SynapticFire

Note to Self

Starting a Saturday class at the end of the semester and basically dive-bombing a law class in the middle of everything else you've got going on is not a bright idea.

Looking Ahead

For a less-ranty - and maybe more coherent? - change of pace.

Applications for Practicum placements were handed out last week; we have been instructed to have our placement sites lined up by February to start our Practicums in the Fall of 2010.

I understand the idea of needing to plan ahead, and the importance of lining up a supervisor and site and interviewing as many as possible until you find the place that will work and a supervisor you can work with.  I get it, I really do. And usually, I'm all for getting things settled sooner rather than later - it's one less thing I need to worry about.

At the same time, there are so many decision points for me related to my "non-school" situations between now and then.  I can peer into to the future as much as possible and plan to the best of my ability, but there are some decisions I simply cannot make until other things - which are ultimately completely outside of my control - fall in to place. Or until the probability lines get clearer, anyway. 

Things like (but not exhaustively):  Will my partner find a new job soon after the year?  Will we need to move?  Will I still be working with the company I am now, or will the other opportunities I have in the works pan out?  Coming up on the holiday rush means that, likely, none of these things will be answered "in time", so I have to navigate a little bit blind.

Luckily, I'm adaptable so I know that anything that happens, I'll be OK.  I just have to admit a certain level of discomfort in making such big decisions without solid bearings.

Money & Medicine

Health Care and Public Policy

 

Time for a soap-boxy post. 

 

Aside from being something I’m wrestling with this week on a personal level, it’s clear:  Those who create public policy surrounding health care have completely missed the point.  There could be any number of reasons why they’ve done so.  Personally, I think it happens to be that they have simply neglected to examine what the ACTUAL cost of health care is – they are too busy bickering about ideology and are completely willing to just look at the monthly premiums offered by health insurance companies and say “Of course that’s affordable!”  They neglect to factor things in like co-pays, or prescription cost, or any number of other things that add to the out of pocket expenses in addition to premium cost. 

 

Here’s the general gist:  My partner is slated to lose his job at the end of the year.  He’s been given adequate notice and overall they’ve been incredibly fair, so no complaints there.  What that does mean is we will lose his (absolutely fabulous) insurance.  SO, we have to find our own.

 There are a number of other parts of the financial situation that complicate things – I work part-time, which means my share of the premiums through my company plans are more than if I were to work full-time.  My company’s options are - to put it nicely – crap.  I’m a grad student – I’m broke.  But between the two of us, we (thankfully, because it would be really hard otherwise) make too much money to qualify for any subsidized plan through the state (assuming he gets another job in a similar range which, while not impossible, will take time and doing).  

 

Overall we’ve got a clear idea of how much health care we use and need.  Since my partner’s current insurance is unbelievably good, we’ve been pretty spoiled.  By “spoiled” I mean “gone to the doctor when needed” (annual physicals and 2 additional visits to treat my sprained ankle; tooth cleaning once; and mental health visits to treat our learning disabilities).  So we’re pretty much low-users of the policy, overall. 

Keeping all of those variables the same – doctors visits, prescription coverage, and even adding in vision care (because I’m blind as a bat), we’ve crunched the numbers and it’s simply ridiculous – and not worth the money! (Provided, of course, that nothing catastrophic happens but if it does all bets are off, anyway…)

 

Here’s where public policy gets it so very, very, VERY wrong. 

 

I’ve evaluated a number of plans for per-month cost, after adding up premiums, co-pays, deductibles, etc.  The cheapest INSURED option – the cheapest “individual + one” plan, among all, even those offered by the state – comes out to cost us, out of pocket, a mind-numbing  $6,101.16 per year, or $508.43 per month.   Which also is way, way, under the $8,000 “out-of-pocket” limit on this particular plan, because (naturally) the monthly premium doesn’t count. There are a few other options that are approximately $650 per month in costs after all is said and done. 

 

That’s the cheapest “most affordable” option.  I have a LOT more than a lot of people and I’m not trying to plead poverty, but on what planet is 50% of my net take-home pay – affordable? That’s working 2 weeks of my part-time job JUST to afford health care.  Wha?!

 

What’s really ironic is that, in crunching the numbers and using the same variables, that if we were to self-pay for *everything* (using the self-pay rates I’m used to dealing with all of those years I was without health insurance) AND pay the full extent of the tax penalty for BOTH of us next year, we would wind up with only, out of pocket, $468.83 per month in expenses.  BUT WITHOUT the tax penalty, we would pay only $290.83 per month in health care costs – for everything.

