HEARING -- HARASSMENT -- HOPE

HEARING AIDS

As often happens beginning when I first encountered Ronni Bennett’s writing at her blog  “Time Goes By”  eleven or so years ago, her words often prompt me to think about the topic or associated matters introduced.  Her subject (11/13/17) discussing hearing loss and using hearing aids prompted me to make this comment though edited which I’m sharing here in case readers didn’t see it there.   

I’ve long believed aids to sensory system losses should be regarded as a fundamental health care need.  We are the information our brain receives through our senses -- just as the ability to communicate in some form or another is vital to our well-being, whatever our physical state.   Our priorities seem not to recognize these facts until we begin to lose these abilities  at any age, though the older we become the more prone to their functional decline we are.

What that means is — eye care, including glasses ..... ear care and hearing ..... are two  senses of critical importance to our retaining  a healthy mental — cognitive status.    Maintaining this state holds special significance as we age -- our bodies start to reflect the wear and tear of living -- and the ability to communicate — hearing and speaking to express our needs, wants and feelings — becomes increasingly vital.

For many years, at least in earlier generations, people disdained wearing glasses and were often the butt of disparaging jokes i.e. called “four eyes” and other terms, just as many others with various disabilities were subjected to put-downs.   We seem to have become more accepting of glasses use, but many people are still too proud to use hearing aids, or are in denial they have hearing loss — often blaming others for not speaking clearly or loudly  enough.

Also, many with hearing loss, or those who communicate with them, don’t use the techniques needed to best enable their hearing with what residual hearing they have.  As a Speech-Language-Hearing Pathologist (retired now)  I have additionally provided services for individuals with hearing loss, some with their family members, and others — to best maximize hearing aid use and benefits.

The first thing to understand is that not all hearing loss is amenable to correction simply by amplification.   Purchasing amplifying hearing aids would obviously be of little benefit for some in that case.   Having hearing evaluated by a licensed and certified American Speech-Language-Hearing (ASHA) Audiologist who is trained to identify not only hearing loss types,  but also possible medical issues requiring further medical assessment is recommended,  as opposed to hearing assessments provided by some businesses simply testing and  selling hearing aids.

My experience has been that too many people expect hearing aid(s) will return their hearing to be exactly as it was before the loss.  Unfortunately, it’s not that simple.  Numerous factors come into play, and the brain processing of information that the ear mechanism receives with the help of the aid(s) must be relearned in the brain. 

(Darlene’s description in her TGB blog comment describing the challenge she’s had appreciating music again is an example of that process, though speech sounds are processed in different brain areas and are more amenable to intelligible adaptation.)

For the brain to best adapt to the hearing aided sounds -- the individual needs to wear the hearing aids over time.   All too often when my services were requested the hearing aid(s) had been spending most of their time in the drawer as others report in their TGB comments.  Also, the individual with hearing loss did not know how to compensate for the aid(s) short-comings, or what they needed to educate their friends and family to understand about how to best communicate with them.   Or, those same caring family didn’t pay attention to what was needed and my patient’s hope was they might listen if they had a professional explain it to them.

Attenuation issues are a common complaint with hearing aids.   Our brain has the ability to selectively focus on one speaker in a crowd while somewhat tuning out some of the crowd noise, for example.   Amplification simply turns up the volume on all sounds.   Aid users must learn through use and practice how to accommodate and adapt to making their aid(s) work best for them in all situations.     Considering our individual unique perceiving skills, doing so will vary to some extent for users depending on how they respond to the differing hearing situations they’re in, their hearing loss and possibly the type aid they have.

I note from what users have written in comments at TGB that the hearing aids promoted as having attenuation capabilities leave much to be desired.  This should be a cautionary tale to explore their limitations  with a competent professional before purchasing.

All that said, using hearing aids can be a godsend for those with hearing loss and those with whom they interact.    Given the technological knowledge and skills in this nation, high quality inexpensive hearing aids should be available to everyone with hearing loss who needs them.

  

HARASSMENT

Me too!   That exclamation supports what far too many individuals around the world experience.  Here in the U.S., the courageous outpouring of individuals revealing the pain and mental suffering they’ve experienced -- afraid to protest against those who have harassed, molested or physically assaulted them at some time during their life time.  

Nothing angers me more than those whose ignorance causes them to condemn individuals finally feeling able to safely identify their perpetrators, sometimes from decades earlier in their life.  I hear the condemners of those who have been violated disparage them by saying, “Why didn’t they come forward to report it immediately after it happened?” – therefore, they make the erroneous assumption the act, whatever it was, did not occur.

I can personally vouch for the fact that revealing having been harassed, been aware of others harassed, molested or groomed for assault and naming the perpetrator is as authentic in reporting whether doing so occurs immediately afterward, 77 years later, or on any given day in between!  That does allow that some effort can be made to authenticate the report.

In my case, I only recently learned the perpetrator of one of my unsolicited events was convicted twenty years later following other persons experience.  He had ascended to a high position in a trusted life-saving caregiving position by that time.  I have wondered how many unrevealed others there were in the interim following me and before them?  

Thought to be a first time offender and such a credit to society in his work position, I think he may have been released.  That has led me to wonder how many more since then?   I’ve concluded given what his age must be now, he must surely have expired or is physically harmless. 

Lest you ask, he has lived across country from me and I don’t intend to invest my time or money into tracking him down now.  Had I  known about all this years ago I most certainly would have contacted authorities there then.

I won't describe a number of my additional experiences, or that of others I know to be fact,  but a startling though minor one to me at the time was the occasion years ago I was waiting at a crowded crosswalk on a famed street in San Francisco, California and received an unsolicited buttocks grope – supposedly to be interpreted by the groper as a compliment, I gather, much as I’m told routinely occurs in Italy, possibly other select European cities and cultures.  Knowing what is harmless and what is not isn't always easily determined and can be learned by some too late. 

HOPE

Our Offender-in-Chief has hardly modeled morally desired behavior for persons in power based on documented reports of numerous instances in his adult life as he self-described..   Though this was known before his election, a minority of this nation’s electorate still voted for him – some, reported to be of strict but hypocritical religious moral beliefs, ironically, continue to support him.

There may be hope that his supporters are decreasing in numbers.  Desperation, due to increasing threats to his credibility and legitimacy, has motivated him to resort to his standard playbook of instigating distraction, deflection and attack, as usual, in such circumstances. 

