The Unintended Student Loan Scandal, written by C. Patrick

Enter C. Patrick., guest writer to Reclining Society and his take on the abuse of taxpayer supported education funding under the pretense of enhancing the collective society. He is a science professor to a major state college.

Today I was notified that I will receive a 3% salary raise owing to increasing income from tuition my college is receiving. Unlike many universities that are generating funds through tuition increase, my college has chosen to open the academic floodgates and increase total enrollment, nearly doubling the number of students in the past ten years. Although a boon to my place of employment and, more recently, my wallet, I have mixed feelings about this policy. While making higher education available to all is a noble idea, the underlying motivations for increasing enrollment and the effects on society are potentially less than ideal. Masked underneath the mantra of providing education for the masses is a more greed-driven agenda on the part of universities and colleges.

Grabbing a piece of the federal education loan pie has become the major priority among most academic institutions which results in increased personal debt for students. Even further, it creates increased pressure to prevent students from failing so the college may maintain its income. Students that probably should not have been admitted, and subsequently, should not have been allowed to continue, are instead bestowed degrees and pushed out the door to make room for the next customer. This has led to a commoditization of college education, and it is now not uncommon to see minimum wage jobs held by college graduates.

Overall we are sliding into a situation where taxpayer dollars in the form of loans and grants are used to saturate the market with college-educated job hunters whose degree has been devalued. I suppose one could argue that increasing the general education of a population is a good thing; however that’s essentially backing the use of taxpayer money on a very expensive social engineering experiment. While there certainly are methods of addressing this problem, including placing restrictions on the college majors eligible for federal loans, none are politically palatable, and most would probably be perceived as attacks on the ability of everyone to receive equal opportunities at higher education. 

Impressions of Veteran's Day 2013

"Happy Veteran's Day!" I was told via texts from ancient Army buddies. It was obvious those texts were mass messages. "Thank you for your service, Battle Buddies!" I was told by being tagged in a facebook post along with 89 other individuals. In honor of Veterans' Day, any form of social media was plastered in generic well-wishes to service members from... other service members and/or service member families.

Analyzing the posts/texts, there weren't any posts (if there were, they were very minimal) from civilians. It is like we are a group of guys hanging out at the bar rooting for our football team and when our team scores we make our way around the room patting each other on the back. Everyone in the bar wears the team colors and feels that our unity somehow impacts the results of the game. Whether we win or lose, we appreciate the show of support from... ourselves.

It was my impression that service members care about service member issues but the rest of the world does not. And even further, it is my impression that the generic "thank you for your service" messages from my fellow Army friends was more a ploy to turn the attention back to themselves to highlight their own heroism than to actually thank their fellow comrades in arms.

Maybe I'm a cynic about the texts and posts because I don't really feel an expression of gratitude to me is warranted because the Army gave me more than I ever gave it. And it's an ugly truth for me to say, but there are other service members who are just biding their time unable to pass a PT test or using the service for personal gain (tuition benefits, health care, bonuses, etc) so signing the line was really a selfish act. I felt as if I were another number on the roster on some list with those posts. And it's those same lists that have actual veterans who have sacrificed, who have both the physical and mental scars of war, who have actually led and commanded other soldiers, who are role models and heroes, who have performed valiantly under the worst circumstances.

I won't speak for others, and I don't mean to be unappreciative, but personally I don't belong on that list. I know some service members that do, but I refrained from thanking them as it feels hollow and my gratitude would be seen just as insincere as the FB post because it was only on Veterans' Day that I felt inclined to say "Thank you."

One friend suggested that if we are really grateful to Veterans then we should actually start supporting them by becoming aware of Veteran/service member problems that plague the services and give actual time and money to their causes. It sounds like a good plan and I fully agree, but if you return to my first paragraph, the impression is that only service members seem to care about service members and even the actual displays of caring can be a front to glorify the self. I would like to think that Veterans' Day means something, but I'm sad that for most it might really be a bunch of guys hanging out at the bar on game day.

A Case Example Supporting the ACA

Two Mondays ago a patient came into the clinic with complaints of upper right abdominal pain that hurt most when he would take a deep breath in. He had this pain a week ago and it resolved with ibuprofen. Sunday night he became uncomfortable with feeling feverish and nauseous. Monday the pain itself returned and was unrelieved by ibuprofen. The pain radiates to his mid-back and up to his neck. He thought it might be worse with eating, but couldn't affirm it definitively. He is a non-smoker, non-drinker, full-time worker, morbidly obese uncontrolled diabetic on metformin and on blood pressure medications. He cannot afford health insurance and so wanted to keep costs as low as possible. Exam showed tenderness to touch mid-upper abdomen, the rest of the exam was unremarkable but it was difficult to assess some things due to size. My differential diagnosis list included gall stones, hepatitis or pancreatitis. My money was on gallstones and I strutted around telling everyone else it was so. I had labs ordered and sent him for an abdominal ultrasound. (I was so proud of my diagnosis!)

