Preexisting From the Start

As the American Health Care Act made it through the House, I felt great concern for my patients. Working as a Neonatology Fellow in the Neonatal Intensive Care Unit (NICU), I take care of many premature and critically-ill babies. I work with an amazing team that includes neonatal nurse practitioners, neonatal nurses, respiratory therapists, nutritionists, pharmacists, social workers and so many more. On any given day, one little baby can have between three to ten physicians, nurses, and other NICU team members providing care for the baby and support for their family.

Despite the constant intensive care these infants receive, the likelihood that any given neonate will leave the NICU with a chronic medical condition and/or an increased risk of developmental delay is, unfortunately, high. While technology has advanced greatly in recent years, a baby born prematurely will not grow and develop as well as he or she would have inside the womb.

Take, for example, a baby born at the earliest of viability. This baby would have only spent between 23 to 24 weeks in the womb (instead of 40) and weigh barely over 1 lb. A baby born at this gestational age has an incredibly underdeveloped brain, lungs that are not ready to be breathing in oxygen, kidneys that cannot effectively regulate water and salt, and intestines that aren’t prepared for breast milk or formula. Their skin is so thin that using even the smallest tape to attach cardiorespiratory monitors can cause significant tearing and bleeding. This baby will stay in the NICU for three to six months and need to receive intravenous access for medicines and nutrition. The baby is at an incredibly high risk for serious infections, significant bleeding in the brain, kidney failure, and many significant organ problems. If the baby survives, they may need continued respiratory and feeding support when he or she is ready to leave the NICU. They will, definitely, need developmental support. Upon discharge, this baby will need follow-ups from their primary pediatrician, developmental pediatrician, physical therapist, speech therapist, and occupational therapist.

Without making a single choice in his or her life, this baby will already have been diagnosed with multiple diseases, thereby having multiple pre-existing conditions. While the Affordable Care Act expanded Medicaid and protections to individuals with pre-existing conditions, TrumpCare stands to make it easier for insurers to raise premiums or deny insurance to those same individuals. This stands to cause even more harm to families already on a tight budget, who now have higher deductibles to cover when their baby has to follow-up with multiple specialists.

Because of this, the American Academy of Pediatrics (AAP) was strongly against TrumpCare. The AAP covers nearly 66,000 healthcare providers associated with the Pediatrics profession, including myself. Despite the AAP’s and most other healthcare organization’s strong opposition to the AHCA, most Republicans in the House completely ignored those of us who’ve seen the benefit of health insurance to our patients.

That leaves me with significant concern. As a Pediatrician and Neonatology Fellow it is part of my job to advocate for babies and children who are unable to do so for themselves. The American Health Care Act pushed by President Trump and his Republican colleagues will harm children and their families if passed in its current state. My patients’ families will find affordable health insurance more difficult to come by, and that is unacceptable. I stand with the AAP in strong opposition to TrumpCare and will continue to advocate for the babies and their families who will be negatively affected by this legislation. As the AHCA heads to the Senate, I strongly encourage all individuals who feel that health care should not be prohibitively expensive or denied to individuals based upon pre-existing conditions to call their Senators and voice opposition to TrumpCare.

Phonebanking: It’s Not as Scary as You Think

There are some important special elections coming up to fill the seats of members of Congress who left to serve in the Trump administration. We need to support candidates who’ve taken positions in line with our initiatives. Besides sending donations, we can make a big impact by phone banking – calling voters in their districts. Phone banking provides an opportunity to communicate and reinforce the candidate’s message with a large group of voters in a short amount of time. And it’s something you can do remotely.

Whether it’s your first rodeo or you’re a seasoned pro, phone banking can be tough. The anxiety of talking to strangers (some of whom might not be thrilled to talk with you) and the feeling of responsibility to your campaign and candidate can leave you feeling a little apprehensive about sitting down and dialing that first number.

Knowledge is power. Let’s put those fears to rest.

Who am I calling?

