Wednesday, September 10, 2008

Channeling Paul

In the comments to the post below, Paul wrote: 
Doug,

Have you noticed that over the last several years we have “hammered out..” a budget that actually shrinks our opportunitu to hammer out one in the future? What I mean is this…

As we shift more and more to federal funding as an answer to our budget we become more and more enslaved to the whims of federal budget makers. Is this the Sacramento’s fault? Ultimately I would say yes, after all they are the ones that say yeah or nay.

But lets be fair – we do not need to search far to find fantasies and fallacies about unmatched state dollars, waiver, backfill, and outrageous numbers like 1.4 Billion in untapped federal monies. In fact, we do not need to search at all. The advodivas, the advocrates – the politicians are within our own ranks.

How can we not love a person that implies through poignant protestation that we are being short changed 1.4 Billion dollars? We love him or her just as we love the politician that tells us that he or she will cut our taxes and double our entitlements at the same time.

Until we can address our realities Andy words are axiomatic, “It does not, will not, cannot exist in our government.” Until we acknowledge that some of our efforts at home are, “little more than the brightly-colored bunting and balloons of a democracy”
I have noticed, just as I noticed that you said articulately something I've been trying to squawk out for the lifetime of this blog. Missing from his list is the amount of time, energy and audience we waste debating the prevalence of "classic" autism.  There are a few problems that I would identify in our approach:

1.  We argue with the idea of waste in the system before looking for it.  If there is waste in the system, and we all know there is, it is interfering with effective support for people with disabilities and counteracting the well-spent funds.  If there is waste in the system, identifying and eliminating it would be that much funding we would not have to defend.  That we find so many ways to fight against the unexamined implication also allows those who would cut our finding to decry wasteful spending without expectation of quantifying it.

2.  That we even care what resources might be available takes the conversation away from the mission and into the money.  We will never win an argument about money.  We have people who need and deserve our support.  They are compelling people, sympathetic people and above all, people.  It is easy to not care about acronymmed arcana like FFP.  It is hard to dismiss a human striving to overcome a profound challenge.

3.  Nothing depresses me more than the number of my dear friends in the DDS advocacy community who have been saying for 8 years that we can't start the important fight until funding is secure.  Funding will never be secure.  As long as you think funding comes first, you have surrendered the battle for everything you say matters.

13 comments:

Andy said...

Douglass Writes: Nothing depresses me more than the number of my dear friends in the DDS advocacy community who have been saying for 8 years that we can't start the important fight until funding is secure. Funding will never be secure. As long as you think funding comes first, you have surrendered the battle for everything you say matters.


I, the Topic Adherent, exclaim, "Amen, Amen, Amen! Brother Doug!"

As much as I may bemoan our reimbursement rate, each and every time our services to an individual have stunk, it was never due to our funding.

I think I have a clear understanding of how, where and with whom our services need to improve. Our efforts at these improvements will not be effected whether our rates are frozen or doubled over the next few years.

I worry about maintaining health benefits for our staff. I'd love to pay a living, rather than a clinging, wage. Funding matters for this. I'd love our services to be consistently as good as our reputation. Honesty and leadership matter for this.

--The Topic Adherent

(A Topic Adherent should not be confused or categorized with a topical ointment. Two different things.)

Doug said...

Two somewhat different things, Andy.

paul said...

“That we find so many ways to fight against the unexamined implication also allows those who would cut our finding to decry wasteful spending without expectation of quantifying it.”
-Doug-

We should make that a rap song!!

But agreement is no fun – may I tighten the rope that we walk until Cartmen sez, “Screw you guys – I’m going home” (oops sorry)?

Discussions on a list-server or blog can be merely academic, vain, waste of time…etc. This might all be true, but it could be argued that is is so because we chooose it to be..Even so …

When a consumer engages in “unsatisfactory behavior” we ask why and toss words at them like, “the behavioral chain”, “antecedents”, “precursor behaviors”, “reinforcements”, “negative reinforcers”, or in same cases we just presume mind control nanoprobes placed in the drinking water by the evil Dr. Interpre…oh…sorry.

Whatever you want to call our “science” [junk, pseudo, faulty, “Outrageous, egregious, preposterous”, sublime, ingenious] I am always surprised that we NEVER turn it upon ourselves. What does that say about views about equality? …I digress..

Perhaps we should ask WHY we take a particular course of action or WHY we don’t take a particular course of action.

Why do we even make implications that are unexamined, which is a nice way of saying that we make unsubstantiated implications, or baseless implication? Pondering answers may be enlightening.

The textbooks say that rewards, including both intrinsic and extrinsic, determines all our actions. Presuming for now that the textbooks are correct, we must assume that there is a reward, and maybe even a great reward in making baseless implications.