Well, the labs showed elevated liver enzymes, inflammatory markers, and elevated pancreatic enzymes. His ultrasound came back negative for gallstones. It put us back to the beginning with no diagnosis. The other providers at the clinic did not know what was wrong either. We decided to take the watchful waiting approach to see if this would resolve on its own as the patient could not afford even what we had already done.

The next day the patient called after spiking a 102* fever. He was sent to the emergency room. My preceptor kept in close communication with him. She text me last Wednesday to tell me "He has gallstones after all." He was admitted to the hospital due to its severity and the impact it was having on the pancreas and liver. (Admittedly, I was proud my original diagnosis was correct.)

I touched based with my preceptor today to find out how he was doing. He had to have his gallbladder removed. He continues to run fevers so they are concerned that he has pericarditis (inflammation of the heart, probably infectious causes). He is now under the care of a specialist and may need hospitalization.

It makes me sad that he ended up having this experience. The cost of labs, ultrasound, the office visit, the emergency room visit, the hospital stay, surgery, specialists=$$$. He didn't have insurance previously because he couldn't afford it. His job didn't provide it. Because he has a pre-existing condition his premiums would have been unreasonable. Guess what he really can't afford now?

And how many people are like him, walking around not taking appropriate care of their health because of cost? We all will lose to patients in this similar situation. He simply will not be able to pay his medical bills. He will probably make monthly payments of $50 until the hospital writes off the debt. Or he will need to file bankruptcy. Ultimately, it’s the whole population that will shoulder this debt. Had he had affordable insurance and was able to take care of his health under the supervision of a capable provider, maybe none of this would have happened to begin with.

With that, I encourage everyone without insurance to visit their state’s health care exchanges. Find out about the various plans, see if you qualify for subsidies. ENROLL and begin the process of taking care of your health.

Republicans are Missing Out on the ACA

Republicans are missing out on a golden opportunity to make meaningful changes to health care in the United States. I originally was not a supporter of the Affordable Care Act (ACA)—I wanted to go all in with full national coverage—but I have caved to the inevitable. Since the Supreme Court has upheld the legality of the bill I think it is unwise to keep fighting it so zealously.

We know that our current health care system does not work. Health care is provided to those who can pay. The more you are able to pay, the better your “benefits.” While we have Medicare, Medicaid, and state-provided insurances, these programs is only for the poorest of poor and is mired in bureaucracy and restricted treatment options. Studies show that when people have access to affordable health care they will be healthier, when they are healthier they are more productive. Productivity creates a thriving economy with less people draining the welfare systems. (Oh, and providing health care in any civilized society might be the humane thing to do.)

Anyway, the argument for health care reform has been made. Both reigning parties presented ideas to fix it and the Democrats/ACA won. (Although it's technically not a leftist idea since it’s modeled after Romneycare… but I digress.) With the implementation on its way there are currently two schools of thought:

1. Obamacare is doomed to be a failure. Doomed. And we must do everything possible to stop it, to sabotage it. It is our obligation to keep things the way they are (as in broken).

2.Those darn Republicans. If this thing fails, it will be because it never stood a chance with the Repubs kicking and screaming the whole way. All of our energy and resources were spent fighting the opposition instead of focusing on the implementation of the ACA.

Surprising to myself, as I have flipped through all the radio stations and all the news articles, I think the second thought has quite a bit of validity. But I want to introduce one school of thought that I have not heard yet and want others to consider:

3. Switch gears, Republicans. The Supreme Court has said it is legal, stop fighting it. Join the Democrats with its implementation. Find solutions within the goals of the ACA to all the faults you are so quick to point out. Make something work for America for a change. We have clearly stated that we want a working health care system now. Instead of being the guy that “opposed Obamacare from the beginning,” be the guy that said “You know what? I didn’t agree in the beginning and I still have my doubts, but the people have made their choice. I am going to stop thinking about my next campaign talking points and instead try everything I can to make the ACA work because that’s what we need.”

That’s what needs to happen now. If we can accept that the ACA is coming, we can move on to the next step of becoming involved in its success. Right now, the ACA is a strictly “liberal” phenomenon. The Republicans are missing out on some fantastic opportunities. How great would it be if one of the Republicans were able to balance the ACA to meet the needs of the US?

As I have said before, the ACA is great in theory, even Republicans have admitted to it. The only way to prove a theory is to test it and to test under optimal circumstance. I want to encourage everyone to write your representatives and insist that they not only support the ACA, but also become involved in its implementation so that it will represent the health of all Americans.

Join us on Facebook

This blog gets little activity and methinks it's because my acquaintances don't really blog. They often come here when a new post is shared on my FB page and then return to FB to leave commentary on my "share." OK, fine. So Jadon and I set up a page you can easily "like" and follow posts: facebook.com/recliningsociety.

