Americans are so fickle! We seem to be satisfied only when everything is going just great. Instant gratification. No memory. That's why Obama's approval rating is just under 50%. Sometimes I think we don't deserve him. McCain would have been far worse.
Other times, I think the republicans got out in 2008 while the going was good. The economy in shambles, the deficit out of control, wars not being concluded...how bad could it get? Time to cut and run, give the problems to Obama and then blame them on him. So far, this cynical strategy seems to have some traction. After all, if people can listen to Glenn Beck they can believe anything.
I'm very happy I voted for Obama. He's quietly pursued progress in many areas and achieved quite a few goals in just over one year. The stock market has rebounded and the economy is slowing rebounding - slow, but much faster than most people would have predicted twelve months ago. Iraq is winding down to a conclusion, and Afghanistan is on a timetable. Obama's won a health care reform war that some opponents wrongly thought would be his "Waterloo", and a financial reform package is also likely to pass. He's beefing up education policy, and he's done pretty well with foreign policy. Not too much to complain about!
Republicans and tea partiers call Obama a socialist or worse. The problems they decry were made worse during many years when their own party was in control, but memories are short and anger, even inane anger, is powerful. It's not what Obama has done, but the idea that he personifies a government that does things and influences our world, that is the reason they hate him. I just disagree with them, for the most part.
Time is on Obama's side, I think. As the country continues to heal economically, and, if there are no big uncontrollables to sidetrack him, Obama's steady pace of accomplishment will win back the independents. This will be true especially if his opponents continue to oppose but have no plan of their own to sell. November's elections will be important, but they will not make or break Obama. He has several more years to make the case for his approach, and the republicans need to worry about 2012 - it's far from in the bag for them.
Wednesday, April 21, 2010
Friday, March 26, 2010
Entitlements Gone Amuck!
Our country's political process has been broken for a long time, but I'm not talking about the partisanship that seems to be tearing us apart right now. I'm talking about the decades-long loss of political will to to say "no" to unaffordable spending. We are now on the verge of a massive upheaval that will be required to get us out of the giant hole we have put ourselves in.
Governments at all levels are swimming in debt, saddled by huge unfunded pension and medical liabilities, and trapped by gold-plated labor contracts that seem ironclad. There is no easy way for many of these public entities to escape bankruptcy, and that's why I predict a massive upheaval over the next few years. It's going to be interesting.
Under-taxing and over-spending got us into this mess, and correcting the problem will require over-taxing and under-spending for quite a while. In addition, the fix may also require the "managed bankruptcy" of many governments. This unavoidable medicine will certainly cause a massive upheaval in our society as we rebalance our governments.
It's almost funny that addressing the entitlements problem has taken so long, since it's been as obvious as the noses on our faces for a long time. In the private sector, we saw GM slowly die as its untenable labor contracts killed off its competitiveness - and then we paid to fund its bankruptcy and backstop the outrageous deals it had made with its workers. But who can save all these bankrupt governments? Only us, by forcing change that will be hard for all of us to take. Or, will the politicians demogogue this issue until our country collapses under the weight of its incredible debts and unfunded entitlements?
The stock market is currently jumping up and down in reaction to the problems Greece's insolvency is causing the EU. Greece is a tiny player, but its unraveling finances are creating great uncertainty. What would the world's reaction be when its largest economy can no longer pay its bills? Massive upheaval, that's what, and perhaps of the worst kind that one cannot even speculate about without praying hard. That's why we need to engineer our own mini-massive upheaval, starting this year. A stitch in time saves nine, as they say.
Governments at all levels are swimming in debt, saddled by huge unfunded pension and medical liabilities, and trapped by gold-plated labor contracts that seem ironclad. There is no easy way for many of these public entities to escape bankruptcy, and that's why I predict a massive upheaval over the next few years. It's going to be interesting.
Under-taxing and over-spending got us into this mess, and correcting the problem will require over-taxing and under-spending for quite a while. In addition, the fix may also require the "managed bankruptcy" of many governments. This unavoidable medicine will certainly cause a massive upheaval in our society as we rebalance our governments.
It's almost funny that addressing the entitlements problem has taken so long, since it's been as obvious as the noses on our faces for a long time. In the private sector, we saw GM slowly die as its untenable labor contracts killed off its competitiveness - and then we paid to fund its bankruptcy and backstop the outrageous deals it had made with its workers. But who can save all these bankrupt governments? Only us, by forcing change that will be hard for all of us to take. Or, will the politicians demogogue this issue until our country collapses under the weight of its incredible debts and unfunded entitlements?
The stock market is currently jumping up and down in reaction to the problems Greece's insolvency is causing the EU. Greece is a tiny player, but its unraveling finances are creating great uncertainty. What would the world's reaction be when its largest economy can no longer pay its bills? Massive upheaval, that's what, and perhaps of the worst kind that one cannot even speculate about without praying hard. That's why we need to engineer our own mini-massive upheaval, starting this year. A stitch in time saves nine, as they say.
Thursday, March 25, 2010
The Roman Catholic Problem
Organizations with a strong hierarchical structure have it for one primary reason: they want a lot of control. Sometimes this can be good, but it often goes bad over time. In the case of the Roman Catholic church, having strong central control was probably pretty good for a long time, but now the hierarchy is in trouble for covering up a lot of sexual misconduct by priests.
As a protestant outsider, I have no strong sense of why the Roman Catholic church has been so lax with respect to policing its own. A cynic would say that this church has so long been a haven for so many pedophiles at all levels that it regarded pedophilia as one of its privileges. A more pragmatic person would say that the church regarded guarding its reputation as being more important than holding a few of its priests to account for sins and crimes. A kind person would say that the church's labyrinthine structure and extreme conservatism made it time-consuming to pursue questions of priestly misbehavior. My guess is that all three points of view have some truth in them.