 

Because here’s what’s really sick – I added up the cost of EVERYTHING my partner and I would normally use in medical expenses throughout the year.  Estimated, of course, but not lowballed. 

 

On our own, without insurance at all, we would spend $3,490 in medical care in a year. 

The CHEAPEST premium we have available to us, through the state, would cost us $5,745.96 per year. 

 

We lose over $2,300 a year just in the act of buying insurance – and that’s before a SINGLE CO-PAY OR DEDUCTIBLE.

 

I understand what Massachusetts was trying to do here.  To make insurance “affordable” to all, widen the risk pool through mandated participation to include those who would normally not carry insurance because they don’t need it (healthy, young, trust fund, whatever).

 

But the initial premise is inherently flawed.  Health insurance companies exist to make a profit, NOT to provide health care.  All “widening the risk pool” has done is allow them to charge the same insane rates to everyone and make even MORE of a killing, because the vast vast majority of those who don’t need it won’t even come close to using even the value of their premium in health care costs!!  All widening the risk pool does is guarantee the insurance company a fatter bottom line.

 

So I don’t understand is why, after all of this common-sense number crunching, the idea of a universal, single-payer health care system is so inherently frightening to so many people. 

 

You want to talk about widening the risk pool?!  THAT’S how you widen the risk pool – everybody’s in.  Everybody pays taxes (and thank god we’re still a progressive system, although my professor argues it’s getting more regressive every year), and everyone chips in.  Not everyone will need massive levels of care. Most people won’t even use what they have.  But it will be there when you need it. 

 

IF you still insist insurance companies can have a piece of the pie (and they will, because there is always risk and that’s what insurance does, it mitigates risk), then there is no reason I can see at the moment that a single-payer system can’t work in tandem with catastrophic health insurance policies that cover massive expenses as a result of accidents or something.

 

Oh, wait.  We already have something like that.  It’s called accident insurance, and it’s nowhere near as costly as health insurance.  So it seems like the risks are calculated and mitigated, according to market forces. 

 

It’s time for me to stop ranting.  I think I will bring this up in class and ask my finance professor’s opinion.  I’m not saying that as a lame tie-in, either – I am genuinely about curious what he has to say about this situation.

 

 

 

Why Day Planners & I Don't Always See Eye To Eye

Ideal vs. Reality - time spent during a typical weekday.

“Ideal”

8:00 am: Get out of bed, put in contacts, dress. Have time for makeup, hair, accessorizing.

8:30-9:00: Leisurely breakfast and a nice cuppa, chatting with my partner as I double-check my things for the day.

9:05: Begin commute via T; read entire chapter for following day’s lecture.

9:45: Arrive at work with time to spare, boot up computer and mentally organize for day. Enjoy tea and biscotti (brought from home) while sorting and responding to the day’s email.

10-3:30: Able to work on projects in the order I’ve designated them; crossing off more things from my task list than are added.

3:45: Board T to Suffolk for class.

4:15-7:00: Engaging lecture full of insightful discussion and new concepts.

7:20: Home after class, change into gear to run.

7:30: Run/shower.

8:30: Healthy dinner, conversation about the day and classes with my partner.

9 or 9:30: Read/study/write as required.

11:00: Indulge in one of my relaxing crafty hobbies for a short while.

11:30: Bed

 

“Reality”

8:00 – 8:30 am: Alarm goes off.  Hit snooze button. Doze and chat with partner.

8:40 am: Alarm goes off.  Check time.  Mutter about how late it is and begin to brave the day.

8:50 am: Contacts finally in eyes, try on 3 different outfits before finding one that works. 

8:55 am: Gather all of my things while my partner makes me tea in my travel mug, and packs my lunch.

9:05: Wolf down breakfast. Leave prepared tea on kitchen table.

9:10: Arrive at T station to find it’s a slow train day.  Read chapter for following day’s lecture.

10:00: Get to my desk and find three new tasks I need to follow up on.

10-3:35: Put out fires started through no fault of my own.  Fight with a stubborn desktop and irritatingly slow network connections.  Leave work wondering how I could be so busy and get nothing done.

3:50: Board T to Suffolk for class after waiting on platform for what feels like eternity.

4:15-7:00: Engaging lecture full of insightful discussion and new concepts.

