way that elicited the answers that I felt I was looking for. What I received were answers around “wanting to make the world a better place,” “proving that hard work is what pays off,” “challenges,” and the like. As a friend pointed out, I should have asked “what emotion motivates you?” I do want to make the world a better place, but what I wanted to see was if there was anyone like me in how I was motivated by what is seen as a negative emotion.

For as long as I can remember, I have been driven by anger. If I was upset by something, I used it in some productive way. I remember using it to push myself in athletics in high school. What I didn’t know back then was that I should have been diagnosed with bipolar disorder. What I did know was that I was an adopted Asian female who had known that she was gay since she was pretty young, but was keeping it a secret. Put all of that together, and you can get some anger for motivation.

I wonder if when people talk about resilience and grit, if this is what that is. To be driven by your setbacks...my discharge from the Air Force in 92 for being gay, other significant life events gone awry, otherwise known as “setbacks.” Examples such as when the country to which I have pledged my life tells me that I wasn’t worth wearing the uniform, to a legal issue stemming from my mental health issue, to the common one for most people people telling me that I wouldn’t achieve a goal, became catalysts. I used those things to drive myself, to achieve the NEXT goal. It was a big “FUCK YOU!” to everyone who didn’t believe in me, or judged me - sometimes it seemed to even be my own family. 

But sometimes the anger is a result of something more “organic.” Anger and irritability can be a manifestation of both my hypomanic and depressive states. I have to be aware of when this is the case, because I cannot let either one get too far out of control. Better living through chemistry, even if the drugs* dull down my personality and ability to REALLY think, creativity and the like. (They say they don’t anymore, but they do.) 

My therapist wonders, “Isn’t it draining to be angry so much?” No, that’s the whole point. I use it in a way that it doesn’t feel like “anger.” I use IT, so it doesn’t use ME. I am in control of it. I have to be; otherwise, I’m afraid I would probably be a destructive person, whether to myself or everything/everyone around me, figuratively or literally. I still don’t think she gets it. Certainly, I’m not the only person who is like this, right??? Or am I just fucked up?

Well, now that the topic of the ACA has become hot again, we are hearing stories of people who did not realize that the ACA and Obamacare was one and the same. So I feel that it is relevant to post this information here, because it is always good to be informed. These are not alternative facts.From an October 2013 FB blog post of mine:

Because I am tired of seeing and hearing uninformed and misinformed people talking, posting, etc. about Obamacare, and it has been almost constant, consider this a PSA. (Yes, I realize some people do not realize Obamacare and the Affordable Care Act are one and the same.)

I don't care what side you are on, just actually be informed. Know SOMETHING. Have an alternative plan in mind. Understand what is attempting to be done with regard to actual policy, besides "trample my rights by making everyone pay to have insurance and pay higher premiums."

This is the reading list from the 8 week online course Healthcare Policy and the Affordable Care Act through the University of Pennsylvania.

Growth in US Health Care Costs

  * Kaiser Foundation. Health Care Costs: A Primer (May 2012), available at http://www.kff.org/insurance/upload/7670-03.pdf   * CBO. Technological Change and the Growth of Health Care Spending (January 2008), available at http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/89xx/doc8947/01-31-techhealth.pdf

  * D. Cutler and M. McClellan. Is Technological Change In Medicine Worth It?, 20 Health Affairs 5 (September 2001), available at http://content.healthaffairs.org/content/20/5/11.full. Read the abstract and the policy implications.   * John Holahan & Stacey McMorrow. Medicare and Medicaid Spending Trends and the Deficit Debate, New England Journal of Medicine (August 2, 2012). available at http://www.nejm.org/doi/full/10.1056/NEJMp1204899.

  * McKinsey Global Institute. Accounting for the cost of US health care: A New Look at Why Americans Spend More (2008). Download and read the Executive Summary at http://www.mckinsey.com/insights/mgi/research/americas /accountingforthecostofushealth_care.   * Mark Pauly, The Truth about Moral Hazard and Adverse Selection (2007), available at http://www.maxwell.syr.edu/uploadedFiles/cpr/publications/pb36.pdf. Read pages 1-16. This explains some of the economic rationale behind the parts of our health insurance system that make it so costly.

Structure of the US Health Care System

  * Nauman, T. Medicare 101. KaiserEDU. http://www.kaiseredu.org/Tutorials-and-Presentations/Medicare-the-Basics.aspx

  * Rudowitz, R. Medicaid 101. KaiserEDU. http://www.kaiseredu.org/Tutorials-and-Presentations/Medicaid-101.aspx   * Pollitz, K. Private Health Insurance. KaiserEDU. http://www.kaiseredu.org/Tutorials-and-Presentations/Private-Health-Insurance.aspx

Access to and Quality of Health Care Access

  * Kaiser Foundation. The Uninsured: A Primer (December 2010), available at http://www.kff.org/uninsured/upload/7451-06.pdf. Read pages 1-13.