Whatever the truth regarding the "why", there's no question that, for the younger generation, the Roman Catholic church has been greatly tarnished by the ongoing scandals about pedophilia in its ranks. Older Catholic's who were raised in the church and were virtually brainwashed about the status and rights of priests seem to be immune to outrage about the current situation. It's not at all the same for younger Catholics who see the church as managed by a bunch of old men who seem dedicated to running a church as it always was - an inside game characterized by arcane rituals and obeisance to the rulers. These young people see what the inside game has produced, just like us outsiders have seen. Who would want to be part of that?
Where does the Catholic Church go from here? Well, it's hard to say. They are excellent at stonewalling, and that seems to be the plan at the moment despite the fact that it doesn't seem to be working very well. An alternative would be to decentralize priestly discipline and let the bishops or archbishops take quick action to cleanse the ranks - no doubt there are still more than a few known pedophiles out there. Given the shortage of priests, that's a tough call. Can that church restore its honor for the next generation? The jury is out, for sure.
My guess is that the Roman Catholic church needs to change a lot if it is to survive in North America and Europe. The old guard's time is over, and with it a lot of the historical organizational concepts they held. Women need a lot more power, celibacy needs to become optional, and power needs to be decentralized. The Roman Catholic church's strengths have always been concern for the poor and unwavering belief in a loving god who forgives those who repent. It's time to return to those roots and shed its over-riding concern for its own "inside game".
As a protestant outsider, I have no strong sense of why the Roman Catholic church has been so lax with respect to policing its own. A cynic would say that this church has so long been a haven for so many pedophiles at all levels that it regarded pedophilia as one of its privileges. A more pragmatic person would say that the church regarded guarding its reputation as being more important than holding a few of its priests to account for sins and crimes. A kind person would say that the church's labyrinthine structure and extreme conservatism made it time-consuming to pursue questions of priestly misbehavior. My guess is that all three points of view have some truth in them.
Whatever the truth regarding the "why", there's no question that, for the younger generation, the Roman Catholic church has been greatly tarnished by the ongoing scandals about pedophilia in its ranks. Older Catholic's who were raised in the church and were virtually brainwashed about the status and rights of priests seem to be immune to outrage about the current situation. It's not at all the same for younger Catholics who see the church as managed by a bunch of old men who seem dedicated to running a church as it always was - an inside game characterized by arcane rituals and obeisance to the rulers. These young people see what the inside game has produced, just like us outsiders have seen. Who would want to be part of that?
Where does the Catholic Church go from here? Well, it's hard to say. They are excellent at stonewalling, and that seems to be the plan at the moment despite the fact that it doesn't seem to be working very well. An alternative would be to decentralize priestly discipline and let the bishops or archbishops take quick action to cleanse the ranks - no doubt there are still more than a few known pedophiles out there. Given the shortage of priests, that's a tough call. Can that church restore its honor for the next generation? The jury is out, for sure.
My guess is that the Roman Catholic church needs to change a lot if it is to survive in North America and Europe. The old guard's time is over, and with it a lot of the historical organizational concepts they held. Women need a lot more power, celibacy needs to become optional, and power needs to be decentralized. The Roman Catholic church's strengths have always been concern for the poor and unwavering belief in a loving god who forgives those who repent. It's time to return to those roots and shed its over-riding concern for its own "inside game".
Wednesday, March 24, 2010
An Alternative History of Health Care Reform
President Obama this week failed to get enough support to pass healthcare reform, one component of which was to require almost all Americans to get health insurance, with those less financially capable getting a subsidy to cover part of the insurance cost. This failure was cheered by those who felt being required to have insurance was an intrustion on their rights.
Many of those who rejoiced in Obama's defeat were healthy young and middle aged people who didn't have much money and saw the insurance requirement as a budget problem. Their view was that they'd rather keep their money and take their chances. Now they were able to do that.
What was the outcome of this health reform failure? Well, even though most of these basically healthy people would stay that way, quite a few did not. Some of these younger people were severely injured in auto accidents or incurred serious sports-related injuries. Even more of the middle aged people had these same issues, but some also had heart problems, became diabetic, were diagnosed with cancer, or required a joint replacement. Every one of these unlucky people was very expensive to treat, but they had not purchased health insurance. What became of them?
Thankfully, none of these people were denied health care for serious conditions due to a lack of insurance. These uninsured folks went to emergency rooms, were admitted to the hospital, and got the care they needed. After their meager financial resources were exhausted, they went on public programs that paid for their ongoing medical procedures and medications. Their huge unpaid hospital bills were uncollectable, and they went bankrupt. However, since their assets were small to begin with, their financial losses were not that significant. The losses incurred by hospitals and doctors were much larger.
What happened to the losses that hospitals and doctors incurred for these uninsured patients? These costs just became part of their overhead, and added to the base of costs that they passed on to insurance companies in the form of higher prices. The insurance companies, needing to cover their higher costs, raised rates for all the people they insured. Some doctors took their practices totally private, refusing to accept insurance for payment.
So, Obama's health care reform failed, and things remained pretty much the same as they were before. Uninsured people got treatment for their immediate problems, and many of the poorest ended up on public assistance health care programs. Those who did have insurance saw their rates increase, and they paid higher taxes to offset the costs the government incurred for public assistance health care. In the end, the young and middle aged uninsured who stayed healthy spent their savings on other things, and the uninsured ones who got sick or injured indirectly passed on the cost of their care to those who had purchased insurance.
Many people, understanding this pattern, began to demand that those who do not want to buy health insurance sign an agreement that they will only get care that they can pay for themselves. This concept was incorporated in a new health care reform bill. After that, hospitals opened new wings filled with cots where those whose funds were exhausted died in peace, content that their death was based on principle and remembering all the good things they had purchased with their savings from not having health insurance.