7:45: Finally home after another ridiculously long wait for train.

8:30: Run if I’m lucky. 

                Alternate:  Dishes, cat box, bills, homework, emails, etc…

9:30: Dinner.  Frozen pizza is a balanced meal, right?  Conversation about the day and classes with my partner.

9:45: Read/study/write as required.  If I’m completely brain-dead, we’ll Netflix an episode of junky TV.

12:30 am: Bed

This is why, even though I view day planners as essential and I’d be lost without Google Calendar (as well as a host of other gizmos and systems), I haven’t quite gotten the hang of them. 

Well, at two things in my life are consistently not chaotic.  =)

Insert Hokey Parable Here

My partner and I ran a marathon this past weekend (the 18^th).  It was a first for both of us, and the jury’s still out on if it will be the last.  We finished pretty much exactly ahead of one-third of the pack, at a pace that was actually not that much slower than our normal longer training runs – which is noteworthy only because we had never run further than 16 miles before the marathon (Graduate school cut into training more than I expected.  Yes, my partner told me so).

Remarkably, it was easier than I expected.  Not easy by any stretch of the imagination.  A monster hill around mile 22 had me in tears because my hip flexors were so sore any forward motion was near agony.  So no, not easy.  But overall, looking back at the race and the experience, it was much easier than I had anticipated.  I was asked after the race if I had ever thought of quitting – and the answer was immediate:  No.

 It never crossed my mind to step off the course.  It never even occurred to me there was the possibility I wouldn’t finish.  It was simply a matter of getting to the next corner, the next mile marker, the next aid station, the next hilltop, the next walk break.  This incremental approach wasn’t really conscious - more like a complete surety that we would always be able to make it to the next whatever. We knew inherently that we’d be at least able to make it that far.  The finish line was some vague place in the far distance, and it was in many ways surprising (but undeniably welcome) when we crested the last small rise and saw the banner marking the end of this particular journey. 

What’s oddest about this is that, despite my impulse to brag to everyone I know, the reality that I ran 26.2 miles the other day hasn’t quite settled.  More specifically, it does odd things to your perspective when you are focused on a particular goal and you work toward it for months and months.  For one, the idea of “running a marathon” becomes completely achievable, and eventually becomes in many ways part of your identity.  For me, this seeped into my everyday existence - aside from the actual running -  in the form of the magazines I had subscriptions to, in knowing marathoners (one of them elite), and talking about training and progress with my partner and others.  So it strikes me as a bit odd when someone congratulates me on running the marathon, or exclaims anything from “wow, I’m impressed” to “that’s nuts!” – because it doesn’t seem at all out of the ordinary.

Everything I have said so far is true is grad school, too:

This is a marathon endeavor – that is easily accomplished (although still not easy) by focusing on one goal at a time until you reach the finish line.  Being absolutely certain that your goal is within your grasp is key – there is little room or time for self-doubt.  Surrounding yourself with people who support you, love you, and who contribute to your improvement – in short, those who are invested in your success – is essential.  Finally, respect the work you are doing - it does take time, effort and dedication.

But it's worth it.

 (As a final aside, I will admit I like half-marathons better – still enough distance to allow for challenges and meditative rhythm, but not quite enough to leave me sore for 3 days afterward.)

Thinking of New Possibilities

As I believe I've mentioned before, I am impressed with how much of  a "no brainer" the combination of Master's of Public Administration and Master's in Mental Health Counseling is.  These two disciplines dovetail so nicely - why is this joint degree program so sparsely populated?!

/ahem/  Moving on:

My Fellowship has really opened my eyes to the possibilities for program evaluation - and the utter, dire NEED for such things.  There are so many programs out there which are designed to help government, non-profit, and private sectors alike address what is needed in the world.  And it seems there are so few competent evaluations of those programs to see if they're actually working as intended.

Which brings me to another thing - program design.  The intent of programs are often very noble.  But... often, us do-gooder types will waltz into an area which we have determined "needs help" and start flinging ideas around without addressing what's actually needed.  OR the best way to deliver what's actually needed.  OR addressing the underlying psychological factors that drive the NEED in the first place.  So many programs are designed with glaring flaws that overlook important factors that *will* impact the success of a program from day one. 

The more I learn about public administration  - and reflect on the nature of counseling and care - the more I'm beginning to understand that to manifest the type of change I want to implement in the mental health care and medical fields, I will have little time for actual one-on-one counseling.  I hope that I'm wrong in some respects - but facing that reality is also relieving in others. 