If we find that reward perhaps we can then discuss, and perhaps discover, a method of making that reward harder to grasp, or better yet, impossible to grasp via “unsubstantiated implications”. That is – if we base the penalty for speeding upon the ability to pay even Bill Gates will think twice about speeding.*

Why do we constantly shift away from, “the conversation away from the mission and into the money.” What is the reward?

DISCLAIMER
*Again – I am not advocating for or against this proposition just stating ONE, and only ONE, of it potential consequences. I am not saying that this consequence is POSITIVE, or NEGATIVE, or that it is the ONLY consequence, or that there DOES NOT exist, or DOES exist, other negative consequences that outweigh the positive, or other positive consequences that outweigh the negative. I am saying no more than what I am saying. This post is based on fictional people. Any resemblance to actual persons, or animated characters, is purely coincidental.

paul said...

The following is my thoughts as to why do we constantly shift away from, “the conversation away from the mission and into the money.”

I do not mean to make any judgments about our conditions, or the consequences of any condition. If I say, “we consume a lot of straw” I do not mean to imply it is not worth the end product – gold.

AND - sorry for the qualifiers. It has become a nasty, and seemingly necessary, habit to attach 3 qualifiers to every 1 statement. If I mention only orange, it is frustrating when some presume that I imply that the rest of the rainbow, through the illogic of omission, is peaches, cream, and beyond reproach. Maybe the need for the habit will soon pass.

I have worked with many consumers, far fewer than most on this blog, but enough to see our political bookends.

Alfalfa, the 16 year-old son of a Physician and a Dentist living in a group home (before supported living). Alfalfa had his own room, an IBM 386 (The 486 had been out maybe 6 months), and frequent trips home.

Omega – 7 year-old ward of the court living in an ICF-DDH.

(Real people)

We have a system that says the consumers are entitled to whatever fresh and ripe fruits and vegetables they need to have the same nutritional level as a person without a disability of the same age. The entitlement extents not only payment for the fruits and vegetable, but to whatever assistance is determined to be necessary to procure and select the fresh, ripe, fruits and vegetable.

Individuals like Alfalfa are well informed about fruits and vegetables. He, along with his supports provided by family and friends, knows that a tomato is a fruit, knows how to spot a ripe cantaloupe, and knows how to eat so as to prevent the need to run to the room too fast, or the need to sit in the room too long. Alfalfa does not need to, nor does he want to, exercise his entitlement to the assistance necessary to procure the fresh, ripe, fruits and vegetable. That assistance would likely be below the quality that Alfalfa can provide. Alfalfa needs ONLY money.

Omega may know everything about fruits and vegetables. We don’t know. She does not communicate. It took us 3 years to associate milk with those horrible tantrums. I am certain Omega appreciates that the state paying for her fruits and vegetables, but I bet she is more appreciative of the help she gets in regards to picking and choosing, even when we bring a worm or two home (sorry Omega, Frank was up late at a Frat. party last night.)

The same factors that permit Alfalfa to need only money from our service system also generally provides Alfalfa with a louder voice. That voice extends to the board of the vendors, the board of the Regional Centers, and involvement in the alphabet soup of “advocate” organizations that pen magnanimous position statements.

If Alfalfa needs ONLY money, and the Alfalfa’s comprise 80% of those deciding policy and position it stands to reason that our focus will be solely on money. The focus is to increase the giant pool of money. That is most helpful to the Alfalfa’s. Our self-appointed leaders love “pass through” increases and abhor conditional increases.

Most public assistance programs are based onneed and a person’s ability to pay. Until recently, our system was based solely on a person level of ability or a “developmental disability”. Combined with the Alfalfa/Omega syndrome we likely have one of the few legal, if not ONLY, systems that actually redistributes public resources upward to the affluent and politically stronger.

Who was likely the architect of supported living or self-determination, Alfalfa or Omega? Of course the architect matters not if availability extends equally to all, but it does not. We have no courts of Equity, but only Courts of CASH.

I know I know – this is just the way the stream flows. Privatization has the potential (and in our case I think the potential has been actualized) of altering the distribution of resources and concentrating power upward. We can’t fight it right?

No – we cannot fight gravity, but if the stream is spending too much time flooding small towns and villages we can alter its course through damns, and other projects and make the land more equitable.

Perhaps an objective, non-emotional, apolitical discussion about the advantages/disadvantage of privatization (what we now have) vis-à-vis (I think that is French Andy – but that is a Latin language! Damn) state control.

Note: There are many combinations and permutations of state intervention. That is - combinations and permutations of all, or just one or two from a selection; Payer of the bills, broker, provider, oversight, judge, executioner…etc.

Doug said...

