Archive for May, 2019

Mex-pat

Author: admin

Odd word, isn’t it? It’s used by some to describe people from other countries who become full time residents of Mexico.

We have friends who’re “Mex-Pats” and we recently flew down to their “home city” of Chapala in the State of Jalisco. Chapala is a two-and-a-half hour flight Southeast of Phoenix so we figure it to be about a thousand miles.

Chapala is a typical Mexican town. No high-rises like PuertoVallarta, Mexico City, Cancun or any other major spot. Tallest building we saw was a three-story home.

What we experienced in Chapala was about as close to the real Mexico as you can get these days. Very old with cobblestone streets to rattle your teeth. Cement and stone construction in nearly all buildings. Narrow streets with narrow sidewalks, very small commercial businesses and a central plaza near a Catholic Church built in 1749.

Anyone who talks about “lazy Mexicans” has never spent time in a real Mexican community. Everywhere we went – and I mean everywhere – people were working. From the larger businesses to the guy outside the church we attended who was selling many varieties of washed fresh fruit out of a cardboard box – everyone was busy. We saw no indications of homelessness, no panhandlers anywhere we went. And we went just about everywhere in Chapala.

We passed a street crew of about eight men digging out an old water line. Not three working and five watching. All were on picks and shovels because they don’t use backhoes or other heavy equipment. Many road repairs in the area were the same – done by hand.

Locals we encountered spoke little to no English. Even the desk clerk in our hotel and counter employees at the International airport in Guadalahara about 20 miles away. American money wasn’t accepted anywhere we went. Credit cards worked sometimes and sometimes they didn’t. Pesos were a necessity.

There were no “touristy” areas anywhere. Very small shops with goods mostly made in Mexico. No plate glass windows, no neon signs, no upscale fashions. We found small children of working mothers in several shops. All quiet, well-behaved, playing with small toys, reading a book or sleeping. Not one running underfoot.

The large central plaza was great for people-watching. Musicians, vendors both inside and out, no cars or other noises of civilization. Many choices of food and drink. And large trees everywhere for shade in the hot afternoons.

New commercial development was outside the city. No new car dealers. A couple of movie theaters, a Starbucks and a “Wal-Marche.” Bought Colgate toothpaste – writing on the tube in Spanish. Same with Coke or Budweiser. Very little to remind you of the states.

New construction in Chapala is either on small vacant ground which was never used or where older buildings had been removed. Our friends’ new home, in an older section, was one such. About 1,600 square feet, inner and outer walls solid concrete, a glass wall to an interior courtyard and a beautiful hand-laid convex brick ceiling over the entire living area. Less than $200-thousand.

Healthcare quality is good and available either through clinics, public or private hospitals. The public ones are free but crowded. The private ones charge but fees are much less than the states.

There’s a sizeable contingent of Americans, Canadians, Brits, Germans and other nationalities in Chapala. Moderate temperatures, laid-back Mexican lifestyle, very low cost-of-living, a feeling of being removed from what we call “civilization,” gracious locals who have gladly accepted their new “neighbors” – many enticing features.

But. There’s always a “but.”

Most homes in Chapala are surrounded by high concrete walls. Many topped with steel spikes, concertina wire or electric fencing. Some have guard dogs. Garage and outer compound doors of steel. Most homes and other buildings have large water storage tanks on the roof because of frequent outages. Local tap water, in some places, not safe to drink. Some homes have emergency generators. Security issues are ever-present.

Those cobblestone roads are everywhere so cars and other vehicles take a pounding. Mexican roads can leave something to be desired. Even major highways are often uneven with roller-coaster rides. For serious shopping, car-buying or major medical needs, it’s about an hour drive to Guadalahara.

On balance, we very much enjoyed our small-town Mexican experience. People were welcoming and gracious. The atmosphere was far-removed from the travel guides, time-share condos, high-rises, carefully-trimmed golf courses, fancy dining and other accouterments we hear about. Our host-friends were generous with their time and knowledge of the area. We felt we did get to see what the country is really like.