He has enlisted his partisan appointee Attorney General (shades of Nixon/Mitchell) to pursue questionable accusations involving a foundation associated with the candidate who opposed him in last year’s election.  I’m left to wonder if the Russians are coming and/or the kitchen is beginning to get a mite too warm for him given investigations of him and his family.  .  

RONNI --- FAIRNESS -- AGING HUMOR

RONNI

Surgery successfully completed for Ronni Bennett who I mentioned in previous post…..her recovery in progress ….. updates are being provided by her good friend, Autumn, at “Time Goes By”.

FAIRNESS

Health care in the U.S. continues to be in a state of flux which to my way of thinking is nothing short of being criminal.

Wouldn’t it be wonderful if people could know they would have necessary health care in this wealthy nation of ours

 – that a doctor would see them other than just in the E.R.,

 – that they wouldn’t have to worry about possibly being bankrupted from a catastrophic illness?  

Why shouldn’t American citizens be entitled to health care at least as equivalent to that which we generously pay in our taxes to provide our Congressional Representatives and Senators?

The reality is that most of those we've elected could easily pay out-of-pocket for all their medical care with little or no detrimental effect on their financial situation – not so true for most ordinary people -- not true at all for others.

Here's what fact-checker Snopes says is the current status of health insurance coverage members of Congress will receive if the Affordable Care Act (ACA aka Obama Care) is repealed:  "...members of Congress have a fallback plan. They would be able to return to the FEHBP. Twenty million other Americans won’t."

We might want to ask .....

.....what are the Trump Senate health care plan bill's provisions for members of Congress coverage?  

Why aren’t all Americans regardless of political affiliation …..

….. up in arms demanding fair health insurance coverage?

…..outraged that a foreign nation has attempted to interfere in our elections – and is expected to continue doing so in the future?

…..demanding accountability from our President and his administrators demonstrating that there is no conflict of interest between their personal business interests and actions taken as our government agents?

…..requiring actions to benefit ordinary citizens be given precedence over give--aways to the wealthy?

AGING HUMOR

Decades ago, a few years after we moved to Southern California, the Los Angles NBC-TV affiliate added a couple of new young broadcasters to their on-air talent roster.   The two separately and occasionally in tandem demonstrate some comic talents they often incorporate into their portions of the news programs which they both continue to deliver. 

One is a sportscaster, the other, a weatherman – Fritz Coleman, who has been a stand-up comedian even longer.  Here’s a short, less than 5 minutes, excerpt of Fritz’s humorous comments at a 2014 Conference on Aging in Pasadena. 

Hope you have a few laughs releasing those healing endorphins.

REPRIEVE ---- LOSS

REPRIEVE FOR AFFORDABLE CARE ACT

The Trump/Ryan Health Care Act has been side-lined for now for the wrong reason – only because a minority group within the Republican Party refused to vote for it as they wanted even more draconian measures – not because the Act was a travesty against efforts to provide reasonable health care for the vast majority of American citizens.  

How about the rest of the Republican Representatives, or some of them, meeting with some Democrat Representatives – they could actually try to examine the ACA aka Obama Care to adjust for more cost effectiveness and efficiency.   Some adjustments were expected to be necessary after that legislation was implemented.   Congress could actually perform some meaningful work to earn the salary we hired/elected them to do. 

LOSS

Schmidley's Scribblings  daughter reports her mother has passed away.   I've enjoyed visiting this blogger who offered a true elder's perspective, garnered from years of significant work in our government and a master's degree in history obtained in her seventies.  She was grounded in contemporary life but respected the influence of previous generations she explored in her genealogy.  Her observations were concise, evidencing humor with a sharp wit.  I only knew her through a few years of blogging, but I'll miss her photos, stories, commentary on the world we live in.  

SKIP-A-DAY SYNDROME NOT AGE-RELATED

UPDATE 8/14/15:    Kenju's serious take on what I wrote here prompted me to do a search on SADS, an acronym that just happened to come together as I wrote this Skip-A-Day  piece.  I just now did a Google search and was surprised to learn SADS is an acronym for a seriously legitimate organization dedicated to making people aware of Sudden Arrhythmia Death Syndrome.   I was aware of SAD as referring to seasonal affective disorder, but by adding the "S" I concluded I would not be confusing matters with that group.  However, I did not know there was an official SADS organization when I originally wrote and posted this Skip-A-Day piece. 

I'm acutely aware of the serious nature of the  medical  diagnosis arrhythmia, but  I want to clearly state it was not my intent to infringe on the SADS organization's acronym.  If I ever inadvertently create what I think is an original acronym in the future, I will certainly search to see if it may already exist in some other context, or represent an existing real organization I hadn't known about..  Meanwhile, though arrhythmia has absolutely nothing to do with what I intended as a humorous post, I'm  providing a link to the real SADS organization.  I strongly urge you to click on that link and learn about this arrhythmia syndrome.. 

Then, re-focus by reading the unrelated topic of my Skip-A-Day and hopefully, have a chuckle or two.  You will have to suspend belief since there are arrhythmia disorders in the ICD  code listings, but just not Skip-A-Day which was something else entirely in my imagination. 
    
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Skip-A-Day Syndrome (SADS) is not a medical diagnosis you’ll find in the ICD (International Classification of Diseases -- official listings of diseases, functioning and disability – nor among specific psychiatric and psychological disorders.)  The ICD is where coding numbers are assigned to each of the listings – a system that brings order and chaos to health care -- the latter when getting into the billing for services provided – but that’s another story.

ICD 10 updates 9 this fall with continuing refinements and improvements, hopefully outweighing any new system complications.   But, medical science being what it is with new discoveries and research findings, we can be assured change will continue to affect ICD, as it does most aspects of the world in which we live.   Who could possibly become bored when change is everywhere -- so much a part of our lives?  

As for SADS, I hardly think ICD inclusion is appropriate, nor is official or even unofficial consideration being given to the syndrome’s listing.  In fact, this SADS account is what the medical community considers to be strictly anecdotal.  I would agree with that.   This may even be the first place the syndrome has ever been identified, much less written about.   Who knows if others have ever experienced or observed SADS behaviors?      

I’ve only recently been able to “connect the dots”, so to speak, tracing back in time to when I experienced what I now recognize as my first SADS episode.    My young children had started attending school .   One week there was a day when all their classes were cancelled due to special teachers meetings.   Normally, the only time during the school year they were ever home during the day was on weekends – Saturdays and Sundays.   Of course, if they were ill, or there was a special holiday, they would be home on a weekday, but there would be pronounced activity in our home memorably different from “every day” type living.   So, SADS episodes never occurred those weeks.  But I discovered …..the week they were home on one just plain ordinary unmemorable weekday was what had triggered my SADS!