Many of those who rejoiced in Obama's defeat were healthy young and middle aged people who didn't have much money and saw the insurance requirement as a budget problem. Their view was that they'd rather keep their money and take their chances. Now they were able to do that.
What was the outcome of this health reform failure? Well, even though most of these basically healthy people would stay that way, quite a few did not. Some of these younger people were severely injured in auto accidents or incurred serious sports-related injuries. Even more of the middle aged people had these same issues, but some also had heart problems, became diabetic, were diagnosed with cancer, or required a joint replacement. Every one of these unlucky people was very expensive to treat, but they had not purchased health insurance. What became of them?
Thankfully, none of these people were denied health care for serious conditions due to a lack of insurance. These uninsured folks went to emergency rooms, were admitted to the hospital, and got the care they needed. After their meager financial resources were exhausted, they went on public programs that paid for their ongoing medical procedures and medications. Their huge unpaid hospital bills were uncollectable, and they went bankrupt. However, since their assets were small to begin with, their financial losses were not that significant. The losses incurred by hospitals and doctors were much larger.
What happened to the losses that hospitals and doctors incurred for these uninsured patients? These costs just became part of their overhead, and added to the base of costs that they passed on to insurance companies in the form of higher prices. The insurance companies, needing to cover their higher costs, raised rates for all the people they insured. Some doctors took their practices totally private, refusing to accept insurance for payment.
So, Obama's health care reform failed, and things remained pretty much the same as they were before. Uninsured people got treatment for their immediate problems, and many of the poorest ended up on public assistance health care programs. Those who did have insurance saw their rates increase, and they paid higher taxes to offset the costs the government incurred for public assistance health care. In the end, the young and middle aged uninsured who stayed healthy spent their savings on other things, and the uninsured ones who got sick or injured indirectly passed on the cost of their care to those who had purchased insurance.
Many people, understanding this pattern, began to demand that those who do not want to buy health insurance sign an agreement that they will only get care that they can pay for themselves. This concept was incorporated in a new health care reform bill. After that, hospitals opened new wings filled with cots where those whose funds were exhausted died in peace, content that their death was based on principle and remembering all the good things they had purchased with their savings from not having health insurance.
Thursday, March 11, 2010
The Answer is: Massa's Nuts!
I gave my Rep. Massa the benefit of a few days to explain what happened in the three days between his decision not to run for health reasons to his abrupt resignation from the house of representatives.
Now it's clear that the guy I thought was a harbinger of America's new wave of politicians just lost his bearings, to be nice. It's not just about the "groping", which he attempted to explain in a rather bizarre way. Then, he refused to answer directly Larry King's question "Are you gay?", putting off the answer to his Navy brothers, several of which then dumped on him. Or, was his demise simply the work of Rahm Emmanuel? I suppose it doesn't matter, because Massa has already become just a funny footnote in the craziness of this year's political circus.
I feel bad for him. He could have enjoyed his nice Navy retirement with honor. Now, he'll be a laughingstock everywhere his name is known. Politics can do that for you!
Now it's clear that the guy I thought was a harbinger of America's new wave of politicians just lost his bearings, to be nice. It's not just about the "groping", which he attempted to explain in a rather bizarre way. Then, he refused to answer directly Larry King's question "Are you gay?", putting off the answer to his Navy brothers, several of which then dumped on him. Or, was his demise simply the work of Rahm Emmanuel? I suppose it doesn't matter, because Massa has already become just a funny footnote in the craziness of this year's political circus.
I feel bad for him. He could have enjoyed his nice Navy retirement with honor. Now, he'll be a laughingstock everywhere his name is known. Politics can do that for you!
Tuesday, March 09, 2010
Is Eric Massa Nuts, Or?
Two years ago I walked many streets in Pittsford, my home town, volunteering for Eric Massa's congressional campaign on the democrat side. Massa, a retired Navy officer, seemed to have a lot of common sense and drive, and did not appear to be overly wedded to either the dreamy-eyed wing of his party or the unions. He won. Now he has abruptly resigned the seat, and it's likely a conservative republican will win the special election to replace him. My efforts seem to have backfired in a spectacular way!
The reasons for the resignation are unclear. Last week's news was that a Massa staffer had complained to the house ethics committee about alleged "sexual harassment" committed by Massa, but Massa claimed his resignation was due to concerns over possible recurrance of a cancer that had been in remission. However, this past weekend Massa claimed he was run out of Washington by the democratic leadership who were upset about his intention to vote against the health care bill. One thing is clear, though - Massa is out for revenge.
My ex-congressman is scheduled to appear on the Glen Beck and Larry King shows, where he will likely skewer the democrats with sharp criticisms. He's a good communicator, so I expect his comments will be carried in other media as well. His revenge will be sweet!
What is really going on here? My guess is that Massa, a man accustomed to military discipline and the military's way of accomplishing objectives, could not accomodate himself to the rough and tumble of both Washington and local politics. His fact-based approach clashed with the overt special-interest-based approach taken by "professional" politicians. He supported the public option for health care, and he likely found the union-dominated local democrat party to be unreasonable. He likely was worn out by the pressures he felt from all sides. So, another pragmatic idealist has bit the dust.
I'll be interested in hearing what he has to say on the talk shows, and I'll expect a lot of bitterness to color his explanations. The house democrats probably will regret what they've done to him. Whether or not his comments will be helpful is anyone's guess. I'll wait until the dust settles before I decide whether or not my many hours walking the streets for him were a colossal waste of time. Stay tuned...
The reasons for the resignation are unclear. Last week's news was that a Massa staffer had complained to the house ethics committee about alleged "sexual harassment" committed by Massa, but Massa claimed his resignation was due to concerns over possible recurrance of a cancer that had been in remission. However, this past weekend Massa claimed he was run out of Washington by the democratic leadership who were upset about his intention to vote against the health care bill. One thing is clear, though - Massa is out for revenge.
