The task force train…..

April 29, 2016 by

For years my passion had been the struggle for health care reform in Tennessee.   I thought everyone who had to go to the doctor ought to be able to. It was really that simple.   It seemed like the most obvious justice.   I never understood (still don’t)  the idea that any legitimate rules would say poor people should die for being poor.   I never understood (still don’t) the idea that some people hadn’t earned health care and that they were somehow acceptable casualties.   I  never understood (still don’t)  the idea that a decent people could as a matter of policy and choice leave the more vulnerable of their number behind.

At the beginning it was really I suppose very self centered for us. Gov Bredesen’s rules are going to take away Linda’s health care and I wrote him a letter asking him not to kill my wife. And then we started to meet the people who were to die, the people who could do nothing, the people who had no way to get any help for their suffering. We found a world we didn’t even know existed.

The moment I realized that the state of Tennessee could and would continue to commit health care violence on thousands and thousands of innocent people in the service of some kind of barbaric political agenda was the moment Linda and I both became radicalized in this struggle.

When the battle for expansion started long before there even was an Insure Tennessee we were told that there was no path forward. Tennessee would never cover the uninsured. And then Insure Tennessee happened and what would have been a silly dream not long before seemed to be a real possibility. The impossible seemed possible.

Two crushing years and I don’t know. I have never seen facts be so irrelevant to a political debate and have never seen public opinion so ignored. And now at best maybe the whole thing is on life support. I don’t know.

Speaker Harwell has convened a task force to find an answer based on “conservative principles” (the governor thought he had already done that). Right now it is the only train leaving the station and if it is simply political theater perhaps we are all screwed. People are still dying. Thousands who can no longer wait will possibly be left behind. It sure seems that way.

A lot of people are cautiously optimistic right now. There have been two task force hearings and they have listened to the same people who told them the things people were told about why Insure Tennessee was a good idea. But at least they asked. And I hoped they listened.

One friend told me he thought it was a good idea. He said it gave the Republicans control over something they had lost control of and if there was a way to make it look like their idea maybe they would rush to take credit and something good will happen. A lot of people I know share that hope.

Another friend saw it very differently. He said they were folding the issue of Insure Tennessee into what they saw as the larger issue of Tenn Care. The Republicans never really bought the idea of the urgency of 280,000 uninsured Tennesseans he thought. Their urgency was about a program they thought too big and they never really felt okay about doing one new big thing (Insure Tennessee) while an existing big thing (Tenn Care) was too big to manage effectively. The “pilot programs” the task force has talked about so much are in his eyes about finding a way to bring down Tenn Care costs and not insuring the uninsured. I dont know the answer and at this time don’t know if anyone knows. I think the intent of advocates will be to define the issue as those stuck in the coverage gap in the most intense way possible as the task force meets throughout the state.

One thing does seem to be clear. Whatever their plan it seems apparent it will be small, a pilot program that might take a long time to become statewide. That seems to be a core part of their agenda.

It raises, if it does turn out to be true, a real fundamental issue. If it is seemingly the only political path forward and if, as seems true now, even in the best of circumstances, to focus on far less than everyone in the gap – – if people will be left behind – – how do we respond? Right now every single person I regards the coverage of all 280,000 people as a non negotiable expectation. But the simple truth is that it never made a difference with Insure Tennessee and who is to say the task force will really care what we think. If political reality and moral urgency collide where do we draw the line or should it be redrawn at all? I hope not but I think it might easily be a choice we face.

I hope this train really is leaving the station and I hope it is large enough to take everyone on board. Large enough no one is left behind. Long past time.

The IMD change

April 29, 2016 by

The Center for Medicaid Studies announced a few days ago a change in the use of Medicaid funds for psychiatric hospitalization. I have been talking to friends all day long who I think understand things better than me. I have been told some different things but the bottom line was shared by everyone. The CMS action not only makes more hospitalization and longer hospitalization likely. It makes it legal.

Sections of the article about it are reprinted below.

CMS is loosening up restrictions on Medicaid reimbursement for institutional-based mental health and substance abuse services by allowing states to make a capitation payment for enrollees with a short-term stay in an institution for mental disease (IMD) in its massive Medicaid managed care final regulation released on Monday (April 25)….The final rule says states may make a capitation payment for enrollees with a short-term stay, no more than 15 days, in an Institution for Mental Disease (IMD) to address access problems for inpatient psychiatric and substance use disorder services. The provision will be implemented 60 days after the rule is published….. The National Health Law Program noted that CMS also included a requirement that IMD services must meet requirements for “in lieu of” services. This policy allows states to cover alternative services or settings “in lieu of services” covered under the state plan, according to NHeLP. NheLP pointed out that CMS said this will allow the enrollee to have a choice between IMD and community-based services and that the agency said a managed care plan cannot force an enrollee to get services at an IMD.

