Another opinion generated from the discussion was e mailed by a Connecticut architect. I want to encourage all of you to send in your comments and rebuttals to any of the ideas expressed in this forum. Maybe we can actually get a consensus of good ideas that address some of the concerns raised:
Hi Ralph,
Thank you for this very interesting article on US healthcare. Our healthcare system is definitely a nightmare. It really doesn’t matter who is running the insurance programs in this country. We need to get real, stop the greed and stop making victims out of people. Our country needs a total health and mental cleansing – eat healthy, exercise, stop the unnecessary sweet drinks, junk and fast foods, turn off the TVs and computers - the drug ads have been making hypochondriacs out of Americans for years and most TV shows are garbage. Our society has become so lazy, they want it all now, a lot of it and cheap. It fits with the housing market and the American automobiles situation. That’s my 5 cent.
L
Wednesday, September 16, 2009
Monday, September 14, 2009
A Forum for Discussion on Health Care Reform: Cont'd
An Economist's Point of View
In continuing the discussion on heath care reform we have some thoughts from a former economist with the World Bank:
As an outsider, there are several ways to look at the issue: 1. Discussing technicalities, namely the tools to implement the president's option, including its costs and benefits; 2. To focus on the fundamental policy synthesized by the slogan "No one left behind", which contains two elements (a) affirmation of a social justice pursuit, and (b) depicting the society as a moving system with the implicit assumption that it is forging ahead (But, logically, there is also the possibility that the movement is backwards); 3 the political battle that pits the president against competing commercial interests (e.g. insurance companies and their adjuncts) and a medical profession with diverse views but essentially leaning toward opposition (Right?).
At all levels, it seems that the fight involves heavy lobby work, congressional influences, media intervention and (from my generic point of observation) is conducted mostly with the use of code words (such as socialism) or just buzz words that push the issues under discussion into the quagmire of stereotypes about class (poor), ideology (looser in the "survival of the fittest") and political issue (immigrants).
Of the three aspects, the third is the most interesting for the external observers. Will a very popular president, seen as an exceptional person worldwide, be beaten by parochial sectoral interests? Will a policy be rejected even after having been streamlined to a simple "option", an option further cast in basic terms?
The jury is still out, out perhaps in the streets of Washington. I am convinced that a lot of insight may be drawn from the outcome, well beyond the immediate issue of health insurance. It will be interesting to see.
Vittorio
In continuing the discussion on heath care reform we have some thoughts from a former economist with the World Bank:
As an outsider, there are several ways to look at the issue: 1. Discussing technicalities, namely the tools to implement the president's option, including its costs and benefits; 2. To focus on the fundamental policy synthesized by the slogan "No one left behind", which contains two elements (a) affirmation of a social justice pursuit, and (b) depicting the society as a moving system with the implicit assumption that it is forging ahead (But, logically, there is also the possibility that the movement is backwards); 3 the political battle that pits the president against competing commercial interests (e.g. insurance companies and their adjuncts) and a medical profession with diverse views but essentially leaning toward opposition (Right?).
At all levels, it seems that the fight involves heavy lobby work, congressional influences, media intervention and (from my generic point of observation) is conducted mostly with the use of code words (such as socialism) or just buzz words that push the issues under discussion into the quagmire of stereotypes about class (poor), ideology (looser in the "survival of the fittest") and political issue (immigrants).
Of the three aspects, the third is the most interesting for the external observers. Will a very popular president, seen as an exceptional person worldwide, be beaten by parochial sectoral interests? Will a policy be rejected even after having been streamlined to a simple "option", an option further cast in basic terms?
The jury is still out, out perhaps in the streets of Washington. I am convinced that a lot of insight may be drawn from the outcome, well beyond the immediate issue of health insurance. It will be interesting to see.
Vittorio
Saturday, September 12, 2009
A Forum for Discussion on Health Care Reform
Recently I posted to many of my friends and family a link to an article written in The Atlantic. It had, what I thought, some thought provoking ideas about health care reform and the state of medicine in this country. With all the partisan information being disseminated and flung about like so much flotsam on a raging sea, I was hoping to get some considered response to this and generate some further discussion from you out there in the ether. For those of you who never read the article it can be found at this link:
http://www.theatlantic.com/doc/200909/health-care
Since then I have received some responses that I believe are worth posting.They bring into the discussion some personal experiences that need to be aired so we may be able to best determine what works, what doesn't work, what the health care professionals in the trenches think, what those in the business legitimately fear most about potential reform (and how we can best address those concerns), what we can practically afford to provide to the population as a whole , etc etc.
I hope to gather my thoughts on this and write my own prescription for reform but for now I am delighted to offer several responses from a few of you with something to say. I hope you choose to offer your own comments and continue to elevate this important discussion: For now here are two interesting perspectives.
Reply #1 A Physician's response:
Let me preface my comment with some background information. I am a physician, specifically a Radiologist. I am salaried by a University. I work at a critical access, not for profit hospital. I do not order exams. The referring doctor does that. So there is no "moral" issues. I cannot refer cases to myself. (See the STARK LAWS).
First: I couldn't disagree more with the premise that health care should be run like business. That is part of the problem that exist now in medicine. In the good old days that the basic unit of work ( and reimbursement) was between the physician and the patient. Recently there are any number of business trained administrators trying to get as much profit out of the process as possible. They have nothing to do with the care delivered but they have everything to say about the money. In the "good old days" any profit was channeled back into hospital refurbishment, technical improvements, personnel and indigent care. The new working model for so many hospitals is demoralizing for the health care workers who work in them. The nurses and technologists and other personnel are chronically understaffed and underpaid. There is little to no "improvement" unless it can be shown that it will make money. "Quality of care" is a language not spoken by administrators. If you want to make changes that are in the best interest of quality, you may as well tell your dog because he /she will listen more closely. So much for why the hospital "killed your dad".
Second: Government programs: Medicaid and Medicare reimburse at a rate which often does not cover the cost of the procedure. For years the American College of Radiology encouraged all Radiologists to continue to provide mammograms even though we lost money on every exam. That is just one example. Also, as many in the auto industry are now learning with the current "cash for clunkers" deal, the government will deny your billing because you forgot to cross a "t" or dot an "i". And literally will not consider paying any claim that is more than 3 months old. Now after your office staff submits your bill and gets denied over and over and argue and resubmit, the cost (which didn't cover the expense to begin with) now becomes even less. Now we need increased office staff to claim the payment we are due. Add 8% to the bill just for billing!