My ex-congressman is scheduled to appear on the Glen Beck and Larry King shows, where he will likely skewer the democrats with sharp criticisms. He's a good communicator, so I expect his comments will be carried in other media as well. His revenge will be sweet!
What is really going on here? My guess is that Massa, a man accustomed to military discipline and the military's way of accomplishing objectives, could not accomodate himself to the rough and tumble of both Washington and local politics. His fact-based approach clashed with the overt special-interest-based approach taken by "professional" politicians. He supported the public option for health care, and he likely found the union-dominated local democrat party to be unreasonable. He likely was worn out by the pressures he felt from all sides. So, another pragmatic idealist has bit the dust.
I'll be interested in hearing what he has to say on the talk shows, and I'll expect a lot of bitterness to color his explanations. The house democrats probably will regret what they've done to him. Whether or not his comments will be helpful is anyone's guess. I'll wait until the dust settles before I decide whether or not my many hours walking the streets for him were a colossal waste of time. Stay tuned...
Sunday, March 07, 2010
"My thoughts are not your thoughts"
The title of this blog is a quote from Isaiah 55, a part of which was read in church this morning. It's a concept that I've really come to internalize during the past few years, since it allows me to embrace both religion and science and also come to terms with human tragedy.
Being religious is a choice, of course. Nobody forces me to choose it, and there is precious little hard evidence that would make this choice a logical one. Nevertheless, I choose to acknowledge a God, even a God that would make itself known to sentient creatures like us. But this God's thoughts are not my thoughts, and I don't presume to have any idea about the ultimate purpose of creation. What I do presume is that God would like to see us creatures make as much "progress" as we can, both scientifically and socially. So, I think that when man landed on the moon God said, "That's pretty good", and when women got the vote God said "It's about time!" But these thoughts are nothing like our thoughts, since we cannot comprehend all there is to know about the universe in a moment, as I believe God can.
Perhaps my most significant personal belief is that God can be "good" and still not often intervene to shield individuals, humanity or the earth from natural events that we would regard as tragedies. We know that good people and bad people get cancer; humanity could be wiped out by a rogue asteroid; and, the earth will burn up sooner or later. Could "goodness" only relate to creating the conditions where progress can occur on an individual or societal basis, with the rest pretty much left up to us? This idea seems likely to me, especially since we are able to contemplate the creator and develop theories about how to achieve human progress. But I don't rule out the possibility that God might give humanity a nudge from time to time, which leaves some room for a divine Jesus or perhaps other divine visitations - we sure do need a little help from time to time!
Someday my end will come, and I will follow all my human predecessors back into the dust. I'm not overly concerned about this natural event, since it can hardly be deemed a tragedy if everyone does it. What does intrigue me is whether or not I'll ever get some insight into what God had in mind when God set in motion all of this stuff we now experience. If my "spirit" does survive, I doubt it will ever begin to comprehend the mind of God. "My thoughts are not your thoughts" likely pertains forever. But it would be nice to get a little taste of what this was all about, wouldn't it?
Being religious is a choice, of course. Nobody forces me to choose it, and there is precious little hard evidence that would make this choice a logical one. Nevertheless, I choose to acknowledge a God, even a God that would make itself known to sentient creatures like us. But this God's thoughts are not my thoughts, and I don't presume to have any idea about the ultimate purpose of creation. What I do presume is that God would like to see us creatures make as much "progress" as we can, both scientifically and socially. So, I think that when man landed on the moon God said, "That's pretty good", and when women got the vote God said "It's about time!" But these thoughts are nothing like our thoughts, since we cannot comprehend all there is to know about the universe in a moment, as I believe God can.
Perhaps my most significant personal belief is that God can be "good" and still not often intervene to shield individuals, humanity or the earth from natural events that we would regard as tragedies. We know that good people and bad people get cancer; humanity could be wiped out by a rogue asteroid; and, the earth will burn up sooner or later. Could "goodness" only relate to creating the conditions where progress can occur on an individual or societal basis, with the rest pretty much left up to us? This idea seems likely to me, especially since we are able to contemplate the creator and develop theories about how to achieve human progress. But I don't rule out the possibility that God might give humanity a nudge from time to time, which leaves some room for a divine Jesus or perhaps other divine visitations - we sure do need a little help from time to time!
Someday my end will come, and I will follow all my human predecessors back into the dust. I'm not overly concerned about this natural event, since it can hardly be deemed a tragedy if everyone does it. What does intrigue me is whether or not I'll ever get some insight into what God had in mind when God set in motion all of this stuff we now experience. If my "spirit" does survive, I doubt it will ever begin to comprehend the mind of God. "My thoughts are not your thoughts" likely pertains forever. But it would be nice to get a little taste of what this was all about, wouldn't it?
Friday, March 05, 2010
Paying for Government Action?
I keep getting these emails from Obama's non-governmental support group, asking for money to combat those nasty republicans. "Help us get health care passed", they cry, "send us $5 or whatever you can". No, thank you very much.
Don't get me wrong. I want to see health care legislation passed, even though I'd prefer a public option. I just don't want to fund non-governmental groups. I thought the way to get policies that you favor enacted is to elect those who favor those policies. I did that, and they won. Now I just want them to do what they promised. They don't need my money to do that.
The democratic congress has been a major failure, in my opinion. If they don't have the will to pass health care legislation through "reconciliation", then they have blown their final opportunity. This should have passed it last year when they had a filibuster-proof majority in the senate, but they frittered that away as only democrats can do.
The democrats don't need my money to make their point. Obama, Pelosi, and Reid can get all the media attention they could ever want. So, just get on with it, folks, and stop begging!
Don't get me wrong. I want to see health care legislation passed, even though I'd prefer a public option. I just don't want to fund non-governmental groups. I thought the way to get policies that you favor enacted is to elect those who favor those policies. I did that, and they won. Now I just want them to do what they promised. They don't need my money to do that.
