Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Monday, July 30, 2012

The Cost of Healthcare

 Several years ago, at a meeting of America’s Health InsurancePlans, I listened to a futurist speak of America’s Health costs and what they might be in the future.  His approach was different from what I had been exposed to in the Insurance industry, where we are absorbed in Loss Ratios (what portion of premium actually goes into care) and Profit (what shareholders expect from their investment in the companies that provide health product and services).  His approach was from the perspective of what tolerance level the American public might have for supporting health care and what they might expect from that investment.

At the time, the U.S. was investing about 17% of the Gross Domestic Product in healthcare.  The devils in the details surrounding that are many, and he mentioned several:  What about the billions of dollars in over-the-counter medications and supplements included in that number? How to separate from the number what is making people healthier and improving quality of life from what is sustaining life? How to explain the U.S. position in infant mortality (quite high, relatively) and longevity (quite low, among industrialized nations)?  In short, how to analyze the bang for our very big buck?

He mentioned that, at that time, Japan was spending about 23% of their GDP on healthcare, but that much of it was going for diagnostic technology, much of  that at the consumer level.  For instance, they had an attachment on the commode that could check for colon cancer on a regular basis, thus increasing the likelihood of early diagnosis and successful treatment.  Similarly, saliva samples could provide early detection of many diseases at an affordable, self-provided level.  He suggested that the American public would be tolerant of a similar investment with similar expectations.

That must have been ten years ago, and I am struck by the fact that none of that seems to have been considered in the Affordable Care Act.  More important, little regard seems to have been given to consumers supporting the ACA for services they might actually find of greater value than the traditional services delivered by and paid to a health community held to little accountability for Outcomes.

President Obama is currently stressing how great the ACA has been in providing care for uninsured children under the age of 26, and for preventing denial of care for prior conditions.  Even before my retirement from WellPoint, both of these situations were embraced by the industry, and, partially in response to regulatory action, were being addressed at no additional premium cost, and there has been little effect on premium since the law required these changes, at least as a consequence of those two factors.

What has me terribly concerned are the planned conditions of future funding for providing care to many millions (300,000 estimated in Riverside, California) of new additions to the insurance roles.

For example, to support the program, there will be a new 3.8% tax on Capital gains.  Last year my Capital gains (a significant portion of my planned retirement) were more than $10,000, new tax $380.  Capital gains on property sales would also be similarly affected, in a depressed market.  Medical appliances, including anything from artificial hips, dental implants, and heart valves, to contact lenses, would be subject to a similar tax on SALES.  A friend in the health appliance industry says that the margin of profit is probably close to that number for established companies, and would exceed start-up costs so much as to guarantee no new entries in the field.  Those who might try would likely find themselves bankrupt and still owing taxes.

This post is too time-limited to discuss the true cost problem in healthcare, but in shorthand, it is caused by a payment system based on number of services provided instead of value of those services.  There is also a component that the U.S. has failed to make patients responsible for their own treatment, failed to prevent recidivisms (backsliding into unhealthy behavior), and failed to develop an efficient system for healthcare delivery.  If only trained Internists or family Practitioners can be trusted to diagnose disease and refer to trained specialists, we will never be able to provide necessary care, no matter how we decide to finance it.

Please feel free to comment if I hit a nerve regarding how you feel about the cost of healthcare.  I read and respond to every one.

My next post will be a little lighter.  I discovered a new word: murmurations and I think you will find facts surrounding it to be interesting.

Saturday, July 21, 2012

Romance

Perhaps it is because both of us like to cook, or maybe it has to do with the fact we are comfortable eating at home and often do take-out rather than go out.  In any case it was a rare occasion recently when, having boxed ourselves with events around our normal Friday suppertime, I asked Mary if she would like to eat out and she thought it an excellent idea.  I provided a selection of four local restaurants that we enjoy and she settled on King’s Seafood, possibly because we still eat seafood at least one night a week, usually on Friday, a carryover from days when our religion encouraged the practice.

Original King's

Abbott's Pier
One if the things we like about King’s, besides the fact that it is only about two miles away by surface streets, is that they commonly feature fresh Sand Dabs, a delicate fish I learned to love when working in the Bay Area up the coast and one I often buy at the local Farmer’s Market.  Another attraction is fresh lobster, of the Maine persuasion, for which our family traces a history including the seventh birthday of our oldest son (starting a very expensive recurring tradition) and my Commander Wetting Down party, a Navy tradition that in my case ended up with my being literally thrown off the pier to “wet down” my new shoulder boards, both events happening at Abbott’s Lobster House in Connecticut.

Abbott's
So we found ourselves seated in the cool evening summer air just off the main dining area: Mary with her Sand Dabs and me, working my way through the process of cracking shells and digging out small morsels of delicately-flavored lobster meat.  We were alone in the moment, conversation drifting from this to that, including memories such as mentioned above.

We hardly noticed another, quite young couple at a table a few yards away, and I suppose they hardly noticed us, as they were very engaged with each other.  At one point in time I did notice them and the fact that they were totally absorbed with each other, even sharing a gentle kiss before settling back to casual conversation.