Third: Insurance Companies:Because the government reimbursements are so low, all insurers expect the same costs to their clients. But if the government is below cost in some cases, the difference has to be made up somewhere. And no one wants to be the person who is paying more. So all this money we all pay for insurance, where is it going? Look at their annual profits!
Fourth: Drug companies marketing directly to patients? Seriously what is the possible motive for that? Here the Walmarts of the world are making a huge difference to patients. Kudos.
Fifth: Litigation: After reimbursements went down the watch words became "economy of scale" and we worked faster and longer hours for the same reimbursement. When in training we were held to a work level of 10-12,00 case per year. Now the average Radiologist is reading 22,000 -25,000 cases per year to try and maintain salary. Enter litigation. You cannot go faster and provide quality. And mistakes are inevitable. Many Radiologists decided to stop providing mammograms because the cost of their malpractice insurance (in some cases, even without any prior claims, there were no insurers that would provide coverage). In some fields the cost of malpractice insurance costs more than the doctors make. So why should they stay in business? Would you? The current health care reforms do not address litigation. Laws are made by lawyers the ultimate self interest group.
Sixth: Patients are not who you think they are. People view themselves as the victims in this scenario. But there are large numbers of patients who come to the ER seeking drugs. They complain of pain. They are well versed in what complaint will get them which test and what medication... Some prick their fingers and put drops of blood in their urine to get pain meds... hematuria requires the ER doctor to order a CT scan to look for kidney stone ... if they don't and miss a stone, they get sued). The young women learn early that they will be covered by WIC for two years if they are pregnant. So in order to get this payment they need a diagnosis. At age 16 they come to the ER complaining of pelvic pain. The ER doc has to order a pelvic ultrasound. And when we document the pregnancy she is on easy street for 2 years (if you call kids easy street). But I have seen women with 9 and 10 consecutive pregnancies, all children later taken away for neglect and become wards of the state where they are an additional burden on society.
The young men who do not want to work come in complaining of back pain. So they get examined and x-rayed (again heaven forbid you miss a compression fracture you will get sued). And many get put on Oxycontin. They turn around, go out into the parking lot and sell their prescription for $3,000.
Fifth: Socialization of medicine: I had the opportunity to see Howard Dean's insurance reforms and their effects first hand when I lived and worked in Vermont. He created Doctor Dinosaur which made health care for children in families making less than $60,000 a year free (government reimbursed below cost). The intention might be laudable but the result was that it put out of business every private practice pediatrician in the state. All of them were forced to move into hospital practice. In some cases the hospitals subsidized the practices to help keep them alive. Many pediatricians quit and left medicine in dismay.
You will have to forgive Doctors if they are skeptical about government involvement in medicine. Those of us who have been in health care long enough know that many of the problems medicine has today were created or accelerated with government "getting involved" and I personally am terrified at what is still to come.
Health Care is a complex issue. It cannot be solved without addressing all the underlying problems.
People expect the best care (all the latest high tech modalities) , delivered perfectly (no mistakes), with immediate results and free to them. Tell me please what business in this country delivers such a product? Patients in other countries have to wait, or have strict limits on what the country will and will not pay for, and the doctors cannot be sued. If Americans want to give up all the things they now demand, then I am sure the health care reform can happen. But realize this, since we can't afford the health care we are providing now, there will have to be limits ( same as if you were paying yourself) and there will have to be decisions made on what is cost effective to treat and what is not. This will not be popular. The seniors know this and that is why polls show them 44% opposed to the current form of reform. This is not a scare tactic, it is a fact that no politician wants to own up to.
Unless we have a serious non partisan discussion, we may pass a bill but we will not fix what's wrong.
Dr. D.S.
Reply #2 A British Perspective:
Hi, Ralph,
Haven't time to read through all this, but as someone who grew up with the British National Health System, I've been railing against the American insurance-company driven system for decades. The main problem here is that health care is a for-profit business. It should not be! The only real solution is a single-payer system that includes everyone, with no exclusions for pre-conditions, no deductibles and no paperwork. Hard to believe but that's what we have in Britain. Like Americans we have deductions taken from our paychecks to pay for our coverage. If you're not working, or retired, you're still covered anyway.
For all the touting of Medicare as the perfection solution here, as someone who is now on it I can tell you it has its shortcomings. Sure it's better than nothing but I'm still fighting over a bill that I believe should have been paid in full when my Medicare plan says it's part of my deductible.
Just the stress and effort involved in getting what you're entitled to makes you sick!
I'm with Rep. Weiner from New York who says single payer is the answer. But I don't expect for one minute we'll get it in my lifetime. Obama's plan, with the public option, will be an improvement on what we now have. There'll be no exclusions and some control over out-of-pocket costs. I'm not thrilled by it but will certainly take it for now.
Rita B.
http://www.theatlantic.com/doc/200909/health-care
Since then I have received some responses that I believe are worth posting.They bring into the discussion some personal experiences that need to be aired so we may be able to best determine what works, what doesn't work, what the health care professionals in the trenches think, what those in the business legitimately fear most about potential reform (and how we can best address those concerns), what we can practically afford to provide to the population as a whole , etc etc.
I hope to gather my thoughts on this and write my own prescription for reform but for now I am delighted to offer several responses from a few of you with something to say. I hope you choose to offer your own comments and continue to elevate this important discussion: For now here are two interesting perspectives.
Reply #1 A Physician's response:
Let me preface my comment with some background information. I am a physician, specifically a Radiologist. I am salaried by a University. I work at a critical access, not for profit hospital. I do not order exams. The referring doctor does that. So there is no "moral" issues. I cannot refer cases to myself. (See the STARK LAWS).