I lost track of what day it was, because, clearly, it seemed as though this had been a weekend day or they wouldn’t have been home.    Yes, I could have looked at a calendar, but that doesn’t always help unless you’ve been marking the days off.  Besides I was really busy around the house and with them -- who cared what day it was!  My bedside alarm clock featured time only.  We didn’t have computers or smart phones then, where the day, date and time appear on the screen when the digital devices are turned on.    But directing ones attention to the specific screen area where that information appears is required. 

After that first SADS episode, I realize now, I continued to have such lapses periodically until my children graduated from high school.    Those day disorientation events were infrequent because the teachers didn’t have too many all day meetings during each school year, fortunately.

The following years of my life I may have had an occasional SADS episode, but I don’t recall any of them specifically now.   Consequently, I’m unable to connect them to any one stimulating causal factor, unlike the teachers meeting events. 

I had completely forgotten all about such SADS episodes until the past year when I began to work less, eschew obligatory commitments and generally revel in engaging in whatever, whenever I felt like doing so – or even doing nothing.   I, truly, could lose track of time – delighting in not even looking at the written pocket calendar I prefer to keep vs using one of my digital systems. 

None of those latter digital systems are the first thing I look at each morning.  In fact, I may not look at them until evening, or may even skip a day or two, including reading my email.    After all, this is not a business I’m in and I’m no longer on call every week day – this is my life, now.  (Using the devices in business is a whole different matter.)  Just as long ago, I ceased allowing the ringing of a phone to command my presence (answering machines helped) -- no digital device – cell/smart phone, computer – is going to usurp my control.  

I’m not completely irresponsible -- a few significant people are able to text me, so when that signal goes off, I attend to it immediately, thus I recognize importance where I think it matters.

Sometimes, I don’t even direct my attention to the day/date/time on my digital device screens.   I don’t deliberately think about not doing so, but just doing so is not an established habit.  Consequently, seems I might have had an occasional day slip by but “no harm, no foul” as the saying goes.  And then ……..

This is how I became aware of Skip-A-Day Syndrome (SADS) -- how I searched my memory to discover and conclude this was not an age-related disorder as some might be quick to ascribe to any such slip-up by an older person.   Am I rationalizing or deluding myself?

One morning I rolled out of bed, took care of my morning personal care, dressed, then drove to my early annual eye doctor appointment only ten minutes away from my home.    How strange!   I observed the gates to the office and parking lot were closed, but noticed cars lining both sides of the street for half-a-block, though no people were in them.   I discovered an open area where I was able to park across the street from the doctor’s office.   I was actually a few minutes early for what would be the first appointment time of the doctor’s day, so I waited.   He always seemed to have lots of people in the office booked for the same hour.

No one showed up outside at the time the office would open.   Oh, I thought, the staff must already be inside….the parking lot is probably locked to keep cars out because they’re going to resurface it today.   So, I exited my car, walked to the sidewalk gate, only to discover that it was still locked.   Did they forget to unlock it?  How would those people from the other cars have gotten in?    Maybe they didn’t go to his office but to some other location nearby. 

Hm-m-m .....I turned and walked back to my car.   Using my cell phone, I called his office number printed on the annual reminder card they always send me.  I reached an answering machine – surprised a live staff member hadn’t answered my call.    I left a short message, thinking they must be busy as usual, would hear me and call right back saying they’d unlocked the gate.   After a few minutes I decided maybe I better double check the date – after all, it’s right there on my phone’s screen. 

Well, whaddya know!   It’s Sunday!  My appointment is for Monday.   I quickly phoned his office again and laughingly left a brief message that gave them a chuckle to start their Monday morning workday and another chuckle when I spoke of it the next day at my appointment.   Even my doctor was laughing when he came in the examination room.   

That must be my purpose in life – to make everybody feel good.   Laughing releases those healing endorphins you know!

   

Profound U.S. Changes

Profound changes have been occurring in the United States of America during my lifetime over the past three-quarters of a century.   Recapping the progressive nature of all these changes would require describing considerably more than what I want to write here now.

Most recently our Supreme Court has ruled in favor of individual freedoms for all Americans to wed their loved partner.  This act will result in significant benefits for many individuals who deservedly will now become full citizens. 

Another Supreme Court ruling has made it possible for this richest of nations to continue to provide health care for some of our citizens who might otherwise have been without such assistance.  More plan refinement must continue for the ultimate benefit of all.  

Other issues involving symbols associated by so many with racial oppression are finally being relegated to a long overdue status of significantly reduced prominence as evidenced beginning with South Carolina's Confederate flag relocation.  Tragically, the life of many innocents allegedly taken by a hate-filled mentally-warped-thinking youth with allegiance to that very flag has been the impetus to arouse Americans to examine our morality on this issue.

Perhaps now we'll -- once again -- following another killing disaster -- seriously consider action to curtail the role of guns in our society.   We might even want to re-examine the use of the death penalty in our criminal justice system for all, but especially for the sake of wrongly convicted innocents.

We still have many important domestic issues to resolve over which we have some control and must act on them.   Clearly there are other unpredictable external forces we're unable to control taking actions that we will simultaneously need to address.  We must demand those elected legislators mired in obsessive ideology to the degree they neglect realistic practical action recognize compromise is an art they must acquire and practice for us to have an effective government.

The Supreme Court still needs to reexamine their erroneous decree interpreting corporations to basically have person status.  We, the people, have reaped the lopsided results allowing our political system to be corrupted even more by big money -- this in a time when such inequity exists between most citizens and the small obscenely wealthy percentage of those absorbing the bulk of all profits.

History is fraught with lessons of what can occur in a nation where such financial disparity is present.  Those who seek to be our government leaders, plus our nation's financial and corporate leaders would be well-advised to re-establish parity with citizens.  We citizens would be wise to take more responsibility for our government and its actions so discontent does not build to a potentially destructive force imperiling our democracy and republic.  Forces exist that all too readily want to usurp our way of life, belief in individual freedom and free speech.

LIVING IN RETIREMENT YEARS

Retirees today are beginning to have a variety of living choices that are discussed in various blogs and at different sites when a browser search is made, so I won’t attempt to discuss all of them here.  