How it affects things will depend on your particular state. I don’t know that it will exactly be the same in any two states. So much of what I have to say is directed specifically towards what I believe will be issues in Tennessee. Some of the issues are probably common to most states.

1. The first thing to realize is somebody still has to pay regardless of the rules and how this is done will have a lot to do with how this rule affects specific states.

2. The articles reference “capitation payments.” What this means is that mco’s are paid not so much for the needs of the people served as much as a lump sum per person served. This means if a person costs more than the lump sum payed you are in the hole. Your hope is that there are enough people who cost less to make up for the people who cost more.

3. Insurance companies will not passively take a loss. If they are presented with the possibility of loss due to significant new expenses they have a couple of options.

A. Insist the state pay them more money. In Tennessee Medicaid takes about a third of the budget. State lawmakers have a task force right now whose big hope is to significantly cut that budget. A demand for a significant increase in budget because of a rule coming out of Washington is not likely to be warmly met.

B. If the state does not adequately meet anticipated new demands then one option would be to regulate that demand. Even if something is legal it still must be justified by medical necessity. If you make it difficult for people to justify on the basis of medical necessity longer stays then that will decrease the amount of financial loss you incur.

C. But you will still incur massive loss. This rule change means much state hospitalization formally paid for by state mental health budgets will now fall on state Medicaid budgets. In Tennessee that is not an insignificant amount of money. Everyone in the state hospital will not be on Medicaid but the expense will still be real.

D. One option, that will be a primary option, will be to change other benefits you pay. It means ending coverage of some service or services currently provided or decreasing reimbursement rates to providers. Tennessee will do both I believe. Case management services have been on the chopping block before and I wonder if they won’t be amputated this time. Dropping reimbursement rates to providers had also been a topic of discussion. The rate is already extremely low. Rate drops will put some providers, particularly small providers in rural areas in danger of going under.

E. There is another term used in the new rule that depending on how it is interpreted may really muddy the waters. The rule says that IMD services can be “in lieu” of contracted services. If the rule actually means what it says people on Medicaid can not be forced to accept services in lieu of contracted services. In other words, hospitalization by this rule would have to be voluntary. Voluntary.

F. No one knows how exactly the rule will be interpreted. In Tennessee there is no voluntary state hospitalization. All state hospitalization is based on committal. How will this affect things??

G. Aside from how this might affect the rights of individuals what would happen if a state Medicaid trying to manage a potential ocean of new expenses said that based on this rule they would not approve hospitalizations that are not voluntary? I don’t know if such a thing is even likely. Just food for thought.

All this is to say there are more questions than answers. The potential for this rule to have unintended consequences is real. It could easily mess up far more than it “solves.” Again I think it may well vary from state to state. As salvation it does not solve much. At most it gives political victory to some folks passionately searching for it.

It will doubtlessly affect in some way the ongoing debate about mental health legislation on the federal level. That effect will be much clearer in coming weeks.

Pointing fingers… On politics and the descent to madness

April 28, 2016 by

Much of our political discourse just seems to be an argument about who to blame and a promise to  do something about those people who keep messing things up.   It is not about a call to any higher vision or principles or any hopes for a better life.   It is about men and women of immense egos telling us we deserve to get even and we can count on them to help.   It is about America reduced to a reality TV and trying to articulate the truth of our lives in a 140 character tweet.

We are constantly being sold solutions in search of a problem. We are told our anger, or fears and our fears and prejudices are now moral sensitivities and no one has the right to offend them. Tennessee has tried to solve the threat of who goes into what bathroom. We have tried to make the Bible our official book (It is not dangerous unless you read it.). Finally we decided that our mental health system need not serve anyone our therapists and counselors think are morally challenged.

Meanwhile, 280,000 people remain without access to health care after our legislators refused to even talk about a plan already approved that would help everyone at no cost to the state. The Speaker of the House has know convened a task force to figure out how to do attack this problem using genuine “conservative principles.”

National politics help to keep Tennessee from looking totally pathetic. The scariest thing is not so much who wins. It is that someone will. Right now even though I like some candidates more than others I have a real problem seeing a path that will arrest our further descent into madness and chaos. I fear it is reality TV destined to run forever and I wonder what happened and where we are yet to go.

I have a friend who tells me that democracy is something that must be done everyday and instead we sold it to people who think a better country is defined by what makes them richer and more powerful. Perhaps we need to demand our country back, and insist that our principles need to be more than apology for the injustices we inflict on the poor and vulnerable and that a government that prizes the voice of ordinary people can not be run by people who think they are better than everyone else.

I simply refuse to believe this is the way it had to be. If I matter, if you matter and if it matters that we matter can there not be a path to something better? Must our politics, must the way we use power simply be about the misery we perpetrate on each other?

I am sick of pointing fingers. Maybe it is time for all of us to say that life is more than who is to torture and who is to be the victim. Maybe it is time for us to say we all live in the same boat and the water is rising so very fast.