First: I couldn't disagree more with the premise that health care should be run like business. That is part of the problem that exist now in medicine. In the good old days that the basic unit of work ( and reimbursement) was between the physician and the patient. Recently there are any number of business trained administrators trying to get as much profit out of the process as possible. They have nothing to do with the care delivered but they have everything to say about the money. In the "good old days" any profit was channeled back into hospital refurbishment, technical improvements, personnel and indigent care. The new working model for so many hospitals is demoralizing for the health care workers who work in them. The nurses and technologists and other personnel are chronically understaffed and underpaid. There is little to no "improvement" unless it can be shown that it will make money. "Quality of care" is a language not spoken by administrators. If you want to make changes that are in the best interest of quality, you may as well tell your dog because he /she will listen more closely. So much for why the hospital "killed your dad".
Second: Government programs: Medicaid and Medicare reimburse at a rate which often does not cover the cost of the procedure. For years the American College of Radiology encouraged all Radiologists to continue to provide mammograms even though we lost money on every exam. That is just one example. Also, as many in the auto industry are now learning with the current "cash for clunkers" deal, the government will deny your billing because you forgot to cross a "t" or dot an "i". And literally will not consider paying any claim that is more than 3 months old. Now after your office staff submits your bill and gets denied over and over and argue and resubmit, the cost (which didn't cover the expense to begin with) now becomes even less. Now we need increased office staff to claim the payment we are due. Add 8% to the bill just for billing!
Third: Insurance Companies:Because the government reimbursements are so low, all insurers expect the same costs to their clients. But if the government is below cost in some cases, the difference has to be made up somewhere. And no one wants to be the person who is paying more. So all this money we all pay for insurance, where is it going? Look at their annual profits!
Fourth: Drug companies marketing directly to patients? Seriously what is the possible motive for that? Here the Walmarts of the world are making a huge difference to patients. Kudos.
Fifth: Litigation: After reimbursements went down the watch words became "economy of scale" and we worked faster and longer hours for the same reimbursement. When in training we were held to a work level of 10-12,00 case per year. Now the average Radiologist is reading 22,000 -25,000 cases per year to try and maintain salary. Enter litigation. You cannot go faster and provide quality. And mistakes are inevitable. Many Radiologists decided to stop providing mammograms because the cost of their malpractice insurance (in some cases, even without any prior claims, there were no insurers that would provide coverage). In some fields the cost of malpractice insurance costs more than the doctors make. So why should they stay in business? Would you? The current health care reforms do not address litigation. Laws are made by lawyers the ultimate self interest group.
Sixth: Patients are not who you think they are. People view themselves as the victims in this scenario. But there are large numbers of patients who come to the ER seeking drugs. They complain of pain. They are well versed in what complaint will get them which test and what medication... Some prick their fingers and put drops of blood in their urine to get pain meds... hematuria requires the ER doctor to order a CT scan to look for kidney stone ... if they don't and miss a stone, they get sued). The young women learn early that they will be covered by WIC for two years if they are pregnant. So in order to get this payment they need a diagnosis. At age 16 they come to the ER complaining of pelvic pain. The ER doc has to order a pelvic ultrasound. And when we document the pregnancy she is on easy street for 2 years (if you call kids easy street). But I have seen women with 9 and 10 consecutive pregnancies, all children later taken away for neglect and become wards of the state where they are an additional burden on society.
The young men who do not want to work come in complaining of back pain. So they get examined and x-rayed (again heaven forbid you miss a compression fracture you will get sued). And many get put on Oxycontin. They turn around, go out into the parking lot and sell their prescription for $3,000.
Fifth: Socialization of medicine: I had the opportunity to see Howard Dean's insurance reforms and their effects first hand when I lived and worked in Vermont. He created Doctor Dinosaur which made health care for children in families making less than $60,000 a year free (government reimbursed below cost). The intention might be laudable but the result was that it put out of business every private practice pediatrician in the state. All of them were forced to move into hospital practice. In some cases the hospitals subsidized the practices to help keep them alive. Many pediatricians quit and left medicine in dismay.
You will have to forgive Doctors if they are skeptical about government involvement in medicine. Those of us who have been in health care long enough know that many of the problems medicine has today were created or accelerated with government "getting involved" and I personally am terrified at what is still to come.
Health Care is a complex issue. It cannot be solved without addressing all the underlying problems.
People expect the best care (all the latest high tech modalities) , delivered perfectly (no mistakes), with immediate results and free to them. Tell me please what business in this country delivers such a product? Patients in other countries have to wait, or have strict limits on what the country will and will not pay for, and the doctors cannot be sued. If Americans want to give up all the things they now demand, then I am sure the health care reform can happen. But realize this, since we can't afford the health care we are providing now, there will have to be limits ( same as if you were paying yourself) and there will have to be decisions made on what is cost effective to treat and what is not. This will not be popular. The seniors know this and that is why polls show them 44% opposed to the current form of reform. This is not a scare tactic, it is a fact that no politician wants to own up to.
Unless we have a serious non partisan discussion, we may pass a bill but we will not fix what's wrong.
Dr. D.S.
Reply #2 A British Perspective:
Hi, Ralph,
Haven't time to read through all this, but as someone who grew up with the British National Health System, I've been railing against the American insurance-company driven system for decades. The main problem here is that health care is a for-profit business. It should not be! The only real solution is a single-payer system that includes everyone, with no exclusions for pre-conditions, no deductibles and no paperwork. Hard to believe but that's what we have in Britain. Like Americans we have deductions taken from our paychecks to pay for our coverage. If you're not working, or retired, you're still covered anyway.
For all the touting of Medicare as the perfection solution here, as someone who is now on it I can tell you it has its shortcomings. Sure it's better than nothing but I'm still fighting over a bill that I believe should have been paid in full when my Medicare plan says it's part of my deductible.
Just the stress and effort involved in getting what you're entitled to makes you sick!
I'm with Rep. Weiner from New York who says single payer is the answer. But I don't expect for one minute we'll get it in my lifetime. Obama's plan, with the public option, will be an improvement on what we now have. There'll be no exclusions and some control over out-of-pocket costs. I'm not thrilled by it but will certainly take it for now.
Rita B.
Monday, June 22, 2009
Rain rain, go away! Is it different this time?