The democratic congress has been a major failure, in my opinion. If they don't have the will to pass health care legislation through "reconciliation", then they have blown their final opportunity. This should have passed it last year when they had a filibuster-proof majority in the senate, but they frittered that away as only democrats can do.
The democrats don't need my money to make their point. Obama, Pelosi, and Reid can get all the media attention they could ever want. So, just get on with it, folks, and stop begging!
Friday, February 26, 2010
The Sad Truth About Health Care
There's an old rule that roughly applies in so many situations - the "80-20 rule". It means that 20% of a population accounts for 80% of a certain result. For example, as a church treasurer I know that 20% of contributing families account for 80% of the total contributions in many churches. Or, as I look out my window this morning, I consider that 20% of the times it snows account for 80% of the total annual snowfall in Rochester. Well, the same concept likely applies to health care - 20% of us probably account for at least 80% of total health care costs.
My ten years of work on an ambulance have given me a new outlook on health care. Prior to this work, I thought that people got sick randomly and that health care costs were distributed rather widely across the entire population. Now I know that this is not true; health care costs are concentrated in a few sub-groups of our population. If we are to get these costs under control, the areas of concentration are the primary places to look for savings. Yet these areas don't seem to be discussed at all in the "great health care debate" now taking place in Washington. This lack of candor represents a failure of our governmental process.
So, where are the costs concentrated? As you might guess, we spend a lot for health care of aged people with serious chronic health problems - heart disease, respiratory disease, circulation problems, and cancer. More than 25% of total health care costs are incurred for people who are in their last year of life, and much of this is spent in the last month of life. I've met many of these people - people whose quality of life is questionable at best due to pain, invasive medical treatment, and altered mental status due to the drugs they have been administered. I have serious doubts about the value of costly medical interventions for many of these patients, and some countries have established protocols that limit such interventions. Republicans have characterized these protocols as "death panels", and perhaps they are correct. However, in my view such panels are necessary and humane. Significant cost savings would be a by-product of letting these people die with dignity.
A second area of health care cost concentration relates to people with chronic diseases; diabetes and coronary/respiratory issues are likely the major ones, although other conditions like lupus and Crohn's Disease are also common. These are diseases that require constant attention and patient compliance with treatment regimens. In my experience, patient non-compliance is often an issue that results in frequent hospitalizations and increasingly costly interventions. At some point, non-compliance should result in the categorization of the patient as not interested in being stabilized, and costly interventions should be curtailed. It seems strange, but I've often felt that non-compliance is aimed at getting attention...but should society pay a high price to deal with conditions that patients knowingly create?
Health care costs are also concentrated for older persons with very severe mental illnesses. A large number of citizens are now permanently hospitalized for severe dementia or Alsheimers - conditions where many of them do not know where they are or who their relatives or caretakers are. When these people are afflicted with life-threatening medical conditions, is it right to employ costly procedures to continue a life they often cannot comprehend? I think not. Their families should have the authority to let them pass on with dignity and without pain, and at some point should be held accountable for costs that a "panel" feels go beyond reasonability given the overall condition of the patient.
Lastly, chronic drug use causes a host of severe health problems. These persons often cycle in and out of hospitals regularly, each time incurring very large bills that they cannot pay. One might wonder if there should be a limit on the cost any person can put onto society due to voluntary behavior. This is a very difficult issue, but also one that is much larger than most people would ever guess.
The issues discussed above are relatively new. During the past 50 years, medical science has developed the ability to keep many people alive who in previous times would have expired from natural causes. I'd be the first to agree that in many cases these life-saving procedures have added years of productive life to many, and particularly to those with cancer or heart disease. I am thankful that we live in an age when terrible diseases can be cured or arrested. However, it may be that technology has now forced us to come to grips with the reality of resource allocations to health care.
When the total cost of prolonging certain lives becomes great, one must consider the benefits of employing these resources elsewhere. For a fraction of the avoidable costs I've identified above, for example, every child could receive a college education or technical training, or the infrastructure of Haiti could be rebuilt. What other great needs might be met? Or, for you, does maximizing physical life for every person outweigh all other considerations? Something to think about...
My ten years of work on an ambulance have given me a new outlook on health care. Prior to this work, I thought that people got sick randomly and that health care costs were distributed rather widely across the entire population. Now I know that this is not true; health care costs are concentrated in a few sub-groups of our population. If we are to get these costs under control, the areas of concentration are the primary places to look for savings. Yet these areas don't seem to be discussed at all in the "great health care debate" now taking place in Washington. This lack of candor represents a failure of our governmental process.
So, where are the costs concentrated? As you might guess, we spend a lot for health care of aged people with serious chronic health problems - heart disease, respiratory disease, circulation problems, and cancer. More than 25% of total health care costs are incurred for people who are in their last year of life, and much of this is spent in the last month of life. I've met many of these people - people whose quality of life is questionable at best due to pain, invasive medical treatment, and altered mental status due to the drugs they have been administered. I have serious doubts about the value of costly medical interventions for many of these patients, and some countries have established protocols that limit such interventions. Republicans have characterized these protocols as "death panels", and perhaps they are correct. However, in my view such panels are necessary and humane. Significant cost savings would be a by-product of letting these people die with dignity.
A second area of health care cost concentration relates to people with chronic diseases; diabetes and coronary/respiratory issues are likely the major ones, although other conditions like lupus and Crohn's Disease are also common. These are diseases that require constant attention and patient compliance with treatment regimens. In my experience, patient non-compliance is often an issue that results in frequent hospitalizations and increasingly costly interventions. At some point, non-compliance should result in the categorization of the patient as not interested in being stabilized, and costly interventions should be curtailed. It seems strange, but I've often felt that non-compliance is aimed at getting attention...but should society pay a high price to deal with conditions that patients knowingly create?