Campaigns get lists of voters to call from the political party and/or public voting records. That means you’ll be calling likely supporters who tend to vote regularly.
Admittedly, the lists aren’t perfect. In the rare event you get a voter who supports the opponent, all you need to do is say thank you and hang up; you don’t need to get into a debate. Occasionally, the voter will just hang up in your face. Don’t take it personally; it wasn’t anything you did. Just move on to the next call.

What do I say?

The campaign provides a script for you to follow. There are three types of calls:

ONE: Voter identification – Find out who supports your candidate. The script is quick and straightforward: Do you intend to vote for my candidate? You record the voter’s response, selecting from the categories provided. If they’re a strong supporter, there may be a follow-up question asking if they want to volunteer.

TWO: Persuasion – This is a call to someone who is undecided. Unless you’re an experienced phone banker, it’s unlikely you would be asked to make this type of call.

THREE: GOTV – Get Out the Vote. This is the type of call you make within a few days of the election to make sure your supporters follow through and vote. The script will lead you through a series of questions to ask that are designed to help the voter make a plan to get to the polls. That may sound silly, but it’s easy to get caught up in your daily routine and forget that it’s an election day.
Make sure you read the script out loud a few times before you start making calls. You want to sound like you’re talking, not reading. If you’re with another phone banker, it helps to do some role-playing to get used to responding. The more comfortable you are with the script, the more comfortable you’ll be when you’re talking to real voters.

How do I make it fun?

Seriously? Yes, it can be fun.

Do it with friends. No, it’s not a conference call. But you can get together while you make individual calls. Gather in a coffee shop or restaurant with WiFi; make a sip of that latte’ your incentive. Or meet in someone’s home and reward yourselves with pizza and beer when you’re done.

Make a game out of it. Put candy (jelly beans?) in a bowl, and ration out one piece for every five calls.

If you’re calling with a group, pass around a hotel call bell. Ring it a few times when you get five positive responses and then pass it along.

My top ten tips:

1. Set a goal for how long you’ll make calls. I stick to about three hours at a time, though I take time-outs to visit the bathroom or refresh my beverage. This helps you make a commitment to the task, but it also sets a limit – I can make it until then.

2. Allow five rings before you hang up.

3. Smile and dial. People can hear smiles. That’s because your facial expression changes both the way you feel and the way you sound. If you’re smiling, you’re going to feel better and sound more enthusiastic on the phone, and that will have a big effect on the conversations you have. Set up a small mirror to check yourself. (No, you’re not being vain.)

4. Don’t give people easy outs when you start the conversation. The answer to “Can I ask you a few questions?” or “Do you have a few minutes?” is almost always “NO.”

5. The script is a baseline. Your goal is to figure out which way someone’s considering voting. Be friendly, make it a conversation, and get the necessary information.

6. Avoid getting into a debate. You’re not going to convince that voter to change, and they’re just wasting your time. Say thank you and hang up.

7. Don’t badmouth other candidates unless they do first.

8. Don’t be afraid to say you don’t know. Refer them to the candidate’s website. There may be a spot to record a note, and someone else will return the call.

9. Don’t stress over a call you think went badly. The good news is that that person doesn’t know you and you’ll never have to talk to them again. Think about what went wrong and how to do it better next time, but don’t dwell on it or beat yourself up. There are always other voters.

10. Okay, I ran out. Send me yours!

Circle Breathing


I had coffee with a friend last weekend.  We compared notes regarding our respective acts of rabble-rousing and resistance. My friend is a mostly-retired psychiatrist (in other words, she is WAY smarter than me); who had not been expecting to expend her early retirement energy in active political resistance; yet, here she is.  Here we are.

She and I are aligned in philosophies and have a shared sense of dread, grief, and horror regarding the current administration.   For us, this sensation is both a catalyst to action and a burden–a burden that often takes residence in our guts and minds like an OCD virus that threatens our sense of inner peace and causes bouts of crankiness that are sometimes directed at innocent nearby targets, such as our husbands.

The past couple weeks have been a good opportunity to take a mental break.  The D is doing an excellent job of exposing his own incompetence and blinding narcissism without any help from myself, his many detractors, or the ‘fake’ media. In my friend’s words:  “He is doing our job for us.”

