The President's speech was impressive, but as John Nichols of the Nation observed, hardly a rousing "to-the-barricades" oration. The proposed "limited public exchange" is not what supporters had in mind but won't "threaten" insurance companies.
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Last night, President Obama laid out his vision for health care
reform before a special joint session of Congress. The pillars of his
plan are: i) Curbing the worst abuses of private insurance, ii)
Requiring everyone to have insurance, iii) Insurance exchanges, which
are basically government websites where customers can order insurance
off a “menu” of plans, the idea being that if tens of millions of
people order the #2 Combo, everyone’s lunch will be cheaper.
The president made it clear that the country can’t afford to wait
for reform. Last night, he took on the self-proclaimed fiscal
conservatives who claim that they oppose reform because it would
increase the deficit. “Put simply, our health care problem is our
deficit problem. Nothing else even comes close,” Obama said. The
president reminded the audience that each of us pays a “hidden tax” of
$1000 dollars a year to subsidize charity and emergency care for the
Obama still talked about “options” and “choices.” But he
suggested that they would be offered mainly by insurance companies that
would be enjoy “incentives”—i.e., new streams of taxpayer dollars—if
they agree to abide by consumer-friendly regulations and come up with
strategies for covering more of the uninsured.
The president expressed support for a very limited public option, a
kind of welfare program that only about 5% of Americans would choose to
join. This is not the public option his liberal supporters had in mind.
It’s non-threatening to the insurance companies, though. Private
insurers love the idea of the government low-grading the insurance pool
and taking on the sickest people who can’t get coverage anywhere else.
That means private insurers can make even more money off the remaining
healthy, paying customers.
James Ridgeway of Mother Jones is even less optimistic, “As for the public option, that’s pretty clearly gone down the drain.”
One GOP legislator decided that a joint session of Congress was
basically a town hall with the president. Rep. Joe Wilson (SC) screamed
“You lie!” when the president explained, for the umpteenth time that
undocumented immigrants will not be covered. As with the town halls,
Wilson’s performance had a whiff astroturf about it. Sure enough, Sue
Sturgis of Raw Story found that Wilson pocketed over $2 million in campaign contributions from the health care industry.
The president also reminded America that health care reform will not pay for abortions. (For more on myth-making around women’s health, see Laurie Rubiner’s excellent post at RH Reality.)
Instead of presenting a vision and asking Congress to line up behind
him, the president stressed that he was synthesizing a compromise
position incorporating ideas from the left and the right. Instead of a
coherent vision, the president’s scheme sounds more like a last-ditch
compromise plan to enable him to declare victory. Like many Democrats,
the president seems to be confusing the strategic with the expedient.
If “reform” means saddling ordinary Americans with expensive mandatory
insurance without a meaningful public option to keep costs in check he
could doom the electoral fortunes of the Democrats for years to come.
It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.
As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.
I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.
International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.
“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”
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In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.
The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.
The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.
“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”
The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.
Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”
Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:
Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.
It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.
We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.
I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.
Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.
Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.
Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.
My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.
It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.
I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.
The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.
The final rule to Section 1557—which builds on a history of federal civil rights laws—prohibits the “denial of health care or health coverage based on an individual’s sex, including discrimination based on pregnancy, gender identity, and sex stereotyping,” according to the Department of Health and Human Services (HHS). The rule mandates that covered health programs and activities under the ACA “treat individuals consistent with their gender identity.”
Wednesday’s publication serves as a revised update to a 2013 report coauthored by Lambda Legal, the Human Rights Campaign (HRC), and the Committee on Lesbian, Gay, Bisexual and Transgender Rights of the New York City Bar Association on best practices in transgender care. The report’s authors recommended, among other measures, that hospitals adopt nondiscrimination policies with regard to gender identity and expression, and amend their respective Patients’ Bill of Rights to provide for transgender patients, including the right to privacy, and freedom from abuse and harassment based on gender identity.
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New recommendations in the updated document offer tips for appropriate collection of gender identity data—such as accurate pronouns—in electronic health records, and policy recommendations that would strengthen access to hormone therapy, which refers to the use of estrogens or androgens to induce physical or psychological characteristics consistent with a person’s gender identity.
Advocates contend that transgender people face serious barriers to quality and affordable health care: an analysis of the 2011 National Transgender Discrimination Survey of nearly 6,400 trans and gender non-conforming participants found that 19 percent of respondents reported being refused care as a result of their gender identity, while 28 percent postponed or delayed needed care due to discrimination.
Discrimination against trans patients ran the gamut from violence and harassment at the hands of medical professionals or hospital staff to verbal abuse in medical settings, according to the analysis. Respondents to the 2011 survey, which represents the most up-to-date and comprehensive data on discrimination against the trans community, reported being subjected to unnecessary and invasive physical exams, mockery, and violations of their privacy.
About 2 percent of respondents said they were physically attacked in a doctor’s office, while 28 percent said they experienced verbal harassment in a medical setting.
Survey participants reported incidents in which doctors conducted unnecessary pelvic exams, and one patient—whose gender identity was different from their sex as assigned at birth—said a doctor forcibly examined their genitals and discussed the case with other hospital workers in violation of HHS’ Health Information Privacy Act (HIPAA).
Authors of the revised guidelines say that many trans people opt to disengage themselves from the health-care system altogether, rather than endure abusive and insensitive treatment, resulting in poor health outcomes for the trans community.
“Just 21 percent of hospitals participating in the HRC Foundation’s 2016 Healthcare Equality Index (HEI) had specific policies outlining procedures and practices to eliminate bias and insensitivity toward transgender patients,” Tari Hanneman, deputy director of the organization’s Health and Aging Program, said in a press release issued Wednesday.
“This revised publication will go a long way in helping more hospitals adopt crucial policies and practices to ensure that transgender patients are welcomed and treated with appropriate care,” said Hanneman, who authored the HEI, which evaluated more than 2,000 health facilities for the 2016 index.
The revised document offers policy recommendations pertaining to patients’ access to personal items that would help with gender expression—such as makeup and gender appropriate clothing—and other items that assist with gender presentation, including material used in binding, padding, and tucking.