Hospice Patients Alliance: Consumer Advocacy

Black Shoes

by Ron Panzer
President, Hospice Patients Alliance
June 17, 2005

You can learn a lot from the shoes someone wears. You can learn much when you see someone without shoes, with worn, callused dusty feet or worn out sandals, boots, or even high heels or loafers. I've seen the poorest of the poor walking along dirt roads in Asia. Their feet are callused and tough. They can't afford shoes, and if they did, they would be well-worn and dusty.

Shoes indicate not only how wealthy or poor a man is, they reflect how the individual approaches life, just as clothes help to shape the image presented to the world. What if your only direct contact with someone was to see their shoes? What would you learn? What could you learn? What if those shoes were the shoes of the President of the United States and you were brought into the room, forced down on the ground, and placed nose to shoe, ... nose to shoe of the President of the United States. And then, though you had so much to say, so many concerns for the vulnerable, you were shown out of the room without a chance to say one word. What would it all "mean?"

All the Presidents wore shoes, and back to the beginning they kept their shoes in as good a condition as was possible: shiny, clean, well-tied, undamaged, un-scuffed up. You know that the wealthy and powerful can afford the very best, and that a person with shiny shoes in perfect condition cares about the image they present to the world. The shoes of military personnel are renowned for the mirrorlike "spit" shine demanded of military discipline. The President's shoes have that shine, but there are staff available to shine those shoes.

The shine on the shoes of a soldier in the military means something quite different from the shine on the shoes of the President. On the one hand you have a sense of pride in the nation, dedication, discipline, obedience, a willingness to serve and sacrifice for a greater cause; on the other hand you have a sense of power, discipline, and the ability to command obedience.

The shine on the shoes of both the soldier and the President (the "Commander and Chief"), represents a continuous spectrum from lowest to highest, all part of the military arm of the federal government, yet the President leads the nation's elected government as well as the military.

Shined shoes can imply a certain degree of wealth, success and often, power. You know that those wearing shiny shoes care about the impression they make upon the world, and the power they wield, whether small or large, is bestowed upon them from above, for a time only. Power comes in many forms: power to run a business, power to head a government bureaucracy, power to manage a health care facility or the affairs of the nation.

No matter how much power any man may have, he is still just a man. But imagine what the soldier would look like without those dress shoes? Imagine what the President would be like without his shoes? The uniform and shoes complete the impression being given to the world. Without them, any man is seen more than anything else as "just a man."

What about those shiny shoes (of the President)? What more can we learn? You know that those shoes exude the power of that highest national office. But power without application is meaningless. And power applied can have many results. How does the President apply his power? Where does the President take his shoes? While we hear much talk about all the good things each President is going to accomplish, I want to see where he chooses to walk.

We know that the President's shoes travel widely, meeting the leaders of nations from all over the world. We know that the President's shoes support him in his meetings with the Congressional leaders, his Cabinet of advisors, the wealthy and many of the most gifted and powerful individuals of our time. We know that the President's shoes travel to campaign stops, political fundraising rallies, meetings with wealthy corporate leaders. We know that the President's shoes take him, sometimes for "photo-ops" to visit school children, military bases, and university campuses.

But how often do the President's shoes take him to the dank, often depressing halls of our nation's nursing homes? How often do the President's shoes take him to witness the last dying moments of the elderly, disabled and ill?

For decades, Congress has held hearings on the abuses, neglect and harm perpetrated upon defenseless elderly, disabled and chronically ill in our nation's nursing homes. When has the President of the United States made a point of working to bring real relief to those suffering within understaffed, abusive situations in our nation's nursing homes?

Did President John F Kennedy's shoes take him to the halls of our nation's nursing homes? Did Lyndon B. Johnson, Richard Nixon, Gerald Ford, or Jimmy Carter's shoes take them to the halls of our nation's nursing homes? Did Ronald Reagan, George H W Bush, Bill Clinton or George W Bush make the trip? Did they make the commitment for change? Did they actually do anything that effectively prevented the ongoing abuse, neglect and harm to the elderly and vulnerable in our nation's facilities?

All the Presidents have "talked the talk," but their shoes, going as far back as you wish, have failed to "walk the walk," and visit with our nation's frail, vulnerable elderly and disabled, and commit to effectively change the oppressive conditions allotted to the forgotten and forlorn.

What can you learn from a pair of shoes? They are what they are. They reveal what the Presidents have done and not done. The shoes reflect the man, who is not what he says he is, but is what he is: what he has done or chosen not to do. Where his shoes have traveled tells much about who he is.

When you are shown the President's shiny black shoes, up close, you know you are in the presence of the most powerful man in the world. But when the men who wear those shoes fail to express any concern, fail to follow you into the field, fail to bring any relief, fail to even acknowledge the suffering of the vulnerable, you know that those shoes are black, hard and unyielding. You have no misconceptions. There is no confusion. You know there is no "compassion," just the shiny black shoes of a man in power, temporarily empowered, who has chosen to ignore the plight of the vulnerable.