The D’s firing of FBI Director Comey is a clear obstruction of justice; the initial reason given was Comey’s revelation of newly discovered Hillary emails in the late days of the 2016 campaign. This is a laughable and ironic justification from The D regarding an act that he previously praised, and one that most likely tilted the balance of election in his direction.  On the heels of that debacle, The D shared classified intelligence with his Russian BFFs during a cozy photo op (for Russian press only). That may be one traitorous act too many, even in the eyes of Republican cronies — time will tell.

There is a rumor that several Republicans are considering withdrawing support from The D in a belated attempt to restore their integrity, or at least a facade of integrity. This may be a window of opportunity for them to actually hear what their constituents are saying during the current Congressional break.

Ultimately, The D’s cluelessness and blinding narcissism will be the primary reasons for his seemingly inevitable downfall.  The House of Cards is starting to crumble; the cracks in the orange veneer are getting more obvious.  As much as I’ve enjoyed a week or two ‘off’, watching events play out, I/we cannot return to the not-my-problem complacency that allowed The D to be elected in the first place.

I used to sing in a choir.  For long-sustained notes, we used a technique called ‘circle-breathing’: each chorister sneaks a breath at a different time, so that the audience hears one seamless long-sustained note, without a perceptible break. Circle-breathing depends on teamwork, recognizing that each individual needs to, occasionally, catch their breath.

To my persistent friends: take a breath when you need to and protest loudly when you are able.  Collectively, our voice is unbroken and undeterred.


Courtesy of Paula is a local member and contributor to Indivisible Madison.

RTT Update 05-23-2017

We visited State Senate Minority Leader Jennifer Shilling’s office today to discuss the Health Care Protection Package she has backed as well as the topic of gerrymandering in Wisconsin.  We spoke with Kara Pennoyer, Shilling’s Chief of Staff.

Question: Senate Bill 13 (SB13) would help prevent gerrymandering in Wisconsin.  Do you know of any Republican representatives that are on the fence regarding this bill?

Kara:  None that I know about.  This topic is split pretty much down party lines, but it is something that you can still ask them about.  The new maps did away with ‘purple districts’, so there is little incentive to support any effort to redraw the maps.

Question:  Are you focusing energy into pushing SB 13 at this time or are you waiting for a few more sessions?

Kara:  Most of the activity involving gerrymandering and drawing districts is happening in the courts at the moment.  We are focusing our energy on creating bills that show why the current system is bad and what we would do instead.  Our aim is to gain community support and make sure people are informed.  These issues aren’t always talked about as much outside of Madison, so we are trying to spread the word but that is sometimes difficult.

Question:  Are there any people we could talk to in attempt to get them to cosponsor the Health Care Protection Package?

Kara: We have all the Democrats on board, I believe.  Many Republicans are on record supporting the things that this proposal would protect; for example, ensuring coverage for people with pre-existing conditions and coverage of people up to age 27 on their parent’s insurance.

Question:  Will there be a time for public testimony regarding the Health Care Protection Plan?

Kara:  This is a Democrat bill, so a public hearing is usually not scheduled.  Some states require public testimony sessions for all bills, but not Wisconsin.  But, if you know which committee is reviewing a bill, you can pressure them to hold a public hearing.  A few years ago, for example, there was a Democrat bill on breastfeeding that was not scheduled for a public hearing and a breastfeeding coalition talked the committee into hearing testimony.  Right know the Health Care Protection Package is being reviewed by the Senate Committee on Health and Human Services and the Assembly Committee on Health. (links to these committees are included at the bottom of the update)

Question: Walker’s proposed budget would cut down the number of people on the parole board.  What is Shilling doing about this?