Maybe it is time.

The torture of mentally ill prisoners

April 28, 2016 by

On poor people and Insure Tennessee

April 28, 2016 by

The post below was written some time last year but still really relevant.  Speaker Harwell’s task force is really about not just telling a story about what  it means to be without insurance in Tennessee but selling that story.   As you listen to them consider the story they are telling.

This is the story often told about poor people……

Life is much about trying to figure out how it makes sense- trying to find a story that tells us what’s going on and why. Politics is a competition of stories.   Advocacy is the fight to give one story primacy over another.

In the last months I have become as emotionally invested in the battle to expand healthcare in Tennessee as I have anything in a long time.   The personal stake has been great but in larger context it has been a battle of stories.

There is a frame of reference, a story, that says that being poor is a willful condition of a large group of people who are lazy and gleefully dependent upon whatever they can get from the government. Their appetites, the story goes are insatiable. They chronically cheat and without management will literally steal us all blind. Some states are now at the point where they not only manage how much food they eat but what kind. It is viewed as a legitimate consequence for the kind of people they have chosen to be.

The lack of health-care is also viewed as a consequence of willful choices. If they only worked harder, tried harder, if only they paid their way they would not be asking, no demanding, for what others work hard for.

Bigotry to have wide commerce must be cloaked in common sense. And the story about poor people is to too many the ultimate common sense. It explains clearly that they bring bad things on themselves. It explains why helping them is bad for them (it makes them more dependent and thus less likely to try harder to make life better) and why the poor are a threat to regular working people. (Personally I think the threat of poor people just gives the rich cushion from too many difficult questions but that may just be me.)

There is increasingly a polite bigotry. It says the problem is not with the poor (after all we are not bad people) but in the misguided and dangerous ways some would have us help them. They counsel patience and waiting. Sometimes though the nastiness seeps out but most are more polished than Senator Gardenhire. But bigotry in the end does not depend on the clothes it wears.

Poverty should not be a crime or seen as God’s judgement on our character and there
is a political vision that sees it that way. For too long in Tennessee it has been a too common vision

The legitimization of evil… The Tennessee assault on LGBT people

April 27, 2016 by

Counselors In Tennessee Can Now Legally Refuse LGBT Patients –

Today Tennessee made a giant step towards the legitimization of evil in its mental health system. Governor Haslam made it legal today for counselors in Tennessee to refuse to provide treatment to people they have sincere and deeply principles against. The target of this law was the LGBT population in Tennessee.

It means that people who by training, commitment and the ethics of their profession are supposed to help people with the worst of personal problems and issues can now say those issues offend my sensibilities. People who are told they can trust their counselors with their most personal secrets are now told “… except your sexual orientation”. People who are told to be honest and open are now told “… well not too honest….”

In Tennessee counselors are now told you have the right to discriminate “as long as you are sincere.” Bigotry and hate are now expressions of sensitivity according to Tennessee law. There might be a word to describe the utter meanness of this law but it is past any word that comes to mind.

Point blank…. This law will not simply be a law that discriminates. It will be a law that kills, a law that results in the death and unnecessary suffering of hurting people. It is a law that attempts to legitimize evil.

With one signature Governor Haslam has put an asterisk next to the name of one whole group of people. He has said the unconditional personal regard that you may have thought of as due to you as the client of a professional counselor is highly conditional for you. He has said that the prejudice of any counselor is a legitimate determination of rather or not they will ever work with you. He has said that it is legitimate for counselors to regard a whole population as too dirty and too disgusting to work with.

According to research I have read one of the most common issues that people in the LGBT population most frequently seek help for has to deal with issues of suicidality. How long will it take before someone who sees a mental health system that defines his identity as to dirty to tolerate, someone who badly needs help decides he can’t trust the very system that is supposed to help and ends up dying? How long??

This law attacks the integrity and credibility of the mental health system. How can a “helping profession” tolerate the legitimization of hatred as a legitimate part of its operation? On a million different levels this is wrong.

Mental health makes strong claims to be founded on medical science. Are we next to say that doctors don’t have to deal with heart attacks or other chronic diseases if the identity or life style of a patient offends them? When do you draw the line?

What happens when somebody says he has deeply and sincerely held personal principles about race. This law would really make no distinction. Once licensed hate knows no boundaries, no limits.

This law is so bad. It really legitimized evil. Add your voice today to others already speaking out. Make your voice count. Silence will make all of this so real.

