As we approach two years out, a quick perusal of the blogosphere turns up more than a little Katrina backlash going on.
Much of it comes, sadly, from outright ignorance. Let's spend a few minutes, shall we?, responding to just a few of my favorite misconceptions:
"Isn't the Gulf Coast rebuilt yet? The government pumped in $100 billion already!"
Get on a plane to the Coast and you'll see for yourself the status of rebuilding. GulfCoastNews.com has a great article summing up where the Coast is and why it is so far from what any sane person would consider normalcy. They also correctly point out that $100 billion has been allocated; the actual amount being used is far, far less. A major reason I left the Coast was a belief that this recovery is going to take many, many years--I'll now say more than a decade--and I wasn't prepared to sacrifice my sons' childhood(s) to that.
"Those people living in trailers must be plain lazy if they haven't rebuilt their homes yet."
Ah, this one never gets old. For those who insist that there's been more than enough opportunity to rebuild, let's do the math, using some very rough estimates:
* Assume 5000 homes needing repair or rebuilding in Waveland and Bay St Louis (this, of course, leaves out Pass Christian, Long Beach, Gulfport, Biloxi, and New Orleans; I'm confining this example to the area I know best)
* Assume your average contractor has repaired and/or rebuilt 5 homes in the past 2 years (this might be generous, since my experience says a new home takes over six months to build, and almost nothing was started in Bay-Waveland until at least late winter-early spring 2006; then again, not every home needed to be rebuilt from scratch; maybe only a third? Which is actually a staggering number, so we'll keep that estimate where it is.)
* For all the homes to have been repaired within 2 years, that would mean 1000 contractors in the area. Now all of you out there who think there are 1000 contractors in Hancock County, please raise your hands. And that doesn't include the subcontractors and workers. By the time you add it all up, for all the homes to be rebuilt, the area population would have to be comprised entirely and exclusively of construction workers. And then you're left with wondering where they'd be living, since they're busy fixing other people's homes.
This little scenario also assumes that everyone received a fair settlement on their home and can afford to rebuild. Which leads to...
"If I was in that situation, I'd just pick up and leave."
Set aside emotional, historical, and family ties to the area. Financially, many residents are between the rock and hard place and Hell. They still owe a mortgage on a property which in many cases may be a slab. They can't afford to rebuild, since--oh, who knows why, maybe the insurance companies didn't give them a fair shake, maybe they didn't have flood insurance, maybe they didn't qualify for the Mississippi grant program, maybe they already lost a few thousand to a crooked contractor. And they can't sell the property since the real estate market has tanked. There are a record number of properties for sale--and a record low number of buyers. News flash, no one wants to buy a home in Bay-Waveland right now. Did I mention the astronomical price of wind insurance?
Your options? Keep trying to get by, sell the property at a major loss, or foreclose. That's about it. Which would you choose? Oh, by the way, it might be hard moving to a new place with no money and/or no credit...
And, finally,
"You people get what you deserve for living below sea level."
Um, Bay St Louis is 20 feet above sea level. It's actually the highest point on the entire frickin' Gulf Coast. That didn't mean much against a 30-foot storm surge. Which is pretty hard to imagine, but hey, it happened.
Why blame the victims? Why wallow in, and almost gleefully celebrate, the ignorance? Has anyone said those Minnesotans should have known not to trust an old bridge? Were New Yorkers at fault for living in the most prominent American city on 9/11/01? Why haven't we started yelling at the populations of Key West, Miami, coastal North Carolina, Galveston to pick up and leave, MORONS, before the next hurricane strikes and we have to clean up your mess, you crybabies? Why stop there--why should we feel sympathy or even responsibility for a post-earthquake San Francisco, a snow-bound Rochester, a flooded-from-broken-levee Fresno, a water-parched Las Vegas, a terrorist-hit Washington DC?
Is it simply Katrina fatigue? After the emotional drains of 9/11 and school shootings and war in Iraq, do we just have nothing left?
Is the dismal recovery simply too unbelievable to comprehend? Perhaps many Americans have a hard time accepting that the government of their great country could have been so callous and incompetent, and therefore they rationalize and project that the Coast's residents simply must have had a larger role in the current failures.
Or is it about southern rednecks of Mississippi hick-towns and dangerous inner-city blacks in New Orleans ghettos? Who must have been in their pre-Katrina situations due to their own slothfulness and moral failure? Are we in the throes of a neo-Puritanism revival that insists people's destiny is entirely self-determined and not subject to the earthly influences of the material world around them? Or even better, perhaps we'll just go all-out-Calvinistic (and no, don't go all Calvin-and-Hobbes on me, that's not what I'm talking about): these people are poor and uneducated because God has deemed they should be that way! We should no more feel pity on them or help them than we should try to improve the lot of a common dog!
Whatever the motivation behind the ignorance, perhaps the most concerning aspect is the fact that its adherents feel so free to profess it, with vehemence and self-righteousness. Perhaps we can thank Rush Limbaugh, and his protege, Bill O'Reilly, for the decline in courteous civil discourse in America today. Then again, the anonymity of the blogosphere certainly tempts many to more extreme emotions, outright provocation, and a lack of responsibility.
I enter a plea for tolerance, or at least, respect. In other words, stop the hatin'. Don't go spouting off on topics you know very little about; take the time to listen to the stories from the Coast. As anyone who has visited the region--let alone lived there--can tell you, it's all far worse and more overwhelming than you have been led to believe, or can even imagine.
But enough preaching, let alone to the choir. Good night, peace, and God bless.
Showing posts with label Katrina. Show all posts
Showing posts with label Katrina. Show all posts
Tuesday, August 21, 2007
Sunday, June 24, 2007
Enough
A few weeks ago I hinted at a Big Project.
Enough waiting: The Project has culminated.
Dr. Scott has left the building.
Or rather, Dr. Scott has closed his doors. His practice is no more. He has had enough, and has left the Gulf Coast.
Some of you reading this blog admired me for staying. Staying wasn't about courage. It was about caring, and hope; nothing more. I still have my caring; indeed, if not, I would have left Mississippi long ago. In fact, that was the only thing keeping me, and it was a damn big thing, almost trumping all else. But the hope has gone.
