Citizen at Large

Fostering Feedback: An Epilogue

So a quick follow-up to my last posting that concerned my disappointment regarding the apparent lack of response to a seemingly blatant abuse of power in my local town.   As you may recall, this involved the abrupt dismissal of a maverick finance committee member.  Well, I wrote a letter to the editor of my local paper conveying the sentiments I had articulated here.  When I called the editor to tell him my letter was coming, he concurred with my surprise that there had been no outrage expressed over the incident and was pleased that my submission helped validate the importance of the article he ran.  The day the letter ran, I received a call from the fired finance committee member in question, expressing his gratitude for the letter.  He also told me that he was continuing his reform efforts, even though he no longer held his finance committee position, and wondered if I wanted to get involved with such efforts.  In the days that followed, I heard from several different friends that they had read my letter and were glad I’d written it because they, too, had been perplexed by the sudden finance committee dismissal. 

So I’m not quite sure whether or not I want to align myself with the groups working on reform; I need to do more research about what they are doing.  But what I learned in the process is the importance of feedback:  when we speak out, feedback from others (even if it’s negative!) is crucial to making us feel validated, so that we do not feel we are acting in a vacuum.   The dismissed finance committee member needed feedback that someone out there was paying attention; the newspaper editor needed to know that people actually cared about what was in his paper; and I needed feedback from others in the community that my letter made a difference to them.   Of course, the person that really needed feedback was the Town Moderator who had made the dubious dismissal, so I am hoping he saw my letter too. 

Nothing quenches participation in a democracy more than a lack of feedback, when no one seems to really care whether or not one is speaking up or taking action.  And nothing makes elected officials’ jobs easier and more easily corruptible than a lack of feedback from their constituencies, or in other words, a lack of accountability. 

What have been your experiences with speaking up in your community? 

Participation and Accountability in a Democracy

Upon returning from a two-week vacation, I found myself sifting through a huge stack of mail.  I glanced through a two-week old edition of our town’s weekly newspaper in the pile, and noticed one of the front-page articles was reporting that a member of the town’s finance committee was being sacked; I was intrigued. 

So I am still learning about my new town’s governmental structure.  As far as I can tell, my town is run by an elected five-member board of selectmen.  The Board of Selectmen then appoints a Town Manager, who, along with a staff, runs the day-to-day operations.  The town also selects a Town Moderator, who is responsible for appointing volunteers to fill slots on all the myriad of town committees, including the Finance Committee.  My town, with its New England roots, still holds an annual town meeting, where each resident attending can vote on the various proposals put forth by the Board of Selectmen, which are primarily budget items.  It is, in theory, a very participatory form of democracy. 

I attended my first annual town meeting several weeks ago, and left very pleased at how hands-on the governing of our town could be.   One of the presenters was the now-canned finance committee member.   He was proposing an apparently radical change in the budget creation process, one that would empower the finance committee to make cuts where necessary as well as make the whole process more transparent to town citizens, with the intended outcome of lowering our sky-high property taxes.  As far as I could tell, his logic made sense, and it seemed to resonate with many of the attendees; however, the board of selectmen and the other finance committee members seemed very resistant to the idea.   So you can imagine my interest when I realized this maverick finance committee member was not being re-appointed.  The article said the town moderator, after consulting with town selectmen and other finance committee members, had thought it was best not to renew this appointment, since he felt that this individual could not be effective “if he doesn’t want to follow the same process that the rest of the [finance committee] members want to follow.”  When I read this, I was quite shocked at the audacity of the move.  I felt certain there would be a citizen response in the next week’s paper (which was also in my mail stack) expressing some outrage, or at least concern over what had happened, but there was none.  Nor was there any discussion in this week’s newspaper that I just received today.   Well, at least the local newspaper had thought the story was newsworthy.  But where were the town citizens, questioning this highly dubious maneuver?   Where there is no participation amongst the citizens, there is no accountability amongst their elected officials. 