The man who kept kids from starving

April 26, 2016 by

From 2011

Hopeworks Community

from 2011

One of my favorite stories is the story of Jerry Sternin. He came to Vietnam in 1990 to try to come up with a way to address the issue of malnutrition especially that of child nutrition. Without any great theory of malnutrition or any great resources he found a solution and in the process showed the amazing power of a theory of human change called the theory of positive deviance. His idea was real simple. Even in the worst of situations he assumed there were people who were successful. Not all kids were dying of malnutrition. His idea was find the people who were doing things differently, who were successful and teach others to do the same thing. Find out what works and do more of it. And not only did it work it worked spectacularly. A description of his story can be found in many places but…

View original post 302 more words

To Linda….

April 25, 2016 by


A River cuts through rock…. On the battle to close the Gap

April 25, 2016 by



Insure Tennessee may as a proposal, as a product be dead and buried. Speaker Harwell has formed her task force and at least right now that would seem to be the case. But Insure Tennessee was never the river. It was just one vessel upon it. And I don’t know if they really understand that.

I fear they hope more than anything to change the subject. At least right now I fear so. I think they come not to fix Insure Tennessee or resolve their issues with it but to bury it and still the conversation. They are uncomfortable with people who don’t quiet when they say quiet. They are uncomfortable with people who would talk when they don’t want to listen. They don’t like it when people won’t wait. They don’t want to know some people can’t.

I don’t think anyone really knows what this task force means. It is important that we make the effort to help define that meaning. It is important that the task force not be about what they do when we leave but about our refusal to leave. It cannot be about the conversation they silence us with but our refusal to be silent in the conversation.

In the end it is a simple message. Leave no one behind. There are no acceptable casualties. No one is disposable. It is that simple.

This task force will not give us a verdict. This is not a final word. We have already given that. Three years ago the conversation to expand health care was a conversation we were told we could not even have. It is now a conversation that we must make sure can never be stopped.

What you do and what I do matters. The battle for Insure Tennessee or whatever it finally ends up being called has the ability to make a lasting and permanent impact on the state of Tennessee. Past any one battle, or set of circumstances we have the ability to make a difference that makes a difference. Years from now I think little may be made of who we fought with, but much will be made of what we fought for.

It is a battle for health care, but it is so much more than that. It is about justice and the possibility of fairness and whether or not poverty should mean that sickness and illness should bring with it a threat of unnecessary suffering and premature death. It is about whether or not Tennessee will decide whether or not it has a vested interest in the maintenence of the punishment of poor people for being poor. It is about whether or not a health system will be starved and brought to its knees in the service of a political agenda that neither reflects the values of Tennesseans or their best interests. It is all of these things but even more.

It is a battle for the meaning of people. It is about what the notion of disposable people means not just for those labeled such but for all of us. It is about the dignity of every Tennessean rather they have insurance or not. It is about what it means to be neighbors. It is about caring and love as more than a Sunday speech but as a living and vibrant thing. It is about who we are and who we can be. And as much as any single issue it is the truth of what Tennessee is and can come to be.

Let me be clear. My problem is not that the battle for Insure Tennessee was lost. My problem is that it was never fought. My expectation was not and never about victory. It was a fight being fought that I and 280,000 Tennesseans deserved to have been fought. It was about politicians doing something right for someone other than themselves. It was about people speaking for those never spoken for. It was about honesty and integrity and courage and not about elections and primaries. It should never have been held hostage to Donald Trump or Ted Cruz and it is a mark of shame to the state of Tennessee that it was.

But none of this need the final word. We are the river in the quote at the start of this post. The only meaningful question is not if but when. We need to be the change we advocate for. It is time to not apologize to anyone for acting like citizens of this state. It is time to let those know who would pander our hopes and needs away to political realities that we neither care for their politics or their narrow impoverished realities. It is time to tell people who want us to respect their dignity to acknowledge ours. It is time to tell people who get angry if someone makes them uncomfortable that for 280,000 Tennesseans comfort is the least of their issues.

We are the river.

I heard a story a few days ago about a homeless man in Knoxville. He had worked all his life and like it does for too many people things went wrong. He lost his job and his house and eventually they ended up on the streets. His wife developed cancer and the people who told me the story talked about how much they loved each other. She, they said, died in his arms on the streets of Knoxville. She never had any care. They were also in the gap. How long must we go on wondering who is next?

On AOT and human rights

April 25, 2016 by

Assisted outpatient treatment (AOT) is the psychiatric version of ocean front property in Arizona.  Even more than the assault on the PAIMI program written about in the previous post it is one of the crown jewels of the Murphy Bill,  a bill Rep Murphy tells us will rescue us from an unhealthy obsession with mental health and create a system based on mental illness,  which, he says,  is the only kind of system that will truly meet the needs of those with “severe mental illness.”

There are AOT laws in virtually every state now and I am honestly not sure why Rep Murphy thought there needed to be a national law but he did.   Initially the drive to national AOT looked irresistible but it looks now to face a very difficult path to becoming reality.   The original idea was to financially punish states that did not have AOT and force them to adopt a state statute.   The involuntary commitment of states to AOT did not exactly go over real well.  Rep Murphy did not help things by claiming that anyone who was against his proposals was so because of a personal stake or possibility of personal gain in defending a corrupt system that really didn’t care about the people it claimed to serve.   He burned every bridge and then seemed shocked that no one had come to stand with him.

