Thinking About Healthcare

Hi Everyone,

I've been a little under the weather recently, and so I'm thinking about Healthcare. We have an amazing system in this country. We produce innovative therapies, and we have a great average lifespan. People come from all over the world to be treated here. It's a really great time to be alive. Most of the diseases that killed people prior to the 20th century are now preventable or curable.

At the same time, just getting through all the hassles with the insurance companies can be a source of new stress related syndromes. Sure, it's great that so many people do have insurance coverage. And I certainly understand the need to reduce waste and fraud. But I know people who have spent literally years trying to get compensated for their out of pocket medical payments from the insurance companies whose premiums they have paid, and still haven't received a penny of what they are owed by the terms of their plans.

So I was toying with an alternative or two. I've heard that in some countries, you don't pay your local utility for Kilo-Watt-Hours, or BTUs of gas. You pay them for light and heat. That way it's up to the utility company to deliver them to you in the most effective manner possible. What would happen if we could pay our healthcare providers to provide us with health?

Could I find a doctor or medical group who would take 10, 20 or 100 bucks, or whatever makes sense, a month to provide me and my family with health? That way, I would go to the doctor once or twice a year, follow his advice, and be healthy. If I'm not healthy, he would be required to fix it at his expense. Of course, if I'm injured in an accident, that wouldn't be the doctor's responsibility. But the provider of catastrophic coverage would have lower costs if the doctor is doing the regular scheduled maintenance. It would be like taking care of a car with warranty coverage, no-fault collision damage and liability, and warranty against defects, so to speak.

Either way, like a car, I would be taken care of by the shop, and not have to wait for weeks, months or years to be reimbursed.

What is Truth?

Good morning everyone!

I just received this message and I'm including my response verbatim. Kathryn raises some good questions, and today's post just looks at them.

Have a great day!
Nick

###

Nick, What a brave endeavor! You website is very attractive and well written. I have a couple of suggestions on the introduction which I'm sending to you separately as I wasn't sure how to respond to just the introduction, or for that matter, how to post an idea or comment that isn't in reply to one of your postings.

I was going to suggest you use common words as I found myself pulling out the dictionary to get through the first two paragraphs. After looking up screed and recidivist, I understand why you chose them and congratulate you on an impressive vocabulary. Still, it might be off putting to some. Perhaps you could include definitions when you use uncommon words. Or, if that breaks the flow of your writing, perhaps the words could be linked to a definition that opens if someone clicks on the word. If that is too complicated, don't worry about making changes; I'll just keep the dictionary nearby.

In your introductory paragraph I'd suggest changing "explore the truth" to "explore ideas" or "explore opinions". Someone told me years ago that the truth is constantly changing and is different for different people. I was shocked and offended. I argued vehemently that truth is constant and never changing -- that's why it is the truth. I never considered truth could vary from person to person. Opinions could vary, experiences could vary, and values could vary but not the truth ! I was wrong. My truths are simply deeply held convictions and core values I that never questioned believing they were universally shared. Turns out they are not. One of the fundamental problems today, is that people are so committed to their own truths that they cannot see beyond them and they haven't examined what shaped them. Getting to the bottom of our different truths, means getting very personal and exposing the raw building blocks of who we are, what makes us tick and putting that out there for the world to see and comment upon. Very few people will do that.


Kathryn,

You're very kind. I can't take any credit for the appearance of the site, since I just picked one of the Blogger.com standard templates. I'm just a couple of days into it, so I'm not as familiar with the functionality as I would like. If you would like, I'll just post your comments verbatim in a new post, with my acknowlegement.

Good point about vocabulary. I've gotten so used to keeping a google window open with ___ definition in the search window, I sometimes forget that not everyone does the same. I'll give it some thought and figure out a way to make it more accessible.
I appreciate the point about truth, but I don't happen to agree. (And very importantly, I disagree with a good will, and remain fond of you; A statement I haven't heard in much in political discourse lately.) Although there is an element of Rashômon to any discussion of public policy, objective data do remain.

The sky is blue, measurable with certain scientific instruments to specific bandwidths with understood tolerances. There are x numbers of people engaged behavior y. We can disagree about how things are measured, how to interpret the data, what our working hypotheses should be, and what actions to take. So I will continue to extend my invitation to explore the truth together, and dialogue about our responses to it.

It may come down to a symantic subtlety, and it might be because we often use the word truth, when we mean some combination of beliefs and values.

The challenge I'm taking on is this; Can people of profoundly different world views, beliefs, and values, drill into the details together, get past their strongly held positions and come together in action that allow them to achieve some progress? I can well imagine in some cases it isn't even possible. But for others, I think people can surprise themselves.

As an example, one of the most hotly contested issues these days is abortion. It feels as though there are about 3 people on the planet that are lukewarm about it. For the rest, the other guys are so very wrong. But if the Pro-Choice and Pro-Life (Anti-Life and Anti-Choice, which ever way you want to describe it) folk could just sit down without hurting each other, they could discuss the actual situation. There are x millions of women who are pregnant every year, who may not want to be. Couldn't Pro-Choice and Pro-Life people both support efforts to help women avoid becoming pregnant in the first place, without compromising what they feel should be the public policy toward the unwanted pregnancies themselves? In the course to that work, the people from both sides could get to know each other as people, come to respect that they are acting on their convictions, and bring the level of discourse to another level. That's the sort of thing I hope for with this.

