Wednesday, April 8, 2009

Conditioned to Authority

Someone always knows or understands better! Yes? From the time we are born, through our ‘growing-up-years', then as participating grown adults, most of us may have a sense that for much which goes on in our immediate as well as the greater world, there are others better qualified to make decisions and take responsibility. For reasons that are laudatory, as well as sometimes seemingly practical, the adults around children, acting in what we believe are the children’s best interest, structure and limit the child’s world. “Children are children, you know, and are likely to make mistakes.” We want to protect them, shield them, and direct them in the ‘right direction’. Isn’t it more efficient to experience the right things and be exposed to the right-proven-ideas than to blunder around, explore blind avenues, and waste time not having things work out as planned? We don’t want people or society to ‘fail’. Someone else knows what is best and right for us and is better prepared to make decisions. As adults, do we also then adopt and accept a hierarchy of authority? Do we delegate or abdicate to others, who we perceive as authorities, the decisions and responsibilities that will protect and provide for us? Who has the motivation and self assurance to consider and tackle the uncertainties of our lifetimes, those things that will be “The Black Swans” as described by Nassim Nicholas Taleb? The authorities? Who are they? You? Me? or THEM? . Does this make things run better, or correctly? Correctly for whom, from who’s vantage point, for how long?

As a recently retired middle school teacher, I have experienced during those 40 years what I’m hypothesizing is a large part of the population highly conditioned to accept, desire, and cow to authority, more so as the years have progressed. I will be developing this hypothesis over the next few months through this blog as it relates to all parts of our individual and collectives lives. This will be kind of a debriefing of my world view after the experiences that have shaped me during the past 40 years. Hopefully these writings will raise questions, cause you to reflect and share your understandings from deep within you. I find I typically have more questions than understandings.
I also have biases. I'm sure you will point them out to me/us.

Tuesday, April 7, 2009

Who Profits Now in the Attendant Home Health Care Industry?

An overlooked area of health care is that supporting the aging population facing normal gerontological deteriorative processes. This is not so much preventative medicine, but supportive care. My wife and I have now directly participated witnessing the deteriorative aging process in 4 immediate relatives, both mothers, and two uncles all in their late 80s and early 90s. We experienced extended hospitalizations with the accompanying disorientation, the vegetative state fostered by most 'convalescent/nursing homes', the extreme cost of in-home 24 hour attendant care, and the hurdles of dealing with administrative paperwork, legalities/liabilities of health care workers transporting selves to acquire groceries and medications, etc. I was shocked to learn of the excessive margins (owners' profits) in the operation of home health care, and home attendant care businesses, where the ratio of owner operating costs to care worker salary 3:1, the care worker earning less than 30% of the charges, and in some cases, many making even less than this. The need for these services to the aged is great now and growing rapidly with a huge amount of exploitation of both the client/patients and the health care workers.

Care is being provided by individual workers with good intent, but with (poor/if no training) in the areas of meal preparation, first aide, basic medical symptom recognition and appropriate action, and psychosocial interactive techniques. Most of the workers are first generation Filipino, or other Pacific Islanders here in California. The wages they receive are substandard and sometimes exploitive, with often no job security.

Some form of subsidized training, needs to be a part of the healthcare mix, as these individuals are living at the subsistence level already. As many of these individuals may work 24/7, some accommodation needs to be provided for training that allows the care worker to attend training without losing their current job assignments. Better yet, a subsidized training program prior to working seems more reasonable with a living wage/stipend provided during the training period, followed with a license/certification. This could be a state or Federal program. In addition, as many of these individual care workers COULD be self contractors, the state could ease the process of running a soul proprietor contracting business by providing the counseling resources to locate liability insurance and complete the necessary forms and procedures to establish the ‘business’, as well as have a central site to advertise services as well as assess those services, much like AngiesList.

