Tuesday, June 16, 2009

Health Care Dollars Dilemma

What kind of health care system we may have.

Health care dollar costs rhetoric heats up presenting a dilemma for some. Increasingly articles on the topic are published such as this recent one “The Cost Conundrum” by Aatul Gawande in the June 1st New Yorker. Thanks to Bob Frank who infrequently writes at “Eclectic World” for bringing it to my attention. The article is lengthy but filled with specifics and an overall view of the attitudes and influences that are being brought to bear on health care quality and costs in America today. The author cautions what kind of health care system we may have. Your time will be well spent reading Mr. Gawande’s article as he describes what specific towns can “…teach us about health care.”

Mr. Gawande begins by investigating health services in a certain Texas community he describes as being “…one of the most expensive health-care markets in the country.” He provides the dollar figures Medicare spent there in 2006 as being “…fifteen thousand dollars per enrollee…almost twice the national average.” Another well known Texas city spends half as much. What could account for this difference? You might be surprised what he learned.

Mayo Clinic in Grand Junction, Colorado, operations are also presented where he reports medical problems went down and quality went up. He adds, “…costs ended up lower than just about anywhere else in the United States.” He names communities from Danville, Pennsylvania through Wisconsin, Salt Lake City to Northern California utilizing similar operational approaches as Mayo who demonstrate comparable results.

Arguments from both the expensive and the least expensive systems proponents are not immune to the negative features of each approach their opponents cite. Both supporting groups agree we all want quality care and at the lowest cost especially knowing that overall we have runaway health care costs whose payment we cannot sustain. But what kind of system do we want? How do we get that system and are there sacrifices?

Our present mishmash of public and private medical insurance systems while trying to deliver quality care to meet patients needs is also being expected to maximize the individual provider’s reimbursement rate, Mr. Gawande writes. I’ve certainly experienced and been aware of some of the pressures that can be brought to bear in that regard. There can be a bit of a conflict between providing quality health care and income generation for some. Restrictions are instituted, corners are cut. I want to stress that many in the medical and related professions have resisted all that as have I.

I remember only too well years ago when service cuts were being made. Medical practitioners were admonished to refocus from merely providing quality care to additionally focus on the financial aspects of their work to augment declining income. Insurers and practitioners honed those business skills. Some business people took over medical groups dictating their own orientation. Medical people did become business people, too, with varying priorities in the quality/financial arena.

Mr. Gawande’s article illustrates various aspects of combining desired quality health care with a business orientation. He contends a team approach for quality care and revenue generating such as the Mayo Clinic’s system is more likely to provide us a viable health care plan.

Health care’s providers as well as consumers – that’s us – must adjust our thinking to realities Gwande documents including the whole idea that “more is better.” Seems in medical care as well as other areas of life that concept is not necessarily true. Maybe, we should all keep in mind seeking all the medical tests or procedures known to be available for any given problem is not always the better part of wisdom.

Doctors order most tests because they need to know the results which will effect a patient’s treatment. That's certainly why I recommend some procedures and medical consults. Physicians are also often pressured by patients and/or family members to provide tests for personal reassurance. Also, like it or not, given this sue happy society in which we live, the wise medical practitioner may need the occasional documenting test to justify his or her actions when treating unclear ever-changing medical complications, especially when coping with contentious individuals.

Mr. Gawande examines a broader picture here relative to just what kind of health care system we want. He views the issues as far more critical than whether or not we have a single-payer system, a public-insurance option or the mix of private and public as we have now. To best understand the stakes he describes you must read his article. His account is very readable, revealing the thought processes at work with the health care doctors and administrators he describes as presenting representative attitudes prevailing throughout the medical world in our country.

Many of us have spoken out loudly and clearly that a single-payer system is desired. Some have cited systems such as exist in Canada and Great Britain as models. I can endorse those models only if the major weaknesses of those systems are corrected in any such system we might adopt here:
1. provision for timely delivery of services,
2. provision for only specified short term duration treatment waits for a special group of medical diagnoses not directly life-threatening.

I definitely want our nation to have a system in which everyone receives health care. I also think functional sensory or augmentative systems are essential basic needs for each individual. What that means is:
1. people need dental care, teeth (artificial or otherwise) so they can eat and talk intelligibly.
2. people need vision care, glasses so they can see.
3. people vitally need to be able to hear, aids if they choose, so they can understand.