I'm writing this to explain my actions, not for my own defense, but to give you some insight into the Gulf Coast, post-Katrina. To give insight as to what would make a pediatrician committed to his community finally leave, as to how even hope can be extinguished.
To let you know how much we have failed the Gulf Coast, and how this country as a whole (and especially its leadership) has given up on any pretense of caring. And I use "failed" in the past tense. The damage has been done. Indeed, that is probably the biggest reason why I decided to leave. If no one has come to help yet, and no one is planning to help, then no one will be helping in the future either. (Apologies to those individuals who did come, and gave time and sweat; I hope it's clear that my ire is dedicated to the greater government and the "compassionate conservatives" who support it and believe we on the Gulf Coast just need to hoist ourselves up by our own bootstraps and stop being such ignorant, lazy, greedy whiners.) We had so many chances to turn things around, to set it right. But instead we are condemning New Orleans and Waveland, Mississippi to poverty, third-class status, forever mired in what the rest of the nation thought they were like anyway; ah, the self-fulfilling prophecy. We have doomed a entire generation of children and we have crushed their chances of normalcy, of resiliency, of trust.
When George W. Bush spoke in New Orleans days after Katrina, he promised to do whatever it took to set things right. He gave us hope. He didn't have to say those words. He could have expressed sympathy, mentioned that "the nation stands with you as you rebuild," et cetera, et cetera, et cetera. But instead he promised action. The terrible tragedy would be met with just as equally awesome a recovery.
Perhaps the only thing worse than no hope is false hope. Hear me out: no hope leads to reasonable expectations. No one is coming; make your plans accordingly. False hope, on the other hand, encourages you to go to the brink, even over it. I may be near the end of my rope, my finances, my energy, but at least the cavalry is coming. Until you finally realize that it isn't. And then it's too late, and the anger comes forth.
Debate all you want about Iraq and if Bush lied about what he knew and how we ended up in that quagmire. I know this: Bushie lied about helping out after Katrina. A year and a half after Katrina we learned what many insiders knew all along. He had the authority to waive the Stafford Act's requirement of a local 5-10% match for recovery efforts. It was waived, by executive order, after Hurricane Andrew. It was waived after 9/11. Not for Katrina.
5-10% may not sound like much. But for Waveland, it was. When 90% of your housing is damaged, it's too much. When every component of infrastructure needs rebuiling--sewer, water, electricity, roads, government buildings, police and fire, should we keep going?--it's too much. When you no longer have a tax base to speak of, it's too much.
Ah, we should have just called it quits at that point. But our president promised to set things right, so we stayed.
The government has done NOTHING for healthcare after Katrina. No, let me clarify: it has done nothing for the private practitioner. There was an uncompensated care pool that helped hospitals from August 29, 2005 through January 31, 2006 (oh! so generous!). Hospitals and nursing homes can apply for part of a $160 million pool just released by Health and Human Services (though allocated from the Deficit Reduction Act of 2005--but what's two years among friends?) Oh, New Orleans also gets $10 million to recruit new "providers" into the area (whatever that term means). The ones already here get a big fat F*** You.
Not even a thank you.
Mere days after Katrina officials on the state and federal levels were being told--from people on the ground--what needed to be done. Increase Medicaid reimbursement for pediatricians treating Katrina survivors (both the ones remaining on the Gulf Coast and the ones dealing with the flood of evacuees in Baton Rouge, Houston, and the like). Reimburse for the surge of uninsured patients. Give government resources such as trailers for office space so local MDs can start seeing patients again. None of these suggestions--or others--has been even considered, let alone debated or implemented.
Here's my practice situation: since Katrina my office rent has doubled (I had to move out of my first office after it was destroyed). The rest of the overhead hasn't gone down any, what with added "fuel surcharges," inflation, and the like. My practice was 65% Medicaid--same as before Katrina, though it was still enough to keep the practice thriving beforehand. But the number of self-pay tripled. And the overall numbers? Not as many kids here now. And there won't be for a long while, if there is no affordable housing for families, and it's not the best environment for families anyway.
Oh, in the meantime, I just got the bill for my wind insurance premium, under the state wind pool. $6500. That is not a typo. Good thing we sold the house--though our realtor said we were miraculously lucky, since it was apparently the first house to sell in Waveland this year. Yes, one home sale in six months. No one wants to buy housing, no one wants to move in anymore, and certainly no one can afford the insurance to stay.
Prediction: look for the number of foreclosures to skyrocket in the next 12 months.
And then there is the obvious psychological stress and burnout. Seeing the debris every single day, the construction vehicles, the abandoned homes still waiting to be demolished, the streets being torn up for new sewer pipes and electric conduits. No relief, ever. Granted, everyone in town is in the same boat, which means at least we all understand each other's plight, but then again, it means it's the number one topic of conversation every day.
It hit home when I went to Washington last month for a conference. On the Metro, I didn't hear people asking, "how's your home coming along?" No one on the street mentioned about SBA, FEMA, or insurance. Oh, and things were green; trees weren't snapped; residential lots had nice houses, not abandoned concrete slabs; there were children playing in yards; malls and stores and farmer's markets to visit, restaurants to enjoy; the things that make life nice. That's not life on the Gulf Coast. The Gulf Coast is now a toxic environment.
If anyone from the Gulf Coast reads this, they might protest I am overlooking the good, the progress. Yes, the Coast is being rebuilt. The Bay St Louis-Pass Christian bridge just reopened in May, to much fanfare. (It may sound silly for those of you out of the area, but the importance of that bridge cannot be overstated; it's a real milestone in the recovery of both towns.) But let me remind you that the bridge took 21 months to open. The CSX railroad bridge across the same channel was rebuilt in only 6 months, by private industry. The Biloxi-Ocean Springs bridge isn't set to open until this November. Here we are two years after Katrina and we're still talking about rebuilding basic infrastructure. This is inexcusable. If we're at this point after all this time, it will be another 10 years before we're anywhere close to a normal town, a normal life.
Or longer. I've heard that Homestead, Florida still hasn't recovered from Andrew, now some 20 years ago. I worry that Waveland and New Orleans might never fully recover now. The people with the means are leaving, or working themselves into debt and exhaustion. The only ones left will be the working poor. Maybe some big condo developers will come in--though that in turn would utterly destroy everything that Waveland was.