I’m committed to the concept known as “Living in Place” – remaining in my Southern California home through my remaining years.    Only twenty years or more ago, assists here for those who wanted to stay in their own homes were limited, when I was seeking help so my mother could continue living independently. 

 

Today that situation is improving locally though the options are such that out-of-pocket cost may be prohibitive for many.  One Southern California local area option for some may be a newly formed organization -- REAL Connections for Ageless Living offering support for most every daily living need to enable senior/elder/oldster residents to remain in their homes/condos/apartments/mobile homes.  

Some bloggers I’ve been reading have been sharing thoughts about moving from their home to retirement community housing.  At least one Southern California friend and her husband have been exploring that same possibility.  These communities often introduce prospective residents to their sites by offering downsizing sessions providing recommendations about how to ease making such a move to smaller living quarters.  

They offer more in depth counseling, if requested, to discuss the financial costs, various payment plans, any help that might be available to live in that particular community.  

Anyone considering a move into a retirement community would be wise to make comparisons with more than one such living arrangement, if possible.  

I’ve not attended a downsizing class, but I have provided my therapy discipline’s services in a half-dozen or more retirement communities that provide several levels of care typical in such settings.    Also, I have not investigated the costs to live in any of these communities.  This is a fundamentally vital bit of information that determines whether or not one can even afford to make the move.

Most of those communities I’ve served have been affiliated with prominent traditional religious denominations in some form or another, but that has been an incidental factor in my work location choices.    Each facilities reputation for exceptional quality of care, plus location, has been among the primary factors influencing my work place choice decision process.

Those exploring moving to a retirement community might want to consider that many studies have shown select non-profit organizations offer a higher level of housing, care and services compared to for-profit providers.  The reason is said to be because revenue produced is invested back into the quality of the communities, programs and services—rather than stockholders dividends. 

This seems to me to be a good argument for taking such health care entirely out of the commercial competitive for-profit business world.   Do we really want our health care subject to the Wall Street financial markets manipulations in which profit-making and taking might sometimes take precedence over quality of care?    

The same can be said for most private therapist-owned rehabilitation groups versus non-therapist businessperson owned companies in my experience—especially some of those that are part of Wall Street profit seeking corporations.   Stockholders generally take little or no responsibility for seeing that the company whose stock they own provides quality care -- they’re generally interested only in stock share price profit and dividend dollars.  The presumption is if the profit is high, that must mean the quality of care is, too.   We might wonder if that’s really true?

I can certainly confirm that the health center skilled nursing rehabilitation units in the non-profits I’ve served are generally among the best for overall services compared to others, and many stand alone nursing homes, or assisted living facilities.   There are likely some exceptions, but I can only report on those with which I’ve had personal experience. 

New ownership, time passing, government regulation changes, supervision and adjustments by different management can even make my knowledge of retirement communities and other facilities out dated if I haven’t worked there for a while.

The cost factor will deter many people from living in either profit or non-profit retirement community settings.   Costs and payment options would have to be explored and compared for each community as I've mentioned.   

Prospective retirement home residents would likely want to determine how much, if any, of the entrance fee is refundable and under what conditions.    Another consideration would be to understand how any future fee increases are determined, plus the increased amount that might have to be absorbed if additional payments apply beyond the entrance fee, if new fees can be added.  

The retirement communities I’ve served offer traditional levels of care which includes housing units and apartments for independent living, a multi-unit building with several levels offering assisted living, and a continuing care facility offering skilled nursing care.  Some may provide a special Alzheimer’s/Dementia unit.   

The Green House concept is being implemented in one retirement community here – the first in California.    The concept introduced by Geriatrician Dr. Bill Thomas as described in this NewYork Times article, as a new unit being planned for one local retirement community which will add a flexible level of living with care provisions variation.   Dr. Bill’s blog “Changing Aging” provides much current aging information.  

Each level of care has prescribed criteria that determine a resident’s placement based on their functional abilities.  These criteria will be applied in the event an individual’s functional daily living skills decline and can sometimes result in the resident having difficulty accepting the need for moving to a different level of care.    

Becoming familiar with the specified differences of each care level is information important to understand when gathering material from communities being considered.  The basic criteria differences between levels are the same throughout our State, but some organizations may exercise more leeway, especially if they have empty beds they want to fill.   Again, check your state’s regulations. 

Know your non-medical administration and community/facility physician, medical/nursing clinic director.

Though you don’t expect to need the skilled nursing center’s services, you might wish  to check the nurses to patient ratio there and at the other levels of care; your state’s mandated minimums.    Also, what onsite medical services are available for residents living independently?   What and where is the hospital to which you would be transported should the need arise?

The skilled nursing care/rehab center in some retirement communities may have limitations as to how much disruptive behavior will be tolerated from a patient whose manner is persistently troublesome and/or distracting to other residents.  Occasionally, a patient may require constant attention, become a safety concern, or create issues continuously disturbing to other patients.  This behavior may result in family being requested to incur additional costs to provide private duty nursing aides/companions for a varying number of hours and/or days if family members are unable to be present.  

Before an individual enters a retirement community skilled nursing facility as a non-resident, for rehabilitation and/or due to a variety of medical needs, expecting to ultimately go home they should acquaint themselves with cost of care once Medicare/insurance benefits cease to pay – in case they might need to remain longer.  

Knowing this cost is important in case the patient needs long term custodial care.   Can they afford to stay there, or will they disconcertingly have to be moved – once again – to a less expensive setting – which may create a problem in adjustment for some? 

Many residents generally identify strongly with their retirement community and those who entered as they did.    So, there can be a sensibility of difference from some residents toward those few who have entered solely into the health center skilled care unit from other settings than as retirement community residents.  If this does occur it isn’t necessarily an overt complication.  Staff will make an extra effort to be inclusive with new patient, and often there may be other residents who compensate for such insensitivity, especially when the newcomer makes an effort toward friendliness, too. 

Social factors deserve consideration.   Investigate a retirement community’s culture to help determine how compatible life there would be for you.   I’ve heard stories that some communities can have social groups whose members sometimes behave in ways reminiscent of Jr. High or High School cliques.    But that can be true in any social, governmental and business office group I’ve noted through the years.

The predominant female to male ratio may be of significance for some prospective residents.  The reality is that women outnumber the men the older we all become.   New friendships and companions are sought after with varying degrees of intensity, levels of interest and sometimes competition.  