As I continued to peruse through my two weeks’ worth of mail, I noticed an article in The Economist magazine condemning the latest farm bill passed by Congress.   The author detailed the exorbitant subsidy giveaways to U.S. farmers, many of whom are very wealthy, while ignoring the contribution these subsidies make to the soaring worldwide food prices.   Why am I not hearing more outrage?   There must be more of us who would oppose this bill than those who support it.  But while we’ve all been mesmerized by the presidential campaign, the more mundane but arguably more important actions of our congressional legislators (be they Democrats or Republicans) seem to escape our notice. The devil is in the details, as they say. 

As I read about how the passage of the bill was really a victory of the powerful farm lobby, I was left with the same feeling I had while reading my local newspaper.   There is little accountability for Congress members because there is not adequate citizen participation.  And there are forces making participation both difficult and perceived as ineffective.  The lawmaking & budget-making processes have become so complex and obtuse that it can be virtually impossible to navigate and digest, let alone act upon.  In addition, legislators rely on the principle of concentrated benefits and disbursed costs.  The farmers get the big bucks, so they lobby hard.  Everyone else ends up paying just a little more in taxes, so it’s not worth any one individual’s time to care about a single spending bill.  So all the spending programs (and the farm subsidy program is only one of MANY), with their powerful constituencies and lobbyists attached to them, continue in perpetuity.      

There are deeper problems with our political system, no doubt—the power of incumbency, the lack of meaningful lobbying restrictions, the lack of effective campaign finance reform, amongst others.  But as citizens, we can increase Congress’s accountability by simply paying attention, by participating.   Incidentally, I’ve found a great tool for staying current on Congress’s actions.  Sign up to receive megavote emails that detail upcoming legislation and how your representative voted on the latest legislative actions.     The site, www.congress.org also has information on your elected representatives, bills under consideration, congressional committees, and more. 

 And as for my own local participation, now that I’m back in town, I’ll write in about the finance committee member myself and maybe give our Town Moderator a ring.  Perhaps there will be more to the story…

Of traffic and tragedies

CRASH!!

My kids and I heard the startling sounds of yet another car accident at the traffic intersection two houses down from our home, or rather, at the former home we occupied before moving to a different town about eight months ago.  We lived in that house for five years, a lovely home in a quaint and quiet neighborhood, complete with a 19^th century cemetery across the street.  But this serenity was disrupted at an almost predictable monthly frequency by the sound of a major car accident at that very same intersection.  Over and over again, we would witness the same scene: totaled cars being towed away (one flipped over right into our neighbor’s front yard); bewildered, if not injured, drivers and passengers being carried away by ambulances; and our road being barricaded off by police cars.  The problem was this: a delayed green light on one side of the intersection as well as a blocked view for those on the other side waiting to turn left.  The obvious solution to the problem was simply to install a left-turn green arrow.  After enduring the jarring sounds and frightening scenes for well over a year, I finally starting asking around about why a green arrow was not installed in what was such an obviously necessary place.

Turns out that although the town police and emergency workers had long recognized this intersection as a major problem spot, the intersection is technically located on a state highway, and therefore, under the state’s jurisdiction.  And this little intersection on an otherwise pristine parkway was never going to make it to the top of the state’s priorities. 

Well, OK, I had inquired, and there was nothing I could do—it was in the state’s hands, and the state was not going to fix the problem.  Because who was in charge of the problem area didn’t consider it a priority, a simple fix was not being implemented. 

So the CRASH! BOOM! BANGS! kept on happening, and every time they did, It made me feel both powerless and a little ashamed, that I hadn’t lobbied a little harder, or just bucked the system altogether and put up the green arrow light myself. (Is this possible?!)