Ready to be a Mex-Pat? No. But, the experiences we had and the things we learned were eye-opening in many ways. We have a new appreciation for the country and its residents.

You oughta try the real Mexico sometime. Bueno!
 

Healthcare is a business

Author: admin

A lot a folks these days are bandying about words like “universal healthcare” and “Medicare/Medicaid for all” and similar popular phrases.

Sounds good. Sounds positive. Sounds hopeful. And chances for any to materialize nationally in the near future are slim to none. Like lots of things we want to fix in our lives, the distance between “want” and “get” is a country mile. Or two.

In November, large majorities of voters in Idaho and Utah said they wanted expanded Medicaid programs to take care of hundreds of thousands of uninsured. Referendums in both states passed with significant numbers. In the old days, the legislatures would have heard the call and gotten right to work fulfilling the will of citizens.

Today, not so much. Majority political parties in each state tried their damndest to ignore those voices. Bills were introduced to cut benefits of anything eventually adopted. In Idaho, there was a “poison pill” measure in committee to kill eventual expansion if the feds ever change the funding ratio. In Utah, they tried to flat out stop expansion. Period!

If voters in those states want to see their dreams of more insured folks, they’re going to need a second election to get rid of the naysayers. Maybe even a third and fourth.

Looking to Congress for help is an even more daunting – and certainly doomed – task in the near future. While large numbers of us want significant improvements, too many denizens of that swamp won’t lift a finger. There’s all that lobbying money from insurance companies, the folks making pharmaceuticals and dozens of other interests wanting to keep the status quo.

It’s not as if “universal” care or federal medical programs won’t be expanded or that our payment system for services won’t be improved. All that can – and likely will – happen. But, given the obstacles, those politicians promising such in the near future are blowing smoke.

For those too young to remember, we went through such efforts in the ‘60’s with creating Medicare. Even with favorable majorities in Congress, Lyndon Johnson had to push, pull, promise, horse-trade and literally threaten the political futures of some in both parties to get it. The fight today is way more uphill. The aforementioned drug and insurance outfits and their friends are making it so. Whatever the outcome, it’ll start with political and business decisions – not consumer need. A basic issue that must be solved is how those entities can survive and in what form.

Proof of that is how physicians and hospitals have radically changed business models in the last decade to stay in business with Medicare. Many now use step-down intermediate care to get patients out of the more expensive hospital stays. They’ve hired salaried doctors and “hospitalists” on staff, opened their own related care facilities such as rehab centers and lower-level extended care centers. Many ancillary services previously farmed out have been incorporated into the overall structure.

Physicians have reorganized for Medicare, too. Often, they create a partnership of several specialities, open in-house labs, manage their own testing such as EEG and similar exams and limit nearly all patient visits to 15-minute appointments. Many docs have hired specialty physician assistants so more patients can be seen, spreading the load but not the costs.

Insurance companies started “Medigap” programs which, given the amount of advertising to attract new customers, must have proven profitable. They’ve also changed other aspects of their business models to streamline coverage while assuring income.

In all likelihood, we’re heading to some sort of single-payer system in this country. Call it “Universal” or “expanded Medicaid” or any other popular name. The plain fact is we can’t continue to operate under a system that eats so much of our national resources, is priced out of reach of millions and causes bankruptcies in the thousands each year.

But, to realize a goal of “healthcare for everyone,” the political and business issues must be solved first. If availability and cost containment are the goals, then assuring the survival – in some form – of the medical, pharmaceutical and insurance providers who make up that system must be addressed up front.

No one entity has the answer. And you won’t have traditional quality healthcare of any reliable sort without them. As businesses and corporations, they’ll need to survive or none of us will live to see significant changes.

Politicians who make it sound like we can achieve all that by simply electing them and they’ll make it happen, are glossing over the massive work to get it done.

Healthcare is, after all, a business.
 

Civil War II

Author: admin

Funny what you can overhear while sitting in a diner, a medical waiting room or a theater before the movie starts these days. Interesting. But, sometimes scary.