Be certain to note what amenities are available in keeping with your preferred activities including a pool for use 12 months of year (heated, enclosed,) tennis court, putting green or golf course, computer room, library (may not be as important now with computers/e-books,) exercise center and equipment that could be called a Wellness Center, meeting rooms and other activities – whatever your interests.  

What of interest to you is available in the non-retirement community outside?  What transportation is there that you’re able to use, going where -- including for necessary medical trips – and will someone accompany you, if needed?  

You’ll definitely want to ascertain what high tech services are available and whether they’re available everywhere on the campus or only in select locations.  Is wireless Internet service present and what about television, the phone system?   Hopefully the system is fairly simple to use as some can be complex.  

Don’t forget to eat in the dining room(s) and explore the food fare, maybe asking for a copy of the week’s menu.   Any markets, shopping areas you’ll want to visit? 

Some retirement communities have been formed for a preponderance of those who have served in religious and charitable organizations, such as one here that includes missionaries who lived around the world.    Another community may be primarily composed of retired academic professionals, local government retirees, business/corporate executives, just to name a few groups. 

I’ve known of some residents who were single, alone upon retirement so moved here on the West Coast from the East Coast to join friends, others to be nearer family, some moved here because of the weather.  There are communities attracting individuals of modest means who prefer a social culture quite different from those I’ve noted previously.    The cost factor is a deciding factor influencing selection choices for most. 

Do meet and talk with the retirement community representatives.    Ideally if you could befriend a resident with whom you could freely talk insights would be gained.

Read and be aware of all agreements you sign, including how your rights are affected and any limitations that might be imposed and under what circumstances.  

What sort of communication systems exist within the retirement community, i.e. to obtain emergency help should you become suddenly incapacitated (fall.)   Do they have a newsletter, in-house TV broadcasts?    Are there maintenance helpers and what is the arrangement for using their services with what limitations? 

These are some thoughts and questions that come to mind, but are by no means all inclusive, when I think of choosing a retirement community in which I would live the remainder of my life.  They’re rather randomly presented here.   

My current plan is to “live in place” in my home which is another concept requiring similar but different planning arrangements.   This plan is subject to change should the situation warrant and can be more uncertain than being in a retirement community where arrangements for all levels of care have been established.   I’m following the local services developing currently that are designed to help individuals live in place. 

I do at times waiver in my mind with second thoughts about whether or not the plan I’ve selected is really the best one, especially when some friends talk about having chosen differently for themselves and their husbands.   

You may be wondering as I do, what are the odds any of us will need to go into assisted living or a nursing home?  I suggest you read this Nursing Home Diaries link that provides U.S. Census bureau figures on that very topic – something to consider in the decision-making process, including recognition additional retirement living options are developing. 

What IS available in this immediate future for many elders, especially in this fluctuating health care environment -- one that doesn’t presently support some of the most cost effective ways to provide long term care?

ROAD TO RECOVERY

Here's another slightly edited commentary I wrote recently at BlogHer in an effort to reach readers outside my regular reader's frame of reference.  Perhaps, some of you may be doing the same there or other places.  I would be interested in knowing about your experience in doing so.  

Well, we  have the beginnings of some effort to provide health care to all Americans in this nation.  Let's hope we can constructively build on that rather than having Congress waste time and energy trying to dismantle the program. 

Since this is a Presidential election year, is it too much to expect our Congresspersons to concentrate on creating meaningful legislation instead of all these phony political posturings I'm seeing them take?  If many of them received job performance reviews they'd be quickly judged to be engaging in "busy work" that offers no value to the recovery of this nation from one of the worse financial situations our country has endured.

But then, many of them are millionaires in their own right or will be, so have an increasing disconnect with the majority of Americans like you and me.  Some do still identify with us and are capable of fully appreciating  our work situation, health care needs and living choices.  Others don't have the faintest notion of what ordinary survival living entails, including one Presidential candidate who never experienced such a life in his privileged childhood, much less as an adult.  Unfortunately, by his own repeated words and actions, he seems unable to empathize or even imagine what a regular American's life is really like, since he had been busy investing the monies of already wealthy individuals to make them even richer.  No matter if a few companies and workers jobs were lost in the process -- just the price of doing business to earn investors more money. 

The country's problems can be attributed to those in both major political parties, our government and even some of our ordinary citizens seeking to fulfill the American Dream.  Yes, and us, too, because we didn't carefully monitor and make certain those we entrusted were functioning in their positions as they should.  As the popular Pogo comic strip of years ago said, "We have met the enemy and he is us."

Contrary to what we would all like to believe, or is being promised by various candidates, there is no quick fix.   There is much that can be done to aid in the recovery but not if ideologs fail to refocus their attention from self-interest.  We each need to closely scrutinize what activities and actions engage each of our Representatives and Senators.   We need to directly contact them to express our expectations to these individuals who are our employees and hold them accountable in this Nov. election and those elections to come.

We need to pay attention to sources that reveal where our Congressperson derives his/her financial campaign support -- "Follow the money!"   How do those $$$ correlate with his/her legislative positions?   Take SuperPac ads content as a grain of salt, if you're unable to avoid seeing or hearing them,  since they are suspiciously secretive about revealing their contributors.  You can be confident they have an agenda for what is in their funding sources best interests -- but not likely in the best interests of the average American.  

If you limit the intake of your news sources to a select few whose views mostly coincide with your own, or who promote emotional rants and rhetoric  as a way to distract from the facts, do yourself the service of listening to calmer more rational reports so you can discern what is really happening.  There are neutral non-partisan  fact-check sites you can easily access on the Internet to verify truth from fiction.  There's a lot of fiction being spread.  We must do our homework -- men and women have died protecting our right to have these  freedoms we enjoy. 

Some of you live in critical States said to be the ones to determine how this 2012 election will conclude.  I don't happen to live in one of those States, but it's vitally important to me that you take your responsibilities seriously, know the facts for what and whom you vote since your actions, or lack thereof, will affect me and my family.  I know my Congresspersons and their stance on issues, how to contact them to provide support and/or express my wishes (not that they're always followed,) but the point is the action is vital for this Republic to survive.

I do not want to live in a plutocracy (a nation run by the extremely wealthy,) or a theocracy (a nation dictated to by any religious group,) or any such combination thereof, much less a faux republic/democracy.

Let's move forward toward the gradual rejuvenation of this nation in a manner dedicated to re-building our middle class.....