And maybe the answer is, "so what?" So what if condos come in? Situations change, towns change. So what if Dr. Scott leaves town? (There are still two other pediatricians around.)
I think these things do matter. I do think my leaving has negative consequences for the community. I don't say this simply because I want to feel valued or self-important; I think even if one of the other pediatricians left instead the children of our town would be affected, and for the worse. The community as a whole is worse off.
We have the means to fix these problems, at our fingertips. But they require money. I decided to leave town for many reasons, but finances were at the top. I simply couldn't keep the doors open anymore--and I had the opportunity to leave for a better (and more pleasant and less stressful) life elsewhere.
Bush didn't say that we would rebuild New Orleans "if the budget allowed." I don't see Bush hemming and hawing about the bill for the war in Iraq. We can spend over a trillion dollars on a war of dubious necessity. But we can't find the money to restore healthcare or infrastructure to our own Gulf Coast.
Forgive me for playing the martyr, but I feel like I've been caring for the children of Waveland and Bay St Louis on my own back and on my own dime. I can't do it by myself anymore, and if no one is coming to help, it can longer be my problem. I have to think of the well-being of my own children, of my wife, and of myself.
This blog will continue; there's still more Katrina Story to tell, not to mention more insights into the whole big exciting world of medicine and pediatrics. And I won't forget those I've left behind. In fact, the intersection of disasters and medicine promises to continue to occupy my professional life for a while to come. But it won't be from Waveland, Mississippi. I leave the Gulf Coast with a heavy heart, but I'm excited to be leaving and starting new.
Bay St. Louis Pediatrics
February 22, 2004 - June 15, 2007
Enough waiting: The Project has culminated.
Dr. Scott has left the building.
Or rather, Dr. Scott has closed his doors. His practice is no more. He has had enough, and has left the Gulf Coast.
Some of you reading this blog admired me for staying. Staying wasn't about courage. It was about caring, and hope; nothing more. I still have my caring; indeed, if not, I would have left Mississippi long ago. In fact, that was the only thing keeping me, and it was a damn big thing, almost trumping all else. But the hope has gone.
I'm writing this to explain my actions, not for my own defense, but to give you some insight into the Gulf Coast, post-Katrina. To give insight as to what would make a pediatrician committed to his community finally leave, as to how even hope can be extinguished.
To let you know how much we have failed the Gulf Coast, and how this country as a whole (and especially its leadership) has given up on any pretense of caring. And I use "failed" in the past tense. The damage has been done. Indeed, that is probably the biggest reason why I decided to leave. If no one has come to help yet, and no one is planning to help, then no one will be helping in the future either. (Apologies to those individuals who did come, and gave time and sweat; I hope it's clear that my ire is dedicated to the greater government and the "compassionate conservatives" who support it and believe we on the Gulf Coast just need to hoist ourselves up by our own bootstraps and stop being such ignorant, lazy, greedy whiners.) We had so many chances to turn things around, to set it right. But instead we are condemning New Orleans and Waveland, Mississippi to poverty, third-class status, forever mired in what the rest of the nation thought they were like anyway; ah, the self-fulfilling prophecy. We have doomed a entire generation of children and we have crushed their chances of normalcy, of resiliency, of trust.
When George W. Bush spoke in New Orleans days after Katrina, he promised to do whatever it took to set things right. He gave us hope. He didn't have to say those words. He could have expressed sympathy, mentioned that "the nation stands with you as you rebuild," et cetera, et cetera, et cetera. But instead he promised action. The terrible tragedy would be met with just as equally awesome a recovery.
Perhaps the only thing worse than no hope is false hope. Hear me out: no hope leads to reasonable expectations. No one is coming; make your plans accordingly. False hope, on the other hand, encourages you to go to the brink, even over it. I may be near the end of my rope, my finances, my energy, but at least the cavalry is coming. Until you finally realize that it isn't. And then it's too late, and the anger comes forth.
Debate all you want about Iraq and if Bush lied about what he knew and how we ended up in that quagmire. I know this: Bushie lied about helping out after Katrina. A year and a half after Katrina we learned what many insiders knew all along. He had the authority to waive the Stafford Act's requirement of a local 5-10% match for recovery efforts. It was waived, by executive order, after Hurricane Andrew. It was waived after 9/11. Not for Katrina.
5-10% may not sound like much. But for Waveland, it was. When 90% of your housing is damaged, it's too much. When every component of infrastructure needs rebuiling--sewer, water, electricity, roads, government buildings, police and fire, should we keep going?--it's too much. When you no longer have a tax base to speak of, it's too much.
Ah, we should have just called it quits at that point. But our president promised to set things right, so we stayed.
The government has done NOTHING for healthcare after Katrina. No, let me clarify: it has done nothing for the private practitioner. There was an uncompensated care pool that helped hospitals from August 29, 2005 through January 31, 2006 (oh! so generous!). Hospitals and nursing homes can apply for part of a $160 million pool just released by Health and Human Services (though allocated from the Deficit Reduction Act of 2005--but what's two years among friends?) Oh, New Orleans also gets $10 million to recruit new "providers" into the area (whatever that term means). The ones already here get a big fat F*** You.
Not even a thank you.
Mere days after Katrina officials on the state and federal levels were being told--from people on the ground--what needed to be done. Increase Medicaid reimbursement for pediatricians treating Katrina survivors (both the ones remaining on the Gulf Coast and the ones dealing with the flood of evacuees in Baton Rouge, Houston, and the like). Reimburse for the surge of uninsured patients. Give government resources such as trailers for office space so local MDs can start seeing patients again. None of these suggestions--or others--has been even considered, let alone debated or implemented.
Here's my practice situation: since Katrina my office rent has doubled (I had to move out of my first office after it was destroyed). The rest of the overhead hasn't gone down any, what with added "fuel surcharges," inflation, and the like. My practice was 65% Medicaid--same as before Katrina, though it was still enough to keep the practice thriving beforehand. But the number of self-pay tripled. And the overall numbers? Not as many kids here now. And there won't be for a long while, if there is no affordable housing for families, and it's not the best environment for families anyway.
