The WHO assessed the world's health systems and found that the US ranked 37th. This number has been bandied about a great deal, and my fellow blogger at "What the Hey", after hearing this number on "Sicko", followed her curiosity to find out where it came from. The result is a thought-provoking post that I hope will be followed by a post of her own thoughts on the WHO assessment.
Please read the WHO article on the assessment for yourself. Once you do, read on to hear my own thoughts on the article.
The main thing I want to draw attention to is this paragraph:
"In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country's system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country's system has accomplished in comparison with those of other countries." (emphasis mine)
The bolded part is confusing and inappropriate, unless this explanation of the measurement gets passed along every time someone quotes the ranking of a country from this report. When we hear that the US is ranked 37th, we expect that the US is being ranked against only the other countries, not also against the level of resources available in that country. We automatically say, "With our resources, why aren't we #1?" The answer is, it is because of our resources that we are so very low. Because we have much, much is being expected of us. This fact needs to be made clearer when people pass these facts along. Even better, the WHO should focus on a ranking based on just the italicized (by me) portion, and give the other ranking as a supplementary statistic.
My other issue is that there was no mention of weighting the indicators. Overall health and distribution of health were only two of five indicators - were they also only 2/5ths of the weight? In my opinion, these indicators are far more important than the others. These indicators represent the goal of a health care system: healthy people. The other indicators - responsiveness, distribution of responsiveness, and distribution of cost - seem to me to be fundamentally different, more ways to reach both overall health and a good distribution of health than actual ends in and of themselves. I also do not think distribution of cost should be included, but rather that the WHO should measure people's ability to attain healthcare at all after meeting their other necessities. Otherwise, they are measuring not the health care system itself, but people's access to luxeries after buying health care - which is not the sole perogative of the health care system.
I thought this statement was a bit strange: Dr. Frank said, "What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich." Why is this, specifically, a problem? The poor also pay a greater portion of their income on food and on housing, I would guess. It is no surprise to me that the poor spend a higher portion of their money any given necessity than the rich. As long as the combination of necessities (including taxes) does not exceed 100% of the amount of money a person / family can reasonably earn, I think that there is no moral obligation to fix the situation. While I would be thrilled to support a national policy that seeks to free up, say, a minimum 5% of EVERYONE's income for luxeries after necessities like health care, food, utilities, and shelter (assuming the person is making a reasonable effort to earn the cost of necessities + 5%) - I don't feel we have a moral obligation to do so.
I guess that my question is, why does health care get preferential treatment over food and shelter, such that all *should* pay a flat portion of their income? Why don't we tax to provide all with basic food, as well? And shelter? How many countries give tax-supported food and shelter universally? I'm skipping the standard discussion of socialism here. My point is that, while I support universal health care in the US, I do not think that a health care system that results in the poor paying a higher portion of their income to health care is innately less fair - and therefore, the WHO should not be measuring this "indicator". I believe that universal health care is better, but that is more because I believe that improving quality of life for the poor in general benefits all of society greatly. There are many ways we can spend money improve the quality of life for the poor to get closer to achieving the maximum net benefit for society; universal health care simply seems to be the easiest at the moment. However, we could instead provide universal food and housing vouchers, freeing up money to be spent on healthcare instead - just as one example, I'm not seriously proposing we do this.
I am also suspicious about other hidden values (beyond the clear bias towards universal health care / evenly portioned health care costs), although this one article doesn't have the information I need to assess this. I want to know what "respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health)" includes, for example, under responsiveness. I want to know if that includes things like easy-access abortion "rights" for women (at the expense of the fetus' right to live, and the doctor's right to keep his job without performing what he may believe is murder, etc.) - as just one example of a possible innapropriate attempt to measure healthcare quality that might fall under this bucket, but is based on a set of health values that is not universally shared. I personally would argue that enabling abortion decreases health, since it ends many human lives that could have lived, if only there were a better support system for the woman's pregnancy and the child's care after birth. The WHO assessment may not include such non-universal ideas of health under responsiveness; however, I want to find the time to track the information down so I can know for sure.
