Later On

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Archive for August 5th, 2019

Rural Hospitals Are Shutting Down in States That Didn’t Expand Medicaid

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Several Republican states refused to expand Medicaid, even though the refusal left thousands of their citizens without healthcare insurance and even though not expanding Medicaid cost the state money. And now they are reaping what they sowed. Abigail Weinberg reports in Mother Jones:

Hospitals in rural areas are losing money and sometimes closing down, taking away jobs and limiting health care options for some of the nation’s poorest citizens, according to a study published earlier this week by the Pittsburg Morning Sun and GateHouse Media. And the decision to reject a key part of Obamacare by Republican politicians in red states is exacerbating the problem.

The hospital closure crisis is most pronounced in states that have declined Medicaid expansion, the policy in the Affordable Care Act that offers coverage for individuals whose income is at or below 138 percent of the federal poverty line. Of the 106 rural hospitals that have shut down since 2010, 77 were located in states that hadn’t expanded Medicaid, the study found.

Hospital closures can have devastating impacts on rural communities, Patti Davis, president of the Oklahoma Hospital Association, told GateHouse. “Health care professionals leave, pharmacies can’t stay open, nursing homes have to close and residents are forced to rely on ambulances to take them to the next closest facility in their most vulnerable hours,” Davis said.

As Mother Jones’ Becca Andrews pointed out last year, voters in some of the hardest hit areas heavily favored Donald Trump in the 2016 presidential election. Andrews wrote:

Most closures have happened in places where people came out in droves to vote for Donald Trump—and yet his administration hasn’t done much to turn the tide. Legislation sponsored by Rep. Sam Graves (R-Mo.) would expand funding and create more protections for rural hospitals. But the bill hasn’t gained much momentum: It has sat dormant in the House since 2015, though it was reintroduced last year. Meanwhile, in January, the Centers for Medicare and Medicaid Services reduced the reimbursements for a program that allows rural hospitals to buy drugs at significant discounts. And Republicans have suggested turning Medicaid into a block grant—a fixed amount of money doled out to states. Critics argue this system would just lead to more funding cuts as politicians wrestle over who gets what, potentially leaving hospitals worse off than before.

To date, 14 states have refused to adopt Medicaid expansion, which the federal government pays 90 percent of the costs for, and another three states have not yet implemented it after approving the program. Hospitals in non-expansion states have suffered in part because the states that have resisted the program have higher rates of uninsured people, which means the hospitals there have to provide more uncompensated care, Andrews wroteThe GateHouse study points out that Medicaid expansion would not have prevented all rural hospital closures, but that it would significantly boost funding for medical facilities in some of America’s poorest communities.

The study highlighted Kansas as the state where hospitals have suffered the most, with 70 of its 109 rural hospitals losing money between 2011 and 2017. That crisis has prompted some Kansas Republicans to come around in favor of the program, but the state legislature punted deciding the issue until next year.

The new study also singles out Utah as a rare success story: the state’s rural and urban hospitals share revenue, so only 14 percent . . .

Continue reading.

Written by LeisureGuy

5 August 2019 at 1:56 pm

How to respond to jerks

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Adam Grant has an interesting essay in an email from the NY Times Smarter Living column (though I can’t find it in the paper). He writes:

A couple of years ago I was discussing a study of the habits of great musical composers when an audience member interrupted.

“That’s not true!” he shouted. “You’re totally ignorant — you don’t know what you’re talking about!”

Early in my career, I had let nasty people walk all over me. When a client berated me for my predecessor’s error on an ad, I gave in and offered him a full refund. When a boss threatened to fire me for defending a colleague who was treated poorly, I said nothing. But this time, I was prepared: I had trained as a conflict mediator, worked as a negotiator and become an organizational psychologist.

At some point in your work life, you’ve probably had to interact with a jerk. They’re the people who demean and disrespect you. They might steal credit for your successes, blame you for their failures, invade your privacy or break their promises, or bad-mouth you, scream at you and belittle you. As the organizational psychologist Bob Sutton puts it, they treat you like dirt, and either they don’t know it or they don’t care.

The natural response is to get defensive, but that only escalates the cycle of aggression. Take a classic study in which researchers recorded negotiators with different levels of skill. Average bargainers ended up in three times as many defend-attack spirals as expert negotiators. The experts escaped the heat of the moment and cooled the other person down, too. They calmly commented on their reactions to the other person’s behavior and tested their understanding of what the person was trying to convey.

I had been studying and teaching this evidence for years. Now it was time to practice it. I called a break, walked up to my heckler and said, “You’re welcome to disagree with the data, but I don’t think that’s a respectful way to express your opinion. It’s not how I was trained to have an intellectual debate. Were you?”

I was hoping to start a conversation about the conversation — to redirect the discussion away from the topic and toward some reflection on the tone of the discussion. To my surprise, it worked.

“Well, no …” he stammered, “I just think you’re wrong.” Later, I sent him the data and he sent me an apology.

My heckler was what Dr. Sutton calls a temporary jerk. We’re all capable of those behaviors, and we feel bad about them afterward. One study showed that on days when leaders acted abusively, they ended up feeling less competent and less respected at work — and had more trouble relaxing at home.

But sometimes you’re stuck dealing with a certified jerk, someone who consistently demeans and disrespects others. A few years ago, I had a colleague who had a reputation for yelling at people during meetings. After witnessing it firsthand, I collected my thoughts and called to say I found it unprofessional. My colleague got defensive: “It was necessary to get my point across!”

Research on the psychology of certified jerks reveals that they have a habit of rationalizing aggression. They’ve convinced themselves that they have to act that way to get the results they want. I didn’t know how to respond until recently, when I interviewed Sheila Heen, a conflict mediation expert, for an episode of my WorkLife podcast on office jerks. She suggested finding a way to gently challenge the belief that aggression is necessary: “Really? It was my impression that you were smarter than that, and more creative than that — so I bet you could come up with some other ways to be just as clear without having to actually rip somebody else apart.”

I can imagine having that conversation with a peer. But what if the jerk is your boss or your superior, and you can’t leave?

Research in banks and real estate companies points to two effective ways to break a pattern of abusive supervision. One is to decrease your dependence on your boss. If you can minimize interaction, they can’t do as much harm. The other is to increase your boss’s dependence on you. If they need you, they’re less likely to treat you like dirt.

If all else fails, Dr. Sutton has a tip for changing your attitude toward the situation: Pretend you’re a specialist in jerks, and think about how you’re “really lucky to see this spectacular, amazing specimen.”

Written by LeisureGuy

5 August 2019 at 1:51 pm

Posted in Business, Daily life

Darkfall and Bulgarian Rose

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Darkfall really does have an autumnal fragrance, which was welcome on a warm summer morning as a promise of things to come. My synthetic brush by The Grooming Company did a fine job making the lather, and the Above the Tie S1 removed stubble efficiently but left a few tiny nicks—a sign, I imagine, that it’s time to replace the blade.

A good splash of Saint Charles Shave’s Bulgarian Rose finished the job, and I’m ready for the day—a holiday up here.

Written by LeisureGuy

5 August 2019 at 9:17 am

Posted in Shaving

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