You may be right that many people wouldn't be willing to go through the self examination involved, but wouldn't it be a rewarding experience for those who do?

Thank you so much for writing.

Another Kind of Veteran

"Madam, I am the civilization they are fighting to defend" said Oxford Poetry Professor Heathcote William Gerard, when he was asked about why he didn't fight during World War One. On one level, that's a pretty arrogant statement. But on another level, it was perfectly true. Apart from that educator's not very self effacing assessment of his role and importance, it occurs to me that it may indeed be a very good way to honor the veterans that fought and sacrificed for him and us.

I never had the opportunity to serve, although I actually looked into it on more than one occasion. I love flying and thought the coolest thing in the world would be to be a pilot. When I found out that my eyesight wasn't good enough to be a pilot in the armed forces, I eventually achieved that dream on my own time and nickel (An awful lot of nickels, actually.)

As I thought more about it, I was drawn to the Coast Guard for a time. While the Army, Navy, Air Force and Marines have very important jobs to do, they do pretty much come down to killing people and breaking things. It has it's place, but I found the Coast Guard's additional missions of protecting boaters, saving lives and property, getting in the way of drugs coming in the country, and otherwise doing good, pretty compelling. So I applied for admission to the Coast Guard Academy. Didn't make it. They only take the best, and no political appointments. I sure would have liked to sail on the tall ship, Eagle, though.

A few years later, I looked into just joining up as an enlisted person. And they let me know that my sad old body just wasn't fit enough for them. So I never have been, and never will be a member of the military. I sure admire them though.

Right now, we have kids (don't I sound old?) with their lives on the line. And I'm thinking about what the best way is to honor them. Perhaps they would take some satisfaction in my living the life that their struggle allows me to lead; going to work, raising my son, loving my wife, voting in elections, going to the store, and enjoying the freedom that we've all got to share for almost 230 years. I'll even try to be a little civilized, if it helps.

...And all the weapons would just rust.

Many years ago, I had a wonderful professor in college named John Dumitru. He taught anthropology with a zest and enthusiasm that made all of us students curious about other cultures. He was also my faculty advisor when I was working on a special research project about, what we called transients then, now called the homeless. He encouraged me to get up close to them, talk to them, become one of them for a time, experience how they live, what it feels like. And he made it seem, not only ok, but safe, fun, and cool to do it. Not that being cold, hungry and dirty was safe, fun, or cool, but the complete immersion experience gave me a great deal of understanding I couldn't get any other way.

The reason I'm thinking of Mr. Dumitru today is that I came across a fascinating bit of recent research that reminded me of him. Mr. Dumitru had shared a hypothesis in his class one day that there is a correlation between war and affluence in a society. The thought was (in a very loose paraphrase) that when a very basic society is barely subsisting, there simply aren't the resources to risk on the venture of taking your neighbors goods. But as you get a little grain in your shack to come back to if you were to lose, then you are more willing to set out on a venture of conquest. Then as you become increasingly affluent, you lose the motivation to go taking the other guys things, because you have much more than enough. So the end game was that, if all societies just had enough stuff, they would stop fighting each other. And the direct quote I remember so vividly from a couple of decades ago was, "...and all the weapons would just rust."

As a 19 year old, I found that line of reasoning, and the vision, very compelling. And growing up in what would become Silicon Valley, the place where fortunes are created and dreams come true, it seemed just possible that I could work to create greater wealth for everyone, and they would all just get along.

Now there is a recent study from Harvard, that indicates that the correlation between terrorism isn't to poverty, but to liberty. http://www.news.harvard.edu/gazette/2004/11.04/05-terror.html. Associate Professor Alberto Abadie looked at the world with the assumption that terrorism has its roots in poverty, and when he tested that, found it wasn't so. Instead, he found a continuum similar to the one described by John Dumitru, but linked to the amount of freedom in a society. So when a society is totalitarian, there isn't sufficient freedom to commit a terrorist act. As more freedom is permitted, then there is the ability. And then when there is enough freedom, there isn't the motivation. I'm sure that's a gross over-simplification of Professor Abadie's work, but I hope I'm capturing the gist of it.

As compelling as Mr. Dumitru's vision was, I also questioned it's validity, since we do seem to be living in extremely affluent times. For a fun romp through just what strides have been made in providing material goods to the world, I highly recommend the first few chapters of Gregg Easterbrook's The Progress Paradox. It's a great mood lifter.

In the meantime, here's to a world with enough stuff, and the freedom to enjoy it.

I could be wrong...

The very first point I would like to make is that I could be wrong. I have my own opinions about elections and voting, abortion, God and religion, economics, business, international trade, technology and all the sorts of things that I hope you're interested in too. And I hope you enjoy exploring those opinions with me.

But first and foremost, I'm interested in discovering as much as I can about truth. Whatever my opinions may be today, I flatter myself as being rational enough to know I could be wrong. So I'm going try to do something that you might enjoy trying too. I'm going to try to explore the issues as though I was explaining them to someone from another planet, in language that is neutral, and makes no assumption about what that person may already know.

And I'm going to be open to being pursuaded by you that you may have a better way. If I'm sufficiently impressed by your reasoning, I just might change my mind. It's happened before.