Somebody else's problem

Trash fires and preventable catastrophes

Back in 2011, New York City's Metropolitan Transit Authority removed trash cans from a few dozen subway stations as part of a pilot program. They thought this would be a great way to save money, since you don't need to empty trash cans that don't exist.

Predictably, making it harder for riders to get rid of trash responsibly doesn't eliminate the need to get rid of trash. Debris on the tracks causes fires, which causes delays and increased repairs. These trash fires were happening despite an uptick in trash collection costs for businesses and residences near the subway stations. So, in the end they put the trash cans back and have resigned themselves to emptying them.

This line of reasoning seems to be behind the rationing of home care and preventative health services. Home care, respite care, physical therapy, occupational therapy, and other services are impossible to automate, annoying to manage, and expensive. So, they just make them increasingly difficult to access. And then, predictably, more people end up getting emergency care for things that could have been prevented. This behavior on the part of the UK’s National Health Service keep coming across my desk lately although they’re hardly alone in this sort of behavior. When you have a national health serivce it’s much easier to track.

Since the government wants home care to be provided by families with the costs being born by the familes (effectively free, if not literally free, since the UK gives approved caregivers £69.70 a week, before tax, in a country where a cup of coffee costs £3.40) they limit access to alternatives. Then patients get stuck in hospitals because of the lack of available rehab centers, nursing homes, and home care services.

The government is increasing hospital visits and reducing hospital discharges because they’re hoping a lack of post-hospitalization services and supportive care will force families to provide this care for free. After so much fuss was made about flattening the curve and delaying non-essential care to keep beds open for the most seriously ill patients. While the pandemic continues.

Sometimes an agency can successfully avoid an issue by making it someone else's problem. Other times, their attempts to shirk responsibility result in creating problems for everyone else and worse problems for themselves.

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Efficiency is overrated

On being pulled in so many directions

Giving your future self what you want doesn't require planning or sacrifice

“Thinking of who I was at 19, when my mum was diagnosed, I can see myself tumbling deeper and deeper into the law-of-attraction mindset, until I twisted all of its positives into something darker: that it was my fault her tumour killed her.”

“The standard rate at Central Regional was $1,338 a day, which Narsh could not afford. So, when a patient relations representative offered a discounted rate of less than $60 a day, her husband, Nathan, signed an agreement.”

“Of course, you won’t likely get the right treatment if you have the wrong diagnosis, so this critical decision has major downstream impact. When combined, “recent studies have found that 10-15% of all clinical decisions regarding diagnosis and treatment are inaccurate.”

“Becoming disabled can significantly change a person’s life. Many of those shifts aren’t discussed in a doctor’s office, and there’s no easy how-to guide to follow. Disability doulaing fills those gaps. It can involve practical work like sharing diagnosis journeys and personal experiences with doctors or medication. It can also look like a friend helping another apply for Medicaid or file complicated insurance claims.”