...creating jobs that are not limited to just the service industry as being good enough,

... insisting our government take action to rebuild our nation's infrastructure,

... re-assessing the allocation of government funds that do not penalize the least among us,

...expecting all, including the most wealthy among us.  to pay their fair percentage of taxes,

...determine government budget cuts in many unnecessary subsidized areas,

... institute budget cuts the military/Pentagon has even specified as being appropriate,

... reassess the allocation of all foreign aid within the context of today's world government alignments, 

....revolutionize drug purchasing practices with pharmaceutical companies for Medicare/Medicaid/insurers, 

...demand accountability for the financial industries giants and corporations through the regulation with which they do not self-police and our officials have been negligent in enforcing.

Let's do more than just yell out the window... "we're .mad as hell and not going to take it any more!"

What are you doing or what all do you think we need to do?  

PREMATURE ENDING

A writing group friend’s life ended prematurely -- “…peacefully, surrounded by family,” -- was the startling and sad news I received recently. I’m still processing the thoughts and feelings associated with this loss. Mark, (not his real name,) was one of numerous interesting people I met in the first group I joined for this new-to-me writing activity that I had decided on a whim to pursue after starting this blog.

About five years ago I introduced myself to this group and explained my writing would be for my blog – a term which elicited perplexed looks on almost everyone’s face. I later learned Mark, young talented personable man in his fifties, was the only group member who even knew what a blog was. During the ensuing years he was always very supportive of my writing as I was of his. We shared a similar sense of humor with a quirky thread that often paralleled each others.

Our writing group meetings were structured to be rather casual. Attendance was flexible with necessary late arrivals acceptable. Mark was rarely late and when he occasionally was absent his honest, perceptive, sometimes humorous comments were missed by all. He had shared that he was self-employed, engaged in information age computer technology assignments, so had unpredictable deadlines impinging on his leisure writing time. The group had no required writing exercises, but if new prose or poetry forms were presented we were encouraged to use the opportunity to try them. This was a challenge Mark generally accepted by producing quite remarkable results.

Mark was a prolific writer of material of varying length, mostly fictional stories, which we greatly anticipated reading. A few of his stories were of a science fiction nature or pure fantasy. He created stories that were sometimes peopled by characters who were emotionally wounded and other individuals that were mentally warped who could be wicked dregs of society. Accurate depictions of socially phony individuals with the classic personality traits of various social levels were satirically funny in some of his tales.

Mark had a viewpoint he could express in multiple ways through direct storytelling, with subtle nuances or bold assaults on the readers psyche. He created unusual plots in ordinary settings, often with strangely unique, even weird characters. A few were truly reprehensible as could be their behavior. Occasional descriptive nouns and adjectives he used, or action descriptions, aroused offense in rare instance, but that language enhanced story significance and was not gratuitous.

Eventually, Mark began to share a novel he was writing that he first presented to our initial writing group. We were all soon emotionally invested in his realistic characters, following the complex plot, and appreciating the colorful setting he was creating. The story on the page stimulated strong emotional reactions in the characters and among the readers as their very human behaviors were revealed within his fictional, but specific real life situations.

Mark continued to develop his novel through those five years as our group evolved in member composition, with changes in meeting location and leadership. This past year, after a short summer break, we resumed meeting in the fall. He continued to seek our group’s critiquing, but a year or so earlier had become a dynamic force in a new much more structured writing group that was demanding of increased time commitment. Now his book was ready for further author editing, then referral for professional editing in conjunction with his seeking a book publisher.

Last fall Mark began missing several consecutive weekly gatherings. We were shocked to finally learn this strong appearing, healthy-looking man had been hospitalized. He was in and out of hospital with a heart problem medical diagnosis. We were shocked when eventual medical revelations indicated he needed a heart transplant. About this time we also became aware that he had no health insurance.

These developments raised grave questions in our minds about his recovery and what health services would be available to him. The whole situation seemed almost unbelievable to us, and perhaps to him also. He reportedly carefully considered all factors associated with this major surgery, including organ rejection issues, and finally concluded that the heart transplant procedure was an option he would not choose. He returned home, and after a time, unexpectedly to us, he left this world.

When I learned Mark had died, that fact was mind-numbing to me as I hadn’t grasped the idea his death was eminent. My thoughts that morning I was told of his passing had been focused on a radio news item I heard that the United States has fallen to 37th in life span expectancy in a ranking of countries. Reasons given for this shameful standing included our nation’s lack of a national health care system.

Mark’s death prompted me to not only mourn losing him prematurely, but to wonder how a young Boomer-age man in the prime years of his life, with so much unrealized potential, could have failed to receive earlier-in-life health care that might have prevented his death?

I don’t know all the specifics of his life, but he had shared some of them during these years. He appeared robust and healthy, of normal physical weight and stature. He did not smoke or engage excessively in other self-destructive behaviors to our group’s knowledge. He never mentioned any serious illnesses or diseases that might have been associated with the development of his heart condition. If we had difficulty accepting his medical diagnosis I can’t begin to imagine what an incredible shock it must have been to him.

I recalled that a year ago last spring Mark had traveled with a well-known national politically oriented organization to a large California city up the Coast from Los Angeles. He engaged in pre-primary election campaigning on behalf of State candidates and issues that he strongly supported. He had been equally active in the Presidential election campaign two years ago. Mark had a busy life with his work contracts, social life contact with U.S. family and friends around the country and world. I know he had a vital interest in our nation’s health care system and welcomed expected insurance coverage changes.

Knowledge that Mark had no health insurance has stimulated secondary over-shadowing thoughts about his death. We all could ask many rhetorical questions about why far too many people in our nation lack optimum health care? Why our nation’s health care ranking is so low? How can we best refine the current health plan but not totally repeal it? More questions come to mind that others may wonder about for themselves, much as I’ve asked myself specific questions about Mark’s situation:

Why didn’t he have health insurance?
Was purchasing health insurance beyond his financial means?
Had he believed his odds were high for having no serious medical issues?
I wonder if he had ever received any preventative health care?
How would his life scenario have been different if he could have had preventative health care?

I’m absolutely sure that Mark’s individual health insurance coverage rates would have been very high, based on accounts from other independent contractor Boomer age consultants with whom I’ve spoken. My own family, in generations following the Boomers, have been subjected to excessive obscene health care rates and increases from which none of us are immune. And insurance rate increases persist. California insurance companies have merely put announced increases on a three month hold. The premiums the insured described above must pay are excessive, and seem unlikely to lessen unless further major overhauling of insurance companies and pharmaceutical companies is undertaken. But that does not presently seem to be on anyone’s agenda.