Health care costs are also concentrated for older persons with very severe mental illnesses. A large number of citizens are now permanently hospitalized for severe dementia or Alsheimers - conditions where many of them do not know where they are or who their relatives or caretakers are. When these people are afflicted with life-threatening medical conditions, is it right to employ costly procedures to continue a life they often cannot comprehend? I think not. Their families should have the authority to let them pass on with dignity and without pain, and at some point should be held accountable for costs that a "panel" feels go beyond reasonability given the overall condition of the patient.
Lastly, chronic drug use causes a host of severe health problems. These persons often cycle in and out of hospitals regularly, each time incurring very large bills that they cannot pay. One might wonder if there should be a limit on the cost any person can put onto society due to voluntary behavior. This is a very difficult issue, but also one that is much larger than most people would ever guess.
The issues discussed above are relatively new. During the past 50 years, medical science has developed the ability to keep many people alive who in previous times would have expired from natural causes. I'd be the first to agree that in many cases these life-saving procedures have added years of productive life to many, and particularly to those with cancer or heart disease. I am thankful that we live in an age when terrible diseases can be cured or arrested. However, it may be that technology has now forced us to come to grips with the reality of resource allocations to health care.
When the total cost of prolonging certain lives becomes great, one must consider the benefits of employing these resources elsewhere. For a fraction of the avoidable costs I've identified above, for example, every child could receive a college education or technical training, or the infrastructure of Haiti could be rebuilt. What other great needs might be met? Or, for you, does maximizing physical life for every person outweigh all other considerations? Something to think about...
Saturday, February 20, 2010
Tiger...
It's not funny how so many people love to jump to negative conclusions, including those who discount Tiger Wood's contrition and subsequent vow to change his ways. Some say the apology was not sincere because he read from a script; some say it was all driven by the need to repair his commercial value; some say he left out too many details. They are all wrong, and I condemn them for disparaging someone who is trying to do the right thing. Sometimes you just can't win...
They forget that Tiger Woods had many other options, since he's rich almost beyond measure. He could have said that, for him, marriage was a mistake. He could have walked away from the limelight and tended to whatever else he fancied. He could have come back to golf right away and endured some derision until it faded; every topic wears out, you know. Instead, he said all the right things and committed himself to becoming a better man. He stated the true but simple reason for his philandering and what he had to internalize in order to stop it. I give him a lot of credit for saying exactly what needed to be said and no more. Now it's just a question of the doing.
Few of us can identify with a young man who achieved world-class fame and fortune before he was 30. How can we not understand that he had many role models - other athletes and celebrities - who cross the line every day and get away with it because that is their persona? And, of course, there were uncountable women who would do anything to get his attention. How easy it would be to fall! I believe that very few men would have been capable of withstanding that level of sexual pressure at his age, and I would not have been one of them.
I am giving Tiger my full support in his effort to come back in every way. Based on his history of incredible accomplishment, perhaps he will again set the example for making a beautiful sculpture from the trash of life. Go get'em, Tiger.
They forget that Tiger Woods had many other options, since he's rich almost beyond measure. He could have said that, for him, marriage was a mistake. He could have walked away from the limelight and tended to whatever else he fancied. He could have come back to golf right away and endured some derision until it faded; every topic wears out, you know. Instead, he said all the right things and committed himself to becoming a better man. He stated the true but simple reason for his philandering and what he had to internalize in order to stop it. I give him a lot of credit for saying exactly what needed to be said and no more. Now it's just a question of the doing.
Few of us can identify with a young man who achieved world-class fame and fortune before he was 30. How can we not understand that he had many role models - other athletes and celebrities - who cross the line every day and get away with it because that is their persona? And, of course, there were uncountable women who would do anything to get his attention. How easy it would be to fall! I believe that very few men would have been capable of withstanding that level of sexual pressure at his age, and I would not have been one of them.
I am giving Tiger my full support in his effort to come back in every way. Based on his history of incredible accomplishment, perhaps he will again set the example for making a beautiful sculpture from the trash of life. Go get'em, Tiger.
Wednesday, February 10, 2010
Earning Your Life's Prospects
Black leaders visited President Obama today and harped on the 16.5% unemployment rate for black Americans, which is much higher than the 9% rate for whites and 12.5% rate for Hispanics. The NPR news report mentioned their focus on the chronically unemployed base in the black community. I'm also aware that a high percentage of young black men are unemployed. It's a shame, but it's also their problem in far too many cases. We've got to have a little more personal accountability here.
The high schools in Rochester are open for business every day, and there are no state troopers keeping black youth out. If the students are from low income families they qualify for free breakfast and lunch at the school. Free transportation is provided to and from school. In other words, there are no institutional impediments to getting a good education in the city of Rochester. Yet only about 50% of Rochester's high school students graduate. It's not a discrimination problem; it's a social problem.
Nothing would make me happier than to see every black youth graduate from high school, then college, and then enter the work force prepared to compete on the basis of equal preparation. If the unemployment rate of high school or college-educated blacks stayed much higher than that of other races, then I'd complain about this apparent discrimination and try to do something about it. But I have little sympathy for those who don't take advantage of the opportunity to become educated and able to contribute to the U.S. economy.
I've heard all the rationalizations about kids growing up in poor, disfunctional families. I know it's tough to grow up in those conditions. At the same time, it's a matter of community pride and intent - if there isn't any, then nothing will change. Just giving money to poor, disfunctional families does not change attitudes. There has got to be an intent to succeed for success to occur.
I've been working with a group of Burmese refugees for several months. They've recently come the U.S. with only the clothes on their backs, and many come from tribal societies. Most have no English when they arrive. I'm amazed at how they have strived to adjust to American society, learn English, and get jobs. Their upward mobility from the absolute bottom is a sight to behold! The difference between them and many who surround them in poor neighborhoods is that they have decided to get with the program. There's no secret about what it takes to achieve some upward mobility in this country.