Augmentative communication systems are vital for many that are not always readily available.

We need to closely track what our current leaders are doing relative to the insurance system adopted for us. We definitely must have some action. Frankly, I believe we all deserve an insurance system at least as good as what we provide our Congressional Representatives and Senators. They’re all better equipped financially to pay for their own insurance and medical bills if they had to than most of us. Given their failure for so many years to resolve our health care system problem we cannot avoid the truth before us that they just aren’t performing well in their jobs. Now is the time to hold their feet to the flame on the health care system issue.

We won’t be remiss if we communicate our views by whatever means is at our disposal to those we’ve placed in office to carry out our wishes.

Thursday, June 11, 2009

Auto Mourning -- Chrysler

I’m in mourning for America’s auto industries major manufacturers, Chrysler, General Motors and Ford. Major changes and bankruptcy are impacting Chrysler and GM. Ownership of Chrysler is now shared with an Italian company, Fiat. GM’s status is more uncertain as is their bankruptcy filing since they do not yet have a suitor to share ownership.

I feel some anger toward these auto industry companies because I believe their executives and boards of directors invited their own downfall by failure to plan car designs and environmental operational changes for the future. I also believe auto consumers must share a portion of the responsibility for their demise since they persisted in recent years buying large monstrosity gas guzzling vehicles reinforcing the auto manufacturers desire to please them.

Vehicles my family has owned in long years past have not always been the most gas efficient, but we did come to recognize the nation and world's conservation environmental needs long before these auto companies apparently were willing to do. We certainly didn’t welcome the most egregious offending vehicles of the past ten years or so. Had we been young with younger children/youth and their athletic, and dancing teams to transport hither and yon, perhaps we might have succumbed to the lure of some of those large bus and truck-like transportation units. I do realize some of them are more efficient then certain regular autos we see driving about, but each of us will have to assess our own transportation system versus polluting concerns. We clearly must adapt now to changes, either willingly or otherwise, given our country’s economic state and the environmental issues facing our nation and planet.

I recall some of the very first automobiles I owned, the thrill and sense of pride I felt purchasing my very first car. Most importantly to me was the feeling of independence that owning a car gave me. I could go anywhere, anytime, on my own.

The day came when I could finally afford my first car -- used, of course. My choice was made following the trusted recommendations of a family member mechanic who had performed repairs on all the major auto company brands. He concluded Chrysler products would hold up best and be the easiest for a mechanic to repair, so I gave serious consideration to his advice. Today's auto repairs are quite different and I've since owned other auto brands.

That first car was special as the first of many experiences in our life tend to be. Somehow, in a manner I’ve long since forgotten, I became aware of a 4 door blue Chrysler sedan, a 1950 New Yorker, I think. In retrospect, I long ago realized that was hardly the kind of car a single girl in her mid-twenties needed. But I was assured by my mechanic the car was in good operating condition and was a good value for the price. Also influencing my purchasing decision was that the car was my favorite blue color. Another attraction was the Chrysler had an early version of the automatic transmission. All I had to do was let up on the gas pedal and adjust the stick shift on the steering wheel each time I wanted to shift gears -- a coordination that wasn’t difficult to learn.

This semi-automatic gear shift was quite an improvement over older model cars with a straight stick gear shift on the floor. That old way of shifting gears required the driver to use one foot pressing to the floor a clutch pedal in coordination with a gear shift by hand, then slowly releasing that foot pedal clutch while pressing the gas pedal with the other foot for just the right acceleration. Poor coordination resulted in jerky forward or backward car movement or maybe even stalling the motor. Many a driver became frustrated or enraged other drivers with erratic car motion trying to develop their driving abilities.

Beginning drivers and good versus poor drivers using these older standard car transmissions were judged klutzes or pros by their ability to perform this coordinating driving skill smoothly. Most drivers, including me, had their share of jerking, stalling driving moments. Getting stuck in slow traffic, or worst of all having to stop going up a hill offered it’s own challenges to keep the car motor going, then resume momentum when traffic started again. I became quite good at driving smoothly with standard transmission cars, but relished my Chrysler's semi-automatic automotive advance.