The second version of the bill decided that perhaps a big stick might have been a little over the top and substituted a big carrot.   They would not punish those who did not have AOT.   They would pay those that did extra.   This version has gotten a little more support.   Some organizations have jumped on board since the overt nastiness was somewhat muted but for many people the coercive passage of a coercive Bill has not went well.  

I live in Tennessee which does not have AOT.   As much as I object to Tennesseans being committed I also object to Tennessee being committed.

AOT is based on a central irony I have never heard anyone even begin to explain.   Rep Murphy will explain to you in great details how the current mental health system really sucks.   He will tell you it does not in any way meet the needs of the “severely mentally ill”.   Then in the next breath he will tell you how important it is to pass a law that allows you to commit people,  force them to accept treatment in this awful system.  I  still don’t get it.   Is he saying that the system sucks (His rhetoric goes into overkill on this point) or is he saying that choice sucks.   He seems to have a great affinity for coercion as long as he is doing the coercion.

AOT is a little answer to big problems and the volume that Rep Murphy presents it at does not make it any bigger.   He throws out huge numbers of “severely mentally ill”  in jails and prisons and then tells you they are there because they were not coerced into mental health treatment.   Forget for a moment the remarkably simple minded nature of his reasoning.   Forget for a moment his seemingly endless faith in the power of coercive mental health treatment. Forget for a moment that he ignores the affects of poverty,  racism,  trauma,  homelessness,  drugs and many other social determinants of human behavior on crime.   Forget all that and look at AOT.

In most states it is far from a bustling success.   The numbers served in comparison to the numbers served in the entire system are miniscule.  New York,  which is the promised land of AOT serves last I checked about 2000 people… about 1/3 of 1%.  Perhaps if this is true in the state which tries harder than any other to commit people then there is not the widespread need for committal that Rep Murphy says underlies our current crisis.

They tell you that medical facts provide the foundation for the operation of AOT yet one study says that if you are black you are 5 times more likely to be committed than if you are white.  –

There are just many problems with the whole thing and more and more they are coming to roost.   Right now it looks doubtful that the Senate will drink the AOL kool-aid.   Even in the House there seems to be some reluctance to move forward on a bill that as written is so different than the Senate version.   They want a “bipartisan” bill to emerge but seem to be struggling with the idea that a bill based on the casual acceptance of coercion as a building block of the mental health system is going to have some problems with getting Democratic approval.   It is becoming more obvious that if Rep Murphy must have his way that there may not be any way.

Rep Murphy is going uphill right now.   That is obvious perhaps even to him.   But he is a true believer and is not going to stop.   And this is not a done deal.   As dangerous as AOT is and as dangerous as other aspects of the Murphy Bill are Rep Murphy is also dangerous.   There is no promise about what kind of deals people eager for some kind of deal might make in a conference committee.

Talk to your legislators.   Tell them you want mental health reform that actually addresses problems and not ideology.   Tell them that coercion is not part of any solution and that you do not believe justice and a respect for human rights are incompatible with helping troubled people build a better life.   Tell them to vote for you if they want you to continue to vote for them.

Rep. Murphy would have us have faith in a psychiatric vision and a system that has proven dangerous to too many people it had served.   He  asks us to have faith and trust in the good will and judgement of something less and less people have faith in.   He defends the power of a role that has progressively lost power and says the solution to the problems of the way things are now is to go back to the way things were.

If Dr Torrey and company are defeated here rest assured they will be back with the next shooting,  the next tragedy.   If they don’t make it on a national level they will be back at your state legislature asking for more power.   In some states they are already there.   Be vigilant.   Your voice matters but only if you use it.

I close this post with the words I started the previous post about PAIMI with.   They still apply perhaps even more on this issue than on PAIMI.

Thanks for your time.   Be well.

Only people with power believe that the
human rights of vulnerable people are not worthy of protection.   Only people with power would have us believe that the protection of those rights prevents them from the lawful and appropriate use of their power.   Only people with power would have us believe that those who would protect those rights are more dangerous and more trouble than those who would threaten those rights.   Only those with power would have us believe that the role of government is to get out of their way and not be concerned with how they would treat vulnerable people.   Only those with power would have us believe that they need to be protected from the people who would protect the vulnerable from them.

PAIMI and the defense of human rights

April 24, 2016 by

Only people with power believe that the human rights of vulnerable people are not worthy of protection.   Only people with power would have us believe that the protection of those rights prevents them from the lawful and appropriate use of their power.   Only people with power would have us believe that those who would protect those rights are more dangerous and more trouble than those who would threaten those rights.   Only those with power would have us believe that the role of government is to get out of their way and not be concerned with how they would treat vulnerable people.   Only those with power would have us believe that they need to be protected from the people who would protect the vulnerable from them.