Oh, in the meantime, I just got the bill for my wind insurance premium, under the state wind pool. $6500. That is not a typo. Good thing we sold the house--though our realtor said we were miraculously lucky, since it was apparently the first house to sell in Waveland this year. Yes, one home sale in six months. No one wants to buy housing, no one wants to move in anymore, and certainly no one can afford the insurance to stay.
Prediction: look for the number of foreclosures to skyrocket in the next 12 months.
And then there is the obvious psychological stress and burnout. Seeing the debris every single day, the construction vehicles, the abandoned homes still waiting to be demolished, the streets being torn up for new sewer pipes and electric conduits. No relief, ever. Granted, everyone in town is in the same boat, which means at least we all understand each other's plight, but then again, it means it's the number one topic of conversation every day.
It hit home when I went to Washington last month for a conference. On the Metro, I didn't hear people asking, "how's your home coming along?" No one on the street mentioned about SBA, FEMA, or insurance. Oh, and things were green; trees weren't snapped; residential lots had nice houses, not abandoned concrete slabs; there were children playing in yards; malls and stores and farmer's markets to visit, restaurants to enjoy; the things that make life nice. That's not life on the Gulf Coast. The Gulf Coast is now a toxic environment.
If anyone from the Gulf Coast reads this, they might protest I am overlooking the good, the progress. Yes, the Coast is being rebuilt. The Bay St Louis-Pass Christian bridge just reopened in May, to much fanfare. (It may sound silly for those of you out of the area, but the importance of that bridge cannot be overstated; it's a real milestone in the recovery of both towns.) But let me remind you that the bridge took 21 months to open. The CSX railroad bridge across the same channel was rebuilt in only 6 months, by private industry. The Biloxi-Ocean Springs bridge isn't set to open until this November. Here we are two years after Katrina and we're still talking about rebuilding basic infrastructure. This is inexcusable. If we're at this point after all this time, it will be another 10 years before we're anywhere close to a normal town, a normal life.
Or longer. I've heard that Homestead, Florida still hasn't recovered from Andrew, now some 20 years ago. I worry that Waveland and New Orleans might never fully recover now. The people with the means are leaving, or working themselves into debt and exhaustion. The only ones left will be the working poor. Maybe some big condo developers will come in--though that in turn would utterly destroy everything that Waveland was.
And maybe the answer is, "so what?" So what if condos come in? Situations change, towns change. So what if Dr. Scott leaves town? (There are still two other pediatricians around.)
I think these things do matter. I do think my leaving has negative consequences for the community. I don't say this simply because I want to feel valued or self-important; I think even if one of the other pediatricians left instead the children of our town would be affected, and for the worse. The community as a whole is worse off.
We have the means to fix these problems, at our fingertips. But they require money. I decided to leave town for many reasons, but finances were at the top. I simply couldn't keep the doors open anymore--and I had the opportunity to leave for a better (and more pleasant and less stressful) life elsewhere.
Bush didn't say that we would rebuild New Orleans "if the budget allowed." I don't see Bush hemming and hawing about the bill for the war in Iraq. We can spend over a trillion dollars on a war of dubious necessity. But we can't find the money to restore healthcare or infrastructure to our own Gulf Coast.
Forgive me for playing the martyr, but I feel like I've been caring for the children of Waveland and Bay St Louis on my own back and on my own dime. I can't do it by myself anymore, and if no one is coming to help, it can longer be my problem. I have to think of the well-being of my own children, of my wife, and of myself.
This blog will continue; there's still more Katrina Story to tell, not to mention more insights into the whole big exciting world of medicine and pediatrics. And I won't forget those I've left behind. In fact, the intersection of disasters and medicine promises to continue to occupy my professional life for a while to come. But it won't be from Waveland, Mississippi. I leave the Gulf Coast with a heavy heart, but I'm excited to be leaving and starting new.
Bay St. Louis Pediatrics
February 22, 2004 - June 15, 2007
Thursday, May 3, 2007
Katrina in the News
1. From Kevin, M.D.:
Physicians at West Jefferson Medical Center in New Orleans are suing the state of Louisiana for $100 million in uncompensated care after Katrina.
I'm not sure a lawsuit is going to work, but I do admire their chutzpah. Because I don't see the state or federal governments giving any money willingly.
2. From the always astute Dr. Hebert:
The Washington Post reported this week that the federal government declined over $800 million from foreign governments after Katrina. Yes, you heard right. It was offered, and George W. said "no thanks."
Yet our government says it has no money for health care in the Katrina zone (or for waiving the Stafford Act's 10% local match, despite that having been the case for both 9/11 and Hurricane Andrew).
And of course, we have billions and billions for the Army in Iraq, but that's another story.
Which leads to our third and last item for today...
3. President Bush's veto on the troop funding bill was the lead item on the news a day ago. But a tip of the hat to the New Orleans Fox affiliate (Fox 8) for pointing out that the vetoed bill contained more than military matters.
In fact, H.R. 1591 contained billions of dollars for additional Katrina relief.
So yet again, the fate of the Gulf Coast is tied to the Gulf War, and not for the better.
As Nathan McCall said, Makes Me Wanna Holler.
Physicians at West Jefferson Medical Center in New Orleans are suing the state of Louisiana for $100 million in uncompensated care after Katrina.
I'm not sure a lawsuit is going to work, but I do admire their chutzpah. Because I don't see the state or federal governments giving any money willingly.
2. From the always astute Dr. Hebert:
The Washington Post reported this week that the federal government declined over $800 million from foreign governments after Katrina. Yes, you heard right. It was offered, and George W. said "no thanks."
Yet our government says it has no money for health care in the Katrina zone (or for waiving the Stafford Act's 10% local match, despite that having been the case for both 9/11 and Hurricane Andrew).
And of course, we have billions and billions for the Army in Iraq, but that's another story.
Which leads to our third and last item for today...
3. President Bush's veto on the troop funding bill was the lead item on the news a day ago. But a tip of the hat to the New Orleans Fox affiliate (Fox 8) for pointing out that the vetoed bill contained more than military matters.
In fact, H.R. 1591 contained billions of dollars for additional Katrina relief.
