A Blind Trust: An Alternative Fee Structure Towards Access, Care, and Healing

This is a proposal for a presentation written for a fall conference of licensed counselors. This piece could have been titled “Why the Birdhouse? Part II”

Four years ago, after wrestling, figuratively speaking, with sliding scales, Medicaid reimbursement, and client’s with no insurance, I began an unusual fee structure in my practice: I extended to my clients that they may determine their own fee. Rather than I set the rate they must pay, they choose what they will pay.

In order to aid their decision, on my website, they are given some data including the break-even cost per session as well as the average fee other clients pay. Realizing that under such a system some clients may feel some shame (for example, those who could only afford less than the break-even rate) I go one step further and tell my clients in our first session that they need not report how much they choose to pay; or even if they pay. Fees are monitored collectively rather than individually so no one who cannot afford care will be told they cannot come. Everybody comes. They do their best, as do I, and it all works out well for everyone. The initial impulse of most outsiders hearing of this system is shock that such a system works at all. The widespread presumption is that, given the choice, clients will choose to pay as little as they can which would turn out to be less than I need. However, my clients consistently, reliably, every year I have done this so far, contribute more than I need; not less. In modern parlance, this system is profitable. But that, as you may have already guessed, is far from the point.

The tangible changes this system has brought about have nothing to do with my income. The most tangible, of course, has already been stated: No one is turned away. The other is clients may come at the pace that feels best for their needs rather than their budgets. Surprisingly many, essentially all, come no more often than is necessary. They feel no pressure, in either direction, to come more or less often, than they need.

The intangible outcomes of this fee structure are, in my opinion, more impressive. Because sessions are not conditioned on payment, my clients understand plainly that our time together is unconditionally for them. The part which money plays in creating distance is eliminated and we are all singularly-focused on their healing. This, as you may imagine, allows a deeper trust to develop. Everyone still knows there is an expectation to pay, and of my trust in their sense of responsibility to do so, by which we generate a mutual respect knowing our reciprocal needs are being met. As such, they sense no fear, self-protection, or defensiveness on my part; as if my client’s might hold some threat to me. Due to my willingness and vulnerability, they relax more quickly, are less guarded, and share more freely. It allows us to be both more honest and heartfelt with each other and therefore, it seems safe to presume, the therapeutic changes in the scaffolding of the mind begin sooner and last longer.

In this presentation I will describe how and why this system works including practical logistics, the necessary boundaries, the nature of the relationship, and the disclosure of information. For those who are troubled by the role of money in our health care system, our economy, and our interpersonal relationships, this presentation makes a small contribution to the long process of discovery of new ways to care for others and to live well together.

This will be a simple presentation requiring only a few images (e.g. graphs), a description of the fee structure and its outcomes, followed by a long-ish Q&A conversation with the audience. One hour should be sufficient time but, if there is interest, we could take ninety minutes. I am grateful for your considering this presentation proposal. This is my first. Thank you.

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From Wangari Maathai’s onBeing interview “Marching with Trees”

But I want to say that God is in me, God is in you, God is in the trees, God is everywhere! If God is everywhere, if that concept of omnipresent, is true, then God is everywhere. He doesn’t have shape, he doesn’t have size, he doesn’t have color. So we ought to see God in everyone of us. And if we did see God that way, we would have a different idea of how we should relate to each other and to the other species.

Spoken by Wangari Maathai in interview with Krista Tippet, OnBeing in episode of April 18, 2019.

Another fb response, May, 2019

A fb friend shared the above meme. Here was my reply. I want to retain it here.

When you say ‘those who work zero hours a week,’ do you mean the retirees who no longer work but now draw Social Security and Medicare? Or the veterans who did not make the ultimate sacrifice for the cause but can no longer work? Or, the non-veterans whose bodies or brains are also disabled so that no employer will hire them? My dad’s brother and mother both lived in government-subsidized housing because, in this country, those who own the land on which those buildings were built can more easily afford homes and those who built them often cannot.

But judging by the images in the meme, it seems the culprits are not retirees, veterans, the disabled, or the working poor. Judging by the picture, its white politicians who register as Democratic socialists and black people; or game show hosts. If the tax code is making marginal people poor,
wealthy politicians, the next time they reform the tax code, could do so in such a way to begin to share the burdens with the rest of us.

And I linked in an NPR article entitled, “President Trump Defends Himself Against Report He Did Not Pay Taxes for Eight Years”

Trying to learn how to say what needs to be said. Putting a shoulder to the plow for the quiet revolution of the heart.

Why The Blindfold? II

While doing the blindfolded hugs demonstration at the Durham Farmer’s Market today I was asked to stop. Ostensibly because I did not email to ask permission but realistically because such public displays of safe, unconditional love and care make some people afraid. They would describe it differently of course. Which makes me all the more determined to continue performing this act of loving resistance.

Between hate and fear, there is only one degree of separation. If a mile-wide gulf is not left, or made, for Love, the other two could soon overshadow it. Be a Light unto the world. Are you one among the tipping point or standing with the weight on the other end? Much love and many blessings to you and all those you Love.

April 27, 2019

special thanks to the photographer Camilla Hovey for spontaneously snapping some pics and sharing them with me.

From Rev. Dr. Martin Luther King Jr’s “Stride Toward Freedom”

If the moderates of the white South fail to act now, history will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people. Our generation will have to repent not only for the acts and words of the children of darkness but also for the fears and apathy of the children of light.

“Stride Toward Freedom: The Montgomery Story” by Martin Luther King Jr. Harper & Row Publishers, 1958, p. 202

Small Group?