PAIMI (Protection and advocacy for individuals with mental illness) is the governmental program set up to protect the rights of those labeled “mentally ill.”     Representative Timothy Murphy,  author of the Murphy Bill,  at one point last year dismissed the operations of PAIMI as “reprehensible”  and his bill as written would make sure that PAIMI no longer plays a  major role in efforts to insure the safety of anyone receiving services within the mental health system.   It would say the human rights of any person with mental health needs  is incidental or irrelevant to the quality of their lives.   It would say that those who would demand the human rights of those within the mental health system actually cripple the ability of that system to provide the services essential to the welfare of the most vulnerable people it serves.

The Bill would tell us to do other than what they suggest will threaten the ability of psychiatrists to exercise their legitimate authority. It would tell us that psychiatrists can and should be trusted with this authority, that they have knowledge and skills that others don’t have and to limit their authority would compromise the effective use of that knowledge and skills.

All of this is nonsense on many levels. No psychiatric diagnosis makes a person less a person and makes him any less deserving of the rights we would accord any other person. The reality of the possibility of manipulation, hurt, and injury that anyone with a psychiatric diagnosis faces from those who would control him “for his own good” is well documented and clear to anyone who makes any effort at all to open their eyes to the reality of what mental health treatment can be. Furthermore it is a slander to thousands and thousands of professionals who don’t feel their professional role should give them license to disregard the rights of others and that furthermore such disregard is neither helpful or essential to the quality of care any individual receives.

If you don’t know what PAIMI has meant to your state you need to find out and then you need to make sure you share that knowledge with both your Senator and your Representative. The mental health bill in the Senate does not include the attack on PAIMI that the House Murphy Bill does and there seems to be little support to change that. Let your Senator know you support him in this. The PAIMI provision is a major source of conflict still in the House. Let your Representative know you consider this a poison pill and ask him not to support any Bill that includes this. It is especially important to let the House leadership know this. Despite Rep Murphy’s pr theatrics there is some evidence to suggest they are less than sold on pushing this Bill forward. Tell them that human rights is not a partisan political issue and that treating those rights as a therapeutic irritant is not one of those evidence based practices Rep. Murphy is so fond of talking about.

PAIMI has played a major role in Tennessee. They not only helped to identify major problems in the adult group home system but were a major part of the attempt to resolve many of those issues. In partnership with the Depth of Mental Health they are a major part of trying to insure that everyone treated within the system is afforded the same protections available to any other citizens.

There is every reason to believe that we can keep the PAIMI provisions of the Murphy Bill from seeing the light of day but the issue is not settled. Your voice matters. Speak loudly…. Speak now. Please.

We need a dream…

April 23, 2016 by

We need a dream
A dream that says
That hate is wrong
That all people deserve
To live
Free from fear
And violence
That none of us
Should be the victim
Of names or labels
That would make us
Less than human
We need a dream
A dream that says
That poverty is not
A disease or
A judgement from
God upon the
Character of the poor
And that even the poor
Should share in the
Opportunities available to
All men
For humanity
Is not measured by
The content of our wallets
Or our social status
We need a dream
A dream that says
No one should die
From the denial of
Medical care
That in a land
That can feed
It’s neighbors
No one should
Go hungry and
That no human being
Should be homeless
We need a dream
A dream that says
Love is stronger
Than hate
That division
Cripples and chains us
And makes us less
Than we can be
And that we will
Never rest
Never stop
Never walk quietly away
When confronted with
Injustice or injury
That the hurt
The pain
The suffering of my neighbor
Is a violation
Of me
What I care about
And the common humanity
Of all people.

The task farce

April 23, 2016 by

Below is the text of a Facebook post by Rep. Harry Brooks  of Knoxville.   It describes the agenda of Speaker Harwell’s task farce(force).