Individual care worker contractors would reduce the overhead to nearly “0”, while improving the salary compensation of the worker and reducing the cost to the patient/client. The overhead would be minimized by the municipality, state, or federal agency overseeing this contracting/licensing/certification/training/advertising. Accountability of care workers could fall on 2 sources, family members, or in the event of no available family, a municipal/state/federal caseworker, much like those used for foster care. Family members would also require training on what to observe/assess and how to assist through training once again provided through municipal/state/federal resources. How about if all of this became a part of the K-12 public education curriculum, right from the start? What a novel idea, teaching real life skills in school!

For the instances that large scale business provide for these services, some form of oversight and monitoring of the businesses that provide these workers is needed, as they should surely be NOT FOR PROFIT businesses. If profits are hidden in owner salaries and administration, as I suspect is currently the case, then there needs to be some way of creating a transparency here so that excesses are not being taken.

The need is huge and a profit based industry will not support the need of individual elderly who need these services, and who are mostly on minimal incomes themselves.

What IS Working and What Is NEEDED?

With 90% of the workforce still employed, take a look at the parts of the economy that ARE working. We have electricity flowing to our homes, waste and sewage are removed, water is available, the grocery stores have shelves filled with food, gasoline is there when we need it, the communication grid still allows me to use the internet/phone/tv cable, UPS trucks still are dropping off packages, pharmaceuticals are there if we have the money for their purchase, the courts/lawyers seem to be available and functioning, cash still comes out of our ATMs for those that have cash or credit, doctors/dentists/optometrists and hospitals still seem to be in business, schools are open but are getting more overcrowded though getting by with fewer supplies and support, planes still streak across the sky, and the freeways and roadways are still bumper to bumper at commute time. What does this tell us about what is necessary in the economy? To what extent are these components in danger? How can we insure the continued availability of these structures to support our society. If not the focus of those who are setting policy, what is THEIR FOCUS? As people become unemployed, to what jobs in the economy are they to be re-directed? How do we open up the job market to the employable? How do we provide living wages for those who will work? How do provide for the potential improvement of jobs for the ‘under-employed’? Are we each individually going to have to move-over a bit to make room and maybe SHARE part of our employment job market?

Sunday, April 5, 2009

Needs and Wants and Needs Not Met

Needs and Wants and Needs Not Met

We are trying to live in an economy of wants. We've been living in ignorant bliss, nourished by whom? Natural law dictates that we can only live in an economy based on meeting needs, if that economy is to be maintained and stable. Aside from the obvious needs of - food, water, and shelter – what are our other needs? Acceptance, approval, being valued, being wanted, being recognized, learning and appreciating, safety, security, and the elimination of risk and fear constitute a social/psychological need! These last needs are non-material.
Our present economy of wants capitalizes on our social/psychological needs, and in a virtual way attempts to meet or replace these needs with something that can be commoditized and sold, ‘wanted’. Social/psychological needs take individual work, risk, and sometimes perceived sacrifice to achieve. Work, risk, and sacrifice we often set as virtues, but do we also get another set of signals to avoid, if not abhor these when we view them through a pragmatic lens? If shown something that appears to satisfy one of these needs, are we easily persuaded to purchase it, ‘want it’ to soon find it really doesn’t satisfy the real underlying need and we continue to search, find, want, and buy. Is this the basis for our consumption based economy which necessitates ever increasing levels of consumption? Is the real satisfaction of the underlying needs not being found, and the need to consume continues.
Why the need for ever increasing levels of consumption? We can produce what we need today with many fewer hours of human work. Do we then invent jobs to employee those who are not needed to provide for real needs. As we live in a closed system, this can not go on indefinitely. One solution may be to put more people to work for fewer hours producing the products and services that meet real needs. The social/psychological needs presently perceived as wants, may be then realized in the time individuals are not working at paying jobs, but instead interacting socially with others. What changes might evolve in the interrelationships of people over several generations if time was available and spent to meet our social/psychological needs, rather than earning money?
Who are the beneficiaries of ever increasing levels of consumption? We are being encouraged to help our economy grow. How far can an economy grow, forever? What if the paradigm was for a stabile, balanced economy? I’ve not yet heard politicians, or anyone in finance or positions of power suggest that a stable balanced economy is to be desired. Why? For that matter, I’ve not heard anything in the media about the significance of population and technological capacity as it relates to the marketplace or economies.