Wednesday, March 26, 2008
Tuesday, March 25, 2008
Neat poem about St. Brigid
I ran across a poem about St. Brigid while looking for prayers to saints Brigid and Bernadette, since those are the saints whose names I borrowed for my children's middle names. It's a cute poem, but I also liked the commentary by the poster:
"There is a problem here. On the one hand, it can be argued that if our family members do not choose to make sacrifices for God we have no right to make that choice for them. . . . On the other hand, I far more frequently hear Christians argue that their sacred duty to keep everything nice for their spouses and children prevents them . . . from volunteering even quite moderate amounts of their time and money for worthy causes down the block. . . . You will note that Saint Paul, writing to the Corinthians, told them that marriage, while instituted of God and a sign of the union between Christ and His Church, was not without its dangers to the spiritual life of the Christian. But the danger he saw had nothing to do with sex. He was concerned instead that the married are tempted to overvalue security, to feel that they cannot afford, for their families' sakes, to take chances. . . . I have no final answer to give, but commend it to your consideration."
This really hits home. It's a dilemma that takes on a different shape for me, since I am the Catholic half of a mixed-faith family where the other half is agnostic. Right now I know I should be pushing to share more of our family's gifts with others - and yet, and yet . . . you can probably guess the myriad of ways that I end that phrase which begins "and yet". If you do not suffer from "and yets" yourself, undoubtedly you know someone who does.
There is one "and yet" that is worth mentioning: God has given me many gifts and resources, and yet I do not know, at this point, just how he is calling me to use them.
For now, I think God will be most pleased by me adding prayer and discernment into my life. But just in case, maybe I should start praying this little prayer: "If I'm wrong about Your Will, Lord, please hit me over the head with my mistakes so that I cannot ignore You, and lovingly correct my errors. Amen." A cheeky prayer, perhaps, but I believe it is also sincere.
"There is a problem here. On the one hand, it can be argued that if our family members do not choose to make sacrifices for God we have no right to make that choice for them. . . . On the other hand, I far more frequently hear Christians argue that their sacred duty to keep everything nice for their spouses and children prevents them . . . from volunteering even quite moderate amounts of their time and money for worthy causes down the block. . . . You will note that Saint Paul, writing to the Corinthians, told them that marriage, while instituted of God and a sign of the union between Christ and His Church, was not without its dangers to the spiritual life of the Christian. But the danger he saw had nothing to do with sex. He was concerned instead that the married are tempted to overvalue security, to feel that they cannot afford, for their families' sakes, to take chances. . . . I have no final answer to give, but commend it to your consideration."
This really hits home. It's a dilemma that takes on a different shape for me, since I am the Catholic half of a mixed-faith family where the other half is agnostic. Right now I know I should be pushing to share more of our family's gifts with others - and yet, and yet . . . you can probably guess the myriad of ways that I end that phrase which begins "and yet". If you do not suffer from "and yets" yourself, undoubtedly you know someone who does.
There is one "and yet" that is worth mentioning: God has given me many gifts and resources, and yet I do not know, at this point, just how he is calling me to use them.
For now, I think God will be most pleased by me adding prayer and discernment into my life. But just in case, maybe I should start praying this little prayer: "If I'm wrong about Your Will, Lord, please hit me over the head with my mistakes so that I cannot ignore You, and lovingly correct my errors. Amen." A cheeky prayer, perhaps, but I believe it is also sincere.
Health care
I love having good health care. It's an unspeakable luxury, and yet it is such a basic necessity as well. Because of my employer's policy of providing employees and their families with great care for no cost to the employee, we've been able to visit the doctor as much as we needed without a second thought - and haven't paid a single cent yet. After years of having no health care, limited care, or expensive care - well, not even having a second thought about receiving good care is a major relief.
But you know what? After spending years with no health care, I would gladly lose some of the quality of my current health care to have universal health care in this country. What good is quality when so many people receive little care at all?