It has been a week filled with long House Floor sessions this week in Nashville. However, we made progress on a few key issues. This week I would like to turn your attention to an announcement made by Speaker of the House, Beth Harwell, and Governor Haslam.
For the past year or so, the Tennessee General Assembly, and Tennesseans as a whole, have heard much discussion over the path for our healthcare system and the issues facing it. As many of you guys know, we had the Insure Tennessee bill last year that failed.  Since then, members of the Tennessee General Assembly have heard from many constituents in regards to this issue. We have realized that there is a healthcare problem amongst many Tennesseans today, and Speaker Harwell’s announcement speaks to that.
The Speaker announced the formation of a Healthcare Task Force for the purpose of improving access to medical care. It has been named the 3-Star Healthy Project. The task force is composed of Representatives Roger Kane, Cameron Sexton, Matthew Hill, and Steve McManus.
The 3-Star Healthy Project’s Task Force will be charged with developing a list of options for making TennCare more efficient and increasing access to medical care for Tennesseans. These options will be tested through a set of pilot programs. One concept under consideration is that the pilots would be launched in different areas of the state and successful pilots would be phased in over time. Staggered implementation would ensure that the rollout of the 3-Star Healthy Project proceeds only after key benchmarks are met. Phased implementation timelines are widely used in quality improvement initiatives currently in the health care sector.  This will allow Tennessee to monitor the success of three pilots to determine which works best for Tennesseans and control costs the most.
Initial discussions among members yielded the following examples of conservative ideas for the pilots: encouraging enrollees to take more responsibility for their health and use of healthcare services; creating Health Savings Accounts funded by enrollees’ premiums to pay copayments for doctor’s visits and prescriptions; providing support for enrollees who want to re-enter the workforce.
Another unique feature of the Project the Task Force will consider is the concept of thresholds and “circuit breakers.” In order for these pilots to be implemented beyond an initial area, costs from the previous phase of implementation could not exceed a predetermined benchmark. The Task Force is charged with identifying such benchmarks, as well as an overall “circuit breaker,” which would immediately end a pilot should the state’s share of costs increase.
The Task Force will evaluate these ideas and others brought to the attention of its members over the next two months. The Speaker has asked the Task Force to return a report to her in June.  They are set to have their first meeting April 26th and 27th.
I hope everyone has had a great week. Please feel free to contact me if you have any questions, or if I can be any help to you. I can be reached by email at or by phone at 615-741-6879. It is an honor to be your representative.

In case there was any doubt this has nothing to do with trying to find a way to find coverage for 280,000 people.   The conservative Tennessee principles she likes to reference are simple….. LET THEM DIE.

Her task force is not about the transformation of Insure Tennessee into something more palatable to their sensitivities.   It is about closing the conversation,  stopping the discussion and talking about something else.

Read again what Rep.  Brooks says,  “Initial discussions among members yielded the following examples of conservative ideas for the pilots: encouraging enrollees to take more responsibility for their health and use of healthcare services; creating Health Savings Accounts funded by enrollees’ premiums to pay copayments for doctor’s visits and prescriptions; providing support for enrollees who want to re-enter the workforce.

This is not just inadequate.   It is fraudulent and criminal.   This is don’t give a damn masquerading as political principles.   This is a small group of people trying to pump a reality as divorced from the real world as possible.

This is trying to shut down a discussion you don’t like and praying that people die fast enough so that no one realizes they still have something to say.

It is the Harwell task farce.

What now?

The living of Cecil Cook…. go rest high

April 23, 2016 by

Cecil Cook was my best and good friend.   He died several years ago and this was written a couple of days after he died.   He was the best person I have ever known and my hope is one day to be half the person he was.   His death was tragic but his living magic.   I still celebrate it.

(Sometimes people ask me what posts on this blog matter to me.   This is my favorite)

You meet very few incredible people in this life.  My good and great friend Cecil Cook was such a person.

They called this afternoon.  He died in a plane crash yesterday.  He was the only one aboard a small plane.  They dont know what happened, dont know when they will.  They said he was literally minutes away from a safe place to land.

Today has been numbness and tears, both without warning, in moments forever, like a terrifying dance. I try to tell myself that he is in a better place and how lucky I was to know him, when so many didnt have the honor, but I feel ripped and torn and life a little less in some important way I dont understand.

Cecil was a good person in a way that goodness really means something.  Kindness was for him not an affectation like it is for some people.  It was not a burden to be endured.  It was not what he tried to be or what he had to be.  It is simply what he was.  It was breath and light and sun.  It made no sense to think of him in any other way.  And with him you knew that kindness was really strength and you found yourself hoping that someone might tell you you were at least a little like Cecil.  He had the unique ability to tell people no matter what their pain, what the circumstances of their life were, that the door to their life was still open.

Cecil was the chaplain at Ft. Sanders in Knoxville.  For 16 years it has been his hospital.  Today I stood in the chaplains space, in the offices, the hallways, and chapel and watched as person after person came to say goodbye or just to come and look and see if it was true.  Some wanted to talk.  Some just stood quietly and cried.  From cafeteria worker to nurse to doctor to administrator they all came.  Their words were simple, “….he was my friend….”  We talked. After a while we just stood.  Then we left.  We had no where to go.  We just didnt know what to do.

But while his death was tragic and the days ahead will seem slow and immobile this is not about his death.  For you see the living of Cecil Cook was the real miracle.  It was the real story. And that is really what I want to share.

We met Cecil about 10 years ago.  My dad was in the hospital dying from cancer.  My wife and I had traveled with 2 of our kids 250 miles to be there.  The kids were 10 and 12 and waiting in the waiting room was no what they can do.  So they got on the elevators and starting riding.  I guess they saw the hospital that day.  I went looking for them, but never came close.  Finally they came in with a smile on their face telling me that we had to meet this guy they had met.  In their rush of words I got he was the chaplain but really didnt understand much else.