So, black leaders, go home to your communities and ask the hard questions. Tell the truth. You get what you give, and if you give no effort you can expect nothing. Chronic unemployment is not just about lack of opportunity; it is mostly about lack of preparation.
In this month of Martin Luther King day, I mourn his passing partly because he held up great expectations for the people he led. His successors seem to focus mostly on handouts. It's a darn shame!
The high schools in Rochester are open for business every day, and there are no state troopers keeping black youth out. If the students are from low income families they qualify for free breakfast and lunch at the school. Free transportation is provided to and from school. In other words, there are no institutional impediments to getting a good education in the city of Rochester. Yet only about 50% of Rochester's high school students graduate. It's not a discrimination problem; it's a social problem.
Nothing would make me happier than to see every black youth graduate from high school, then college, and then enter the work force prepared to compete on the basis of equal preparation. If the unemployment rate of high school or college-educated blacks stayed much higher than that of other races, then I'd complain about this apparent discrimination and try to do something about it. But I have little sympathy for those who don't take advantage of the opportunity to become educated and able to contribute to the U.S. economy.
I've heard all the rationalizations about kids growing up in poor, disfunctional families. I know it's tough to grow up in those conditions. At the same time, it's a matter of community pride and intent - if there isn't any, then nothing will change. Just giving money to poor, disfunctional families does not change attitudes. There has got to be an intent to succeed for success to occur.
I've been working with a group of Burmese refugees for several months. They've recently come the U.S. with only the clothes on their backs, and many come from tribal societies. Most have no English when they arrive. I'm amazed at how they have strived to adjust to American society, learn English, and get jobs. Their upward mobility from the absolute bottom is a sight to behold! The difference between them and many who surround them in poor neighborhoods is that they have decided to get with the program. There's no secret about what it takes to achieve some upward mobility in this country.
So, black leaders, go home to your communities and ask the hard questions. Tell the truth. You get what you give, and if you give no effort you can expect nothing. Chronic unemployment is not just about lack of opportunity; it is mostly about lack of preparation.
In this month of Martin Luther King day, I mourn his passing partly because he held up great expectations for the people he led. His successors seem to focus mostly on handouts. It's a darn shame!
Monday, February 08, 2010
Tim Tebow and Abortion
I'm really glad that Tim Tebow's mother did not have the abortion that doctors recommended she have. She made a great decison for herself, her family, Tim and many thousands of Florida Gator fans. She was right, they were wrong. But, she could have been wrong and she could have died as a result. You win some, you lose some. It's wrong to generalize from the results of an individual case, but that's what Focus on the Family did with their Super Bowl commercial.
I'm "pro-choice", primarily because I support the individual freedom that people are supposed to have in America. Even before being pro-choice, I'm "pro-contraception" - I don't want any babies conceived by accident or against the will of the mother. That's why we have only three children; we wanted to stop at three, and we made sure we did. But I digress...
"Freedom" means just that. If it's your body, you should be able to do what you want with it - what could be more personal than that. Not allowing a life to begin, or being able to end your own life, is the most personal expression of freedom that I can think of. I may disapprove of the decisions that some people might make in these areas, but I would never consider taking away their right to make those decisions. That's why I am perplexed by the "get government out of my life" crowd who are also vehemently anti-abortion. Huh?
Secondarily, I'm "pro-choice" because I believe families should make decisions about their future by considering all the likely outcomes of their decision to have, or not have, a baby. Many families, for example, cannot stand the strain of caring for a special needs child on top of the other major challenges they may be facing; many divorces result. Other families might have a structure that would accomodate, or even thrive with, the challenge of raising a special needs child. In short, every family is different; a "one size fits all" prescription on abortion makes no sense in the real world.
Some folks think this issue hinges on the crucial question of "when does life begin"? I don't feel that way at all, even though I'd say I have a very high respect for life. I just believe that life is full of hard choices and tragedies; any of us could be dead tomorrow, for example, from some unforseen cause either man-made or natural. There is no certainty in life, the uncertainty increases as one moves down the economic ladder, and God does not step in to save those who happen to be unlucky - including those who are not born due to someone else's choice.
Good for you, Tim Tebow. Your mother won the pregnancy lottery and you won the Heisman. It's a great story of pluck and luck. Now, let's hear the story of the child born with some terrible defect who died after enduring several years of agony, during which time its family went bankrupt and fell apart. After all, one conclusion based on anecdotal evidence deserves another, don't you think?
I'm "pro-choice", primarily because I support the individual freedom that people are supposed to have in America. Even before being pro-choice, I'm "pro-contraception" - I don't want any babies conceived by accident or against the will of the mother. That's why we have only three children; we wanted to stop at three, and we made sure we did. But I digress...
"Freedom" means just that. If it's your body, you should be able to do what you want with it - what could be more personal than that. Not allowing a life to begin, or being able to end your own life, is the most personal expression of freedom that I can think of. I may disapprove of the decisions that some people might make in these areas, but I would never consider taking away their right to make those decisions. That's why I am perplexed by the "get government out of my life" crowd who are also vehemently anti-abortion. Huh?
Secondarily, I'm "pro-choice" because I believe families should make decisions about their future by considering all the likely outcomes of their decision to have, or not have, a baby. Many families, for example, cannot stand the strain of caring for a special needs child on top of the other major challenges they may be facing; many divorces result. Other families might have a structure that would accomodate, or even thrive with, the challenge of raising a special needs child. In short, every family is different; a "one size fits all" prescription on abortion makes no sense in the real world.
Some folks think this issue hinges on the crucial question of "when does life begin"? I don't feel that way at all, even though I'd say I have a very high respect for life. I just believe that life is full of hard choices and tragedies; any of us could be dead tomorrow, for example, from some unforseen cause either man-made or natural. There is no certainty in life, the uncertainty increases as one moves down the economic ladder, and God does not step in to save those who happen to be unlucky - including those who are not born due to someone else's choice.
