Check this one out!
Wednesday, April 29, 2009
Check this one out!
Tuesday, April 28, 2009
And check out my earlier posts on the environment: http://tinyurl.com/cfwkrh, http://tinyurl.com/d2zljz.
You can read my earlier posts on health care rationing here http://tinyurl.com/cb8vef and here http://tinyurl.com/d8tost, http://tinyurl.com/dhdqrr, http://tinyurl.com/cxfsr9.
And here's a good health care blog to check daily: http://www.healthcarebs.com/
And here's more from the inestimable Charles Krauthammer:http://tinyurl.com/cp2oj9 .
Monday, April 27, 2009
Saturday, April 25, 2009
Springtime in the "Biggest Little City in the World"!
Enjoy the sunshine, water sports and malt, vino, veritas, and pretty young girls!
Reno is much more than neon lights!
Disclaimer: This is not a paid advertisement....drat!
Friday, April 24, 2009
"Why do you think the stimulus package pours $1.1 billion into medical "comparative effectiveness research"? It is the perfect setup for rationing. Once you establish what is "best practice" for expensive operations, medical tests and aggressive therapies, you've laid the premise for funding some and denying others.
"It is estimated that a third to a half of one's lifetime health costs are consumed in the last six months of life. Accordingly, Britain's National Health Service can deny treatments it deems not cost-effective -- and if you're old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements (http://tinyurl.com/dcej9g) ."
Tuesday, April 21, 2009
But now I am more ill. I was released last week from my second hospital visit within one month for pnemonia, and truth is I've suffered one infection after another since last August. Despite good medical care, this is, I guess, the nature of the beast.
Making me well again and keeping me well will be expensive. I'll need perhaps two more infusions of immunoglobins (I had one in the hospital last week), catscans and when my blood is stronger, more chemotherapy. And this comes at tremendous cost, so much so that I feel guilty over it. I am fortunate because I have good insurance to pay for the excellent health care I receive, but I wonder how long that will last: 1. only so long as I remain covered by my husband's secondary insurance and 2. only so long as a health care provider decides that the care needed to prolong my life makes economic as well as medical sense.
Condition #1 will be determined by my husband's lifespan. Condition #2 will be determined by politics.
Already, my physician needs to decide if his office can give me the infusions I need. The problem is that reimbursement to the doctor is less than cost...although perhaps not for me since at the moment I have good secondary coverage to Medicare. Possibly, I can receieve the infusions at the hospital (which charges five times as much as the physician's office but is reimbursed more). Reimbursement is determined by Medicare. My private supplementary insurance also pays according to Medicare's rule book; that is, it cannot exceed the price fixed by Medicare.
The Obama administration is concerned that not all Americans enjoy the coverage I do, and that concern does weigh on me also. However, the president's answer is to turn writing a revolutionary health care plan over to Democrats in Congress...that's the Nancy Pelosi/Harry Reid bunch that send shudders through even the healthy. The plan of attack will be to sell the idea that universal health care will reduce the cost of medical service and make health care available to all. This is an economic policy, not a medical care policy (see Thomas Sowell http://tinyurl.com/dfar8k), and it's bad economics.
Universal coverage will increase the cost of providing healthcare: afterall, more people must be served. The cost savings promised through computerized record keeping will not make up the difference. The only way costs will go down when more people are placed in the system is to reduce the cost of the care given either by shoddy reimbursement leading to curtailing services (defacto rationing of care) or by overtly reducing the services offered (i.e. rationing care). Another intermediate and likely outcome is to delay services, which, perversely, will increase the time people are ill and incompacitated and increase the cost to the overall economy of sick leave and other social services intervention.
Maybe this is necessary in the interest of fairness. That is certainly the argument of advocates who claim large numbers of Americans are uninsured and many face bankruptcy trying to keep up with health care bills.
However, research shows much of this claim is not true. Economist John Goodman of the National Center of Policy Anaylsis refutes assertions that other countries with universal health care have better health care results than the U.S. His extensively documented article is available in PDF format at http://tinyurl.com/d8cfb8. Goodman posits that "all developed countries face...rising costs, inadequate quality, and incomplete access to care." He points out that the acknowledged superior American medical care "uses fewer physicians, nurses, hospital beds, physician visits, and hospital days" than the typical European universal care system.
Goodman continues: "a comparison of the British National Health Service (NHS) and California's Kaiser Permanente found that Kaiser provided more comprehevsive and convenient primary care and more rapid access to specialists for roughly the same cost."
Some medida commentators (Froma Harrop, for one, see http://tinyurl.com/de3ym8) claim worse medical results from American healthcare. That simply is not true. For one example, Goodman points out that after five years, the survival rate for all cancers for men and women is considerably higher in the U.S. than in all of Europe.