So why am I thinking of this now?  As I said, we’ve moved away, and so far, fortunately, I haven’t witnessed any traffic accidents from my current kitchen window.  But I was listening to a show on NPR yesterday in which experts were debating how to handle the devastating effects of Cyclone Nargis given that Myanmar’s governing military junta has refused to allow into the country virtually all international aid. It’s been over two weeks now, during which the death toll has climbed to an estimated 78,000 with another 55,000 missing; moreover, an estimated 2.5 million people are in critical danger of losing their lives because of the lack of food, shelter, clean drinking water and medical treatment.  The U.S., France, Britain, and many other nations along with the U.N. have been clambering at the gates of Rangoon lined up with plentiful food, water, and medical supplies ready to be dispatched to the hard-hit Irrawaddy Delta region.  Yes, what is WRONG with the junta? It is an unconscionable position of historic proportions, turning, as Britain’s Prime Minister Gordon Brown says, “…a natural disaster into a man-made catastrophe.” There is nothing I can write here that could possibly capture the magnitude of this tragedy, or the true evil of Myanmar’s rulers whose pride and utter disregard of their own people will have sweeping, if still undetermined, consequences.

I am, however, going to attempt to connect the minor local traffic problem to this global disaster, though I know it is a stretch. In doing so, I am not in any way trying to trivialize the Myanmar tragedy.   

The experts debating today on the radio represented two viewpoints: one, continue the diplomatic efforts to convince the junta to let supplies and aid workers in ASAP. The other, disregard the junta and simply go in, using force if necessary, to provide immediate relief to the millions in danger of losing their lives.  Proponents of the first argument made reasonable arguments, mostly having to do with setting the precedent of respecting sovereignty and with getting involved (from the U.S.’s perspective) in yet another foreign entanglement which could get messy.  So I understand that line of thinking, just like I understand that the state has jurisdiction over that dangerous intersection.  But here’s what I wonder, if another million people lose their lives needlessly because the world could not agree to simply defy the perpetrators of murderous negligence, will we look back at that and say we were wise?  I cannot believe it to be so. 

I’m not sure somehow yet has lost their life in a traffic accident at that intersection, but when that happens, I, and likely my former neighbors, will wish we had taken more action, and not simply been satisfied with being told that it was out of our hands.  Sometimes, we have to buck the system to do the right thing, even—and perhaps especially—when it’s in our own backyard.  

What is your opinion on how the Myanmar situation has been handled? 

Have you ever tried to change something for the better, but given up, perhaps too easily?  

The Case for Character

So I haven’t been struck by any local issue lately, but it’s hard to avoid the ever-present coverage of the Clinton-Obama-McCain race. 

It seems that the airwaves are crowded with the dredged up personal histories and the latest personal gaffes of the presidential candidates.   In response to criticism, candidates often offer up a common refrain, deflecting personal attacks by saying, “we need to get back to the real issues.” 

Yes, it’s always, “let’s get back to the real issues”—like healthcare, the economy, the war in Iraq, and so on.  While I do not quarrel with the gravity of these issues, I cannot understand why personal issues are not relevant, why in fact these are not the relevant points of information, particularly in the prolonged Democratic campaign where the two candidates have remarkably similar positions on many of the major issues.

This is not a critique of any of the candidates (truth in advertising, my favorite candidate has already dropped out), but, rather, a critique of the values by which we judge political candidates.  Should we be disturbed that Barack Obama’s former pastor, Jeremiah Wright— who led the church in which Obama found religion, who married him and Michelle, and who baptized their children—spews alarmingly racist and anti-American speeches?   What is it just the exhaustion at the end of a long day of campaigning that caused Hilary Clinton to fabricate a story about landing in Bosnia amidst sniper fire?   Is the Keating Five scandal in which John McCain was implicated really so long ago that it can be dismissed from relevance? (And by the way, I am not offering these up for rhetorical purposes only—I am really querying whether these charges should be seriously considered in assessing a candidate or not.)

With the prolonged presidential campaign generating record media coverage (and therefore record media profits), it is no surprise that the media want to squeeze anything they can out of the campaigns to keep the story alive.  Indeed, the campaigns seem to have largely become a means to entertain the public: the pleasure of catching a candidate in a fib; the delight of turning a “too perfect” candidate into something not so perfect; the titillation of a salacious report.   Yes, for decency’s sake, let’s get to the real issues, and out of the muck.   

But character matters, nonetheless.