I would settle for good, free care for all people under the age of 18 (or 21 - to give young folks a chance to get their feet on the ground). I understand that some people hate giving others a free ride for even the most basic necessities, and don't agree with me that the benefits outweigh the costs. But seriously, people, give the kids health care at least. Don't make someone choose between taking her child to the doctor for a check-up or paying the electric bill, and don't make a child's health suffer for their parent's poverty. I'd like to see people covered through age 21 - buying healthcare in college was a joke for me, even at the low rate of about $550 a quarter.
But you know what? After spending years with no health care, I would gladly lose some of the quality of my current health care to have universal health care in this country. What good is quality when so many people receive little care at all?
I would settle for good, free care for all people under the age of 18 (or 21 - to give young folks a chance to get their feet on the ground). I understand that some people hate giving others a free ride for even the most basic necessities, and don't agree with me that the benefits outweigh the costs. But seriously, people, give the kids health care at least. Don't make someone choose between taking her child to the doctor for a check-up or paying the electric bill, and don't make a child's health suffer for their parent's poverty. I'd like to see people covered through age 21 - buying healthcare in college was a joke for me, even at the low rate of about $550 a quarter.
Three different family styles
My husband and I are in the unusual position of having tried three very different family styles during the last two years. We've been a traditional family, a two-income family, and a reverse-traditional family.
We first went to the "traditional" family three months before I gave birth to our twins. We didn't really have a choice. I was having trouble working due to painful side effects of the pregnancy, and had to quit. I stayed home until the girls were 8 months old. I can see why this has been a favorite family structure for so long. Breastfeeding was easier, and both my husband and I were well-supported in our new roles as SAHM (stay at home mother) and WOHF (work outside the home father). Our children and home got my full attention, and I knew that what I was doing was important and would change the world. I also enjoyed doing something so new (to me) and challenging. I loved staying home, and if DH had loved his job and made enough money I would probably still be staying home and just doing software work as a volunteer and for a hobby.
The killer disadvantage of the "traditional" family was that it wasn't economically feasible, for us. DH just didn't make enough at his job to cover health care, even with WIC helping to cut our grocery costs. We were still several hundred dollars short each month, and by the time I returned to work we were paying for groceries on our credit cards. DH also didn't enjoy his job, and didn't feel that it was particularly stable. So back to work I went.
Being a two-income, egalitarian family is nice in concept but difficult in execution. We had great, guilt-free childcare provided by my MIL three days a week, and DH worked four tens with Tuesday and Wednesday off - so he could take the girls two days a week. However, he worked late hours. Housework was still largely on my shoulders, although DH helped a lot with dinner and laundry. DH worked late, so four nights a week I put the girls to bed alone. Three days a week I did this after a busy day of work, not eating dinner until after 8:00 pm when they fell asleep, then stayed up until nearly 11:00 cooking, doing housework, showering, and getting ready for the next day.
The switch to a reverse-traditional family wasn't a new idea for us. We'd toyed with the idea of a stay-at-home dad since we were dating. At first the idea was just something thrown out, one of many possible futures together, barely glanced at before the conversation turned to something else. With me now being exhausted by trying to "do it all", we quickly picked the discussion up in earnest. Six months after starting the two-income routine, Bjorn quit - with envious encouragement from his coworkers (who were all laid off nine months later).
The hardest part of the reverse-trad family, for us, was figuring out where the lines were while Bjorn ramped up. I think people often don't realize how many skills housework and parenting take. Most of us who are (or have been) highly involved in homemaking built a large repetoire of skills over the course of our childhoods. Our mothers taught us their own skills. However, it seems like women get an unfair advantage in the homemaking department - and that was definitely true with Bjorn and me.
The result was a long ramp-up period for Bjorn. While he had very solid fathering skills, his homemaking-while-fathering skills hadn't really been honed. I, on the other hand, had very strong opinions about nutrition, cleanliness, and parenting. Letting go of the homemaking sphere is actually very difficult for me, and I still continue to do more homemaking and exert more control over the family sphere than a normal breadwinner.