So yet again, the fate of the Gulf Coast is tied to the Gulf War, and not for the better.
As Nathan McCall said, Makes Me Wanna Holler.
Wednesday, March 21, 2007
We don't care how they do it in New York, and apparently the feeling is mutual
I caught a glimpse of the NBC Nightly News last week and was surprised to see a feature story about Dr. Persharon Dixon, a pediatrician who left Atlanta to work with the local community health center here after the storm. The health center has her riding around in a mobile van, a rather ingenious setup. The van and her work is sponsored by the Children's Health Fund out of New Yawk.
The broadcast gave me a peculiar feeling of pride, revulsion, and anger.
Only the first emotion is directed at Dr. Dixon. I've met her, and she's a wonderful woman and pediatrician, very sincere and caring. I have nothing but good things to say about her.
The latter two emotions I reserve for the Children's Health Fund.
A mobile health van is a good thing. A community health center is also a good thing. But so are local pediatricians. I don't claim to know the timeline or organization of CHF's involvement with healthcare on the MS coast after Katrina, but I do know this: CHF sure as hell never called me. Not to ask what I thought the kids might need, not to ask how CHF might integrate into the existing health structure, not even how we might work together.
All right, Dr. Scott: be reasonable! They have no obligation to call every pediatrician on the coast. You are a private practice, they hooked up with a non-profit. Besides, they're here helping out, just be grateful and appreciative!
First, there aren't that many pediatric practices on the coast. Here in Hancock County there are three pediatricians, and one of them already works for the community health center. How hard would it have been to pick up the phone and call the other 2 pedi's here?
Second, and more importantly, good intentions are no excuse for arrogance, particularly when intruding on someone's home turf. The CHF has a press release which notes that Mississippi already had pathetic medical care before the storm, and a shortage of primary care physicians. That may be true, but not on the coast. Me and my colleagues are not ignorant back-woods hicks who need us a little edumacation from the big city experts. We need help, not competition. Yes, we can learn from CHF's experience, but they can also learn from ours.
And so, once again, the locals continue to toil for (what somedays appears to be) naught while the out-of-towners grab the attention. "Look! Look at what we are doing for these poor Mississippi children! Look how we are helping when no one else will!"
Go ahead, call it sour grapes. I know I have it coming. But when the spotlight leaves, will the local providers leave also? Having exhausted our resources, with no outside help for us, what will happen then? I hope CHF has a fleet of those mobile health clinics ready, because that's all that may be left for health care on the coast.
The broadcast gave me a peculiar feeling of pride, revulsion, and anger.
Only the first emotion is directed at Dr. Dixon. I've met her, and she's a wonderful woman and pediatrician, very sincere and caring. I have nothing but good things to say about her.
The latter two emotions I reserve for the Children's Health Fund.
A mobile health van is a good thing. A community health center is also a good thing. But so are local pediatricians. I don't claim to know the timeline or organization of CHF's involvement with healthcare on the MS coast after Katrina, but I do know this: CHF sure as hell never called me. Not to ask what I thought the kids might need, not to ask how CHF might integrate into the existing health structure, not even how we might work together.
All right, Dr. Scott: be reasonable! They have no obligation to call every pediatrician on the coast. You are a private practice, they hooked up with a non-profit. Besides, they're here helping out, just be grateful and appreciative!
First, there aren't that many pediatric practices on the coast. Here in Hancock County there are three pediatricians, and one of them already works for the community health center. How hard would it have been to pick up the phone and call the other 2 pedi's here?
Second, and more importantly, good intentions are no excuse for arrogance, particularly when intruding on someone's home turf. The CHF has a press release which notes that Mississippi already had pathetic medical care before the storm, and a shortage of primary care physicians. That may be true, but not on the coast. Me and my colleagues are not ignorant back-woods hicks who need us a little edumacation from the big city experts. We need help, not competition. Yes, we can learn from CHF's experience, but they can also learn from ours.
And so, once again, the locals continue to toil for (what somedays appears to be) naught while the out-of-towners grab the attention. "Look! Look at what we are doing for these poor Mississippi children! Look how we are helping when no one else will!"
Go ahead, call it sour grapes. I know I have it coming. But when the spotlight leaves, will the local providers leave also? Having exhausted our resources, with no outside help for us, what will happen then? I hope CHF has a fleet of those mobile health clinics ready, because that's all that may be left for health care on the coast.
Monday, February 26, 2007
Tourists, Go Home
Ever since Katrina passed through, tourists have been coming here by the carload and busload to see the devastation. On the whole, I've been a supporter of this idea of "disaster tours" or "disaster pilgrimages." As much as you might read or see of Katrina, I assert that words and pictures simply cannot convey the total experience. In order to fully understand Katrina, you must experience its aftermath first-hand: the 360-degree immersion, the assault on all your senses, the mind-numbing sight of block after block of debris and destruction. Even at this late date, 18 months after the storm, most outsiders would be shocked at the extent of what has not been done, and the further publicity of such can only help.
Besides, this event has become part of history, and it's only natural that people will want to come and bear witness, to tell their friends and family, just as crowds flocked to Ground Zero in New York City in the months after 9/11.
All the same, this is not a sterile museum exhibit, or an isolated preserve. People live here. People work here.
About once a week I'll be driving home, and a car ahead of me will stop. In the middle of the street. And people will step out and gape and start taking pictures.
Other times cars will creep along Beach Boulevard at less than 10 miles per hour.
Please, people! I wouldn't drive like that if I came to visit your town!
Yes, by all means, come and see the devastation for yourself. Contribute your dollars to the local economy while you're at it. But is it too much to ask that you obey basic driving rules? We've been through enough already. If you're going to come and visit, at least show some respect for the people trying to live semi-normal lives here. Not stopping in the middle of the street would be a great start.
Besides, this event has become part of history, and it's only natural that people will want to come and bear witness, to tell their friends and family, just as crowds flocked to Ground Zero in New York City in the months after 9/11.
All the same, this is not a sterile museum exhibit, or an isolated preserve. People live here. People work here.
About once a week I'll be driving home, and a car ahead of me will stop. In the middle of the street. And people will step out and gape and start taking pictures.