With the barrage of political scandal in the past 35 years (many say since the outbreak of Watergate), voters have become increasingly cynical of their politicians, and therefore disaffected and apathetic toward the government run by them.  The tragedy is that even though the media still gleefully cover any hint of scandal, voters seem largely desensitized to it, and rightly so.  With a plethora of politicians caught breaking the law, breaking marriage vows, and lying to the public, eventually voters get worn down, and as a defense mechanism for their cruelly destroyed hope in government, they laugh it off, and decide to expect nothing better from anyone swearing on a Bible to uphold the U.S. Constitution.  And then as a way to make certain individuals acceptable as political candidates, we are told that a candidate’s personal life should have nothing to do with his/her ability to govern.  But the way a person has behaved in his/her family, business affairs, and community is exactly what has built their character.  Examining a candidate’s political as well as personal behavior should be fair game, not for entertainment value, but for serious consideration as we look to the future.

While the details of a candidates’ healthcare plan or economic stimulus package should arouse our interest, the likelihood of those exact plans being converted into laws is almost zero.  Furthermore, while proposed policies presumably do reflect the political philosophies of the candidates, they are formulated with a host of advisors and with many different constituencies in mind.    Understanding the differences in where candidates stand on the “issues” is important, but may not give us insight into who a candidate really is: what is the level of his/her integrity, does he/she have courage, how does he/she react under pressure, to whom is he/she beholden?   Certainly when George W. Bush was elected on a platform of compassionate conservatism and mild isolationism, voters had no idea that 9/11/01 was right around the corner.    Since we cannot predict the issue that will be top of mind in two, four, or eight years, a candidate’s judgment and moral character is more important than his/her stance on current campaign issues.

Thus although candidates may urge us to simply “focus on the issues,” we also must discern which of the latest-revealed details of a candidates’ life merit serious consideration and which simply reflect harmless personal foibles, accidental missteps or past misdeeds for which apologies have been issued and from which characters have changed for the better.    A daunting task, to be sure, but important nonetheless, to our being effective participants in a democracy.    

How do you evaluate a political candidate? 

A Law-abiding Citizen

I recently heard a report on NPR about a Massachusetts legislator doing some legislative “spring cleaning.”  http://www.npr.org/templates/story/story.php?storyId=88512208 Legislator Byron Rushing was attempting to wipe out 20 laws he considered archaic from the Massachusetts’ lawbooks.  Some of these included: being a member of the Communist party, being on birth control while unwed, and spitting on the ground.  I’ve heard of other out-dated laws, too.  Whenever I tour Boston’ s Freedom Trail, someone mentions how it’s still illegal for ladies to wear high-heels on then Boston Common.   Although these examples might seem quaint and even cute, they are official statutes, written on the official books somewhere.

So here is the question: What does a law actually mean?  Does it mean that someone intends to enforce it, no matter how archaic or obscure?  Or must it have some sort of constituency of legislators, police officers, and the like who publicize and then enforce it for it to have any efficacy?  If a tree falls in a forest when nobody is around, does it actually make a sound? Likewise, if a law has no constituency supporting it, does it actually exist?

The problem for me is this: I want to be law-abiding (although I can’t say this absolutely, because I regularly, and willfully, break traffic laws).  My husband and I are considering purchasing a large electronic device (you might guess what it is).   Since our neighboring state, New Hampshire, has no sales tax, and since we live 30 minutes from a New Hampshire store that carries this item, we concluded that the rational thing to do was to buy it up there.  Many of our acquaintances have done the like; in fact, New Hampshire stores actually advertise their no sales tax status to woo Massachusetts customers. But in compiling our taxes for this year, we ran across something interesting:  Massachusetts state law requires one to pay a “use tax” on any purchases one made out-of-state. It’s coincidentally the same rate as the state sales tax of 5 percent. Talk about an unheard fallen tree!   Is anyone aware of this law?  What about all of the zillions of stores in the MegaMall on the New Hampshire/Massachusetts border?   I’ve never heard about the use tax from anyone—not even in the context of some smug new owner of a flat screen TV gloating that they’d both avoided the Massachusetts sales tax and evaded the use tax.  So what were legislators thinking when they passed this law?  Was it to actually dissuade out-of-state purchasing, earn state revenue, or simply appease Massachusetts retailers? Was there ever any attempt to enforce it or even publicize it?  