The MSMHC training (and clinical work for licensure after that) will give me the tools I need to, above all ask the right questions. What are we trying to do?  Why?  Is this needed?  What do we need to do to find out what's needed?  If it didn't work as expected, why not? What are we missing?  What are those intangible factors that we're forgetting?  If this program is in place, what then?  How do we work collaboratively with the people we're working for in order to address the underlying causes?  What are the psychological impacts of anything we're looking at?  What's the most salient factor? How can we address that?

So I think I need to spend some time with my faculty supervisor and begin to ask if there are agencies out there that specialize in this kind of work - the evaluation of companies, non-profits, and social services to determine if what we want to do is a) actually getting done and b) actually the work we should be doing in the first place.

I see room for me in all sorts of places if I take this tack - the research end, of discovering gaps in service (hell, I've already started down this career path because I've recognized a massive abyss of a service gap for families dealing with TBI).  The program creation end, of implementing new programs and embedding evaluation tools from the very beginning.  The evaluation aspect - picking apart a program and asking if it can be accomplished in different and better ways that work with those we are serving.

I can't wait to see what's out there!

Lazy Teaching? (a minor rant)

I understand that people have varied "learning styles".  I understand that for some, lecture isn't their cup of tea.  I really do get that discussion and dialectical approaches are useful for many.

But can we please get a handle on "group discussions" in classes? It's like a plague these things are so common - read the material, get separated into groups to "discuss" the perspectives each of us can bring to the material as it pertains to a particular set of questions.  Lather rinse repeat. 

It just strikes me as lazy teaching.  Perhaps I'm biased because of a particularly lousy instructor I had while in undergrad who frequently employed this "learning exercise".  Frankly, though, it comes across more often than not (to me) as "I didn't feel like preparing a lecture today, so why don't you teach yourselves?" 

I'm all for learning from the rich and varied experience of my classmates, and having a classroom environment that is open to comment and discussion.   But I am here (in class, at Suffolk) for the expertise and experience of the faculty.  If I crave discussion or my peer's thoughts, there are - I'm certain - at least a dozen forums online that I can join to get "perspective".

Because, really: If I wanted to join a book club I would have done so. 

/rant

New Horizons

The professor of my Fundamentals of Public Administration class exhorts us to “challenge ourselves” in the class; to not stay safely within the comfort zones of our various strengths.  And it occurred to me, later, that this entire degree is somewhat out of my comfort zone.  This (Public Administration) is an entirely new field for me; my professional goals have always been more aligned with the Mental Health Counseling side of this joint degree.  My training and “expertise” lies more in the therapy/counseling realms; budgeting and formal managerial studies are, by default, way outside my comfort zone.  Does leaping into this new field altogether count as “challenging myself”?

Even though I’m more uncomfortable in my MPA classes than my counseling classes, just by nature of familiarity, there is much more overlap than one would first think.  I’m really learning how much I love program evaluation – and just how much study and research many of the public/mental health programs can offer from a managerial standpoint that can have fantastically broad impact on many sectors of society.

I was talking to my Fellowship faculty supervisor the other day about the fact that something many individuals in the helping professions forget is the evaluation piece of the puzzle.  There is so much data that we are, as counselors, required by law to collect and maintain.  Intake forms all the way through treatment and termination – there is so much information there!  A satisfaction survey here, an added questionnaire there, and you suddenly have the means to determine need and efficacy of a given program – or, at least, be closer than you were.  Learning what can be *done* with this kind of data is so exciting for me, and I can feel it opening all sorts of doors for me.

I’ve always asked the questions like “Is this what is needed?  How did it work?  What are people getting out of it?  What can we do to make things better?”  Being able to that professionally is a fantastic prospect. 

My “rah rah Suffolk” moment for this post: 

I just think that the MPA/MSMHC program is a brilliant idea.  It’s a blend of a business/administration degree focused on the business tools needed to pragmatically launch any enterprise (but especially one that will demand collaboration between the public and private sectors), and the therapeutic tools needed not only for counseling but the psychological understanding that is useful in any inherently political setting.  In only the first few lectures, I’ve found quite a number of overlaps between to seemingly disparate fields - and I love seeing such connections not only recognized, but supported and taught in such an innovative way.

