Thursday, November 10, 2016

So There Was This Election...

Tuesday brought about nearly the worst possible election results for me both nationally and statewide (with very few silver linings) that I could have hoped. I say this as a county employee who works with poor and disabled populations within an increasingly fractious state mental health system. I say this as a union worker. I say this as a married gay man. I say this as the father of a young man with a congenital disease that will require medical treatment and monitoring for the rest of his life. And I say this as the guardian of a mentally disabled man who depends on Iowa's messed up managed Medicaid and mental health system for all of her services. Plus my retirement savings took a nosedive that night.

I was a bit grumpy yesterday. And I went to bed quite early -- largely because I couldn't sleep much the night before. I didn't protest the election. I didn't get into any fights -- though I did tell one of my high school friends to back off. I didn't threaten to leave the country if Trump won -- though I did check out the Canadian immigration website before it crashed. (Spoiler: They don't want me. I'm too old.) I didn't rage against my Green Party friends. I didn't even rage against my Republican friends and family members. Basically, I slept for about twelve hours and got refreshed for another day of work.

For the record, I'm disappointed that Trump lost. I'm still pissed that the GOP obstructed President Obama's Supreme Court nomination. That's what really pisses me off the most when it comes to the federal election scene.

But I'm much more upset that Iowa just lost our balanced legislature. For close to a decade, the Democrats have (barely) held onto the Senate. It kept Iowa helped maintain balanced decisions. And it helped Iowa maintain its status as a marriage equality state. Now it's all up in the air. There's no balance. It's all one-sided. I get that some people like this. I get that some people don't care. But it's strongly affects my career. It strongly affects my family. And it strongly affects my retirement.

Over the past five years or so, Iowa has gradually messed around with its mental health system -- and not for the better. It got rid of county case management for mentally ill adults with Medicaid and replaced it with integrated health home care coordinators. IHH care coordinators basically work for less money and with higher case loads. The state has gradually lost more and more inpatient psychiatric beds so you can only get emergency treatment if you are actively suicidal or homicidal. If there's a psych bed. Often there's not. Because the governor has gradually cut down the census at the state mental health institutions and then used those lower census numbers to justify closing down two of the four MHIs. The state juvenile facilities have also been closed. I anticipate that the other two MHIs will be closed by the end of June 2017. Then last year, Iowa's governor started a process of giving the state's entire Medicaid system to three different for profit managed care organizations. In addition to ongoing reports of under-payments and denied payments and nonprofit medical and service organizations closing down as a result of the MCO process, what's left of the county case management program is all but gone. And then there are the regions, which I won't go into here.

Let's just say that it's all been very overwhelming for a while.

Here is what helped me get through the MCO process and what will help today:

1. The election happened. The MCOs were going to happen somehow or another last year. I knew that. I couldn't change that. I had to accept that. Trump will be our president. Pence will be our vice president. The GOP will control all branches of the US federal government. The GOP will control all branches of the Iowa government. At some point, you have to accept that this will be the scene for at least two years. It will drive you crazy if you don't accept reality.

2. Pick your battles. I couldn't stop the MCOs, but I could network. I could stay informed. I could write letters and make phone calls to various legislators and to CMS. I could attend rallies. I could attend public hearings. I could even volunteer to speak at hearings if I wanted, which I didn't -- but I learned who to cheer on! Even though we didn't stop the MCOs, we managed to get attention. We managed to delay the MCOs and bring about some positive changes. And we got the media to pay attention -- enough attention that they continue to report excellent critiques of the MCO roll-out. There will be plenty of battles to pick nationally and statewide. Get involved. Learn who to call, who to write to, and who to support. And realize that you might not win most battles, but you can still bring attention to your battles and even bring about some modifications.

3. Take care of yourself. Over the past year, I realized that the system is going to continue twisting and turning in horrific ways. I don't have a lot of control over much of it. I'm just there for the ride and hoping that things will gradually twist and turn into something more humane. But I have embraced the joy of funny memes. I've learned to get up from my computer when something causes my blood pressure to spike and take a lap around the office. I have learned the benefits of slow, deep breaths. I hug my dogs. I read comic books. I binge-watch shows on Netflix. I dream about community radio or running my own show. I exercise. And I will keep doing these things to keep myself as sane as possible.

4. Forgive your lapses. Sometimes things will get overwhelming. You will get pissed off and break into tears when things appear bleak. Allow yourself to break down and then build up your resolve again.

5. It's not all bad. I might not like the MCOs, but they do good. My oldest boy will soon join a gym with help from his MCO. There are better non-emergency medical transportation services right now (in some corners of Iowa) than before the MCO change. I am positive that Trump and Pence and Branstad will do some positive things also. Welcome improvements when they appear.

That's how I got through the MCO transition. That's how I've continued to adjust to the MCOs (not to mention the regions). And that's how I plan to get through the current political changes while working for balance with others.

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