That meant that I came home to a messy house and lots of work in the evenings still - but I wasn't on my own in the evenings anymore. Bjorn wasn't having his energy sapped by a job. Without the expenses of Bjorn working, we were even coming out a little ahead financially. Since he quit, we've been working on balancing homemaking work: He's been learning how to do more, I've been learning where I feel comfortable letting things go, and he's been learning to tell me when I'm being a busybody and need to back off and trust him. We still use a lot of temporary solutions, like the "honey-do" list (IM messages from me at work, now starting to become a two-way support system), but overall things are falling into place.
The other disadvantage of the reverse-trad family is subtler: Support is mixed. Some people supported us enthusiastically. Bjorn's coworkers saw him getting out of the rat-race, and cheered him. My coworkers saw me as a great example of a feminist, and seemed to appreciate that I would be staying in my career long-term. However, older people seem to be confused by a woman who "chooses" to work, and my more-traditional family ranges from supportive to one member who informed me that, as a woman, my job was inherently less stable than my husband's (this was before his entire team was notified that they would be laid off) - and also that I would never be able to bear being away from my children (to her credit, I sometimes have to remind myself that my paycheck is a form of parenting - I am providing food, shelter, clothing, and more to my kids when I am at work, so I am still mothering). However, this problem is fading as those who know us see things working and adjust, and as we become used to the slightly surprised or confused reactions (and even enjoy them a little).
The reverse-trad family isn't right for most families, but it also tends to be overlooked sometimes. In general, I think families that choose a smaller income and fewer hours at work don't get the acknowledgement that they deserve - nor do we recognize the skills, energy, and quality of life that homemakers and childcare providers give us. There's more to quality of life than a GDP, after all.
We first went to the "traditional" family three months before I gave birth to our twins. We didn't really have a choice. I was having trouble working due to painful side effects of the pregnancy, and had to quit. I stayed home until the girls were 8 months old. I can see why this has been a favorite family structure for so long. Breastfeeding was easier, and both my husband and I were well-supported in our new roles as SAHM (stay at home mother) and WOHF (work outside the home father). Our children and home got my full attention, and I knew that what I was doing was important and would change the world. I also enjoyed doing something so new (to me) and challenging. I loved staying home, and if DH had loved his job and made enough money I would probably still be staying home and just doing software work as a volunteer and for a hobby.
The killer disadvantage of the "traditional" family was that it wasn't economically feasible, for us. DH just didn't make enough at his job to cover health care, even with WIC helping to cut our grocery costs. We were still several hundred dollars short each month, and by the time I returned to work we were paying for groceries on our credit cards. DH also didn't enjoy his job, and didn't feel that it was particularly stable. So back to work I went.
Being a two-income, egalitarian family is nice in concept but difficult in execution. We had great, guilt-free childcare provided by my MIL three days a week, and DH worked four tens with Tuesday and Wednesday off - so he could take the girls two days a week. However, he worked late hours. Housework was still largely on my shoulders, although DH helped a lot with dinner and laundry. DH worked late, so four nights a week I put the girls to bed alone. Three days a week I did this after a busy day of work, not eating dinner until after 8:00 pm when they fell asleep, then stayed up until nearly 11:00 cooking, doing housework, showering, and getting ready for the next day.
The switch to a reverse-traditional family wasn't a new idea for us. We'd toyed with the idea of a stay-at-home dad since we were dating. At first the idea was just something thrown out, one of many possible futures together, barely glanced at before the conversation turned to something else. With me now being exhausted by trying to "do it all", we quickly picked the discussion up in earnest. Six months after starting the two-income routine, Bjorn quit - with envious encouragement from his coworkers (who were all laid off nine months later).
The hardest part of the reverse-trad family, for us, was figuring out where the lines were while Bjorn ramped up. I think people often don't realize how many skills housework and parenting take. Most of us who are (or have been) highly involved in homemaking built a large repetoire of skills over the course of our childhoods. Our mothers taught us their own skills. However, it seems like women get an unfair advantage in the homemaking department - and that was definitely true with Bjorn and me.