Kara:  Shilling does speak to people in our prison system who have worked to get their GED while incarcerated.  She has said that it is frustrating for them to get ready to transition back into society and then not have a chance of parole.  If you are interested in helping out with criminal justice in Wisconsin, I recommend that you get in touch with a local group of ‘Wisdom’. (A link to this organization is included at the bottom of this update)

Question: Would you consider backing or creating a minimum wage bill where the minimum wage is tied to housing price?  To some, especially in rural areas, a $15 minimum wage is ridiculous since small businesses couldn’t afford to pay that.  It may be more reasonable to base minimum wage on housing.

Kara:  We have introduced a $15 minimum wage bill.  We could discuss relating the minimum wage to housing.

One last cool thing:  Kara also told us about as a resource to stay informed about budget votes and proposals.  This website records votes and proposed amendments.  It also summarizes what is being voted on and you can sign up for email updates.

Wisdom organization link:

Assembly Committee on Health:

Senate Committee on Health and Human Services:


RTT Update 05-16-2017

This week we visited Senator Baldwin’s office and met with Flora Csontos, Baldwin’s regional representative for Southwestern Wisconsin, and State Director Janet Piraino.  The topics of discussion were the status of the American Health Care Act (AHCA or TrumpCare/RyanCare) in the Senate and the status of creating an independent investigation into Russian interference in the election.

Flora:  Senator Baldwin has been calling for an independent investigation into Russian interference in the election since day one.  Since the firing of FBI Director Comey, she has continued this push and has a press release stating that Trump and his administration are not above the law.  (Press release linked below).  Unfortunately, there currently is not a timeline on either the Russian investigation or the healthcare bill.

Question: Has Senator Baldwin considered putting her foot down in the senate by objecting to unanimous consent?  This is used to set aside a specified rule of procedure in order to expedite proceedings.  Could she object with the purpose of disrupting ‘business as usual’ until we get movement on the Russian investigation?

Flora:  I will pass this on.  I am not sure if this is the plan at the moment.  Senator Baldwin is in senate leadership, so they are discussing strategy and trying to find ways to respond to these unusual times.

Question: Can Senator Baldwin try to make hearings as public as possible?  We understand that not everything can be public – for example the hearings on Russian interference in the election.  But could the hearings on the AHCA be as public as possible?

Flora:  We will pass that request on.

Question:  Can you please hold more town halls in rural areas?  Senator Baldwin has experiences that make her personally invested in health care.  Affordability and access to health care is an area of common concern between Democrats and Republicans.  She should capitalize on this common ground and her own personal experiences to communicate with people outside of her normal demographic and use this as an opportunity to listen to their concerns.

Flora: Senator Baldwin does try to hold town halls during congressional recesses.  She just had two in Milwaukee and Prescott.  She holds round tables and listening sessions and she also visits churches and businesses in an attempt to reach many different people.  I will pass along the request to hold more of these meetings in rural areas.

Flora: I wanted to say that I am very excited that you are all still here.  We in Senator Baldwin’s office want to be here for you.  Keep calling and meeting with us!

Join us next week when we will visit Minority Leader Shilling’s office to discuss the Health Care Protection Package proposed by Senator Erpenbach and Rep. Riemer.

Senator Baldwin’s Press Release following the firing of FBI Director Comey:

Senator Baldwin’s Press Release on TrumpCare vote in the House:

More info on Unanimous Consent:
Or, you can check ‘Robert’s Rules of Order’, 11th edition, pages 54-56 (ISBN 978-0-306-82020-5) for more information on unanimous consent.

Correction: Senator Johnson Didn’t Mean What He Wrote

Previously I wrote about why we need to avoid a large-scale healthcare bill like the AHCA. I quoted verbatim from a letter I received from Ron Johnson that made the same point.

Here’s that excerpt again:

We should not try to replace one oversized, “comprehensive” Washington-written plan, Obamacare, with another. Instead, I favor a step-by-step process of continuous improvement — identifying problems and fixing them.

Since then, Senator Johnson has joined the subgroup of the Republican Mens’ Caucus that is writing the senate version of the AHCA. This seemed contrary to his statement, so I reached out to his office today.

A spokesperson at his Milwaukee office denied that Senator Johnson had taken the position that I received in writing, and could not account for the letter that was sent to me and others in my community (I’ve confirmed that the wording in the letters we received is identical).