You know, Paul, even Omega doesn't need only money. (S)he needs someone to identify the need for money, procure and deliver that money. Presumably, even Omega with simple needs benefits if those needs are met simply. Omega's tax-paying parents probably would rather not pay for the complicated process that brings Omega money if a simple one would do just as well.

paul said...

“You know, Paul, even Omega doesn't need only money.”
-Doug-

No – aguably she needs a lot more. And – arguably, Alfalfa needs only a little, and perhaps nothing, more. That is the reality I claim.

Omega “… needs someone to identify the need for money, procure and deliver that money.”, AND a whole lot more. Although, I would wager that Alfalfa would complain little about, and likely profit from, a system that places cash in hand with no strings attached.

By way of the above, and by the reasons stated in my last post, this is why I believe that any dicussions involving the more or the “whole lot more”, like how we can meet simple needs simply, digress into purely $.

paul said...

“Presumably, even Omega with simple needs benefits if those needs are met simply.”
-Doug-

Perhaps – perhaps not, but I disagree with “presumably”. Success depends a lot upon whether the goal of ‘needs are met’ has a higher priority and greater value than “met simply”.

What is our ideology? Meeting the needs, or meeting as many needs as we can - simply?

What should be our ideology? Creating a healthy and equitable services system or creating as healthy and as equitable a service system as we can from privatization and minimal government intervention - simplification?

If we have a disfunctional system is the problem ALWAYS solved through simplification? Is our problem always solved through intervention, regulation (complication)? Simpler than what?

There is emotional appeal to words like “simply”, “economically”, “efficiently”. I will spare adding the “more” to each one..It sounds good, especially when we use these terms as if they have an entire argument with a conclusion all rapped up into one word. (say not more..say no more)

Unfortunately, there is no argument or conclusion encoded in such a word as “simply”. Simpler than what? Simpler than what we have now? What does that look like?

Some of the monetary benefits under the Social Security Act are VERY simple, but I know of several individuals with disabilities that continue to live at home, when other arangements are arguably MUCH more appropriate. This is because their parents rely upon the monthly check. This is a simple as it gets, but in this case is the consumer benefiting from simplicity?

As we all have come to learn, a Fannie Mae and Freddie Mac were exempt from the regulations the required other financial institutions to maintain a particular capital/asset ratio. Fewer requirements was certainly, a much more simple, hands-off, way of doing business.

Some will argue that the problem is with the GSO. The governement sponsored the whole thing..too complicated (damned New Deal).

Others will argue our problem was the result of government withdrawal and privatization (damned 60’s). Others will argue that this market was not underegulated but improperly regulated. Interesting point/question. I don’t know the answer.

If a simple system fails we can always counter the push for more complexity by retorting that the system failed not because it was too simple but because it was improperly simple? Or – if a highly regulated sysem fails we can counter calls for simplification and privatization with the retort that the system did not fail because it was overly regulated but because it was regulated improperly.

Unlicensed Day programs are arguably the simpliest form of service delivery we have and I would argue they are also rot with the most abuses (both finanaical abuses and abuses against dependent adults) and have an over percentage of staff with criminal records. Should there be more oversight? More regulation? Less oversight (let the creative forces of private enterprise find a solution), less regulation? Or – the same oversight and regulation with more accountability?

I guess my question is

What does “met simply” mean?
What is is more complicated than, and what is it simplier to?

Anonymous said...

As important and enlightening as channeling Paul is . . . can anyone find the channel changer?

As deep and as endlessly ponderable as the posts on this topic are . . . has anyone else also reached their limits of contemplation?

I am reduced to posting limericks on the DD discussion group moderated by a former dance partner on this blog---one who, not long ago, abruptly left this dinner table without asking to be excused.

Anxiously awaiting,
Andy

Gordian (Maker of Knots) said...

Anxiously Awaiting Andy,

I think that Doug is busy trying to find a small Sarah Palin wig and glasses that will fit his Artemis doll. I do have a string-activated voice box that says, “Yu Betchya”. Maybe I can make an offering of this magical device at the foot of Mt. Olympus and perhaps Zeus will vouchsafe his return.

Doug said...

Gordon, I believe, made the Gordion knot. I'll get a new post up this week. Your patience is appreciate. How many times does the rabbit go around the hole again?

paul said...

"Gordon, I believe, made the Gordion knot."

I thought that it was Gordius' son that tied the knot?

Doug said...

Wikipedia agrees with you. I win.

paul said...

"Wikipedia agrees with you. I win."
Doug

I dont know! Maybe you should correct Wikipedia. This is important stuff ya know.

You were too nice, "Gordian (Maker of Knots)"...please.

Doesnt this schmuck know that Gorian is an adjective and not a proper name..geez.

To bad we are too busy "reforming" developmental services, or we would let him have it eh!!

the humanity!