Other times cars will creep along Beach Boulevard at less than 10 miles per hour.
Please, people! I wouldn't drive like that if I came to visit your town!
Yes, by all means, come and see the devastation for yourself. Contribute your dollars to the local economy while you're at it. But is it too much to ask that you obey basic driving rules? We've been through enough already. If you're going to come and visit, at least show some respect for the people trying to live semi-normal lives here. Not stopping in the middle of the street would be a great start.
Wednesday, January 24, 2007
Foresight/Hindsight
I really should have posted this yesterday, but I have my office staff as my witnesses. I gave 5:1 odds that Bush doesn't mention Katrina or New Orleans in his State of the Union address, and 10:1 that he doesn't mention the Mississippi Gulf Coast. And I was right on both counts.
I realize that this week I seem to have gone from "Just Practicing" to "The Katrina Blog." I promise I will get back to more medicine-related stuff soon. But you must realize that:
(1) For those of us here in the Katrina Disaster Zone, this is really all-encompassing. It affects truly every aspect of life here, every minute of the day, everywhere you go. I'll stop writing about Katrina when things are back to normal. That should be in about another 10 years or so.
(2)...Or it might be never. Katrina has been a life-changing event, not only for the residents here, but for our entire country. Disaster response and recovery has become a prime issue for people everywhere, but we obviously still have a lot to learn. In fact, even though citizens have taken many lessons to heart, I'm not sure our government has learned any lessons yet, and seems doomed to repeat them when (and not IF) the next disaster strikes.
(3) Don't ask us to "get over it." We haven't asked New Yorkers to "get over" 9/11. 9/11 changed America's entire mindset and priorities--as it should have. 9/11 was a man-made disaster with profound repercussions. Yet Katrina, a natural disaster affecting far many more people, has already faded into memory, as Bush's speech last night illustrates so well.
(4) Finally, things are not chugging along smoothly down here, despite what y'all might think. I'd refer you to this enlightening article at Gulf Coast News.
And besides, it's my blog, so I can write what I want. Ideally its focus is on the intersection between Katrina and health care, but it's going to veer back and forth at times. Hopefully, wherever it goes, it will continue to hold your interest. And I promise that there's lots more of Katrina Story to tell.
I realize that this week I seem to have gone from "Just Practicing" to "The Katrina Blog." I promise I will get back to more medicine-related stuff soon. But you must realize that:
(1) For those of us here in the Katrina Disaster Zone, this is really all-encompassing. It affects truly every aspect of life here, every minute of the day, everywhere you go. I'll stop writing about Katrina when things are back to normal. That should be in about another 10 years or so.
(2)...Or it might be never. Katrina has been a life-changing event, not only for the residents here, but for our entire country. Disaster response and recovery has become a prime issue for people everywhere, but we obviously still have a lot to learn. In fact, even though citizens have taken many lessons to heart, I'm not sure our government has learned any lessons yet, and seems doomed to repeat them when (and not IF) the next disaster strikes.
(3) Don't ask us to "get over it." We haven't asked New Yorkers to "get over" 9/11. 9/11 changed America's entire mindset and priorities--as it should have. 9/11 was a man-made disaster with profound repercussions. Yet Katrina, a natural disaster affecting far many more people, has already faded into memory, as Bush's speech last night illustrates so well.
(4) Finally, things are not chugging along smoothly down here, despite what y'all might think. I'd refer you to this enlightening article at Gulf Coast News.
And besides, it's my blog, so I can write what I want. Ideally its focus is on the intersection between Katrina and health care, but it's going to veer back and forth at times. Hopefully, wherever it goes, it will continue to hold your interest. And I promise that there's lots more of Katrina Story to tell.
Friday, January 19, 2007
Score: NY Times 3, Katrina Recovery 0
The NY Times scored a trifecta blast this week against the administration's so-called recovery and rebuilding since Katrina.
First, on Wednesday Jan. 17, in the Business section: a column discussing "What $1.2 Trillion Can Buy." The $1.2 trillion in question being, of course, the cost of the war in Iraq--so far, with more expenditures undoubtedly planned. (Actually, as the article explains, direct appropriations have been a mere $700 billion, with indirect costs making up the rest--the author, David Leonhardt, arrives at the $1.2 trillion as "the actual money that Americans would have been able to spend in the absence of a war.") Congress has spent a total of $100 billion on Hurricane Katrina. Even if you account for spectacular amounts of diversion, fraud, and waste (as has been the case ever since August 29), just think what even another $100 billion could do to finally get this recovery moving. There is a snide but apropos bumper sticker making the rounds here: it says, simply enough, "SCREW IRAQ, REBUILD THE GULF COAST."
Second is today's lead Editorial entitled, "Nowhere to Turn for Shelter." In a dead-on analysis, the Times holds the Bush administration to task for the shameful inaction on housing on the Gulf Coast. To quote: "...The response to the drowning of New Orleans has been a failure on every level...There has been no concrete action plan for reconstruction--only a patchwork of programs marked by dithering, bickering and bureaucratic finger-pointing throughout. The federal response was, after great delay, largely to cut a check and let overmatched local officials try to sort it out...The time is long past to turn from planning to action. And those in need of shelter today cannot take comfort in housing that won't be ready for another two years...That New Orleans remains a shattered city is a sad monument to impotence for the most powerful country in the world. Our grand plans were never laid, our brightest minds were never assembled, our nation's muscle and ingenuity were never brought to bear in any concerted way to overcome the crisis of the Gulf." (my italics)
Lastly is a Letter to the Editor also published today, strikingly forceful in its poetic elegance in tying together the above two thoughts. The letter reads, in its entirety:
First, on Wednesday Jan. 17, in the Business section: a column discussing "What $1.2 Trillion Can Buy." The $1.2 trillion in question being, of course, the cost of the war in Iraq--so far, with more expenditures undoubtedly planned. (Actually, as the article explains, direct appropriations have been a mere $700 billion, with indirect costs making up the rest--the author, David Leonhardt, arrives at the $1.2 trillion as "the actual money that Americans would have been able to spend in the absence of a war.") Congress has spent a total of $100 billion on Hurricane Katrina. Even if you account for spectacular amounts of diversion, fraud, and waste (as has been the case ever since August 29), just think what even another $100 billion could do to finally get this recovery moving. There is a snide but apropos bumper sticker making the rounds here: it says, simply enough, "SCREW IRAQ, REBUILD THE GULF COAST."