The result was a long ramp-up period for Bjorn. While he had very solid fathering skills, his homemaking-while-fathering skills hadn't really been honed. I, on the other hand, had very strong opinions about nutrition, cleanliness, and parenting. Letting go of the homemaking sphere is actually very difficult for me, and I still continue to do more homemaking and exert more control over the family sphere than a normal breadwinner.
That meant that I came home to a messy house and lots of work in the evenings still - but I wasn't on my own in the evenings anymore. Bjorn wasn't having his energy sapped by a job. Without the expenses of Bjorn working, we were even coming out a little ahead financially. Since he quit, we've been working on balancing homemaking work: He's been learning how to do more, I've been learning where I feel comfortable letting things go, and he's been learning to tell me when I'm being a busybody and need to back off and trust him. We still use a lot of temporary solutions, like the "honey-do" list (IM messages from me at work, now starting to become a two-way support system), but overall things are falling into place.
The other disadvantage of the reverse-trad family is subtler: Support is mixed. Some people supported us enthusiastically. Bjorn's coworkers saw him getting out of the rat-race, and cheered him. My coworkers saw me as a great example of a feminist, and seemed to appreciate that I would be staying in my career long-term. However, older people seem to be confused by a woman who "chooses" to work, and my more-traditional family ranges from supportive to one member who informed me that, as a woman, my job was inherently less stable than my husband's (this was before his entire team was notified that they would be laid off) - and also that I would never be able to bear being away from my children (to her credit, I sometimes have to remind myself that my paycheck is a form of parenting - I am providing food, shelter, clothing, and more to my kids when I am at work, so I am still mothering). However, this problem is fading as those who know us see things working and adjust, and as we become used to the slightly surprised or confused reactions (and even enjoy them a little).
The reverse-trad family isn't right for most families, but it also tends to be overlooked sometimes. In general, I think families that choose a smaller income and fewer hours at work don't get the acknowledgement that they deserve - nor do we recognize the skills, energy, and quality of life that homemakers and childcare providers give us. There's more to quality of life than a GDP, after all.
Should really start posting some of these old drafts . . .
I seem to keep writing drafts, and then not publishing them. Often, these are the posts where I am noting my opinions on things that matter to me. I think I kind of chicken out, heh. Other times, they are posts about things going on in my life that never got finished because, well, when things happen in my life I just get really busy.
Then I get some time to blog, but because I have something else that I want to say I don't post the old posts. And I feel awkward posting twice in one day before going silent for a week or two, so I tell myself I'll do it tomorrow.
I'm going to quit doing that. Just an FYI, you may see several posts in one day - and then nothing for a while. This blog really is intended to be more like a public diary, and diaries shouldn't have to keep schedules.
Then I get some time to blog, but because I have something else that I want to say I don't post the old posts. And I feel awkward posting twice in one day before going silent for a week or two, so I tell myself I'll do it tomorrow.
I'm going to quit doing that. Just an FYI, you may see several posts in one day - and then nothing for a while. This blog really is intended to be more like a public diary, and diaries shouldn't have to keep schedules.
Thursday, March 20, 2008
I am a "family man"? or, The search for labels that I like
For some reason, stepping outside of the normal roles for men and women by becoming a "reverse-traditional family" has made me crave definition. I think it is the fear that people will assume I am a "career woman", putting the "fulfillment" and "stimulation" of the adult workplace before my family - with the implication that I don't find my family to be important, fulfilling, or stimulating.
This probably sounds a bit silly, but having a label helps me work out the appropriate expectations for me to have of myself. I am very used to being the main person doing the housework, since during the early relationship and before I went back to work after the girls were born I did a great deal of the homemaking. I can easily start to feel responsible for too much, and start trying to control things that are now in my husband's sphere of life. Labels give me stereotypes that I can use for role models.
