I started this blog in 2008, but soon let it lapse as I became an almost–weekly contributor to the New York Times Economix blog from 2009 to 2014. This felt pretty demanding on top of my regular job and I needed a while to recover and reconfigure.
Many of my posts there focused on care issues, and I’ve put together an annotated list of about 45 of them that fall into the same categories I use on this blog. Reviewing them was an interesting process for me. It helped build my confidence in what I’m doing here.
I learned a lot from my engagement with what I consider a very fine news organization. I gained a larger audience for my ideas. I improved my fluency as a writer. I also read enough rude personal comments online to gain at least some immunity to them.
But I have to say I didn’t love the format. I was asked to write an “analysis” rather than an “opinion” blog. I was discouraged from adopting a personal or informal tone. I generally felt constrained by the context. The copy-editing was great, but as a freelancer, I never got much editorial feedback on substance.
Ironically, it was a NYT article on family policy that rekindled my desire to resume writing on these issues for a broad audience. Even if it’s a small audience!
The email exchanges I got into as a part of a larger response to that article made me realize the importance of maintaining a strong on-line platform to discuss care issues. Thanks to all! I will summarize some of the things I learned from those exchanges in my next post.
I am interested in health care incentives at the staff level, because I offer ways for staff to interact more effectively and pleasantly with their patients. Current practice is striking in that, in such a hyperCapitalist political and cultural context, health care on the ground is exactly the opposite – financial incentives for quality do not exist, and any informal incentives (i.e. gifts or tips) are severely limited and discouraged, to protect vulnerable patients from exploitation.
Ironically, this leaves nurses in a position in which the only way to earn more hourly is to switch jobs, or to age – so called ‘merit’ raises are given across the board equally, and older nurses make so much more than than their younger colleagues that they retire much later than usual – working nurses in their 70s and even 80s are much less rare than people might think, and many new nurses are currently having trouble finding work. It is not at all uncommon to find older nurses who are thoroughly burnt out, have little enthusiasm left for patient care, yet continue to work solely “because there’s a mortgage to pay,” – in all seriousness I quote an actual example, currently still working with no incentive whatsoever to provide anything beyond the absolute minimum, service with a scowl. Which is exactly what she provides.
Communism, it turns out, is alive and well, in the U.S. health care system – leaders pretend to pay for quality, and workers (many, anyway) pretend to provide it.
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