Still, what about the uninsured in America? Goodman claims that of 46 million uninsured, 12 million are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP). Of the remainder, 17 million live in households making more than $50,000 annually (one-half of these in households making over $75,000). Many of these uninsured are young and healthy and decide to forego insurance for other priorities. Their lack of insurance does not lead to early death. Even when these suffer a debilitating illness, Goodman points to a Rand study that "suggests...insurance status has little effect on receipt of recommended care" once they see a physician.
As to saving money because of more efficient government accounting practices (which sounds like an oxymoron on the face of it), Goodman found that when "the hidden costs shifted to [private] providers of care and the social costs of collecting taxes to fund Medicare are included...Medicare and Medicaid spend two-thirds more on administration than private insurance...."
In addressing whether the private market can work in health care, Goodman looks at the costs of cosmetic surgery, corrective vision surgery, and walk-in health clinics. These are not dependent on insurance reimbursement, yet they are not only successful, increasing in numbers performed, but have also enjoyed price cuts of up to 30% in the past 15 years.
Health care is an issue that will grow in importance, particularly as the population (read baby boomers) age and there are fewer workers to support the twin entitlements of social security and Medicare. Writing separately in the March 2009 issue of Imprimus from Hillsdale College, Goodman points out that Medicare will eat up one of every 10 federal discretionary dollars in three years. By 2030, the progam will take one of every two tax dollars. This is a dismal prospect for the economy, and for the quality of care people will receive in the not distant future. A strong private market solution, or more likely solutions, to inadequate health care provision is needed quickly...especially before advocates of universal government care can take the country down a road that will insure higher costs and lesser results for all. It's important that Americans wake up to this challenge and think through innovative private insurance plans that will preserve the high quality of our medical care. If not, we will all be in the same boat, but it will be a leaky boat of poor medical results with more suffering and more deaths.
Thursday, April 16, 2009
In fact, the tea parties were expressive of a genuine and growing angst over the role of the federal government in people's pocket books and lives.
However, the wide-eyed Speaker of the House is right that most members of the "great middle class" haven't reached the limit of their tolerance for government intrusion, ooops investment, in their lives. Could that change?
State legislators are desperately trying to take up any tax slack Congress has left them, and they are sighting in on beer drinkers, most of whom, more or less, Mrs. Pelosi, fall into the category of "the great middle class."
Beer, of course, has a noble history. It is mankind's first fermented beverage, having been brewed perhaps as early as 10,000 BC. It's featured as follows in the Gilgamesh Epic from the third millenium BC, describing man's rise to culture:
"Enkidu, a shaggy, unkempt, almost bestial primitive man, who ate grass and could milk wild animals, wanted to test his strength against Gilgamesh, the demigod-like sovereign. Taking no chances, Gilgamesh sent a whore to Enkidu to learn of his strengths and weaknesses. Enkidu enjoyed a week with her, during which she taught him of civilization. Enkidu knew not what bread was nor how one ate it. He had also not learned to drink beer. The whore opened her mouth and spoke to Enkidu: 'Eat the bread now, O Enkidu, as it belongs to life. Drink also beer, as it is the custom of the land.' Enkidu drank seven cups of beer and his heart soared. In this condition he washed himself and became a human being."
Beer is, accordingly, almost sacred. This passage should give warning to legislators in Oregon, Maryland, Idaho, Arizona, Michigan, and California: Don't mess with the brew.
Will they listen? The Wall Street Journal reports politicians in Oregon want to raise the state tax on beer by 1,900%...from $2.60 to $52.21 per barrel. This reflects their altruistic concern to fund drug addiction, of course, and to reduce a $3 billion budget deficit to allow them to spend again. Ignored are 96 Oregon breweries that "contribute 5,000 jobs and $2.25 billion to the state GDP."
And tourism money as well. Just yesterday the Taiwan News touted Portland, saying the city "is in love with hefty brews with spine and character. The Oregonian has a beer columnist. At least one restaurant has a beer steward. It has been written that you can get into a fist fight here over who makes the best India Pale Ale. Yet Portlanders aren't all beer snobs. The city is a prime Pabst Blue Ribbon market."
Well scratch the latter from the good taste category, but you can see beer is integral to offsetting Portland's otherwise settled reputation as granola crunching land.
And one wonders why lawmakers would even consider raising the cost of a pint of brew by $1.25 to $1.50 during an economic recession? Why offend further "the great middle class"? Why, but for greed for power, take on Joe Six-pack, college frat boys, and football fans? This is an issue crying for an astro turf movement.
In Oregon, Maryland, Idaho, Arizona, Michigan and California, and even across the sea in the United Kingdom where another scandalous tax increase on brew is imminent, legislators need to heed the wisdom of Jake Handy:
"Sometimes when I reflect back on all the beer I drink I feel ashamed - Then I look into the glass and think about the workers in the brewery and all of their hopes and dreams. If I didn't drink this beer, they might be out of work and their dreams would be shattered. Then I say to myself, 'It is better that I drink this beer and let their dreams come true than be selfish and worry about my liver.'"