For those of us in the Northeast who treasure our sunny summer months of June, July and August, the recent seemingly unending pattern of constant and soaking rain has many of us wondering if it is somehow different this year. Certainly in my memory I do not recall such an extended period of almost daily precipitation during our summers.The precipitation has been at times almost like that experienced in tropical rain forests-long, humid and drenching. If June is a harbinger of things to come we all better get used to wearing rainwear as part of our summer outfits.
If you feel this amount of rain is unusual you are not alone and your perception is backed by the facts. A recent article in Time magazine claims that precipitation in the United States has increased an average of 5% in the past 5o years. Doesn't sound like much but it is building. Scientific models show that Northern climates are getting wetter as Southern and Western areas of the country grow drier. It may be that Seattle, notorious for its rainy, gloomy weather, may have nothing on New York if this cycle continues and there is no reason to believe it will not. As the planet warms, contributed mightily by our continued dependence on the burning of fossil fuels, we can expect this process to only accelerate.
Its hard to imagine that New York, with all its hustle and bustle will operate as efficiently if the climate in the area is predominantly wet and dreary! Who can deny the energizing and uplifting effects of a daily dose of sunshine. One can imagine a precipitous (pun intended) decline in productivity if we all have to work in the new weather paradigm of endless rain storms?
One thing is for sure we all better stock up on our Vitamin D supplements! Maybe there is an investment idea in all this. Hmmmm.
If you feel this amount of rain is unusual you are not alone and your perception is backed by the facts. A recent article in Time magazine claims that precipitation in the United States has increased an average of 5% in the past 5o years. Doesn't sound like much but it is building. Scientific models show that Northern climates are getting wetter as Southern and Western areas of the country grow drier. It may be that Seattle, notorious for its rainy, gloomy weather, may have nothing on New York if this cycle continues and there is no reason to believe it will not. As the planet warms, contributed mightily by our continued dependence on the burning of fossil fuels, we can expect this process to only accelerate.
Its hard to imagine that New York, with all its hustle and bustle will operate as efficiently if the climate in the area is predominantly wet and dreary! Who can deny the energizing and uplifting effects of a daily dose of sunshine. One can imagine a precipitous (pun intended) decline in productivity if we all have to work in the new weather paradigm of endless rain storms?
One thing is for sure we all better stock up on our Vitamin D supplements! Maybe there is an investment idea in all this. Hmmmm.
Thursday, May 14, 2009
Review of Gian Tornatore:" La Copa Del Mondo" from the CD Fall"
Artist: Gian Tornatore
Track: La Copa Del Mondo
CD: Fall (Sound Spiral SS1301)
Musicians: Gian Tornatore (Tenor and Soprano Saxophones); Nate Rdiley (Guitar);
Jon Anderson (piano); Thomson Kneeland (Bass); Jordan Perlson (drums).
Recorded: July 10th & 11th 2007 Acoustic Recording, Brooklyn, NY
Composer: Gian Tornatore
The circularly repeated theme of “La Copa del Mondo” draws you in by the virtue of its tension building nature. Anderson and Tornatore are particularly in sync with each other throughout their juxtaposed playing. Saxophonist and composer Tornatore has penned an interesting piece of music that builds up an almost frenetic anxiousness without veering into reckless abandon. Guitarist Radley floats on top of the rhythm of the ceaseless energy of Perlson’s drums, Kneeland’s bass and Anderson’s piano in a facile demonstration of lyrical fluidity. Tornatore’s tenor is wispy and spirited as he negotiates liquid lines of purposeful notes his solo. Despite the feeling of tension the song purposefully elicits it never veers off track and is skillfully navigated by Tornatore’s confidant delivery, with his astute use of space between notes. A nice syncopated tom solo by Perlson accentuates this textural piece just prior to the coda.
Sunday, May 3, 2009
Review of Daniella Schacter's "The Peacocks" from Purple Butterfly
Artist: Daniela Schächter
Track: The Peacocks
CD: Purple Buttterfly
Musicians: Daniela Schächter ((vocals, piano); Alex Spiagin (trumpet & flugelhorn); Joel Frahm (tenor saxophone); Massimo Biolcati (acoustic bass); Quincy Davis(drums).
Recorded: June 22, 2008 Michael Brorby Studio, New York
Composer : Jimmy Rowles and N. Wintone
Pianist and vocalist Daniela Schächter has a hauntingly beautiful and magnetic voice. It is clear, accurate and can at times be deliberately stylized to a monotone. Her unique interpretation of what notes to use where is disarming and so you are magnetically drawn to listen, pulled by the idea of not knowing where she will take you next. With some fine performances throughout the album by Alex Sipiagin on flugelhorn and Joel Frahm on saxophone, Schächter’s voice is nevertheless most beguiling when accompanied in the trio format. On Jimmy Rowles beautiful “The Peacocks”, skillfully accompanied by Massimo Biolcati on bass and Quincy Davis on drums along with her own piano, her interpretive skills shine. She has great control of her voice and when she ventures up some apparently skeptical, vocally dark alleys that stray from the expected she somehow manages to skillfully emerge to the daylight undaunted. You become a convert; a believer that she was always knew she was heading in the right direction, even if you weren’t so sure. A talented, stylized vocalist that shows us there is always another way to sing a great song.
Ralph A. Miriello
Friday, March 27, 2009
The Death Penalty and the company we keep.
There was an interesting little article in Wednesday's New York Times by Mark McDonald and Michael Wines that reported on Amnesty International's recent annual report on the death penalty for 2008. Now I know this is an emotional subject for many people and that opinions are strongly divided as to the necessity of this practice as a deterrent to the proliferation of violent crime, but sometimes if we step back and see who were are lying in concert with we might be surprised.
I found it telling who the leading practitioners of the death penalty were in order of their body count. At the top of the list was China with its 1.718 reported kills (this number is believed to be suspect since everything in China is done with a veil of secrecy). The runner-up was that "axis of evil' member nation Iran, certainly a bastion of intellectual thought and free of expression. Here the Iranians racked up 346 kills! Not to be outdone, our friends in the more progressive and cosmopolitan sheikdom of Saudi Arabia, were ranked third with 102 kills. Then guess who was next on this ignominious list? You got it friends, we were. The United States, a beacon for free thinking,humanitarianism and an advocate against human rights abuse in other nations had a total of 37 executions! According to the Death Penalty Information Center the state with the most executions last year was Texas with 18! Those progressive folks in Pakistan, where woman are still buried alive for not following the marital wishes of their families, actually killed one less person than we did last year.