  * Kaiser Foundation. Medicare: A Primer (April 2010) available at http://www.kff.org/medicare/upload/7615-03.pdf. Read pages 1-7; 13-14.

  * Kaiser Foundation. Medicaid: A Primer (June 2010), available at http://www.kff.org/medicaid/upload/7334-04.pdf. Read pages 1-4, 7-12.

Quality

  * Elizabeth Docteur & Robert Berenson, How Does the Quality of US Health Care Compare Internationally?, The Urban Institute (August 2009), available at http://www.urban.org/uploadedpdf/411947ushealthcarequality.pdf

  * GapMinder World (2012). Find the US on the following graphs by hovering over the circles and compare its performance to other OECD countries (in light green): infant mortality (www.bit.ly/Kpa1h3), life expectancy (www.bit.ly/MSsLuR). Play with the indicators that interest you.

  * Frederic Blavin et al. Uninsurance is Not Just a Minority Issue: White Americans are a Large Share of the Growth from 2000 to 2010, The Urban Institute, (November 2010), available at http://www.urban.org/UploadedPDF/412698-Uninsurance-Is-Not-Just-a-Minority.pdf.

  * Kyle J. Caswell et al. The Financial Burden of Medical Spending Among the Non-Elderly, 2010, The Urban Institute (November 2012), available at http://www.urban.org/UploadedPDF/412696-The-Financial-Burden-of-Medical-Spending-Among-the-Non-Elder...

  * Bryon Auguste et al. How Health Care Costs Contribute to Income Disparity in the United States, McKinsey Global Institute (March 2009), available at http://www.mckinseyquarterly.com/EconomicStudies/CountryReports/HowhealthcarecostscontributetoincomedisparityintheUnitedStates2328?gp=1#. Register for free access, then click download PDF.

  * Linda Kohn et al., To Err Is Human: Building a Safer Health System, Institute of Medicine (2000), available at http://www.nap.edu/openbook.php?record_id=9728&page=1. Read the executive summary, pages 1-15.

Health Care Malpractice

  * Michelle Mello, Understanding medical malpractice insurance: A primer, RWJ Foundation (January 2006), available at http://www.rwjf.org/content/dam/farm/reports/reports/2006/rwjf17974.  Read pages 1-7.

  * Letter from CBO to Senator Orrin Hatch regarding CGO’s Analysis of the Effects of Proposals to Limit Costs Related to Medical Malpractice (October 9, 2009), available at http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/106xx/doc10641/10-09-tort_reform.pdf

  * Michelle Mello & A. Chandra. The Cap Doesn’t Fit, New York Times (July 9, 2009), http://www.nytimes.com/2009/07/12/opinion/12mello.html?_r=1

  * Kevin Sack, Doctors Say ‘I’m Sorry’ Before ‘See You in Court’, New York Times (May 18, 2008), available at http://www.nytimes.com/2008/05/18/us/18apology.html?pagewanted=all&_r=0

  * University of Michigan Health System, The Michigan Model: Medical Malpractice and Patient Safety at UMHS, available at http://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhshttp://www.uofmh Review the summary and any articles you find interesting.

  * Jonathan Welch, As She Lay Dying, 31 Health Affairs 12 (January 2013), available at http://content.healthaffairs.org/content/31/12/2817.full.pdf

History of health care reform; The ACA: An Overview

  * Kaiser Foundation. National Health Insurance—A Brief History of Reform Efforts in the US (March 2009), available at http://www.kff.org/healthreform/upload/7871.pdf

  * CBO, Key Issues in Analyzing Major Health Insurance Proposals (2008), available at http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/99xx/doc9924/12-18-keyissues.pdf.  Read the sections on insurance premiums and choice of plans, pages 59-99.

  * Elisabeth Goodridge & Sarah Arnquist. A History of Overhauling Health Care, New York Times (March 21, 2010), available at http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717HEALTHLINE.html. Browse for interest

  * C. Mery et al., The modern history of US health care reform, American College of Surgeons (2010), available at http://www.facs.org/fellows_info/bulletin/2010/mery0710.pdf. Read for specific policy interests.

