Symptoms from my diagnoses of bipolar 2 and social anxiety disorder kept me from working, socializing, forming relationships, and living independently for more than a decade.

I worked my ass off to improve my wellness, and for the past 6 years I have worked as a Peer Support Specialist for 2 different public agencies. I tell my story to other people with mental health and substance issues as part of my work. If anyone’s interested, I’d love to share it here too.

https://kffhealthnews.org/news/article/nonprofit-hospitals-tax-breaks-community-benefit/

POTTSTOWN, Pa. — The public school system here had to scramble in 2018 when the local hospital, newly purchased, was converted to a tax-exempt nonprofit entity.

The takeover by Tower Health meant the 219-bed Pottstown Hospital no longer had to pay federal and state taxes. It also no longer had to pay local property taxes, taking away more than $900,000 a year from the already underfunded Pottstown School District, school officials said.

The district, about an hour’s drive from Philadelphia, had no choice but to trim expenses. It cut teacher aide positions and eliminated middle school foreign language classes.

“We have less curriculum, less coaches, less transportation,” said Superintendent Stephen Rodriguez.

The school system appealed Pottstown Hospital’s new nonprofit status, and earlier this year a state court struck down the facility’s property tax break. It cited the “eye-popping” compensation for multiple Tower Health executives as contrary to how Pennsylvania law defines a charity.

The court decision, which Tower Health is appealing, stunned the nonprofit hospital industry, which includes roughly 3,000 nongovernment tax-exempt hospitals nationwide.

“The ruling sent a warning shot to all nonprofit hospitals, highlighting that their state and local tax exemptions, which are often greater than their federal income tax exemptions, can be challenged by state and local courts,” said Ge Bai, a health policy expert at Johns Hopkins University.

The Pottstown case reflects the growing scrutiny of how much the nation’s nonprofit hospitals spend — and on what — to justify billions in state and federal tax breaks. In exchange for these savings, hospitals are supposed to provide community benefits, like care for those who can’t afford it and free health screenings.

More than a dozen states have considered or passed legislation to better define charity care, to increase transparency about the benefits hospitals provide, or, in some cases, to set minimum financial thresholds for charitable help to their communities.

The growing interest in how tax-exempt hospitals operate — from lawmakers, the public, and the media — has coincided with a stubborn increase in consumers’ medical debt. KFF Health News reported last year that more than 100 million Americans are saddled with medical bills they can’t pay, and has documented aggressive bill-collection practices by hospitals, many of them nonprofits.

(article continues)

Hi everyone! I am new to Tildes and wanted to say hi to the ~Health community. I am on a 28 hour emergency general surgery call today and have a bit of downtime. I also noticed that the post on the moral crisis of America's doctors had some interest so I thought I would answer any questions about that or training to be a surgeon in the United States. I am finishing my 2nd year of a 7-year training program. Ask me (almost) anything!

I'm writing this post in the spirit of the powerful conversations that I had participated in on reddit in /r/adhd. I'm giving up reddit, after this recent fiasco. And, so, I hope to find a similar community here.

And, so, here we go.

I recently quit my job in Big Tech after 7 years in that space. Corporate America, and Big Tech in particular (among other fields) is a human meat grinder. Humans go in and husks come out. After taking a medical leave of absence from work due to complications from anxiety, and multiple medical interventions, I realized that I needed to evaluate whether my job, even my career, was sustainable for me. It only took a few weeks, after returning to work, to accept that, yes, this job and perhaps this career are actively harming me. After talking about it with my wife, at length, I found relief in quitting.

At the core of it: my career has simply been incongruent with my values.

Sure, I've always been a nerd. I was the "brainy" kid. I didn't know how to people well (though I'm told that I'm not on the spectrum or not in any meaningful way). I'd always been overweight and prone to stress. Throughout my life, I was often labeled as the "sensitive" one by people. I rarely felt as though I fit in with any group of people, save perhaps for the other misfits who would band together because they didn't with in with any group of people.

Just before the pandemic began, at the tender age of 47, I was diagnosed with ADHD Combined type. More recently, I was diagnosed with C-PTSD, that I have likely suffered for 40 of my 50 years.

Now I know where that weight comes from: self-medication to give me a dopamine hit and numb me to layers of trauma. I also know where the emotional reactivity comes from: emotional flashbacks resulting from the C-PTSD.

1. Lexapro for well over a decade. It helped to blunt the lows but, I've found, also the highs. I rarely feel poignancy with Lexapro. When I have occasionally been able to ween from it, I have felt a far greater range of emotions.
2. I've had an excellent therapist for going on 8 years who practices ISTDP. He's helped me learn to show up for my more challenging emotions instead of instantly reaching to numb them.
3. Adderall and Vyvanse both used to help until I received a stellate ganglion block (Disclaimer: I have been a client of Dr Mulvaney's practice though I link to it as his explanation is excellent; I'd make this a footnote alas tildes doesn't support that extension for markdown)
4. Ketamine (prescribed) to better address the depression and anxiety. Ketamine, as a psychedelic, combined with the skills learned in therapy has let me dig deeper into my layers of trauma, leading to better overall mental health and better self-understanding.
5. Stellate Ganglion Block mentioned above. Short version: it reduced my seemingly PTSD-driven emotional reactivity to about 10% of what it was prior to the SGB. It's like getting a new nervous system. Unexpected side effect: medications that act on my nervous system now respond differently. As a result, stimulants are now extremely uncomfortable for me whereas before they were effective. Before the SGB, I would say that fear was my primary emotion. Now, I feel things.

I know: I'm privileged. I'm an "old white dude who profited from being in Tech". Yep. True. But I can't retire yet; we don't have that kind of money. We do, however, have enough such that I have the luxury of time to figure out my next steps.

What I have right now is the plan to make a plan. The core of it: live a life congruent with my values--not just at some far off retirement but here, now.

At first, step 1 was to answer this question: "What is the minimum amount of money that I need to earn for us to not massively disrupt our lives?" But then I realized that this is a fear-based question. It means starting out by saying "no" to everything that doesn't earn "enough" money for some arbitrary value of enough.

Where I'm at now, Step 1 Mark II, poses a more inspiring question: "What does retirement look like for my wife and I?" I don't know that we truly get to retire in the sense of living a life of leisure as seemingly many Boomers and earlier were privileged to do. Besides, part of my sense of accomplishment and peace is knowing that I did something to make the world better.

So what do you struggle with?
How are you doing?
What are you doing about it?

Be well.

P.S. This is me trying to do my part, as a new member of this community, to encourage growth not in membership but into different areas of discussion.