I recognize that our prisons are overflowing and that the cost for maintaining a life sentence far exceeds the cost of a lethal injection or the kilowatts used in an electrocution, but really is the price of our humanity so easily bought?
If the old adage "You are judged by the company you keep." applies here we had better look at ourselves and our practices more closely. Thankfully the number of 37 executions this year is the lowest since 1994, so we are making progress, but we need to catch up to the majority of civilized society and eliminate this dated and unseemly practice.
I found it telling who the leading practitioners of the death penalty were in order of their body count. At the top of the list was China with its 1.718 reported kills (this number is believed to be suspect since everything in China is done with a veil of secrecy). The runner-up was that "axis of evil' member nation Iran, certainly a bastion of intellectual thought and free of expression. Here the Iranians racked up 346 kills! Not to be outdone, our friends in the more progressive and cosmopolitan sheikdom of Saudi Arabia, were ranked third with 102 kills. Then guess who was next on this ignominious list? You got it friends, we were. The United States, a beacon for free thinking,humanitarianism and an advocate against human rights abuse in other nations had a total of 37 executions! According to the Death Penalty Information Center the state with the most executions last year was Texas with 18! Those progressive folks in Pakistan, where woman are still buried alive for not following the marital wishes of their families, actually killed one less person than we did last year.
I recognize that our prisons are overflowing and that the cost for maintaining a life sentence far exceeds the cost of a lethal injection or the kilowatts used in an electrocution, but really is the price of our humanity so easily bought?
If the old adage "You are judged by the company you keep." applies here we had better look at ourselves and our practices more closely. Thankfully the number of 37 executions this year is the lowest since 1994, so we are making progress, but we need to catch up to the majority of civilized society and eliminate this dated and unseemly practice.
Sunday, March 15, 2009
MRSA : When will we Learn?
Recently I have had the unfortunate luck to have experienced a rather nasty infection on my leg. Mysteriously a small pimple-like eruption on my lower leg appeared and thinking it was a just an ingrown hair or some such thing I tried to pop the little sucker with little effect. I made sure to use alcohol to rub the area after the crude procedure. Shortly thereafter, the site of the offense became rather unsightly, bright red, warm to the touch and started to grow alarmingly in diameter. Despite my care to wash it carefully and treat it with Neosporin-my household remedy for anything topical-it was refusing to get better and growing by leaps and bounds. Not being one to deny myself medical attention when needed, I went to my Doctor who looked it over and concluded that I had somehow contracted an infection, probably from my trying to lance it. He carefully swabbed a sample of whatever discharge he could get for a culture from the now open wound and prescribed a topical ointment and an oral antibiotic, Biaxin, that is apparently the first line of defense in normal infections of this type.
After religiously following the instructions the wound was not responding and getting uglier and larger by the day. Not wanting to act prematurely, for fear of being consider in a state of hypochondria, I watched and waited until I had a coincidental visit to another Doctor that I had planned for an totally unrelated matter. When I showed the condition of my wound to the other Dr. he was alarmed enough to insist that I contact my primary physician again and have it rechecked.
When I called my internist he suggested that he would prefer for me to go right to the emergency room at my local hospital. Needless to say I was starting to get alarmed. When I arrived at the hospital I was admitted and the wound inspected and cleaned. They checked with my physician, to see if he had received any results from the first culture, but the results were as yet unavailable. After a consultation by the admitting doctor with the Center for Disease Controls, they determined that they should give me a powerful antibiotic, Vacomycin, intravenously in case what I had contracted was MRSA (pronounced MERSA an acronym for methicillin resistant Staphylococcus aureus.). This was the first I had heard of this virulent, antibiotic-resistant strain of the common Staph family of infections that has seemingly crept into our society in a stealth-like fashion and is amazingly responsible for the deaths of over 18,000 Americans annually, surpassing deaths by AIDS!
In my particular case, thankfully the results of the culture revealed no MRSA. Instead I was afflicted with a more commonly found Staff infection that proved to be of the type typically found on our skins everyday and usually not inclined to become problematic as mine did. Nonetheless it took two other visits to the emergency room-one to drain the wound and the other to remove the packing- along with an extended dose of double strength Biaxin before I was deemed clear of this episode.
Unfortunately, shorty thereafter, the same thing recurred on the same leg! After two precautionary visits to both a dermatologist and an infectious disease specialist and numerous cultures later I was given a third antibiotic, this time
Levaquin, for a longer period (fourteen days)to rid my body of any traces of this nasty sucker. Now lets make sure we understand I am scrupulously clean, almost to the point of obsession and shower at least two times daily. I do frequent a high-end fitness center several times a week, I suppose this could be a source, although it appears to be clean, well maintained and I generously use cleaning solution provided before and after each use of any equipment.
Perhaps I will never know how I contracted this particularly tough strain. Mysteriously, upon further investigation, I am told it has become more and more common for people to be inhabited by this or some other staph germ. Perhaps our overuse of antibacterial soaps are helping to create stronger strains? Incidents like mine are becoming alarmingly more regular. Hospitals are particularly vulnerable to these infections and are constantly on the defense against these new, more virulent super bugs. No one seems to know why this is suddenly becoming more common except there are signs we are doing this to ourselves. Doctors may be over prescribing antibiotics for routine matters, thus leaving ourselves open to acquiring some immunity to their effectiveness. But even those who recoil from the overuse of medicines on principal may be victim to another source of over exposure to antibiotics.This exposure is the result of the reckless routine use of therapeutic antibiotics in our food stocks.
Clearly, as my little personal experience has confirmed, this is becoming a problem of greater proportions than most people are aware of and should not be ignored. Interestingly enough Nicholas Kristof, of the NY Times, has recently been doing a series of articles on MRSA and how it is developing in areas of the country where pig farming is the prevalent.
It seems that when a recent test of random pork samples was taken from Washington, D.C. markets one out of 300 samples tested positive for MRSA. In Louisiana the same sampling uncovered five out of 90 positive results!While Kristof makes clear that there is no evidence of anyone getting sick from eating cooked pork -the cooking kills the bacteria-it is the handling of the meat that represents the real danger here.