'Tis better to lift a beer than to tax it, to toast the great middle class than to tax it, to quaff culture rather than to tax it, to party with friends than to tax them, to offer to pay for a round all around than to tax all around: Cheers indeed!
But they are also boring…and usually ill written. Items in a list should be parallel grammatically, but so many times they are not. In years of teaching composition I read so many lists that pinged around the mine field of grammatical booby traps, hitting each one, that my patience still explodes at the sight of lists.
I’ve come across only one list I like: “A List of Nothing in Particular…” by William Least Heat-Moon (You can read it here: http://tinyurl.com/cl8ctr). Least Heat-Moon’s list is grammatical (each entry begins with a noun), but it is also whimsical and keen and true, and these are the reasons I like it.
If I were to write a list about today, the best things in no particular order would be these:
1. home after four days in the hospital
4. pink blooms
5. smiles from grandkids with runny noses, not off put by my blue mask
6. a telephone call from a very sweet friend
7. strawberry short cake
8. my cluttered desk
9. an email and pictures of Spain from Cris
10. Spanish verbs clarified (a little)
11. love (felt)
These are not nothings; like bread they are the staff of life. I’ll add that to my list: this wonderful topsy turvy puzzling enticing embracing life.
Tuesday, April 14, 2009
Plum Duff...not your ordinary gruel...but not champagne and caviar either, just well written observations, comments, and opinions on politics, our culture (or lack of same), faith, everyday life and grandkids, of course, plus anything else that strikes my (or your) fancy. I admit up front that I do aim to redirect the world by applying common sense to common and uncommon events, but it's a task too large to succeed without your help. Agree or disagree with me; I'll respond with serious courtesy. And we can digress also along the sidepaths good discussions open. Bienvenidos!
Friday, April 10, 2009
I've just been listening to Fox News, and I heard the president is meeting with advisers to take "aggressive action"...but not against the pirates holding an American sea captain hostage on a life raft in close proximity to a U.S. Navy destroyer. This "aggressive action" will be on the economy...or, as the trend seems lately, against the capitalist base of the economy while our once proud Navy writhes in frustration over imposed inaction. To my knowledge, President Obama has made no comment on this humiliation. He apologizes only to foreign critics. Hopefully, I'm wrong and plans are being made to rescue Captain Richard Phillips and destroy the seat of 21st century piracy. Of course, it could go the other way. Unlike Thomas Jefferson, Barack Obama may decide that paying ransom is less expensive than funding a strong Navy.
Monday, April 6, 2009
We see adversity strike from the blue: anyone--the strong, the weak, the innocent, the guilty can suffer. Some are ground down, but others are also raised up, learning courage and perseverance, hardiness, helpfulness, charity and love. Of course, these latter results show adversity’s happy face; the darker side is degradation and despair.
Lately, I’ve been reading In the Shadow of Progress by Eric Cohen (New Atlantis Books, 2008) in which Cohen discusses the intersection of biological science and ethics. One point made is that our ultimate human adversity is death. None of us will escape death. But that in itself may be a good thing. Cohen cites Hans Jonas, a German-born philosopher who taught at the New School for Social Research in New York from 1955-1976: “Jonas quotes the Psalmist asking God: ‘So teach us to number our days, that we may get us a heart of wisdom.’”
Wisdom knows what is worthwhile in life, what is essential to our dignity, what lifts us up. This is what adversity can teach by necessity because it jolts us from our daily apathy; we must confront our frailty and ignorance. We must see what to value in our transient, mortal selves. We must learn how to live.
Adversity is a fit topic for the Christian Holy Week. Jesus’ pain and suffering on the cross is a cup none of us would willingly sip. Yet Christians believe Christ’s death brings us redemption and eternal life. In my church on Psalm Sunday, we sang, “Ride on! ride on in majesty!/ In lowly pomp ride on to die;/ Bow thy meek head to mortal pain,/ Then take, O God, thy power, and reign.” Thus is the ultimate adversity conquered.
But “science” disagrees and seeks eternal life medically, at least as a backup. Wisdom is needed to guide us to embrace the search for knowledge while carefully evaluating its claims against the truth of human exceptionalism. Cohen’s book takes up the questions that medical technology presents for our human future: wonderful advances against disease and moral questions over means. The book is more exposition than answers, but Cohen does have a conclusion, and it’s worth the effort of reading through his very good discussion to reach.
The above is a submission for Robert Hruzek's "What I learned from adversity" group writing project at http://middlezonemusings.com/. Be sure to take a visit there and read all the entries and make a submission yourself!