I’m confident that Mark would be seeking further refinement of our health care system and approve of the perspective here with my writing about him. I do wish he could express some opinions himself. Several times in recent years he initiated conversation with me indicating he was seriously considering starting his own blog and wanted to talk further about doing so. We never had that conversation. He never started that blog. His time ran out too soon.

A young writing group contemporary was stunned Mark had died since she had been unaware of his problems. She emailed me:

“I do keep realizing it is a privilege to be allowed to experience growing old when I consider how many people are deprived of it.”

Rest in peace my writing friend.

Our Nation's Dilemmas

Our nation is facing numerous dilemmas including, but not limited to:

-- how best to provide all our citizens health care while reducing the system's overall costs.

-- how best to extricate our nation's military troops from Afghanistan while successfully combating terrorism and reducing war's overall costs.

A lively discussion on these topics has been taking place at "Rainy Day Thoughts." I have periodically been contributing comments of my own there. A recent post there, "Health Care or Afghanistan" with the most recent one focused on the issue of U.S. military troops in Afghanistan. I wrote at such length as I sometimes am prone to do in comments on others blogs, I concluded I should probably just post these thoughts here.

The Taliban is not going away. They will regroup as they always have for generations. An American citizen former Afghan in our community explained the history of that group soon after we attacked Iraq.

I came to conclude he understood the situation better than any U.S. government officials, so-called experts and others that I've ever heard expound on the subject. He explained the history of the whole region and that of the Taliban's coming into being -- how their strength has always ebbed and flowed.

His grandfather was, reportedly, a highly respected War Lord compared to some of lesser repute. His father served in the Afghan government. When the Russians came into the country this now-former Afghan was allowed to attend the Afghan Air Force Academy, later trained in Russia. Then Russia was eventually replaced with the U.S. This now-pilot was brought to this country to train, then U.S. pulled out of Afghan. He stayed on becoming an American citizen, eventually successful businessman in our community.

He described how the Taliban has always stepped in to establish order with many Afghan people welcoming them as the lesser of evils -- when the country repeatedly disintegrates into chaos vs some sort of structure, and/or they are faced with "occupiers" of their country and they unite to eject them as they did the Russians.

This former-Afghan has just gone to Afghanistan for a year ostensibly to establish a business per a recent article in our local paper (available in the Claremont Courier recent archives with a fee or subscription.)

We can't undo the failure of the previous administration to aggressively go after Bin Laden in Afghanistan. They seemed too busy with avenging Saddam's years earlier attack on our then-President's daddy (who was our President during the Kuwait War.) They created a nightmare based on lies, betrayed this countries ideals based on the false premise of defending our nation, and have blood on their hands. Maybe we would ultimately have had to attack Iraq from Afghanistan, but we'll never know. We do know not enough focus was placed on capturing Bin Laden in Afghanistan. Pakistan was then and increasingly is now a problem.

Meanwhile, Bin Laden must be laughing in his lair at how our countries leaders fell into his trap and our nation has reaped greater inner destruction than his wildest dreams.

We have a true "catch 22" with Afghanistan and whatever choice we make will not be the correct one. Meanwhile the blood of our young people flows as does that of many innocent Afghanistan people.

Health Care Passes House -- Senate Next

U.S. House of Representatives has passed the health care bill. Next the Senate must do the same, reconciling their bill with the House bill.



I think our Congresspersons should stay in session all the rest of this year, if need be, so they can complete a citizens assignment to get a bill to President Obama for signature by December 31, 2009.

Happens in business quite frequently where special projects require employees to work long hours, days, even weekends sometimes, for successive weeks to meet a deadline. Our Congresspersons have postponed addressing the health care issue for years and years, so an end of the year deadline is not unreasonable now, finally. If our Senators and Representatives really concentrate, don't waste time with political blather, posturing,and game-playing, maybe they can be home for the holidays, or sooner. That's an incentive employees in business often are given.

Representatives and Senators work for us. We need to let them know we're way past the point of tolerating their "business as usual" approach to legislation important to us -- we mean business! Each of us has power with our vote that can affect whether or not they are re-elected come Election Day.

Here's a refresher course describing Congressional bills evolution from birth to realization. This is the process I recall learning from Jr. High/High School civics/government classes.

A Congressperson writes a bill or receives one written by a lobbyist that is then presented to Committee for consideration. If the proposed bill garners Committee passage it can then be presented to that Congressperson's House or Senate membership. Wikipedia effectively provides the following description beginning with a bill in Committee:

"A decision not to report a bill amounts to a rejection of the proposal. Both houses provide for procedures under which the committee can be bypassed or overruled, but they are rarely used. If reported by the committee, the bill reaches the floor of the full house. The house may debate and amend the bill; the precise procedures used by the House of Representatives and the Senate differ. A final vote on the bill follows.

"Once a bill is approved by one house, it is sent to the other, which may pass, reject, or amend it. In order for the bill to become law, both houses must agree to identical versions of the bill. If the second house amends the bill, then the differences between the two versions must be reconciled in a conference committee, an ad hoc committee that includes both senators and representatives. In many cases, conference committees have introduced substantial changes to bills and added unrequested spending, significantly departing from both the House and Senate versions. President Ronald Reagan once quipped, "If an orange and an apple went into conference consultations, it might come out a pear."[23] If both houses agree to the version reported by the conference committee, the bill passes; otherwise, it fails.

"After passage by both houses, a bill is submitted to the President. The President may choose to sign the bill, thereby making it law. The President may also choose to veto the bill, returning it to Congress with his objections. In such a case, the bill only becomes law if each house of Congress votes to override the veto with a two-thirds majority. Finally, the President may choose to take no action, neither signing nor vetoing the bill. In such a case, the Constitution states that the bill automatically becomes law after ten days, excluding Sundays. However, if Congress adjourns (ends a legislative session) during the ten day period, then the bill does not become law. Thus, the President may veto legislation passed at the end of a congressional session simply by ignoring it; the maneuver is known as a pocket veto, and cannot be overridden by the adjourned Congress."

Congress Listen -- Americans Want Change!

Congressional Senators, Representatives -- are you listening?

The American people are angry!

The American people want change, Change, CHANGE!

We don’t care to which political party you’ve given your allegiance, since both major parties have been betraying the American people through too many Administrations.