Good for you, Tim Tebow. Your mother won the pregnancy lottery and you won the Heisman. It's a great story of pluck and luck. Now, let's hear the story of the child born with some terrible defect who died after enduring several years of agony, during which time its family went bankrupt and fell apart. After all, one conclusion based on anecdotal evidence deserves another, don't you think?
Saturday, February 06, 2010
An Easy Winter, Except South of Here
I've been following the news stories about the "great storm" that's hit the eastern seaboard and areas west of it during the past two days. People who never have had to contend with 20-30 inches of snow have no idea of the impact such a storm makes. Transportation is basically halted; power goes out in many areas; and, emergency services are taxed to the limit.
How would you like to experience heart attack symptoms when ambulances cannot make it through the streets, or be a weak 90 year old person who loses power and cannot keep her home warm? Those who can cope think a storm like this is fun, but there are others for whom it results in tragedy. During the three years when I managed our local ambulance corps I saw the unusual problems that a storm can bring; how about an otherwise smart person who runs a generator in a closed garage and almost kills himself, for example?
I remember taking the Xerox corporate jet into White Plains airport, just as a big storm like this hit Connecticut. Somehow I made it to the hotel where I spent the next three days as the city dug out from over 20 inches of snow. Another time, I was at a church retreat in the southern tier of New York when over 20 inches of snow hit; we enjoyed an extra day there and upon arrival at home found our 19 year old son exhausted from shoveling our long driveway. Big snows are truly paralyzing!
It seems strange to be sitting here in upstate New York watching a few snowflakes fall onto the 2-3 inches that have been on the ground for a few days, while people far south of me are trying to cope with a blizzard. We are used to the big snows and we are equipped to deal with them; we've had 62 inches already and hardly noticed it. But, how many people in D.C. own a snowblower? Good luck, you guys! I can at least imagine your pain.
How would you like to experience heart attack symptoms when ambulances cannot make it through the streets, or be a weak 90 year old person who loses power and cannot keep her home warm? Those who can cope think a storm like this is fun, but there are others for whom it results in tragedy. During the three years when I managed our local ambulance corps I saw the unusual problems that a storm can bring; how about an otherwise smart person who runs a generator in a closed garage and almost kills himself, for example?
I remember taking the Xerox corporate jet into White Plains airport, just as a big storm like this hit Connecticut. Somehow I made it to the hotel where I spent the next three days as the city dug out from over 20 inches of snow. Another time, I was at a church retreat in the southern tier of New York when over 20 inches of snow hit; we enjoyed an extra day there and upon arrival at home found our 19 year old son exhausted from shoveling our long driveway. Big snows are truly paralyzing!
It seems strange to be sitting here in upstate New York watching a few snowflakes fall onto the 2-3 inches that have been on the ground for a few days, while people far south of me are trying to cope with a blizzard. We are used to the big snows and we are equipped to deal with them; we've had 62 inches already and hardly noticed it. But, how many people in D.C. own a snowblower? Good luck, you guys! I can at least imagine your pain.
Tuesday, February 02, 2010
More on Haiti
This past Sunday evening a group from my church met at our home. Late in the meeting the subject of Haiti came up. Four of us had been to Haiti, two of us twice, but none had gone together. The common opinion of us all was that Haitian culture was intractably corrupt and the Haitian mode of education and governance would not change regardless of what the "rescuing" countries did.
One of the men mentioned a conversation he'd had with a young man who'd spent 18 months in Haiti with the Peace Corps. This fellow was totally disillusioned after his stint there, and he believed that the country had little hope to become even a second world country. Americans who work in Haiti are involved, generally, in tiny projects that improve the lives of people in the countryside by providing clean water, for example. There seems to be no government interest in or capability to perform major projects that would restructure the country.
I keep hearing diplomats and other high ranking people drone on about giving the Haitians control over the rebuilding projects, but they are mistaken. There are far fewer qualified Haitians than there are projects to manage, and I'd guess that many of those Haitians are well-schooled in the art of corruption. My view is that outsiders should, with Haitian consultation, manage all the projects and employ as many Haitians as possible in responsible positions at good pay. Good training should be given to as many Haitians as possible. However, if a Haitian employee gets involved in corruption on a project, they should be fired.
If and when competent Haitian managers emerge, they should be given more responsibility. It would be wonderful to see a Haitian professional class emerge. But, until that happens, I feel the governmental and non-governmental relief and rebuilding organizations should stay in firm control of where their money goes and how things are done. Otherwise, they are likely to be pouring their resources down the drain.
One of the men mentioned a conversation he'd had with a young man who'd spent 18 months in Haiti with the Peace Corps. This fellow was totally disillusioned after his stint there, and he believed that the country had little hope to become even a second world country. Americans who work in Haiti are involved, generally, in tiny projects that improve the lives of people in the countryside by providing clean water, for example. There seems to be no government interest in or capability to perform major projects that would restructure the country.
I keep hearing diplomats and other high ranking people drone on about giving the Haitians control over the rebuilding projects, but they are mistaken. There are far fewer qualified Haitians than there are projects to manage, and I'd guess that many of those Haitians are well-schooled in the art of corruption. My view is that outsiders should, with Haitian consultation, manage all the projects and employ as many Haitians as possible in responsible positions at good pay. Good training should be given to as many Haitians as possible. However, if a Haitian employee gets involved in corruption on a project, they should be fired.
If and when competent Haitian managers emerge, they should be given more responsibility. It would be wonderful to see a Haitian professional class emerge. But, until that happens, I feel the governmental and non-governmental relief and rebuilding organizations should stay in firm control of where their money goes and how things are done. Otherwise, they are likely to be pouring their resources down the drain.
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