Filling the gas tank recently, listening to two guys gassing up their cars who obviously knew each other. A conversation I never thought we’d hear in these United States of America.

“I’d bet, before the 2020 election, we’re going to have a shooting civil war again in this country,” said one.

The other agreed, saying he was already stocking up on ammunition and had recently bought a second AR-15.

“Not going to get me without a fight,” he warned.

Driving home, at first I was sort of shocked. A second “civil war?” Nah. Just goofy talk. Got home. Sat down at the computer and read this: “I have the support of the police, the military, Bikers for Trump. I have the tough people but they don’t play it tough until they get to a certain point, then it would be very bad, very bad.”

The President of the United States? Nah, just Donald Trump. And, therein lies a problem.

While it wouldn’t be right to lay all blame for division and violence at his feet alone, what were conditions, say five years ago? Were they then what they are today? Did you feel the same about your world then as you do today? Every disaster that befalls a nation needs someone to hold the match. Trump is a torch!

But, look elsewhere. How about Idaho and Utah where voters overwhelmingly ordered legislators in both states to create expanded Medicaid for all. Resoundingly! So, what happened? They produced bills to radically change what the referendums specified; to add work requirements; to twist what voters approved into some other unrecognizable creature. To outright kill it. And, to flip the bird at voters, Idaho legislative miscreants tried to make future referendums all but impossible to achieve success.

Look at other states where court orders to do this-and-that about redistricting, voting laws, added school funding, public safety, civil rights have been all but ignored by state governments. Just flat ignored!

What about today’s tone coming from Limbaugh, Ingraham, Hannity and the rest of the hate talkers? Is it more angry today? Do they often get right up to the line of inciting action against someone, some form of government or some “foreign” religion or country?

What about some of our politicians? Steve King, for one, publically predicting actual, physical confrontation between “red” states and “blue” states. And he’s got a national audience of racists, bigots and white supremacists who listen.

Rep’s Gaetz, Jordan, Meadows, Nunes, Gohmert and the garbage and hate speech flowing from some of the “Freedom Caucus” in the U.S. House. These people didn’t get there – and they aren’t staying there – without votes of millions of Americans who’ve supported them? And Lindsey Graham? Single-handedly stopping House-passed legislation on new election laws and energy conservation. All by himself; while touting the “extraordinary accomplishments” of one D. Trump.

And this. Several years ago, the BLM tried to shutdown an illegal mining operations near Grants Pass, Oregon. Made a number of visits to serve papers. Until that day when a dozen guys in fatigues toting AR-15s met ‘em and held ‘em at bay for a week. Finally, the BLMers gave up. Even closed the Grants Pass office.

How about the Bundys in Nevada who successfully stopped the feds with rifles? It all ended when the feds quit.

The sheriff in Douglas County, Oregon, has repeatedly stated he won’t enforce any new federal gun laws and will arrest any federal agents who try to enforce them. He’s not alone. Hundreds of other duly elected badge wearers have taken the same position. “I’ll decide what to enforce and I’ll arrest others trying to do their lawful duties.”

And, immigration. We’re not solving the problem. We’re making what used to be worth hardly a mention into what could become a powder keg, especially in border states. Mass killing in churches, schools and other public venues. Any progress there? Feeling more and more helpless as the numbers of innocent bodies stack up?

There are many, many more signs of citizen frustration, Citizen disappointment. Citizen anger. Starting with local governments up to the feds, people are feeling their votes don’t count and the system has either failed or, in some cases, begun actively working against their interests and needs.

This is not to say this nation is at the “civil war” stage. It IS to say, if current political and social conditions don’t change – if laws we live under aren’t properly and evenhandedly prosecuted – if violence and other injustices against unarmed minorities aren’t ended – if banks and big business aren’t called to task – if all this and more feeding citizen feelings of helplessness and neglect aren’t addressed and corrected, there will eventually be a bad ending.

Maybe not a civil war. But, a bad ending nonetheless.