We don’t like much of what you’ve done for many years, regardless of the political party in power, or who is President.

We don’t like much of what you’ve NOT DONE for many years, either, including allowing our health care and social security systems to flounder without taking truly meaningful measures to ensure their solvency.

We don’t reject the idea of jettisoning both major political parties for a third party committed to the American people over the special interests you’ve come primarily to represent.

We don’t like what you’re doing now to protect the commercial interests over the interests of the individual in the instance of health care reform.

We don’t like the fact that all American citizens will not have health insurance.

We don’t like that many of you ignore the fact the majority of American citizens want a public option in our health care reform.

We don’t like the fact so many of you are determined to provide for-profit insurers more money by requiring citizens buy insurance from those companies rather than providing a truly viable competitive public option choice.

We don’t like the fact you’re not willing to make available an affordable health care plan to all American citizens such as we offer you.

We don’t like the fact some of you made an effort to hoodwink us into believing adding a “trigger” to a healthcare plan was an effective helpful addition rather than the meaningless proposal it was.

We don’t like all the campaign contribution $monies$ you receive from for-profit insurance and pharmaceutical companies with the unsavory implications that behavior suggests.
(Readers, check on “Open Secrets” the $$$$ your Representative(s) and Senator(s) have received.)

We don’t like the fact that financial markets self-policing regulating authorities did not do their job leading to banks, investment houses, other institutions dissolving and little has since been done to correct that situation.

We don’t like the fact that through the years government regulations were eliminated contributing mightily to the financial markets collapsing debacle.

We don’t like the fact that what market and government financial regulations did exist were not enforced.

We don’t like the fact that meaningful regulations are not now being established for both our banking industry and the financial markets.

We don’t like the fact that financial insiders from the previous Administration literally gave away our tax money to the financial world which the current Administration enabled while individual citizens continue to receive little or no benefit.

We don’t like the fact our tax monies were given to all those banking corporate entities without requiring accountability.

We don’t like the fact so many years went by and so little was done to address the critical issues surrounding climate change.

We don’t like the fact that even now select energy commercial interests are being promoted by many of you under the guise of responsiveness to climate change, despite knowing those companies products are detrimental to citizens health.

We don’t like the implication you do not respect American citizens strongly expressed views as evidenced when you disregard us.

Quite frankly, there are many more actions you've taken, or non-actions, that we don’t like, but I’ll let others describe those here or elsewhere.

"Trigger" Congressional Buyout

Health care reform emerging from the U.S. House of Representatives appears to include a Public Option. Just how that choice will occur, if it does, in the final bill the House and Senate members must formulate, then pass and send to the White House for our President’s signature, remains to be seen in the next few weeks, months ahead.

Bipartisan support for this bill has been abandoned by the sole Republican who earlier alarmed her political party by supporting in committee the bill’s formulation until the Public Option was added without the "trigger" element she wanted. Others in both political parties seem to lack the courage to step forward and vote positively for what the majority of the American people have said they want -- the Public Option.

I strongly urge reading Ronni Bennett’s recent discussion on “Time Goes By” – ‘The (Non)Public Option.’ She gives a succinct analysis on the bill-castrating “trigger,” also offering a view of what is really going on in Washington. She provides an excellent source link to a web site, Open Secrets, by which we can easily see some of the specific corporate and interest groups efforts to wield congressional influence. Their self-interest views may well take precedence in our legislators issue positions over those actions that would be in each individual citizen’s best interests – including yours and mine.

"Open Secrets" is an excellent credible web site reference, for now and in the future, that tracks the monies our duly elected Congressional persons in House and Senate accept in campaign contributions and provides other factual information. Everyone supporting any political party, also Independents, would be wise to read there exactly where the monies and the legislation come together.

"Follow the money!" in relation to specific issues before Congress. Being an intelligently informed citizen is especially needed now and in the decision-making process regarding whether to re-elect some of our Congresspersons on their next election day.

Presently, the correlation of that site’s data can inform us on such issues as health care reform. We may recognize a need to stress our favorable view for a Public Option to select Congresspersons to offset the weight of their political contributors unfavorable views. Your Representative’s and Senator’s name is easily located there.

What's especially interesting right now are the monies the health insurers and pharmaceutical companies are pouring into our Congresspersons’ campaign coffers.

We can be assured that these health care reform plans coming out of Congress are being tailored to be exactly to the benefit of those companies income and not our own best interests, especially if they eliminate the Public Option.

Once again the American people are being sold down the river. Far too many citizens are allowing themselves to be deceived into believing these companies and interest groups so-called compromises reflect legitimate bargaining. Their actions are part of a show-case design process in which they support, alternately protest, then acquiesce to some weakened plan variation. They are attempting to convincingly mislead the public into believing that they are genuinely seeking a solution to the health care issue instead of sincerely assisting with the development of a viable system that’s needed and best for our nation.

The insurance, pharmaceutical companies and their lobbyists are all about strengthening their monopolistic grip on the American health care purse contents. These companies have enlisted far too many of our Congresspersons who either directly or tacitly cater to them. Our nation's intense need for health care costs to decline will not occur except on a most superficial level, if at all, and costs will continue to rise unless private insurers are challenged with an alternative system giving everyone choices including a Public Option.

I care about the kind of country and government that will exist for each of us, our citizenry and future generations. This is not the time to throw up our hands in discouragement and swear off further advocacy for a Public Option, or to abandon our future voting privilege.

It is time now, and will continue to be time, to let our Congresspersons know our views and that we hold them accountable for their actions based on our informed knowledge.

We now have an unprecedented number of ways to communicate our views quickly and easily. Our taking action is always important during the best of times and the worst.

“The price of apathy towards public affairs is to be ruled by evil men.”
A truth as important today as when issued by Plato.

“The death of democracy is not likely to be an assassination from ambush. It will be a slow extinction from apathy, indifference, and undernourishment."
Another truth of which we should be mindful from educator Robert M. Hutchins.

This is not to say we must dedicate every waking thought and action to focusing on issues of our day. We want to enjoy life, lead active lives in all respects, but we do need to devote some time to exercising our right and responsibility for living in these United States by participating in the striving democratic system within our republic.

Health care reform is one of the most critical and important issues of our time. Continuing to do our utmost to bring about needed health care changes including a Public Option may be the most crucial action we can take that will directly affect our own lives, significantly impact that of every American and future generations to come -- our legacy.