The apparent reason for this development, according to the peer-reviewed Medical Clinics of North America report is that permitting the non-therapeutic use of antibiotics in livestock feed was a "major component" in the rise in antibiotic resistance in the general human population. Using therapeutic antibiotics on all types of livestock regularly by agri-business concerns allows them to keep animals in inhumane and blighted, unsanitary conditions that become incubators for infections. In a convoluted circle of lunacy agri-business's obvious solution, to the problems that arise from their mass marshaling of animals for slaughter and the creation of these germ breeding grounds for super bugs, is to therapeutically treat the livestock massive amounts with antibiotics. So much so that more antibiotics are fed to livestock in North America than to the entire human population!
The solution is legislation banning the reckless use of these antibiotics in animal livestock. The solution is more sanitary and humane treatment of animals that are to be processed for human consumption. We must follow the trend to a more sustainable, more organic way to raise and slaughter our livestock. We must allow the normal growth period for these animals to occur without accelerating it unnaturally by the use of growth hormones, antibiotics and feed stocks that artificially produce a greater yield at the expense of a more satisfying and healthful product. Perhaps this will raise the cost of our meat and poultry but why are willing to eat ourselves into an epidemic? We must encourage our legislators to act! We must actively petition against special interests in the agri-business sector that see profit as their only mandate. We must protect ourselves against infection over economic considerations championed at the expense of the health of the nation.
We must support those conscientious growers and raisers that employ methods that eschew the use or growth hormones, antibiotics and inhumane force feeding of animal
at the expense of a healthful product. Only a rejection of these agri-business products through our purchase choices can send a clear and defining message that we are not willing to accept this anymore.
A note encouraging legislation prohibiting the use of therapeutic antibiotics in our livestock to Mr. Obama and to his newly appointed Secretary of Agriculture Mr. Vilsack as well as your state representatives is clearly worth the effort.
PS: Vilsack's email at Agriculture is: AgSec@usda.gov
Mr,. Obama's e mail :http://www.whitehouse.gov/CONTACT/
After religiously following the instructions the wound was not responding and getting uglier and larger by the day. Not wanting to act prematurely, for fear of being consider in a state of hypochondria, I watched and waited until I had a coincidental visit to another Doctor that I had planned for an totally unrelated matter. When I showed the condition of my wound to the other Dr. he was alarmed enough to insist that I contact my primary physician again and have it rechecked.
When I called my internist he suggested that he would prefer for me to go right to the emergency room at my local hospital. Needless to say I was starting to get alarmed. When I arrived at the hospital I was admitted and the wound inspected and cleaned. They checked with my physician, to see if he had received any results from the first culture, but the results were as yet unavailable. After a consultation by the admitting doctor with the Center for Disease Controls, they determined that they should give me a powerful antibiotic, Vacomycin, intravenously in case what I had contracted was MRSA (pronounced MERSA an acronym for methicillin resistant Staphylococcus aureus.). This was the first I had heard of this virulent, antibiotic-resistant strain of the common Staph family of infections that has seemingly crept into our society in a stealth-like fashion and is amazingly responsible for the deaths of over 18,000 Americans annually, surpassing deaths by AIDS!
In my particular case, thankfully the results of the culture revealed no MRSA. Instead I was afflicted with a more commonly found Staff infection that proved to be of the type typically found on our skins everyday and usually not inclined to become problematic as mine did. Nonetheless it took two other visits to the emergency room-one to drain the wound and the other to remove the packing- along with an extended dose of double strength Biaxin before I was deemed clear of this episode.
Unfortunately, shorty thereafter, the same thing recurred on the same leg! After two precautionary visits to both a dermatologist and an infectious disease specialist and numerous cultures later I was given a third antibiotic, this time
Levaquin, for a longer period (fourteen days)to rid my body of any traces of this nasty sucker. Now lets make sure we understand I am scrupulously clean, almost to the point of obsession and shower at least two times daily. I do frequent a high-end fitness center several times a week, I suppose this could be a source, although it appears to be clean, well maintained and I generously use cleaning solution provided before and after each use of any equipment.
Perhaps I will never know how I contracted this particularly tough strain. Mysteriously, upon further investigation, I am told it has become more and more common for people to be inhabited by this or some other staph germ. Perhaps our overuse of antibacterial soaps are helping to create stronger strains? Incidents like mine are becoming alarmingly more regular. Hospitals are particularly vulnerable to these infections and are constantly on the defense against these new, more virulent super bugs. No one seems to know why this is suddenly becoming more common except there are signs we are doing this to ourselves. Doctors may be over prescribing antibiotics for routine matters, thus leaving ourselves open to acquiring some immunity to their effectiveness. But even those who recoil from the overuse of medicines on principal may be victim to another source of over exposure to antibiotics.This exposure is the result of the reckless routine use of therapeutic antibiotics in our food stocks.
Clearly, as my little personal experience has confirmed, this is becoming a problem of greater proportions than most people are aware of and should not be ignored. Interestingly enough Nicholas Kristof, of the NY Times, has recently been doing a series of articles on MRSA and how it is developing in areas of the country where pig farming is the prevalent.
It seems that when a recent test of random pork samples was taken from Washington, D.C. markets one out of 300 samples tested positive for MRSA. In Louisiana the same sampling uncovered five out of 90 positive results!While Kristof makes clear that there is no evidence of anyone getting sick from eating cooked pork -the cooking kills the bacteria-it is the handling of the meat that represents the real danger here.
The apparent reason for this development, according to the peer-reviewed Medical Clinics of North America report is that permitting the non-therapeutic use of antibiotics in livestock feed was a "major component" in the rise in antibiotic resistance in the general human population. Using therapeutic antibiotics on all types of livestock regularly by agri-business concerns allows them to keep animals in inhumane and blighted, unsanitary conditions that become incubators for infections. In a convoluted circle of lunacy agri-business's obvious solution, to the problems that arise from their mass marshaling of animals for slaughter and the creation of these germ breeding grounds for super bugs, is to therapeutically treat the livestock massive amounts with antibiotics. So much so that more antibiotics are fed to livestock in North America than to the entire human population!