Second is today's lead Editorial entitled, "Nowhere to Turn for Shelter." In a dead-on analysis, the Times holds the Bush administration to task for the shameful inaction on housing on the Gulf Coast. To quote: "...The response to the drowning of New Orleans has been a failure on every level...There has been no concrete action plan for reconstruction--only a patchwork of programs marked by dithering, bickering and bureaucratic finger-pointing throughout. The federal response was, after great delay, largely to cut a check and let overmatched local officials try to sort it out...The time is long past to turn from planning to action. And those in need of shelter today cannot take comfort in housing that won't be ready for another two years...That New Orleans remains a shattered city is a sad monument to impotence for the most powerful country in the world. Our grand plans were never laid, our brightest minds were never assembled, our nation's muscle and ingenuity were never brought to bear in any concerted way to overcome the crisis of the Gulf." (my italics)
Lastly is a Letter to the Editor also published today, strikingly forceful in its poetic elegance in tying together the above two thoughts. The letter reads, in its entirety:
Sometimes, I go to sleep and dream that I live in another America. One where we sent 140,000 able-bodied men and women, and one trillion dollars--to rebuild New Orleans.
Friday, January 5, 2007
Doo, doo, doo, looking out my back door
Looking out my back door, I see:- 3 occupied houses
- 8 empty property slabs
- 1 abandoned, empty house
- 1 house under construction
- 5 FEMA trailers
- 1 abandoned car, and
- 1 empty lot
The view hasn't changed much in the past 6 months we've been in this house, other than the house under construction.
This is what it means to live in Katrina-land. Everywhere you go is a constant reminder of the destruction and loss.
This is not a healthy way to live, or to raise children.
Wednesday, January 3, 2007
A medical practice is/is not a small business
I love practicing medicine, which is good, because it's how I pay the bills. My patients often seem to forget that I charge for my services because I need to make a living, but I also need to pay my staff, pay for vaccines, pay for rent and utilities and office supplies and table paper and toilet paper and malpractice insurance and other insurance and what not. Just like any other small business, right? Post-Katrina, FEMA and the SBA have said so. Medical practices received no special treatment. So I try and pursue grants, loans, and other assistance to rebuild my practice. But my revenue is solely and entirely dependent on me seeing patients. So if I'm out of the office (say, for a meeting), I'm not making money.
That's not special, you say. Same as any other professional in a service field--lawyers, plumbers, electricians.
Yes, but an electrician sets his rate, gives you a bill, and you pay.
In healthcare, the insurer sets the reimbursement and pays what they feel is appropriate. This is like walking into Circuit City, seeing a TV for $1000, and saying, "no, I'll give you $700 for it. Thanks!" In theory, the insurer gets to take a cut off the doctor's standard prices in exchange for steering patients to the provider, enabling prompt and worry-free payment. In practice, it's done this way because doctors usually have no choice.
So unlike any other business in town after Katrina, I cannot increase my revenue by increasing charges, because it won't make any difference. I can charge Medicaid $65 for an office visit, or $650, and they still pay me $50.48. But I still have to pay an extra $2 for my $6 roast beef po' boy (mmm...roast beef po' boy). I still have to pay when Merck raises prices on its vaccines. In short, trapped. The only way to make more money is to see more patients.
And there's the final catch: there was an initial surge in population here after Katrina as everyone started coming back, and the contractors and workers started flooding into town. But now the population growth has slowed. Why? Housing. Here in Waveland MS about 90% of the houses were damaged or destroyed. As a result, people aren't coming to the area because there's no place to live. Few houses are on the market; the houses that are, are overpriced (simple market economics, supply and demand), squeezing out poorer working-class families. You can buy an overpriced empty lot, but you'll have to wait about 6-12 months before you can hire a contractor to even start construction.
So the doctors can't raise fees, can't see more patients, still have to pay the bills, and--oh yeah--try to recover all of the losses and expenses related from the storm and the loss of practice. (I'll try to post on that at a later date.)
Why does all this matter? So if I can't make it, shouldn't I just leave town?
First is the personal, community aspect. I feel a commitment to my patients. I want to be there for them when I'm most needed, and see them (and me) through this recovery.
Second: well, doctors are all rich anyway. Shouldn't I just sell off one of my 3 Lamborghinis, or my vacation home in the Bahamas? Actually, pediatricians are generally not rich. Most middle class 2-income families earn what I make--without the associated student loans, and with a good many years headstart on saving for retirement. I realize I'm doing better than many others, but I certainly don't have the resources to weather this for much longer. As is, I've taken out a $40,000 home equity loan and $60,000 SBA loan to cover post-storm and restarting expenses. That's $100,000 in new debt. OUCH. At least the SBA loan can be paid back over 30 years--just like my Stafford loan from med school.
Third, and most importantly, if I leave, who will see my patients? This is not a rhetorical question. There are two other pediatricians in town (one is now employed by the local hospital, the other works for a community health center). They could probably cover things, and patients could also see other pediatricians further away. But then what? A town without good medical care won't be very enticing to new families, or new businesses. And the recovery stalls out and the community never rebuilds.
Is that okay for little old Waveland, MS? How about New Orleans, LA? How about the next city hit by a major disaster?
I'm not even bringing in the moral arguments, that health care is a necessary community service and should be maintained for the good of the community. Or that doctors such as me are being not rewarded, but penalized, for staying on after Katrina. (Every week I get a flier for "Lucrative position! Starting income $200,000!" or something similar. Yet I'm still here????) Just on an economic basis, physicians face inherent difficulties unique to healthcare. We can't respond like other businesses can, yet we're expected to anyway. No special treatment, despite special circumstances.
So what to do? More to come.
That's not special, you say. Same as any other professional in a service field--lawyers, plumbers, electricians.
Yes, but an electrician sets his rate, gives you a bill, and you pay.