Here’s an interesting look at Chrysler cars from 1950-1959 provided by John MacDonald.

I hope our nation’s automotive industry becomes independently strong in the future providing the type of transportation needed in our nation and the world.

Thursday, June 04, 2009

Minimalist Communication


The time has come to recognize that communication is completely evolving to a minimalist state. Traditional phone calls as we’ve known them during which individuals actually talk back and forth with one another are becoming, and in some instances have already become, obsolete. Wouldn’t you know this situation occurs at a time within our country, and in some cases all over the world, when the long distance phone calls can be made at no extra charge.

Much of my life these distant calls cost a premium. If you made such a call for pleasure everyone in the household took turns talking so you could get your moneys worth. Usually the long distance phone call was placed only in an emergency situation – generally because somebody had died. When you stop to think about it, that was a little late then to be calling.

I first became aware this minimalist communication evolution was beginning to occur a number of years ago. Movie makers began shortening most of their films lengths to two hours duration to accommodate television programming time periods. They began to cut out parts of longer movies. Gone have been the films whose story was best told with content that could extend beyond that two hour limit by even five minutes, much less an hour or more. Some movies would be better if compacted into fifteen minutes, frankly, but I usually don’t watch that type anyway. There are also movies whose plot might benefit from being stretched out past that arbitrary couple of hours.

Movies are not alone in experiencing this trend toward brevity in all things. Stage theatre has given way to two act productions from three. Often those two acts are filled with lots of scenes. The long traditional three act play exists now only in the resurrection of classic productions from yesteryear. Many of those are being adapted and shortened in the process.

This time/content compression trend continues to expand. Soon long blogging essays may well become relics of the past, giving way to a combination of text messaging, twittering, and whatever new scheme is created. I’m no authority on either texting or twittering. I confess I only recently tried texting once and have never twittered. Well, maybe I twittered in my younger days, but I think we called it something else that had nothing whatsoever to do with typing alphabet letters and words.

My recent effort at text messaging occurred because someone sent me a text message requiring a reply. I had never read any texting directions in my book of cell phone operation instructions. The book was supposed to be a ‘how to’ manual, so I was at some disadvantage replying appropriately. My cell phone had so many features on it beyond those for my immediate needs, I figured it could take forever to learn all of them at once, especially when I saw the size of that manual – longer than some novels. I mostly add phone feature skills to my repertoire gradually, one by one, through trial and error. So it would be with texting.

There was a slight hitch as I fumbled with the cell phone, because I could never be sure which of the three alphabet letters above the keyboard number I selected would show up in my message. It surely did create some strange but interesting words. The recipient of my reply and I still laugh at the convoluted twisted spelling of her name which she now uses as an alias. I realized that must be how some people come up with the name they give their newborns today, ‘cause there sure are some strange names I’ve encountered.

Texting, as I understand it, involves a lot of abbreviations and phonetic spelling of words. So, we’d get something like: i c u r dun. LOLFOTFL – Then, guess you just type these short little ditties, or longer if you like, back and forth with whoever you’re texting with.

Twittering, I’m told, places a 140 letter/symbol limit on the length of the message. FWIW the preceding sentence is composed of about half the specified number of letters/symbols allowed. (This last sentence is too long to complete the other half of the allowed message length.)

So, you see that short Twitter paragraph of two sentences above is TOO-OOO LONNGGG!

If blogging posts are going to evolve to Texting and Twittering criteria, I’m wondering if I should start trying to adapt my pieces now with these simple rules:
1. Use abbreviations, phonetic spellings only
2. Message is limited to 140 letter/symbols
3. Remember KISS

Here’s my piece for today:

Im sare 4 gm, krislr wrkrs. Y duz r tax mune go 2 biznes, banks, wal strt, naht foks?
Y do progrms tax kts hrt pur, old, sik, disabld, retird? Whn wil al hav helth kar?

(Note: my Word automatic spell corrector is going nuts with these last two lines I typed.)

If Text ‘n Twitter 140 words/symbols isn’t long enough for you, check out this link for Twitzer, then you can Text’nTwitterTwitzer, or Text’nTT. (Twitzer is a Firefox extension: http://shorttext.com/twitzer.aspx)