Trump Immigration Policy Hinders PTSD Treatment

On a separate track from the medication issue (unresolved), I met with a new therapist who does EMDR, which is one treatment for PTSD. She seemed good and thought I’m a good candidate for it based on initial screening. She did her master’s at Case Western, so we’ve both lived in Ohio. The catch is that she’s foreign, and the government rejected her visa application, so she has to leave the country. I don’t think many capable health providers with advanced degrees were kicked out of the country under previous presidents. I apologized. Treating low-income trauma patients isn’t exactly a job Americans are clamoring to do. In fact, this would be my first treatment for PTSD after more than 3 years seeking it in at least 4 different clinics. 
She’s the only clinician at Rainier Beach who does EMDR, so she’s referring me to Renton or Des Moines to see another one. I think those are accessible from the 106 and A Line, though Des Moines is probably a long trip for weekly appointments. I’ve never really been there. I’ll see this therapist again after I get back to follow up on the referral. 
I also got my passport application printed and photo taken, but they stop processing them at 4:00. So I’ll come back tomorrow or Monday to finish that, then I can take my Scandinavia trip. Trying to keep the productive momentum going. New couch coming tomorrow before a night watching Bella and Milo.

Classist, Ableist Health Care

Can’t seem to get med refills or doctor appointment before leaving town. They interrupt and don’t listen to you. I even got hung up on trying to explain why people with autism hate talking on the phone and why it’s such a problem for a supposed mental health provider. Hardly any locations in the city or accessible without a car. I don’t know if I’ll be in drug withdrawal for the two weeks I’m in Columbus. This is how Medicaid and King County Community mental health work. Programs for the poor are poor programs.

Today in Poverty

So. Two weeks ago I saw the doctor. She referred me to physical therapy for my arm and an eye doctor for regular checkup (eyes are vulnerable to diabetes). At the Poor People Clinic, referrals never work properly, so neither place had received one from the clinic. I called the PPC and had to insist to speak to the referral coordinator, and ask specifically when they sent the referrals and how. She repeatedly interrupted me, which is infuriating when your brain is autistic, but I try to explain that and people just get indignant. How dare you call out their rudeness! It’s not like they use email or have website where you can do this. Of course, this woman reflexively blamed the clinics and declared there’s no problem with the PPC referral system, even though another worker there explicitly told me otherwise when a previous one took 6 weeks of fighting to get through. She said she’d call the clinics and get back to me. She called back later and said the clinics had received the referrals. I asked when that happened, and she just said Yes, they got them. I again asked when, and she admitted it only happened today. Her earlier claim was a lie, and if I weren’t angry and persistent about this, I’d probably spend another 6 weeks playing go-between among the clinics to get my PT and eye check.
 
Then I called the disability law firm seeking a second opinion. I’ve left them messages before, and they say they’ll call you back in 24 hours, but they’ve never called me back. Someone took some information from me and said they’d call back. I wouldn’t bet on it. My appeal hearing is scheduled for March, and the judge warned that she won’t grant another delay without a “compelling” reason. The clock is ticking, and I’m apparently better off withdrawing my 2 1/2 year old claim and starting a new one (so, July 2019?) than getting an adverse ruling on this one. You see why I want to make sure before I kill and restart the process.
 
The client I’m sitting for has a home “security” system and seems irrationally worried about crime. So when I leave to walk another dog, I set it before leaving. What I apparently forgot is that it has motion sensors inside, and that I’m supposed to leave two big dogs shut in a bedroom while I’m out so they don’t trip it (I don’t think the welfare of animals should be dictated by alarm systems). Apparently they did. While on the bus to walk another dog, client texted me saying the “security” people called. He asked several questions about what’s going on and what I did. He had me call them to explain the alarm, disable it, and cancel the police call. So I had to give them my name, client’s name, and his address and password. Over the phone. From the bus–where riders around you can hear what you say. Then client told me the alarm is pretty loud and might scare the dogs. So this comes full circle causing lots of frustration while accomplishing nothing. The alarm system that was triggered by dogs tripping a living room motion sensor–not any kind of theft, burglary, or crime–jarred the dogs. And bothered my client while he’s on vacation, and interrupted me from my normal day, making me worry about the dogs and the client’s reaction toward me.
 
These systems do not deter crime. They do not protect property. They do not increase anyone’s safety. What they do is prey on racist fear of cities (Seattle has little crime among big US cities), constantly create false alarms (this is hardly my first time), and make lots of profits for the “security” industry. (Recall Rep. Darrell Issa made his fortune on car alarms) They exploit and increase fear, anxiety, aggressiveness, harmful stereotypes, and division among people. They make us afraid of and alienated from each other. Ironically, the reason it takes me so long to get around town is our mediocre transit system; driving is faster, but much more likely to kill you–compared to both riding transit and being a crime victim. The press sensationalizes crime, while car “accidents” are treated only as traffic issues. But if you look at mortality rates, ignoring the causes of death, they are lower in cities because we use cars less, and cars cause more death than crime. If your goal is to avoid crime (which is no more or less than what WE define it to be), move to the suburbs. If your goal is to stay alive, move to the city.