The solution is legislation banning the reckless use of these antibiotics in animal livestock. The solution is more sanitary and humane treatment of animals that are to be processed for human consumption. We must follow the trend to a more sustainable, more organic way to raise and slaughter our livestock. We must allow the normal growth period for these animals to occur without accelerating it unnaturally by the use of growth hormones, antibiotics and feed stocks that artificially produce a greater yield at the expense of a more satisfying and healthful product. Perhaps this will raise the cost of our meat and poultry but why are willing to eat ourselves into an epidemic? We must encourage our legislators to act! We must actively petition against special interests in the agri-business sector that see profit as their only mandate. We must protect ourselves against infection over economic considerations championed at the expense of the health of the nation.
We must support those conscientious growers and raisers that employ methods that eschew the use or growth hormones, antibiotics and inhumane force feeding of animal
at the expense of a healthful product. Only a rejection of these agri-business products through our purchase choices can send a clear and defining message that we are not willing to accept this anymore.
A note encouraging legislation prohibiting the use of therapeutic antibiotics in our livestock to Mr. Obama and to his newly appointed Secretary of Agriculture Mr. Vilsack as well as your state representatives is clearly worth the effort.
PS: Vilsack's email at Agriculture is: AgSec@usda.gov
Mr,. Obama's e mail :http://www.whitehouse.gov/CONTACT/
Wednesday, February 18, 2009
The Right Way to Deal with the Mortgage Crisis
After today's announcement from President Obama, introducing a plan to save those homeowner's who are facing foreclosure, it has become apparent that despite all the good intentions of this administration they just don't get it! The current proposal would apparently look to help distressed, non-performing homeowner's with a government incentive that would allow banks to restructure the debt of these delinquents, tailoring the debt payment to a nominal 31% of their income.
What is wrong with this picture? We are validating behavior that was basically imprudent at best and fraudulent at worst! Many of these homeowner's (more rightly they should be called debtors in possession) were unscrupulously lured into their present condition by easy money made possible by Greenspan and company's loose credit. Greedy and unregulated groups of mortgage originators, banks, packagers and rating agencies "gone wild" also contributed to this excessive liberal credit binge.
But ultimately aren't we all responsible for our own choices? No one held a gun to a borrower's head and made him sign the papers.
I am often amazed that the normally fiscally conservative groups that look to free market capitalism when things are good are so quick to give up on Mr. Market when things go too far off course. How do unspecified tax cuts help us out of this credit crisis? But we must jump start the economy and tax cuts are the way to go we are told. I don't see the connect if after all the recent tax cuts we have had we still got into the present situation.
If big auto is too big to fail, big banks like Citi and B of A are too large not to be saved and insurance giants like AIG that basically insured beyond their ability are too intertwined into all aspects of the economy to be allowed to be broken up and dissolved in an orderly fashion are not these free market advocates taking the next step into socialism?
Don't get me wrong I believe we need government intervention in these troubled times to set the boat right and start to steer away from the shoals of the economic abyss we let Wall Street and others steer us into, but intelligent, fair and measured government intervention laser focused on what started this whole crisis the housing bubble. Houses have escalated too far too fast and now they need to be adjusted to more realistic values. This will take time for people to adjust to and it will not happen overnight. Nor can we afford for it happen as it has in some of the most high flying markets where values have plummeted precipitously some 30 -40%.
Every time we reward corrupt and failed business policies or personal financial impudence to be bailed out by our tax dollars we do nothing but encourage the repeat of this abysmally aberrant behavior. What reinforces unacceptable behavior more than the tolerance and encouragement of such behavior. When we now turn to government to save those of us who made imprudent decisions we are in essence validating this reckless behavior. How is it fair that for those of us who have consistently driven in between the lines, lived our lives in moderation, paid our debts, sacrificed vacations and luxuries, worked multiple jobs or overtime if necessary to make ends meet, now be called upon to take responsibility for those who ran in the fast lane, skimmed all the cream of life, lived beyond their means and left the bones of the economic abyss for the rest of us to manage to get by on?
This is patently unfair and potentially divisive and incendiary. We are told we can't afford to let this get out of hand or it will take us all down with it! We must act now with premature thought, and willy-nilly policy and cast all are available resources at this problem swiftly and with little regard to the future consequences because to do nothing is too flirt with catastrophe.
I believe a fair and measured approach that focuses on housing makes more sense and has the potential to do more immediate good. I propose that instead of bailing out failed or failing homeowners, which does little to actually stimulate the economy, the government, in cooperation with the banks that they virtually now control, force the banks to restructure all existing mortgages of owner occupied single family dwellings. Both performing or non-performing. They could basically subsidize the lowering of interest rates to say 3% or 4% for these instruments across the board with a simple application. This would serve several purposes.
1) It would be fair and not simply reward those who were delinquent and in trouble.
2) It would allow those existing mortgage holders to reduce their monthly payments and would stave off further delinquencies. It would ameliorate some of the foreclosure problems that now exist and will likely prevent some foreclosures that may be imminent.
3) The additional disposable income for those who do not need the reduction could be used to stimulate the economy through increased spending and or redirecting these monies to other needs like the purchase/lease of a new auto, financing of educational needs or simple retail purchases. In the event that a large portion of people save this money it could be used as additional capital infusion into banks and could help loosen lending criteria for new business.
4) Any and all performing loans would not require any credit or income verification, would be made only up to the existing outstanding principal loan amount and would simply be re-caste with the new rate with no further requirements, no reappraisal, and moderate fixed closing costs.This would likely make it more universally accepted and at a minimal cost to the homeowner.
5) These re-financing's would create immediate work in that sector which is presently in distress.
6)It would reinforce the notion that while we need to correct this imbalance caused by excess we do not just reward excess at the expense of commitment and industry that are the backbone of a stable economy.
6) It would create good will and foster a positive outlook which will restore confidence in the system and our leaders.
While I am sure there are obstacles to such a plan I believe this kind of approach has a better chance of working to stimulate our economy and hold back the current of the present economic slide. It should also be welcome by a majority since it favors no one and shows unbiased fairness.