Can we take our senator at his written word?

This is not the first time that Senator Johnson’s position has been contrary to what he wrote to constituents. This also happened with his communication on the Great Lakes Restoration Initiative.

But, it’s more than that. After I received Senator Johnson’s letter opposing the AHCA and calling for incremental improvement on the AHCA, I called his office to thank him for this stance, and at that time, they confirmed that it was his position.

Regardless of whether he was lying when he committed to standing up for the American people, or whether he has flip-flopped now that he’s been picked for the team, this casts serious doubt on whether we can trust him at all on this issue.


Courtesy of  Nicholas Davies is a local member of, and regular contributor to, Indivisible Madison.

Healthcare Reform: Less Waterfall, More Agile!

Correction: I congratulated Senator Johnson on committing to incremental improvement in healthcare. You can find my quote from his letter below. I have since found out that what he wrote to me is not his position, and his staff could not confirm whether it ever was.

There’s a lot to love about the ACA. I’ve delved deep into that. But one legitimate aspect to gripe about is how it was rolled out: a massive overhaul of the healthcare system, with lots of interlocking parts, and unforeseeable second-order and third-order consequences.

This reminded me of concepts I encounter every day in software development. In my industry, and in many industries that develop a product, there are two main methodologies:


This is when your team goes from outlining requirements to building your product, testing the product, and releasing the product strictly in that order.

Some consequences of this approach are:

  • You often find yourself trying to address all the requirements in one release.
  • The product’s design is very hard to change once the design phase is over.
  • You don’t get consumer feedback until your product is out on the market.

Despite its drawbacks, the waterfall model is sometimes what’s needed to get a product’s first version to market.


Across industries, you may also hear of “scrum,” “kanban,” or “lean” product development. These different terms typically denote logistical patterns for how you should organize your team. But they’re all iterative development methods, meaning that your product development cycle should be very short, with each release improving your product incrementally.

Here’s how this plays out:

  • Any single version may not radically change your product.
  • The design team has ongoing input on the product.
  • Consumer feedback is also continually taken into account.

What does this have to do with healthcare reform?

Well, the House has just passed the AHCA, another overarching healthcare bill that is so bloated and complex that many legislators didn’t read it. Once again, we’re hearing that we have to pass the bill to know what’s in it. But that isn’t stopping Paul Ryan and Donald Trump from making promises about its future impact.

This has every hallmark of the waterfall method.

This is not what we need. I recognize that there are Americans who are not thriving under the ACA and need help. So I’m not going to argue that we need to keep our hands off the ACA.

Another broad reform is risky regardless of who writes it, and what their intentions are. And the kind of reform we would like to see is more than we can hope for right now. It would be safer to take healthcare overhaul off the table entirely, given how little control the American people currently have over what it would look like. Medicare For All is where we need to be headed, but I think we can get there via a more agile approach.

Let’s target places in America that don’t have options in the marketplace today. The “empty shelf” counties. A public option in those areas could fill a niche that the market isn’t willingly filling. Government wouldn’t be replacing industry, just keeping its seat warm.

This would be a small program serving a small slice of the 4% of the population buying insurance on the marketplace. And it could run on an even smaller budget, since it could still be charging premiums like a typical insurer.

Once that public option is established, expanding it would be a smaller change. Changing the funding mechanism to a progressive tax would be a smaller change. And it could adapt as it grows.

I’m not alone in this

What this post was an email I received from Senator Ron Johnson. He said a lot of things that I take issue with, but he got this much dead on:

We should not try to replace one oversized, “comprehensive” Washington-written plan, Obamacare, with another. Instead, I favor a step-by-step process of continuous improvement — identifying problems and fixing them.

I’m glad to see my senator on the right track as far as how to approach the problem. I hope you’ll join me in keeping him committed to this approach and defeating the AHCA. And from there, making sure that any “continuous improvements” solve actual problems.


Courtesy of  Nicholas Davies is a local member of, and regular contributor to, Indivisible Madison.