A Brief Relief?

I saw a doctor and got temporary psych med prescriptions. I’m waiting for them to be ready. That should bring some relief by tonight. This doctor wanted me to alter an existing appointment, I forget why, so I go back Friday to see the kind, understanding, pretty doctor (locum) again. My regular doc is back soon, so she’ll be gone. 

Today’s doc was naturopathic and suggested cranio-sacral therapy (?) for PTSD in Wallingford. I’ll look it up. She says they found a way to get Medicaid to cover it. She also wants to believe my toe numbness is due to high blood sugar, but I’m seeing diabetics online who have the same side effect from the med I take and say it goes away as soon as they switch meds, so I want to try an alternative. I’ll try to do the intake for longer term psychiatry tomorrow. 

A small present I got myself arrived, so hopefully I can get the broadcast TV channels well and watch Jeopardy regularly. 

I got an email blast from a temp agency I worked for years ago, seeking an executive assistant. They’re interviewing me Monday morning. I expect absolutely nothing out of this. They treated me pretty badly in 2012-13 after I did a great job for them in 2011. I mentioned the idea of unionizing temp workers, and they banned me from their Facebook page. It rubs me the wrong way that they’re even open on MLK Day, let alone having people interview then. 

I emailed a bunch of information to the community mental health ombudsman, and he claims interest in helping but won’t deal over email. I’ve emailed and left phone messages for Larry Gossett about a few things, but the man never answers. I’m ready to vote for someone who responds to constituents, rare as that is. 

So call this all cautiously relieved. Never count your chickens before they’ve hatched.

UPDATE: Two meds filled, one not ready until tomorrow.

Gratuitous Torture by Valley Cities

After all this hassle, countless phone calls, voice mails, dead ends, being referred to the wrong people some of whom are out indefinitely, getting sent to voice mail boxes that were full, getting their nighttime message during the day, two weeks of medication withdrawal,messages not being returned, and more I can’t remember offhand; I finally am told that intake appointments aren’t scheduled at all. They’re on a walk-in basis weekdays 8:30-2. I can’t make it today, but that sure would have been helpful to know THREE FUCKING WEEKS AGO! ~€^}{]|<:5(;( 😡😡😡😩😩😡😡😡😩😡😡😡😩😩😡😩😩😩😩😩😡😡😡😡😡😡😡😡😡😡😡😡😡😡