In healthcare, the insurer sets the reimbursement and pays what they feel is appropriate. This is like walking into Circuit City, seeing a TV for $1000, and saying, "no, I'll give you $700 for it. Thanks!" In theory, the insurer gets to take a cut off the doctor's standard prices in exchange for steering patients to the provider, enabling prompt and worry-free payment. In practice, it's done this way because doctors usually have no choice.
So unlike any other business in town after Katrina, I cannot increase my revenue by increasing charges, because it won't make any difference. I can charge Medicaid $65 for an office visit, or $650, and they still pay me $50.48. But I still have to pay an extra $2 for my $6 roast beef po' boy (mmm...roast beef po' boy). I still have to pay when Merck raises prices on its vaccines. In short, trapped. The only way to make more money is to see more patients.
And there's the final catch: there was an initial surge in population here after Katrina as everyone started coming back, and the contractors and workers started flooding into town. But now the population growth has slowed. Why? Housing. Here in Waveland MS about 90% of the houses were damaged or destroyed. As a result, people aren't coming to the area because there's no place to live. Few houses are on the market; the houses that are, are overpriced (simple market economics, supply and demand), squeezing out poorer working-class families. You can buy an overpriced empty lot, but you'll have to wait about 6-12 months before you can hire a contractor to even start construction.
So the doctors can't raise fees, can't see more patients, still have to pay the bills, and--oh yeah--try to recover all of the losses and expenses related from the storm and the loss of practice. (I'll try to post on that at a later date.)
Why does all this matter? So if I can't make it, shouldn't I just leave town?
First is the personal, community aspect. I feel a commitment to my patients. I want to be there for them when I'm most needed, and see them (and me) through this recovery.
Second: well, doctors are all rich anyway. Shouldn't I just sell off one of my 3 Lamborghinis, or my vacation home in the Bahamas? Actually, pediatricians are generally not rich. Most middle class 2-income families earn what I make--without the associated student loans, and with a good many years headstart on saving for retirement. I realize I'm doing better than many others, but I certainly don't have the resources to weather this for much longer. As is, I've taken out a $40,000 home equity loan and $60,000 SBA loan to cover post-storm and restarting expenses. That's $100,000 in new debt. OUCH. At least the SBA loan can be paid back over 30 years--just like my Stafford loan from med school.
Third, and most importantly, if I leave, who will see my patients? This is not a rhetorical question. There are two other pediatricians in town (one is now employed by the local hospital, the other works for a community health center). They could probably cover things, and patients could also see other pediatricians further away. But then what? A town without good medical care won't be very enticing to new families, or new businesses. And the recovery stalls out and the community never rebuilds.
Is that okay for little old Waveland, MS? How about New Orleans, LA? How about the next city hit by a major disaster?
I'm not even bringing in the moral arguments, that health care is a necessary community service and should be maintained for the good of the community. Or that doctors such as me are being not rewarded, but penalized, for staying on after Katrina. (Every week I get a flier for "Lucrative position! Starting income $200,000!" or something similar. Yet I'm still here????) Just on an economic basis, physicians face inherent difficulties unique to healthcare. We can't respond like other businesses can, yet we're expected to anyway. No special treatment, despite special circumstances.
So what to do? More to come.
Sunday, December 31, 2006
An 8-29 commission?
Nola.com is reporting that, with the Democrats set to control Congress, there is talk about establishing a Commission to investigate the government's response to Katrina. The panel would be modeled on the 9-11 Commission, leading this yet-to-be-formed body to be called the "8-29 Commission," referring to the date when Katrina hit the Gulf Coast.
FEMA is already getting defensive:
Apparently Republicans also feel that the current response has been adequate:
For those who don't know, more than a year later New Orleans and Mississippi are still just starting the recovery process. Every day that passes without a clear plan--and the subsequent steps to implementation, which includes funding--makes the recovery that much more difficult, if and when it ever gets underway. It also drags out the recovery since time and effort must be spent making up for lost time and in some cases undoing the damage that the inital delays have caused. Leadership and funding are in short supply, Mr. Luntz, and that is a problem for which the Republicans must take responsiblity. I don't know if Democrats would have done better, but I suspect they would have.
As far as FEMA's Mr. Walker, I suppose you don't need a commission if you know all of your mistakes and you are actively correcting them. In other words, we desparately need a commission because there are lessons that still haven't been learned. I know FEMA and President Bush could use a good schooling.
Happy New Year, everyone. May your 2007 be brighter and more fruitful than 2006.
FEMA is already getting defensive:
Aaron Walker, the national FEMA spokesman, said the agency has acted on "numerous reports from outside interests, Congress, and the White House on how to improve the agency and determine where the missteps were in our response to Katrina.Well-spoken words from a man utterly disconnected from reality. You're doing a heck of a job, Aaron.
"At this point, it is doubtful that futher reports or commissions will reveal new, actionable insight," he said.
Apparently Republicans also feel that the current response has been adequate:
Frank Luntz, a Republican strategist, questioned how impartial a new commission could be.No, the Republicans didn't cause the storm (unless you want to start talking about the possible contribution of global warming...) But the Republicans--excuse me, not all, just some very key Republicans, including the President, and his appointees--have shown an utter failure of leadership, an absence of clear thinking about recovery, a placement of bureaucracy over people, and a basic turning of the back and walking away from the Gulf Coast.
"If you listen to the Democrats, the Republicans actually caused the storm, that they created the hurricane, and did all the damage," Luntz said.
For those who don't know, more than a year later New Orleans and Mississippi are still just starting the recovery process. Every day that passes without a clear plan--and the subsequent steps to implementation, which includes funding--makes the recovery that much more difficult, if and when it ever gets underway. It also drags out the recovery since time and effort must be spent making up for lost time and in some cases undoing the damage that the inital delays have caused. Leadership and funding are in short supply, Mr. Luntz, and that is a problem for which the Republicans must take responsiblity. I don't know if Democrats would have done better, but I suspect they would have.
As far as FEMA's Mr. Walker, I suppose you don't need a commission if you know all of your mistakes and you are actively correcting them. In other words, we desparately need a commission because there are lessons that still haven't been learned. I know FEMA and President Bush could use a good schooling.
Happy New Year, everyone. May your 2007 be brighter and more fruitful than 2006.
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