But out with the archaic and the obscure and on with the new here in Massachusetts: Government officials are just now confirming major hikes in penalty fees for illegal parking in Boston and for speeding on the Massachusetts Turnpike.  The hikes were offered up as a way to boost city and Turnpike revenues, not to actually dissuade people from parking in handicap spots or speeding down the pike.  In this case, I suppose, actually publicizing the fee hikes would only harm the intended outcome of increased revenues. 

So I’m left at a loss:  Which laws does the government expect me as a citizen to obey?  Should I be obeying only the laws that are most eagerly enforced and publicized? Or should I be diligently combing through government statutes to familiarize myself with all the laws out there for me to obey?  Should I continue breaking traffic laws so as to do my part in boosting the state budget?   And finally, where should we be buying that big flat screen TV…?

Have you bumped up against laws you never knew existed?

Do you obey only the laws that are enforceable in a practical way?

Pox Paranoia

So my daughter has been hit by the dreaded pox. 

No, not by the pox of old-fashioned lore, smallpox.  And actually not even by its benign namesake, the chickenpox.  What she has been hit with is Pox Paranoia, contracted from our state’s public health system.   Here’s the scenario:  my daughter recently attended preschool and was “exposed,” along with the other 30 children in her class, to a child who, it turned out, had a breakthrough case of the chickenpox.  The term “breakthrough” refers to a case where a child has been vaccinated—and in this case had received a booster as well—but still contracts the chickenpox, usually in a milder form.  Well, this exposure of the contaminated little girl sent the preschool community into a dither as administrators tried to follow our state’s protocol for handling chickenpox.  

It turns out that although chickenpox is an un-dangerous disease—most of us adults having survived it just fine, albeit uncomfortably, in our childhood—my state has extremely punitive protocols regarding chickenpox cases.  The preschool teacher called me early the next morning to inform me that because my daughter had not been vaccinated, she could not enter the preschool building from day 10 through day 21 of her apparent exposure, which meant nearly two weeks of missed preschool (the cost of those preschool days, mind you, were not refunded by the state mandating her absence!).   

So here is the brief 411 on chickenpox: my children’s pediatrician (one of the most well-respected in our state) strongly recommended against vaccinating kids for the chickenpox for a few reasons: 

·         First, the vaccine has not been around long enough to determine how effective it will be into adulthood, since it was only introduced in 1995. Many experts fear a huge breakout of shingles (the related adult version of chickenpox) amongst adults who were vaccinated but never had the disease, since the vaccine provides fewer antibodies than the actual varicella virus.  

·         Second, the vaccine has a relatively low effectiveness rate, with estimates ranging from 40% (from the skeptics) to 86% (from the federal government’s CDC); thus “breakthrough” cases like the one I described are not unusual.  Because of this, children have to receive at least one booster of the vaccine to maintain immunity, and some experts say that boosters may have to be administered in perpetuity. 

·         Third, chickenpox is not a dangerous disease (with death rates hovering around 0.0025%), and my pediatrician felt that the vaccine had been developed for the convenience of parents and for the bottom line of pharma companies, and not for general public health.  The CDC’s website confirms this when it offers, “children with chickenpox miss an average of 5-6 days of school, and parents or other caregivers miss 3-4 days of work to care for sick children,” as a reason for vaccinating.

In summary, my pediatrician felt it much better for kids to simply contract the disease naturally and then have lifelong immunity. But our state, like 28 others, requires that children receive the chickenpox vaccination before they enter public kindergarten.  My pediatrician’s philosophy was, then, “Hope your kids get it before they start school; if not, they’ll have to get the vaccination.”  Accordingly, he kept a list of parents who wanted to know the minute any patient got the chickenpox so they could send their child over to contract the disease!  And in doing some research on the topic, I came across the trend of having “chickenpox parties,” so parents could expose their kids to the disease.     