Smarter, Not Harder

So the workload has hit me like a ton of bricks. I know I can do it and dig myself out, but this first two weeks of transition have been brutal to say the least. I work 20 hours a week as an admin at a hospital, and then work an additional 8 hours as a Fellow on campus. If the Fellowship were just a few more hours a week - or a few less - I would likely feel so much better. I’m in awe of the full-time working parents in my classes, and I feel like such a slacker compared to them - and then I remember that they are also taking 1 or 2 classes (not four!). There’s also those important things like eating, exercise, and sleep to attend to as well. So it’s clear that I’m insanely busy just like everyone else. As a result of the time crunch, I’ve been trying to figure out how to balance everything.

In undergrad, I had textbooks that I never even cracked because it just wasn’t warranted by the course. Some I skimmed as needed, others were read with utmost attention paid. And I realize that this, perhaps, is not the most scholarly of habits. So back in the summer, I had the optimistic and ambitious goal that I would read *every single thing* that was assigned.

200+ pages of assigned reading per week later, not including assignments… I wasn’t expecting a cakewalk, but sheesh! I’ve done it, but it’s taken some sacrifices (of my long run this weekend, for instance) that I was NOT happy about.

As a result, I’ve had to re-examine my ambition to “really read everything that’s been assigned”. Granted, a graduate program that is two joint professional degrees is not going to be the opportunity for coasting like undergrad was. I will have to work at this. OK, fine. But am I simply working harder, and not smarter?

I know enough about my own learning style to understand that reading is helpful but it is not where the bulk of my understanding comes from. I’m a lecture person - I love love love sitting in class and taking notes, discussing concepts with the professor and my classmates; having the immediate clarification of a concept or a thoughtful elaboration of a related question. The process of listening and taking notes roots things into my brain in ways that reading doesn’t quite do - although I do scribble liberally in the margins to engage that part of my process.

That’s not to say that I don’t understand and appreciate the purpose of the readings. But in the past two weeks, I have been trying to completely overhaul how I study to include reading Every. Single. Word. If I know that’s not how I learn, why have I been trying to do that? I mean, I will read study after study in service of a research paper, comprehend the concepts, and synthesize the data in some really neat ways. It’s not like I *can’t do it at all *- capability has nothing to do with it. It’s just been hard for me to see the purpose of essentially duplicating work, especially when some of the readings assigned in a given week echo each other.

So my new way of looking at things: Don’t underestimate what I am able to absorb through skimming, and simultaneously outlining what I’ve read. Read the case studies first, then the theory. Both will be discussed in class but it is the application of theory that seems most important to my professors, and that’s outlined in the case studies. Make sure I understand the basic concepts covered in the readings, in order to get the most out of the lecture, but don’t feel beholden to memorize every shred of text. There is nothing wrong with going *back* to read something if it isn’t clear, or if it’s been underscored in the lecture that I really need to understand a concept.

What I find most amusing about all of this is how perfectly it illustrates the detrimental effect of self-imposed pressure. For some reason, I selectively forgot that I was successful in undergrad - I don’t need to completely revamp everything, just tweak it in response to the needs of each course. That is one thing I know I am, and that I can offer myself: adaptability. Strategies – not straining.

One Week Down, Lots and Lots to Go

My first week of classes went well; I still don't have a full idea of what the shape of my weeks will look like, since I didn't have class on Monday.  But overall, I am confident of my ability to keep up with the work.

I've even surprised myself by already having 2/3 of my reading done in preparation for next week.  Go me!  If I can maintain the reading this semester on top of the projects I will be very, very happy.

I am increasingly aware that this endeavor will take some serious balancing of time and energy.  While I was not expecting anything else, the need for healthy stress reduction techniques is becoming obvious.

I am glad to feel the sense of support and understanding from the faculty; at the MPA orientation today, the head of the department said explicitly that, as students, our well-being should remain our top priority. Maintaining our health, our family relationships, our sanity is more important - and MUST be more important - than our performance in a class. 

Hearing such statements were reassuring, and it's not being taken by me as a "don't work hard" mandate, but as such:   I WILL do this; I WANT this experience - but I will not be so caught up in a specific timeline or GPA that I will lose sight of the actual goal: I'm here to learn, to engage, to fulfill my own dreams and potential.  I can do great things - and doing them at a pace that does not leave me sick or burned out makes them no less great.

The best part of today, though?  I sat in a room full of overwhelmingly successful and accomplished individuals - faculty and fellow students alike.  And I felt like I belonged.

I hope I never lose that feeling as I continue this journey.