I finally realized what kind of label feels right. I want a female version of "family man". You know, the guy who has a steady, stable job and gets promotions - but never at the expense of his family. He's there for his kids' birthdays, he picks up the groceries and runs errands on his way home from work, and he helps out around the house. Of course, I am not identical to this old, comfy stereotypical man. When at home, I mother - my parenting has a distinctly female style to it. I also do "woman's work" at home - I cook meals rather than do repairs, and fold laundry.
Whatever I am, I absolutely am not a stereotyped career woman, although I am a woman with a career. I will probably get raises and climb the career ladder and be proud of what I do at work - I might as well enjoy myself, since I am stuck there for at least 40 hours a week either way. But ultimately, my job is an extension of my work as a parent.
Whew. I needed to get that out there. Now I've stated my position clearly, and I can quit feeling defensive. LOL, it should be so easy!
Oh, right, we moved into our first owned home. Well, we own it - but we also own a 30 year mortgage that comes with it. I should mention that. And probably blog about it. But that's old news, we moved on Monday the 17th.
This probably sounds a bit silly, but having a label helps me work out the appropriate expectations for me to have of myself. I am very used to being the main person doing the housework, since during the early relationship and before I went back to work after the girls were born I did a great deal of the homemaking. I can easily start to feel responsible for too much, and start trying to control things that are now in my husband's sphere of life. Labels give me stereotypes that I can use for role models.
I finally realized what kind of label feels right. I want a female version of "family man". You know, the guy who has a steady, stable job and gets promotions - but never at the expense of his family. He's there for his kids' birthdays, he picks up the groceries and runs errands on his way home from work, and he helps out around the house. Of course, I am not identical to this old, comfy stereotypical man. When at home, I mother - my parenting has a distinctly female style to it. I also do "woman's work" at home - I cook meals rather than do repairs, and fold laundry.
Whatever I am, I absolutely am not a stereotyped career woman, although I am a woman with a career. I will probably get raises and climb the career ladder and be proud of what I do at work - I might as well enjoy myself, since I am stuck there for at least 40 hours a week either way. But ultimately, my job is an extension of my work as a parent.
Whew. I needed to get that out there. Now I've stated my position clearly, and I can quit feeling defensive. LOL, it should be so easy!
Oh, right, we moved into our first owned home. Well, we own it - but we also own a 30 year mortgage that comes with it. I should mention that. And probably blog about it. But that's old news, we moved on Monday the 17th.
Wednesday, March 5, 2008
Still overwhelmed . . . and I hate parties.
I don't seem to have the drive for consistent blogging, but I guess that's not a big deal. I always half expected by blog to be more of a personal journal than anything. I just don't have the energy to try and coax people to read my words.
Right now, I am depressed. And for one of the silliest reasons in the world, too: I just went to a party. My team just shipped Beta 1 of Internet Explorer 8, and so today was a day of celebration.
I thought I'd gotten over that "alone in a crowd" feeling back in high school or maybe as late as college. Nope. It's still there. Fortunately, I'm now smart enough to just go take a break rather than try and tough it out, but I'm still feeling very depressed after an afternoon of good (free!) food, socialization, playing Rock Band, and getting free drinks (both alcoholic and caffeinated). Each activity was enjoyable in and of itself, but altogether something was just overwhelming for me.
What a silly disabilty to have. Party-fun challenged. Erg, needs a better name. Maybe I'll grab a thesaurus and make something up later.
Right now, I am depressed. And for one of the silliest reasons in the world, too: I just went to a party. My team just shipped Beta 1 of Internet Explorer 8, and so today was a day of celebration.
I thought I'd gotten over that "alone in a crowd" feeling back in high school or maybe as late as college. Nope. It's still there. Fortunately, I'm now smart enough to just go take a break rather than try and tough it out, but I'm still feeling very depressed after an afternoon of good (free!) food, socialization, playing Rock Band, and getting free drinks (both alcoholic and caffeinated). Each activity was enjoyable in and of itself, but altogether something was just overwhelming for me.
What a silly disabilty to have. Party-fun challenged. Erg, needs a better name. Maybe I'll grab a thesaurus and make something up later.
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