Parents who want to vaccinate their children against chickenpox have perfectly valid reasons—chickenpox is no fun for the child or the parent experiencing it, and it can be very difficult to have to miss school and work in order to manage it.  However, in my view, chickenpox does not pose a public health risk and therefore should not be mandated by the state.  The vaccine, like others out there, should be optional, particularly as concerns grow about the risks of having so many vaccines administered to children so young. 

So back to the preschool scenario:  As it turned out, every other preschool child that had been exposed had also been vaccinated, so my daughter was the only one quarantined.   This made no sense to me: if everyone else was vaccinated, then why was my daughter a threat?  And, if she was a threat because of the vaccine’s low efficacy—thus implying that vaccinated kids could still contract a “breakthrough” form of the disease, as had the original contagious child—then why weren’t all other kids a threat to each other? It seems to me that the state’s public health department has been over-zealous in mandating the chickenpox vaccine as well as erroneous in its regulations enforcing the quarantine of possibly exposed people. 

My five-year-old daughter’s already received 13 vaccinations along with many more boosters, and she is due to receive several more before she starts kindergarten. Is it really necessary for kids to get so many vaccinations, especially for those diseases that are not dangerous? What diseases will we be required to vaccinate for next? The 200 cold viruses out there? Big pharma must be licking its chops…

What is your state’s policy regarding the chickenpox vaccine?

What has your doctor recommended to you?

Unhealthy asymmetry

I have mild pain in my left knee (and I am not even that old!).   When I finally saw the physical therapist, the guidance she gave me in doing exercises was, “If it hurts, don’t do it.”  When I changed my workout routine, my knee pain became much more acute.   I thought, “Well, this is probably aggravating my knee, so I should stop.”  But because it was my only option at the time for a decent workout, I kept doing it, and guess what?  The acute knee pain went away.  It was as if working through the pain, I strengthened the muscle, and now I am back to just mild pain.   So which is it?  Work through pain and then the muscle gets stronger, or don’t do anything that causes pain because it may exacerbate the problem?  I’m confused by my body and by the information health professionals have given me; I wish I knew more about how my muscles worked so that I would know what the right next step is for me. 

I am not a healthcare policy expert.  And I am not a doctor or nurse, or any kind of healthcare professional.  In fact, that is my problem. I really don’t know much about my health specifically, let alone public health in general.  But I do know something about economics.  One major phenomenon that causes markets to work imperfectly is something known as information assymetry.  This exists when one party, either the buyer or seller of a good or service, knows much more about the good or service than the other party.   And so applied to the healthcare system, it is the healthcare professionals—the sellers—that know vastly more about our health than we do.  Well, so what, you say, this is precisely why we have doctors and nurses, so we all don’t have to go to medical school.  Point taken, but consider this:  how much money is wasted in the health system because people either overdiagnose themselves (the hypochondriacs) or underdiagnose themselves (the “nothing is ever the matter with me, and I hate seeing doctors” people).  The first set of people use up valuable healthcare dollars by seeing a doctor when they don’t really need to.  And the second may end up wasting a whole lot more if something really is the matter but is caught too late.  Yes, I’m aware of the oft-cited uninsured person as a major culprit in the rising cost of health insurance—these people don’t have health insurance so don’t see a doctor and thus end up with a hugely costly emergency room visit when something does go terribly—and expensively—wrong.  I agree this is a problem.  But what about the vast majority of us, average citizens who have insurance and are in reasonable health?  What if we were more empowered to make better self-diagnoses so that we could be more efficient in using healthcare services—visit the doctor or take the medication when we really need to, and not before or after that? 

So, I still have knee pain.  What to do?  I don’t know whether to just live with the pain or to pursue a treatment within the health system. If I wait, it may simply get better on its own, but it may get bad enough that I will have no choice but to undergo a painful and expensive surgery.  If go back to my primary care physician, he will send me back to the physical therapist, and then will anything be further resolved?   I don’t know, because I lack perhaps somewhat basic information about how my muscles work. 

Information asymmetry. 

Why is it that with something so crucial to our own existence, and incidentally, so crucial to the economic health of our nation, the average citizen has probably only had a semester class in high school about health?  And usually, this “health” class is really just a euphemism for sex ed.  I don’t know about you, but I can’t recall much at all from my junior-year one-semester long class, except that it was the one class that was so boring and so poorly taught that it nearly sabotaged my GPA.  