Parade of Crippling Misery Continues

1/2) I went to the dentist today. For some reason, they split checkups from cleanings, so I have to go back for the latter. They said I need a new crown. Medicaid won’t cover it (nor did federal employee coverage in 2003). The sticker price is $1100, and they have sliding scale fees for which I made an eligibility appointment, but the discount tops out at 50%.
I asked how long a crown should last, and they stuck with “for life if it’s done well”. I gently pushed for a clearer answer, saying there must be statistics on median, average, etc; and they said 15 years. That’s about what I remember being told before. My crown is only 9; I got it in 2008. It’s also either the 7th or 10th one I got on this tooth from 2003-08; they just never stay on, and when moving or switching dentists for insurance reasons, I always have to start from scratch convincing them that I need a gold crown. No other material (all cheaper, of course) stays on.
Gold crowns have other advantages, but I only care about the practical health aspects–I’m not into precious metals or jewelry at all, as I think they suspect sometimes. My only jewelry is a used watch I got for $20. The only other gold I own is a French coin my uncle gave me for my Bar Mitzvah.
The dentist was good about reasonably going over the risks and situation, acknowledging that it’s not urgent but should be done in the next 2 years. At some point, pulling the tooth and ending the root canal/crown drama enters as an alternative. I’ve always wondered about that, because it would be cheaper, less painful, and done forever after one procedure. It’s the very furthest molar in the back, so no one really sees it but me. It’s also my only root canal. The one other tooth I keep an eye on for a possible root canal is fine–they said it looks odd but is healthy, so that’s only cosmetic which I don’t care about. (The Baptist dentist who explained to me that a gay Barney Frank couldn’t be a real Jew made the filling way too big)
This means more hassle, physical pain, and expense. Could I get one cheaper somewhere else? UW dental school? Should I try a private dentist and pay out of pocket? How long will another crown REALLY last? The pain is bearable once every 15 years but not every 15 months. Or should I scrap all this and have the thing extracted? Even if it’s $550, how do I pay for it? Would it be worth buying my own dental insurance? Or getting it done on vacation in Europe? I feel awful saying this, but my grandpa is dying which could involve some inheritance. Should I see if my tooth can wait him out?
It’s just a thorny set of issues no one ever needs.
2/2) I walked a small, sweet dog today who I’ll call Kite. Last summer, for the first time ever, someone complained to me about a dog walking on their lawn. It wasn’t until last month that I checked the DPD website to look up her property limits so I knew where I could and couldn’t let Kite go.
Today another woman yelled at us from another house, apparently unhappy that Kite was walking on the lawn. It was a little hard to see in the rain, but I’m pretty sure she was in a different house than the one that owns the lawn we were on, as Kite regularly has enjoyed for months, both with me and her owner. This woman’s yard is inaccessible, so we’ve never been there. She was yelling at me about this lawn not being a dog walking area when IT’S NOT EVEN HER YARD.
I know where the lot lines are, because I just looked them up. Basically, all the open space short of the next driveway belongs to a house on the corner–where a dog lives. And apparently a nice couple with pre-teen kids.
I couldn’t tell exactly what this woman was saying, but I offered that I’m happy to avoid her yard if she likes (which we already do; there’s no access). If someone doesn’t want a dog on their property, that’s their right. That’s why I looked up the lot boundaries! Kite loves that space, and I didn’t want to get in trouble. I have no idea why this woman is white knighting for her neighbor.
Also, Americans are way too obsessed with their precious PROPERTY and get ridiculously rigid about it. Living beings are more important than property. If Kite were a big, loud, messy, destructive, aggressive, or even reactive dog; I’d understand. But she’s a small (cat sized), quiet, well-behaved older girl who just likes to sniff everything. She pees once in a while, and if she poops, I pick it up. Where’s the harm?
When I looked these homes up on DPD’s site, I also checked them on Zillow. My client rents a mother in law apartment allowed and approved only due to a 2009-era city ordinance. The houses around her are generally big, with very big lots, and high prices due to their good views of and proximity to Lake Washington. The house on the corner is estimated at ~$900,000. So my take is that this is a well-off, privileged white woman who has lost any perspective of what’s important in life. But with everything else I’m dealing with lately (nasty withdrawal from multiple psych meds, shoe destroyed by a dog I was sitting, first ever bite by a dog I was sitting and resulting $323 ticket, broken arm on the same side as my 2015 and 2014 injuries to the same one), and the cold and rain, I didn’t need this.
My client apologized for her neighbors but later said we’re both going to have to keep Kite off the lawn for now. That will take time for her to adjust to, and she won’t understand why. But it’s so stupid. She just likes to sniff all the stuff there, and suddenly she can’t anymore. Reason and compromise lost here. Wealth, privilege, and selfishness won. What makes you decide it’s so fucking important to keep a sweet little dog off SOMEONE ELSE’S lawn? Do you have no bigger problems in life? No higher priorities? Is this a little protest against the fact that a MIL apartment was ever allowed, where a non-rich person (special ed teacher) could move in? It reminds me of the passive-aggressive note I was left at a temp job in 2013 complaining that I didn’t correctly arrange the veggies in their free, twice-daily veggie tray. There are too many of these people, and they have too much power. Could they survive what I deal with?

Insurers Leaving Health Exchanges–What to Do?

This certainly doesn’t look good for Obamacare

So from my perspective, the problem here is simple and was foreseen, and the solution is simple, but virtually impossible.

1) United, Humana, and now Aetna are cutting their participation in the exchanges because they can’t turn a profit. Answer: Health insurers should be banned from making profits, as every other developed nation does. Make them public, non-profit, or cooperatives.

2) Aetna is using its large market share to punish/bully the administration for nixing a merger it wanted. This should have the same solution.

3) Insurers are getting too many new (sick) subscribers at once, and/or their existing beneficiaries are getting sicker. But the New York Times recently reported that not only has Obamacare cut the uninsured rate to a modern low (<10%), but it is actually making Americans healthier. At root, those are the fundamental, critical goals of health reform–not profitability or federal deficits and debt. Let’s keep this in mind. So how to solve #3? Health insurance, like voter registration, doesn’t work when people are excluded by default unless they act. Both need to be automatic–in this case so that healthier people who are cheaper to insure are paying into the system. Shared risk is a basic principle of insurance.

But that alone isn’t enough. We still have a crazy patchwork system where people get their health care in different ways from different places. Each comes with a different population, motive, administration, needs…this complication is a big pain for patients and providers, AND it’s a major reason for our very high administrative costs. Our political system isn’t ready to face this reality, but it’s unsustainable and has to end.

WE MUST GET EVERY AMERICAN ON THE SAME HEALTH SYSTEM.

I don’t care as much about which one it is; the imperative is to get everyone on Medicare (like Canada), or everyone on a fully socialized VA/IHS system (like the UK), or everyone on the exchanges or an employer-based system (like Germany). Then you greatly simplify everything, slashing administrative costs, and have one giant risk pool comprised of the whole country. No system is older or sicker or poorer. There are no big year to year changes because change happens slowly in a group of 320 million. And access to and quality of care are equal for everyone. Many of our health care problems will persist until we do this.