I don't know how I feel about the change. While I am hoping for more activity, FB makes it too easy to become carried away with posting every thought and interesting article that comes around... And then it becomes overkill and loses its value. I'm really hoping that it doesn't turn into that.

We are also planning to do an actual live podcast, which was actually the main ambition when starting this little endeavor. We hope to have a show up soon.

I still plan to post actual blogs here for those that want to anonymously read without having to "like" anything, but please feel welcomed to join us on the dark side.

Healthcare CO-OPs

I had to write a paper for my course Professional Aspects of Advanced Nursing and "take a position" on a current healthcare issue. I had to limit it to two pages using APA format. This is what I came up with. Let me know what you think:

  The Patient Protection and Affordable Care Act (PPACA) passed in 2010 is an ambitious attempt to make healthcare a reality for every citizen, mandating that employers provide health insurance to its employees and that every individual has health insurance. This might become problematic for small businesses and the self-employed or unemployed individuals. As it currently stands, small businesses and the individual have more expensive plans than large employers and coverage is often minimal within these plans. Small businesses and individuals are relatively too insignificant to create favorable change within the current market. Healthcare providers, including nurse practitioners, often feel the strain of their patient’s financial burdens when they are compelled to stray from the standards of practice due to the patient’s lack of coverage or inability to meet high deductibles and co-pays.

  To offset the burden of the mandate and avoid forcing people onto government-run healthcare, section 1322 of the ACA created the Consumer Operated and Oriented Plan (CO-OP) and provided each prospective CO-OP the potential to borrow up to $56.4 million in federal funds to cover the expenses of start-up. CO-OPs that take out a loan have several contingencies they must follow: the health insurance issuer must offer plans on a statewide basis, it must be governed by its own members, and it must be recognized as a nonprofit organization as defined by the state while reinvesting its profits to improve benefits or lower the premiums.

  There is some opposition to the implementation of CO-OPs. Since the CO-OPs are using federal dollars and there isn’t a guarantee that they will be viable, some think that it’s too much of a risk for taxpayers to invest in. Initially, the goal was for all states to implement CO-OPs but because of pressure to decrease federal spending, only 24 states received these funds before budget cuts were made.

  Oregon is one of the 24 states that received federal loans and is the only state to attempt two co-ops—Freelancers CO-OPs of Oregon and Oregon’s Health CO-OP. A major appeal of a healthcare CO-OP is that with each member being a part-owner, the individual will have more autonomy within the healthcare system. Focus groups within Oregon found that consumers are interested in established flat rates for their appointments, being able to contact providers through email, having alternative medicine as part of the plans, and affordable premiums. Enrollment for these two CO-OPs begins in October 2013 and coverage will start in January 2014.

  Oregon nurse practitioners should consider supporting healthcare CO-OPs for several reasons. First, the nature of a CO-OP not only respects the patient’s autonomy but it promotes it. As part-owners of their healthcare policy, patients will be able to vote on the type of care they want covered and the rates that are willing to pay. Second, it is also a form of social justice. As the healthcare system stands today, access to care is limited by the ability to pay. By providing healthcare insurance with predictable costs, patients will be more likely to seek early treatment for both acute and chronic diseases and injuries from their primary provider and reduce emergency room visits. Patients will also be more able to afford medications and procedures that they previously could not.

  Since healthcare CO-OPs that received federal loans are unable to advertise and solicit membership, nurse practitioners should draw attention to these healthcare plans by working within their communities and informing small businesses and self-employed individuals about this option. Having a large enough membership is crucial as it will determine the CO-OP’s viability.

Edding toward a Den of Snow

Edward Snowden has had his passport revoked, and is stuck in Moscow, according to Time.

http://world.time.com/2013/07/02/snowdens-worst-case-scenario-what-if-no-countries-take-him/?hpt=hp_t2

The list of countries willing to take Snowden is shrinking as more say either "no" or "apply in person."

Whistle blowing keeps getting more dangerous.  While Assange is holed up in an Ecuadoran Embassy, Bradley Manning is still facing a whole host of charges for having a greater allegiance to exposing the truth to the masses then protecting them by...what exactly?  Withholding that information?

We are moving to an open source information age.  Secrets are getting harder to keep.  It is up to us to demand open access to information.  We children of the 80's 90's and 00's are the next generation of policy makers.  Our apathy is the only thing stopping us from greater knowledge, and secrets are like water slipping between the fingers of those that would keep it from us.

By my count, Snowden is a patriot.  So is Manning.  Dissent is patriotic.

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Obama said something about protecting whistle blowers once...

http://www.techdirt.com/articles/20130726/01200123954/obama-promise-to-protect-whistleblowers-just-disappeared-changegov.shtml