You stare back at the shiny black shoes.

Are you convinced of the power before you? Yes.

Are the vulnerable assisted? No.

Are you intimidated? Yes.

Are the vulnerable rescued from their plight? No.

Are you reassured? No.

In other words, whether they are shiny black shoes or big heavy black boots, it doesn't make a difference. You might as well have been kicked in the ribs and shown the door. Nothing is done for those you care for; nothing continues to be done for those you speak for.

You are escorted out after viewing the shiny black shoes, without an opportunity to speak, without one word of concern for the plight of the vulnerable. You know that the shiny black shoes, though they carry a man of power, do not represent respect for the needs, concerns or reality of those you see in the nation's facilities. For you, they are what they are, cold, mirrorlike, shiny black shoes.

You received no word from the man who walks in those shoes. You realize: that itself is the message! There is no concern for the vulnerable. No matter how lofty the speeches given by all those Presidential speeches, year after year, President after President, nothing ever changes. The defrauding of Medicare and Medicaid continues. The Justice Department allows it to continue. No executives go to jail, and the abuse, neglect and harm to the elderly and vulnerable continues.

The black shoes? They have moved on, not giving you even the slightest thought.

Which President spoke out about the abominable conditions of the vulnerable in our nation's facilities? Which President signed into law a nursing home reform act that brought about real changes? Which President ordered the Justice Department to go after and arrest those owners and administrators who defraud Medicare and then fill their own pockets with their self-assigned multi-million dollar salaries.

Which President has refused to take campaign donations from those owners and administrators who continue the fraud and consequent abuse, neglect and harm to the vulnerable in their facilities?

Rome's emperors had the power to grant life or order death, ... thumbs up, or ..., thumbs down. Our Presidents have the power to grant life by working to improve the conditions of the vulnerable, or to retain the status quo which continues to result in needlessly hastened deaths for the vulnerable.

There are those who die for lofty ideals, and others who live for those same ideals, as long as they breathe. Yet, there are others who pat themselves on the back for being "practical." These "practical" and powerful leaders manipulate circumstances to assure the sooner (rather than later and natural) deaths of the vulnerable, saving billions for government and maximizing profit for their corporations and for themselves.

They reason that their actions are "justified" and demonstrate "compassion" for the vulnerable by making sure the vulnerable don't suffer the "burden" of life itself. However, real compassion does not insist that the vulnerable die so that others may profit!

When such "practicality" rules the steps of those who walk in the black shoes of power, what chance do the vulnerable have to survive? Even the strong cannot stand against this overwhelming, unswerving pressure to die.

If the poor and vulnerable, or the finally poor and vulnerable, are discarded while the still wealthy are protected and cared for, society determines the value of a life by first evaluating the assets possessed. In the America I love, all men are to be treated equally under the law, and one's wealth does not determine the value of a life. In the America I love, the value of a life is self-evident, needing no justification.

Yet today, life, continued life ..., is bought, and death, hastened death ..., is brought about by the inability to buy continued care, continued life!

When life can be bought in America, and life can be lost in America, solely due to one's assets, then we truly have become a materialistic society, bereft of compassion for the truly poor and needy elderly or disabled!

A society that allows the hastened death of those who are poor (while caring for the wealthy with the same clinical conditions) has entered an evil stage that cannot simply be ignored. If you look into the face of that evil for any length of time, you should be shaken. However, if you are not shaken when contemplating the evil threatening the vulnerable in our society, you may wish to look into your own eyes in the mirror and ask yourself the following: "if I no longer object to evil around me, what does that say about me?"

There have always been, and will always be, the poor, the hungry and needy. But one of the qualities that has made America great has been the willingness of the people to come to the aid of those in need. Yes, America often rewards hard work and ability with success, but an America that is willing to discard the vulnerable in their time of need is not the America that inspired admiration throughout the world.

Great power combined with great sensitivity for the needs of the vulnerable is among the best values America has demonstrated to the world. Great power combined with indifference to the weak and vulnerable inspires only fear, and in its enemies, the patience to wait until that power fails.

Have our Presidents worn the black shoes with sensitivity or with indifference to the vulnerable elderly and disabled? Economics tells us we must often choose between "guns" and "butter" when our government sets its budgetary priorities. However, when there is more than enough funding being spent on "butter," and much of it is siphoned off into the pockets of white-collar criminals, the argument falls apart. We don't need more money spent on caring for the elderly and disabled; we need to take the money that is spent and make sure it gets to those who need it. We need enforcement of the laws and regulations governing health care facilities. We need to prosecute those who cause the abuse and neglect of the vulnerable in our nation's facilities.

Presidents may talk the talk about "compassion," but without walking the walk, without taking action to bring about improvements for the vulnerable, they are sadly, hollow men with no real heart.

The Hospice Patients Alliance is a 501(c)(3) charitable patient advocacy organization acting to preserve the original hospice mission and to promote quality end-of-life services.

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