I never found out how Cecil knew to rescue them, but somehow he found out and did.  He had told them the story of the prodigal son, but somehow in his version every word started with F.  There were farthings, and fitlings, and friends and fathers and a whole lot of other things that I dont remember.  Cecil recited it for us that day also.  Every word did start with F.  I never found out where he found that story either.  Linda and I walked away that day that day better.  In the short time we knew him we already had a sense that pain was not forever.

We became friends.  And what a friend he was.  He was a confidant, he was a support, he was a teacher.  He helped us to know in his giving that our giving mattered.

Cecil had started the Stephen Minister program at FT. Sanders and in time Linda became a Stephen Minister.  He taught the power of the broken reaching out to the broken.  He believed in the value of ordinary human beings and when he would tell stories of those he ministered to you knew he felt as blessed by them and anything he did for them.  If love is measured by what you give, then Cecil had riches beyond riches.

He loved poetry and he loved words.  It seemed like he had every poem in the world memorized and when the occasion called for it he always seemed to know what verse to recite.  I saw him cry when talking about the pain of others and the illnesses he encountered on a daily basis.  But he could listen and he could care and everyone who met him knew they were cared for.  And they knew that although pain was real and inescapable some times that loneliness was not.  And in Cecil’s heart I think they knew the  reality of the God he served.

After years of tagging along with Linda and being an unofficial Stephen Minister I decided to finally take the training and become official.  Our class, Cecil’s last, has just started.  The training will continue and I hope to graduate.  But I will sorely miss him not being there to congratulate me.  He so much shared joy you didnt feel like it was a hard thing to find and right now I wish I knew where to look.

Cecil I think is in a better place and Heaven is a brighter and even cheerier place this night.  I really wish you could have known him.  He was a friend, a colleague, a model, a teacher and I dont know how many other things.  Somehow I always had the feeling he could help regardless of how bad things were.  God is a God of miracles or how else could there be a Cecil.  It was an honor to know Cecil, but you know, I really think he felt like it was an honor to know me.

I dont know how to end.  I dont know if I want to.  The night ahead and days to follow already seem long.  I saw Cecil do a funeral once.  He  turned to the audience and said, “Lets talk about her living…”  It seemed like such a good way to say goodbye.  Good bye Cecil.  I dont know where we would be without you.  You have touched so many in so many ways and I hope when you look down you see in our living a small token of how much you have meant to all of us.

On what we cherish….. when easy just seems very hard

April 23, 2016 by

I found the post below on Facebook memories.   I don’t even know how long ago I wrote it.   Sometimes I post things to certain people.   An answer to a question,  a message,  sometimes support.   I  always hope a lot of people read but sometimes it is just about what one person reads,  one person hears.

The post below is really for me.   There is a line in a song that describes a lot about how I feel right now,  “Easy is getting harder every day…”  

It was originally written for a friend. He was trying to cope with a major tragedy in his life.  I remember telling him the loss of important things need not be the end of finding things important.  

This post is both reminder and prayer for me.   If easy is getting hard for you I hope you will find something in it for you.

I know people that life is not going to change for.  An accident of birth, a victim of circumstances, bad luck….a hundred thousand million different reasons.  Everyday is weight. 

People can not always choose what they live with.  Perhaps the answer is in what we live for.  Perhaps we can in some way choose what we cherish.  Maybe when we cant make things different we can still find a difference.

Do hard things, even very hard things, have to matter as much as good things.  Do loud things make it impossible to hear other things?  Do you sometimes even wonder if there are other things?

Perhaps that is where the journey starts- in knowing there are other things.  In knowing that the loss of something loved need not be the end of loving.  Perhaps that is where the seeds of hope can be found.

I had a great and good friend named Cecil Cook who died in a plane crash several years ago (see “The living of Cecil Cook”).   He was the most helpful person with hurting people I have ever known.  He knew a truth very few people ever knew: that kindness was the greatest strength.  It was like breath to him.  I remember once at a funeral he preached he said, “Lets talk about how she lived…”  And for 30 minutes we told stories and laughed and then cried and then told more stories.

Sometimes we have the wrong conversation with ourselves.  I know I do.  This is a brutal period of my life and sometimes at night sitting on my porch I wonder about kinder spaces and better times.  We all suffer small deaths every day but perhaps the conversation should be about how we have lived.

The deepest injury is not in pain or hard times.  Perhaps it is not even in loss or sorrow, not even in the loss of what we cherished, but in the awful soul killing fear that it doesnt matter what we cherish, what we love, what we care about.  Perhaps that is the injury unto death.

Remember Cecil’s words.  “Lets talk about how she lived…”  Give yourself the same gift.


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