Don’t get me wrong, I loved studying Joseph Conrad in my high school English class and matrix algebra in college (actually that was a bear). But why wasn’t more health education required?  Of course, I wasn’t particularly interested in it at the time, I was young and invincible.  But now that I have three kids who get colds, ear infections, asthma, and my own body succumbing to such things as knee trouble, I wish more had been required, so I could do my own at-home triage more effectively.  I am usually the last person to suggest more governmental interference in our education, but if we are going to require certain subjects taught, why not health?

Beyond putting more health education in our curriculum, we can democratize health information in other ways.  Communities could offer and insurance companies encourage health training courses for parents and other citizens (if I could just get one of those ear flashlights and be empowered to diagnose ear infections!).  And at the very least, doctors should be trained more extensively on the importance of educating their patients with the relevant information.  Some doctors are good at this, but in my experience, when I probe to understand a deeper layer of information about a health problem, they seem reticent to explain—they are too rushed, and besides, how could I possibly be smart enough to understand? And then the information asymmetry is perpetuated.

I know that decreasing this “unhealthy” asymmetry in the system is far from a panacea to our nation’s healthcare woes.  But it seems like an easy place to start.   

Have you had an experience like this within the health system?

How have you learned about your health? 

What kind of health education is required or offered in your communities?

Can you give me advice on my knee??!

A $30 Plumbing fee

A $30 plumbing fee, seems innocuous enough.  At this point in life, $30 was not going to bankrupt our family.  But it still nagged. My husband and I had our water heater replaced.  The plumber had promised a certain charge for his services, but when the bill was finalized, there was this additional $30, attributed to a fee that our town apparently assesses whenever any dwelling has plumbing work done. 

I thought about this fee for a long time.  What possible policy justification could exist for charging a plumbing fee?   Other town fees I paid regularly are refuse fees and water fees.  Well, I don’t have any idea what my property taxes go towards if they don’t cover garbage collection and water usage, but OK, I can sort of understand a fee there.  A service rendered, a fee assessed. 

Hmmm. 

Well, maybe the town feels that it is destructive to have plumbing work done.  But we were not digging up any town pipes that would have caused any damage.   It was a replacement of a water heater, entirely localized to our dwelling.  In fact, it could be argued that by adding a water heater, we were improving our dwelling, thereby adding value to the house, to the neighborhood, to the town. 

Puzzling. 

I did a little research on this water-heater-installation fee.  Turns out that it is a fee that is issued by the Town Building Department.  The Department assesses $15 for small plumbing jobs and $15 for work with natural gas. But why?  What is the fee going toward? A Town Building Department explained that the Department needs to certify that the plumber I am using is state-licensed (note: the state performs the licensing, not the town).  And then the Department is supposed to send out an inspector to ensure that the job was adequately done (which in my case, it did not).  Apparently, this is all for my protection as a Town resident.  So I am charged a fee for this “service,” even though I accepted it involuntarily. 

Two problems here: on a fundamental level, isn’t it my responsbility to ensure I am hiring a licensed plumber who knows what he/she is doing?  But even if I do concede that, for safety reasons, the town may have an interest in ensuring that major plumbing jobs are not being done by plumbing imposters, shouldn’t the Town distinguish between big, important jobs and $100 (well, now, $130) jobs that require a simple water heater replacement before excising a fee?  

But the answer is, if you are a Town Department that needs the extra revenue, then no.  Extra revenue, and extra power too. 

There may in fact be a legitmate and useful purpose for Town Building Departments to zone and regulate as a way to somehow assist a locality in maintaining some degree of balance, order, functionality, fairness, and beauty. But when the Town Building Department has reached its fingers all the way into my basement water heater, it has gone too far. 

So all this has gotten me thinking: Perhaps there are other ways for town governments to boost revenues and expand its domain, all under the guise of protecting the common citizen.  Here are my ideas:

Exercise fee: To ensure that a licensed MD has given me the OK to exercise, to avoid my dropping dead in the gym. 

