Balancing the budget and thinking about health care

One of our MPH courses, we had to do an exercise in which we figured out how to balance the federal budget. We had to do it through making spending cuts alone, and it was unbelievably difficult. It's a good reality check to have to weigh what you want to have happen with the realities of what else would have to be sacrificed to get it. It's a reality check I think more people should engage in when talking about social and health-related programs, taxes, and what cuts and increases really mean when we stop playing year-to-year budget shell games.

The New York Times has a new interactive feature up letting you try that exercise, both by cutting programs and increasing various taxes, with an article explaining how they made their calculations and what the long-term implications of the deficit fight will be:

It [the long-term deficit] comes from the projected growth of Medicare, Medicaid and, to a lesser extent, Social Security. It is the result of baby boomers’ having paid far less in taxes than they will draw in benefits. “The reason we find ourselves in this situation,” said Mr. Bowles, the former chief of staff for President Bill Clinton, “is that we’ve made promises we can’t keep.”

The deficit puzzle focuses on the year 2030 because it is far enough away that the boomers’ retirement will weigh heavily on the budget but near enough that reasonable budget estimates exist. By 2030, the needed deficit cut will equal about 5.5 percent of annual economic output.

By comparison, domestic discretionary spending — all of it, including Head Start, college financial aid, the F.B.I., medical research and airline safety — will add up to about 3 percent of economic output, according to Congressional Budget Office projections. Military spending will equal about 4 percent.

So the solution will have to revolve around tax increases and changes to health care and Social Security. And the country cannot wait until 2030 to implement most of the changes, notes Alan Auerbach, an economics professor at the University of California at Berkeley. If it did, the interest on the national debt could become crushingly large. Deficit cutting will probably be a regular part of politics for the next couple of decades.

It's very popular to talk about cuts in discretionary spending - "let's cut Head Start", "let's stop spending on military technology and spend it on education" but the truth is, entitlement spending is by far our biggest budget item and health care makes up a big chunk of that. Thinking about how to contain health care costs and yes, how to ration health care (not whether to ration health care, since it is already rationed, but how) are going to be a big part of this debate.

Public Health Doula, MPH

Family and friends and celebrations have come and gone, graduation is over, and I can now say that I officially have a Master's of Public Health!

To be honest, it feels a bit anti-climactic - my last semester was busy, but mostly with things besides academic work, particularly once my thesis was done at the beginning of April. Unlike the end of my undergrad degree, which was a relieved crossing-the-finish-line feeling, my graduate commencement was more of a "oh, hi finish line, I knew you'd be around here somewhere" feeling.

Still, I am happy and proud of my shiny new graduate degree, and I'm hoping to put it to good use in the near future...whatever form that takes. In the meantime, I want to take a moment to appreciate how much writing this blog, and reading/connecting with other blogs has been an amazing education in and of itself over the past two years. It's filled in some of the spaces a public health education doesn't address, when it comes to my own particular interests. I've learned how to monitor the heck out of a program in my MPH education, but I didn't have many opportunities to debate the nature of informed consent, hear stories from women who felt judged for formula feeding, or gauge how public health recommendations look to, and are interpreted by, the outside world.

I've also valued the opportunity to connect with like-minded people around the country and around the world. The issues of sex, reproduction, reproductive health, abortion, pregnancy, birth, breastfeeding, our agency as women over our own bodies...these are complex issues with many layers of thinking and learning to work through as we talk about them. Sometimes it feels frustrating to feel like you're starting over at "101" level every time you try to discuss them with someone new. I have been so lucky to find people who are already thinking about these issues and their interconnections, and can not just meet me where I'm at but push me further.

It's also deeply enriched my doula practice. I learn about new topics, techniques, research, and ways of thinking about and conveying information to others. More and more frequently, I find myself referring clients and friends to blogs and to blog posts for questions like understanding rising c-section rates or writing a birth plan. Sometimes I think the blog world should be required reading for new doulas (and other birth professionals!) It expands my worldview beyond what I just learn/hear in my training or from other people locally, and helps me contextualize doula practice in the bigger picture of birth issues and activism.

Finally, I have loved building a small but growing community of readers for my blog. Posting about wondering where to find doula clients and having so many wonderful and generous suggestions was such a help for me, and a boost to my confidence. I am so grateful to all of you who commented on that post, and to all of the readers and commenters out there!

I'm not sure what's next for me as a doula and a newly-minted MPH, but I'm excited to be starting work half-time next week at the hospital where I've been training to be an LC. They are hiring me temporarily as a "breastfeeding specialist" (since I'm not an LC yet), to do several night shifts of lactation support a week. This will be my first experience doing lactation support in the hospital solo, not to mention my first experience working nights (well, I've stayed up many nights as a doula but this seems a bit different!) I am excited and of course at least a little nervous, and interested to see where this leads.

I'm also not sure what's next for this blog - between graduation and traveling, it seems to be that just like last year, May has been a vacation month from blogging! And while it always seems like there are a dozen posts or news items a day popping up in my blog reader or news alerts that I could link to and talk about, it's seemed harder recently to actually get those into the blog. With a shift in my work and to some extent my focus, my posts may change too - more? less? different topics? We'll see!

I do plan to do a post soon on applying to and choosing an MPH program, since I have had several e-mails about that from readers and I would really like to help people understand more about the degree, what it can do for you, and what you should be thinking about when applying. As always, I am open to other requests for topics! Just comment, or e-mail, and let me know.

In the meantime, I hope you'll keep reading, and commenting, and linking, and e-mailing! Every time I check my subscriber stats, I do a little happy dance that more people are interested in what I have to say (because as anyone who knows me will tell you, I love to talk) and I hope that community keeps growing.

How do/did you look for a doula?

Graduation is quickly approaching - my master's thesis is completed, my classes are thisclose to finished, and soon, I'll be a real, live Master of Public Health (a master! doesn't that sound great?) Time to look for a job, right?

Well, timing is creating a bit of a wrinkle for me. While I'll have my MPH in May, the exam to become an International Board Certified Lactation Consultant (IBCLC) doesn't happen until July. And then it's another wait for the results. I'd like to be able to use that credential in my job search. So I'm hesitant to get desperate and commit to some job, any job, right away. All my job ponderings are another post for another day, but for now I'll say that I'm willing and able to hold out for a couple of months at least before committing to something full-time, long-term, in hopes that what I eventually commit to is up my alley (perinatal issues).

That of course does not mean that I won't be working; instead it means that I need to find more short-term and/or part-time work (a situation with which I am depressingly familiar, but yet again another post for another day). Right now, I'm lining up work to teach a prenatal breastfeeding class, possibly continue doing research assistant work for the department, and looking for more ways to bridge the gap - including trying to work as a private doula again.

I have some real blocks about looking for private doula work (did I mention something about other posts for other days?) but I'm trying to move past them and push myself to do some real marketing. I have an extremely basic website up. I have built a nice little group of local references from families I've worked with as a volunteer. I am getting networked with one of the local CBEs. But every time I sit down to make a flyer or brochure, I get stuck. I think "Will anyone really read this? Am I spending a lot of money at Kinko's and time putting these up, for nothing? Do I need to do more targeted marketing? Where, and how can I not look pushy and obnoxious doing this?" (did I mention something about blocks?)

So I am asking you - maybe you used a doula, or are looking for one now. How did you find that person? What were other ways you used to look for one? What ways did you trust the most? Was there anything you really liked, or that really turned you off?

I may be the only doula in the world who has been to close to 50 births and has never learned how to self-market! But, here I am, and I will appreciate it so much if you have an idea or experience you'd be willing to share.