As many of you know, for some time I’ve been thinking and learning about the relationships between people, planet, and money. I know many of you are thinking about such things too and was wondering if you might be interested in forming a small-group.

As I’m imagining it, the conversations would be organic and unstructured, drawing on our own lives, observations, and experiences, with a practice of staying near the intersections of spirituality, personal relationships,
commerce (work/income/wealth/consumption), and politics. We may draw on books, poetry, sacred texts, and news articles as needed but they won’t be the central focus. The purpose of the group would be to exchange ideas to ease stress, build courage, create flow, envision hope, and heal. So far, I’m calling the group ‘Ever-Widening Circles: A small group conversation’ after a Rilke poem.

For the time being, we’ll meet in my office at the Wellness Station in Durham gathering a little after 7:00 pm, beginning at 7:30, and having everyone home close to 9:00 pm. We can decide on more convenient logistics (days, times, places) as the group comes together.

If you’d like to come, feel free to RSVP or drop in on the second and fourth Sunday’s of each month any time between 7:00 and 7:30 at 3001 Academy Rd, Suite 130 (or message me if you’d have a preference for a different evening. Tuesdays and Thursdays are other options). I’ll have hot tea, water, and something fizzy and non-alcoholic to drink. Feel free to bring a snack or beverage for yourself or to share. Thank you. I hope you can come.

Listening to Our Elders

The thing about evolution is that it does not always ascend. Poor choices, like beginning a house which is neither square nor plumb, can lead to a cascade of errors. The other side of the evolutionary coin is that, for those prone to poor adaptations, or ‘choices’ if you will, species do decline, and sometimes become extinct. Some cascades can be catastrophic.

What if success were measured in terms of longevity rather than the magnitude of the population or its carbon footprint? And instead of the incremental longevity of one physical life of one particular being, or the average of their peers, what if success were measured in the geological longevity of a species? And then, what if the most evolved, that is ‘intelligent,’ creatures on the planet, were also the oldest in geologic time? In that case, the shortest-lived species on the planet might have a lot to learn from those who have been here longer. You could call it ‘listening to our elders.’

With a cascade of errors such as our use of fuel energy, profit, debt, violence, and entertainment, our outcomes as a species seem dim unless we begin to make new choices, or ‘adaptations’ as it were. Those choices must include our daily practices of mobility, trade, consumption, care, peace, and comfort. Please turn a gentle gaze. You too will see. There is much to hope for and much more work to do. Please do not be afraid. You are not alone. Join a quiet revolution of the heart. Many have and there is room for many more.

From Marilynne Robinson’s “What Are We Doing Here?”

The severest possible cheapening of labor in early industry was supported by the same theories that drove colonialism and chattel slavery. The system yielded spectacular wealth, of course, islands of wealth based on extreme poverty and on the profounder impoverishments of slavery. Comparisons are made between slavery and so-called ‘free labor,’ which seem always to imply that the second was more efficient than the first, therefore destined on economic grounds to become the dominant system, and to bring with it a general melioration of conditions. It is a very imprecise use of language to describe as ‘free’ a labor force largely composed of children, who, on the testimony of Benjamin Disraeli among many others, could not and did not expect to live far beyond childhood. It is an imprecise use of language to call ‘free’ the great class of laborers who had no rights even to shelter outside the parishes where they were born. The fact of social progress has been treated as demonstrating that laissez-faire works for us all, that the markets are not only wise but also benign, indeed humane. This argument is based on history that is effectively invented to serve it, and on a quasi-theology of economic determinism, a monotheism in that it cannot entertain the possibility or the suggestion that social circumstance can have any other origin than economics. Clever as we think we are, we are enacting again the strange—and epochal—tendency of Western civilization to impoverish.

“What Are We Doing Here: Essays” by Marilynne Robinson. Farrar, Straus, & Giroux, 2018, p. 90

The Pursuit of Wealth, Next Installment

This client replied saying essentially, “Yes and…if it were not for money and wealth there’d be no Biltmore Estate nor that of the Rockefeller’s. Aren’t they worth considering?” They then closed, with a word about the poorly paid immigrants who built the railroads, in a tone of relative agreement. This was my response:

Thank you again for opening this dialogue. I hope it will be ok for me to add one more contribution. I thought your last words about the railroad built by immigrants was a fine way to leave off. But then today a client comes in to tell me about her recent visit to the Great Dismal Swamp on a leg of 9 days in the northeastern part of the state. She tells me of the canals that were dug through the Great Dismal Swamp by hand. Because those overseeing the building, she added, found the purchase of slave labor to dig the canals cost-inefficient, they hired a ship and went directly to Africa for the wholesale price of a ship full. They set them to work to dig the canals, like the railroads, that were then, like now, used for commercial trade and travel. Neither of which those who built the canals or railroads, due to their enslavement and poverty, could much participate. Except, of course, as laborers and commodities to be shipped to and fro.

Which reminded me of another point about the Biltmore House. It is indeed a magnificent structure and for the material and energy that were expended to build the Vanderbilt’s vacation home, each of those men, depending on their number, who labored on the structure, could have built homes for the Vanderbilt’s and themselves. But, while one family occupied the big house, those paid a servant’s wage, could hardly participate in the form of security we know of as owning land and a home. All things which have been done could have been done without money. Money is both motive and barrier; not the act itself.

But this is not ancient history for this economy of ours still functions more or less the same: the poor are resented, or pitied, if they are considered at all, for their inability to participate and the wealthy are admired for their success and, at times, their philanthropy. There are many things left to be desired about this economy we have inherited and adopted. Which, puts it mildly, I think. Thank you again. This has been very helpful for me to think through and articulate my thoughts.