What is wrong with this picture? We are validating behavior that was basically imprudent at best and fraudulent at worst! Many of these homeowner's (more rightly they should be called debtors in possession) were unscrupulously lured into their present condition by easy money made possible by Greenspan and company's loose credit. Greedy and unregulated groups of mortgage originators, banks, packagers and rating agencies "gone wild" also contributed to this excessive liberal credit binge.
But ultimately aren't we all responsible for our own choices? No one held a gun to a borrower's head and made him sign the papers.
I am often amazed that the normally fiscally conservative groups that look to free market capitalism when things are good are so quick to give up on Mr. Market when things go too far off course. How do unspecified tax cuts help us out of this credit crisis? But we must jump start the economy and tax cuts are the way to go we are told. I don't see the connect if after all the recent tax cuts we have had we still got into the present situation.
If big auto is too big to fail, big banks like Citi and B of A are too large not to be saved and insurance giants like AIG that basically insured beyond their ability are too intertwined into all aspects of the economy to be allowed to be broken up and dissolved in an orderly fashion are not these free market advocates taking the next step into socialism?
Don't get me wrong I believe we need government intervention in these troubled times to set the boat right and start to steer away from the shoals of the economic abyss we let Wall Street and others steer us into, but intelligent, fair and measured government intervention laser focused on what started this whole crisis the housing bubble. Houses have escalated too far too fast and now they need to be adjusted to more realistic values. This will take time for people to adjust to and it will not happen overnight. Nor can we afford for it happen as it has in some of the most high flying markets where values have plummeted precipitously some 30 -40%.
Every time we reward corrupt and failed business policies or personal financial impudence to be bailed out by our tax dollars we do nothing but encourage the repeat of this abysmally aberrant behavior. What reinforces unacceptable behavior more than the tolerance and encouragement of such behavior. When we now turn to government to save those of us who made imprudent decisions we are in essence validating this reckless behavior. How is it fair that for those of us who have consistently driven in between the lines, lived our lives in moderation, paid our debts, sacrificed vacations and luxuries, worked multiple jobs or overtime if necessary to make ends meet, now be called upon to take responsibility for those who ran in the fast lane, skimmed all the cream of life, lived beyond their means and left the bones of the economic abyss for the rest of us to manage to get by on?
This is patently unfair and potentially divisive and incendiary. We are told we can't afford to let this get out of hand or it will take us all down with it! We must act now with premature thought, and willy-nilly policy and cast all are available resources at this problem swiftly and with little regard to the future consequences because to do nothing is too flirt with catastrophe.
I believe a fair and measured approach that focuses on housing makes more sense and has the potential to do more immediate good. I propose that instead of bailing out failed or failing homeowners, which does little to actually stimulate the economy, the government, in cooperation with the banks that they virtually now control, force the banks to restructure all existing mortgages of owner occupied single family dwellings. Both performing or non-performing. They could basically subsidize the lowering of interest rates to say 3% or 4% for these instruments across the board with a simple application. This would serve several purposes.
1) It would be fair and not simply reward those who were delinquent and in trouble.
2) It would allow those existing mortgage holders to reduce their monthly payments and would stave off further delinquencies. It would ameliorate some of the foreclosure problems that now exist and will likely prevent some foreclosures that may be imminent.
3) The additional disposable income for those who do not need the reduction could be used to stimulate the economy through increased spending and or redirecting these monies to other needs like the purchase/lease of a new auto, financing of educational needs or simple retail purchases. In the event that a large portion of people save this money it could be used as additional capital infusion into banks and could help loosen lending criteria for new business.
4) Any and all performing loans would not require any credit or income verification, would be made only up to the existing outstanding principal loan amount and would simply be re-caste with the new rate with no further requirements, no reappraisal, and moderate fixed closing costs.This would likely make it more universally accepted and at a minimal cost to the homeowner.
5) These re-financing's would create immediate work in that sector which is presently in distress.
6)It would reinforce the notion that while we need to correct this imbalance caused by excess we do not just reward excess at the expense of commitment and industry that are the backbone of a stable economy.
6) It would create good will and foster a positive outlook which will restore confidence in the system and our leaders.
While I am sure there are obstacles to such a plan I believe this kind of approach has a better chance of working to stimulate our economy and hold back the current of the present economic slide. It should also be welcome by a majority since it favors no one and shows unbiased fairness.
Wednesday, May 28, 2008
The Sad Truth about Current Autos
I was browsing through the Sunday Times and came across what used to be one of my favorite sections, the Automobiles section. This was the part of the paper that would usually bring joy to my heart by presenting the various offerings of the auto industry in all its glory and splendor. Growing up in an era when bigger, faster, sleeker or fancier was part of the thrill of checking out the new autos, the auto manufacturers usually didn’t disappoint my adolescent expectations. But with gasoline prices approaching the unheard of mark of five dollars a gallon and with diesel fuel, a once cheaper alternative, already over that benchmark, I for one am looking at the automobile section with completely new expectations.
Cheap gasoline has gone the way of the Edsel and its demise should have long ago rung the bell for smarter more fuel efficient alternatives for the motoring public. Truly we have ourselves to blame since we seem intent on traveling with all the amenities of our living rooms only on wheels, as is the case with so many oversized vehicles (names will be withheld to protect the guilty) that seem to have been the sales leaders over the past few years. Our suburban penchant for four wheel drive and its inherent fuel inefficiencies has become almost an imperative and for what? Few of us use the off road features so common on most SUV’s. Ninety-five percent of our driving time is snow free yet we pay for the extra cost in fuel one hundred percent of the time in the event we need transportation in an crippling snow storm (when we are most likely not to be on the road anyway) how does this make any sense? In all fairness we have been lulled by the automakers into believing we need all this extra fuel burning weight because, as most people know, it’s the extras that make money for both the automakers and the dealers.
Well people we certainly fell for it all hook line and sinker and that is shame on us, but now I like most people are looking for a vehicle that will be both utilitarian and fuel efficient. If Thomas Friedman is correct in his recent editorial about the effect all this excessive use of fuel is having on growing the wealth of our most dangerous enemies, enough wealth to buy General Motors in three days worth of oil revenues, then as patriotic Americans we can longer turn a blind eye to our shamefully negligent use of fuel in our pitifully inefficient vehicles.
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