The ACA: Access to Health Care

  * Kaiser Foundation, Summary of New Health Reform Law (April 15, 2011), available at http://www.kff.org/healthreform/upload/8061.pdf

  * Department of Health and Human Services, What’s Changing and When (2012), available at http://www.healthcare.gov/law/timeline/. Browse.

  * Kaiser Foundation (2010). “Explaining Health Care Reform: Questions About Health Insurance Subsidies.” http://www.kff.org/healthreform/upload/7962-02.pdf

  * Use the Massachusetts Health Connector to “buy” insurance. https://www.mahealthconnector.org/portal/site/connector/ . (Use zip code 02138 and choose the plan you think would be best for you. When you get to the message that “Enrollment is closed”, click “Browse Now” under the heading “Just window shopping?” Note the monthly cost and what is covered, deductible, copay amount, etc.)

  * Genevieve M. Kenney et al., Opting Out of the Medicaid Expansion under the ACA: How Many Uninsured Adults would Not be Eligible for Medicaid? Urban Institute (July 5, 2012), available at http://www.urban.org/UploadedPDF/412607-Opting-Out-of-the-Medicaid-Expansion-Under-the-ACA.pdf

  * Genevieve M. Kenney et al., Opting In to the Medicaid Expansion under the ACA: Who are the Uninsured Adults Who Could Gain Health Insurance Coverage?, Urban Institute (August 2012), available at http://www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf

The ACA: Cost Control

  * Peter Orszag and Ezekiel Emanuel, Health Care Reform and Cost Control, 363 New England Journal of Medicine 7 (2010), available at http://www.nejm.org/doi/full/10.1056/NEJMp1006571

  * Jonathan Gruber, The House Proposal Lowers Non-Group Premiums, (Nov. 2, 2009), available at http://www.healthpolicyproject.org/Publications_files/Business/2010/GruberHousenongroup11-2-1.pdf

  * J. Gruber, The Impacts of the Affordable Care Act: How Reasonable Are the Projections?, NBER Working Paper #17168 (2011), available at http://economics.mit.edu/files/6829. Read pages 13-20, focusing on content rather than technical details.

  * Stephen Zuckerman & John Holahan, Despite Criticisms, The Affordable Care Act Does Much to Contain Health Care Costs (October 2012) available at http://www.urban.org/UploadedPDF/412665-Despite-Criticism-The-Affordable-Care-Act-Does-Much-to-Conta...

  * Centers for Medicare and Medicaid Services, The Affordable Care Act: Lowering Medicare Costs by Improving Care (2012), available at http://www.cms.gov/apps/files/ACA-savings-report-2012.pdf.

  * Scott Harrington, The Health Insurance Reform Debate (November 24, 2009), available at https://hcmg.wharton.upenn.edu/files/?whdmsaction=public:main.file&fileID=1594. Read for a dissenting view on the cost impacts of the ACA

  * Letter to Senator Bayh from the CBO regarding An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act (November 30, 2009). Download the full text in PDF format at http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

The ACA: Health Care Delivery and Quality

  * H. Komisar et al., ‘Bundling’ Payment for Episodes of Hospital Care, Center for American Progress (July 2011), available at http://www.scribd.com/doc/60255022/%E2%80%9CBundling%E2%80%9D-Payment-for-Episodes-of-Hospital-Care.  Read pages 1-10.

  * Stuckhardt, Leigh, IOM Roundtable on Value & Science-Driven Health Care. “ACA Provisions With Implications For A Learning Healthcare System.” Institute of Medicine of the National Academies of Sciences. http://iom.edu/~/media/Files/Activity%20Files/Quality/VSRT/summary%20of%20ACA%20impact%20on%20the%20...

  * J. Gruber, The Impacts of the Affordable Care Act: How Reasonable Are the Projections?, New England Bureau of Economic Research Working Paper #17168 (2011), http://economics.mit.edu/files/6829. Read section II.B on pages 4-7.

  * McKinsey & Company. Cross-currents in the health economy. http://healthreform.mckinsey.com/insights/latestthinking/crosscurrentsinthehealtheconomy. Download the full report on the bottom of the page and read pages 1-9.

So it seems that I have taken some time away from Tumblr. My last post appears to have been a couple of years ago, and it was automatically posted from Instagram. A lot can happen in that amount of time. From my last text post, which was about 5 years ago, a ton of shit has happened. I think the most significant are as follows:

1. I moved to Dallas where I found my professional “calling.” Professionally, I have found something that brings many things that I am passionate about together. Not many can say that.

2. I had a pretty serious bout of depression, but managed to keep it hidden from pretty much everyone. I even got through a pretty big conference in this state, but I fell apart when I got home.