Diet certification fee: To ensure that the food I consume will not endanger my cholesterol levels.  

Apparel fee: To ensure that my clothing and footgear have been approved for transporting myself safely in public places (one never knows when a loose scarf will get caught in a subway escalator or when a stylish but impractical stiletto heel will lodge itself into a sidewalk crevice and cause its wearer to plunge head-first…)

Where does governmental responsibility end and individual citizen responsibility begin?

One thing is certain: the next time one of these “for-my-own-good” fees hits me, at least I won’t suffer from the same puzzlement again. 

What baffling governmental fees have you encountered?

What determines when a fee is justified and when it is not? And as more and more fees are assessed, does this line of justification change in our own minds because we become desensitized?

The Meaning of 9%

Nine percent. Usually an insignificant amount. Usually we don’t behave differently because of 9%. If it’s the chance of rain, I don’t change my plans. If it’s the rise in the cost of fuel, I still fill up my tank. No, 9% usually doesn’t mean much. But, here’s what it does mean: 9% represents the percentage of registered voters who voted in a recent annual town election.  What seems like a marginal percentage in another context represents the proportion of people who are determining the course of government in this town.

In this context, 9% is abysmal.

This, even in a community which many would consider quite politically educated and engaged (politically-focused bumper stickers abound here). The town newspaper that reported this statistic considered it just an informational point in the larger reporting of the election’s results. As I perused through the results, glancing at the library trustees lineup, the constable, and others (most of whom had run unopposed), I reasoned, “Well, it is a local election after all,” i.e., usually the candidates for office are not well-funded and therefore don’t do a lot of publicity; the candidates and/or issues are not compelling; maybe nobody is even running against the incumbent. A town election simp ly does not hold much interest to most people. And, besides, it wasn’t even held in conjunction with a state or national election, where more people might show up.

 Indeed, we have seen record turnout in recent presidential primary elections and caucuses. But what is this record turnout? 60% in New Hampshire, 45% in California, 40% in South Carolina.  While it is encouraging that so many people showed up to the polls to voice their presidential preferences, what of those people who didn’t show up? They didn’t show up, even given the almost relentless media coverage of the race, general enthusiasm over the wide selection of candidates, and the apparent groundswell of rage towards our current president. 

 So, the 9% still lingers.

I must conclude, then, that many of us (and I must admit this often includes me) simply do not believe that electoral outcomes affect our daily lives, and even if we do, we fundamentally don’t believe we can do anything about it. But, like it or not, government does matter, and local governments may even matter the most to our everyday living.

At the same time, life is overwhelming. It’s hard enough just to deal with the demands of everyday life, let alone think through how some vague bureaucratic policy is affecting it. But, then something happens: you get a traffic ticket and the convoluted court system requires you to spend half a day in court to resolve it. Or the organization you work for makes a poor investment because of a perverse tax incentive.  Maybe you attempt to build a garage on your home and discover that an obscure local ordinance prohibits this.

Then, you care, then, you get mad.  

And maybe you start thinking “Gee, I wish I could do something about these absurd policies,” but perhaps feel powerless and throw up your hands instead.

Well, here’s my attempt to respond to those moments of rage, bafflement, and, to be fair, sometimes even pleasant satisfaction that occur because of governmental policies.

This blog will explore my own encounters with policy and politics as I simply go about my everyday life; I want to dig a little deeper on the how and why policies are formed, on what level they are formed (local, state, or national), what the political philosophy is behind it, and therefore, why politics (read: elections) matter. I’m not a politician, I’m not a bureaucrat, I represent one of the millions for whom policies are intended: a CITIZEN. So I’m going to start paying attention. Maybe you will too. I’m betting that when we’re more aware of how our lives are affected by our political leaders and the policies they enact, we will be more interested in getting politically engaged. And when more citizens are politically engaged, politicians and policy-makers become more accountable and responsible. And with greater accountability comes better governance for all of us citizens.

Join me as part of that 9% who pay attention. I welcome your feedback as well as your stories of how policies are affecting your everyday life.