After there were no more shells to crack, and we were on relaxed coffee time, I mentioned to Mary that I had been watching the couple and she commented that she too had noticed them and that it was part of what was a very pleasant evening.

As I paid the check and prepared to leave, I actually told the couple how they had contributed to our enjoyment and that you don’t often see what can only be defined as Romance anymore.  I asked if they were married, perhaps celebrating an anniversary. But as they shared a glance and smiles, they told me they were actually planning their wedding.

But then, the gentleman surprised me by saying that they too were watching us, marveling at the romance that seemed to permeate our conversation.  He asked how long we had been married and didn’t seem all that surprised when I told him. “More than fifty years.”

As we drove home we both remembered a time, many years ago, when we were travelling with our two sons, eight and four at the time.  We stopped in a little restaurant in a three-flight mall shop on the coast of San Francisco Bay.  After that meal, when I asked for the check, we were told that a gentleman, who had a shop in the complex and often ate there, had paid our check because, as the waitress said, “We were such a nice family.”

Although we stopped at his shop to thank him, he was gone for the night.  For the almost forty-succeeding years we have never quite understood what we did to make that impression, nor have we ever duplicated the impression or the consequence.

At least not until the other night.

I wonder if any of you have similar experiences of exuding a joy without knowing it.  Of casting off some inner feeling that was picked up by total strangers?  If so, share it, please.

Tomorrow we leave for our annual family vacation with kids and grandkids.  The week should give me time to reflect on a subject on which I have some knowledge: the cost of Healthcare.  Since I no longer have a dog in that fight, except my own, personal applications, I might provide some objectivity on what is certainly topical in the politics of the upcoming election.

Come on back in a week or so.

Saturday, July 14, 2012

Arlo Guthrie


Woody Guthrie
One hundred years ago today Woodrow Wilson “Woody” Guthrie was born, a fact that has been memorialized recently on radio and television.  One of the instances was a program on NPR with interviews of, among others, his granddaughter, custodian of his more than 3,000 lyrics, drawings and notes.  Another was a show on “A Prairie Home Companion” where Arlo, one of Woody’s eight children from three marriages, sang songs his father wrote and performed while he was alive.

I was reminded that Arlo has been part of my life almost since 1967 when his father passed away, not because of his famous father, but because of himself.

1967 found Mary and me in New England, to be more specific, North Cambridge, Massachusetts, where a ship I happened to be on was undergoing repairs at the Boston shipyards.  About that time Arlo was recollecting his Thanksgiving on a vinyl disc that was rapidly making its way towards number one on the charts.  The cornerstone of the album was a talking blues, eighteen minute ramble of episodes surrounding his Thanksgiving dinner at Alice May Brock’s renovated de-sanctified church, resulting in a cleanup “Massacree” where Arlo was arrested and held with “mother-rapers and father-rapers” primarily because of his anti-Vietnam War position.  Alice's house was less than an hour away.

The theme and the style of the song must have brought a smile to Woody’s face as he was lying in a hospital bed in New York, waiting to die from complications of Huntington’s disease.  Woody had been a protestor for his entire adult life and his influence remains to this day through his influence on, among others, Bob Dylan, who left his Hibbings, Minnesota home forever on a journey that took him first to Woody’s bedside to pay homage.


Family Legacy - 2005
Arlo - 2007
We continued to run into Arlo though the ensuing years:  Newport Folk Festival in 1969 and 1970, the 40th Alice’s Restaurant Anniversary Tour in 2005, the Family Legacy Tour in 2007, and a fairly recent appearance at the Cerritos Center nearby.

But, in addition to the music, Arlo became a familiar topic of conversation because a close friend was on the cusp of diagnosing and treating the disease that killed his father: Huntington’s disease.

Our friend began to show signs of dementia, well before one would expect Alzheimer’s symptoms.  More careful evaluation of her family history showed signs of hereditary causes: and she began to show signs of tremors.

The tremors or chorea have been associated with the disorder for hundreds of years but the first definition of the syndrome, and its genetic roots didn’t happen until George Huntington described them in 1872, and a deeper knowledge didn’t occur until the mid-1960s when Marjorie Guthrie established a foundation in honor of her husband to find the genetic markers and look for drugs that would lessen the brutal effects.  Our friend was diagnosed almost ten years later.

Suzie now lives in assisted living, seemingly no worse today than she was several years ago, beyond symptoms common to all of us at her age.  Mary and I were discussing her diagnosis just the other day, and the moral dilemma it presented.  At the time of her diagnosis she had three healthy, adult children, one of whom had twins.  The younger daughter and son weighed being tested for the markers for, what remains an incurable disease against the possible relief surrounding a “home free” clearance, and agreed to be tested.  Both were free from the markers.  The older daughter chose otherwise, believing that the possible repercussions to her boys, such as insurance problems, or even their following their father’s footsteps into military life, would be put in jeopardy.

There was no test when Arlo was growing up and one can only presume he came to grips with the uncertainty of his fate by ignoring the problem.  He even produced his own family, and from the looks of how they surround him, they bore him no ingratitude for his omission once a test was available.

I don’t know whether I would want to know about a potential health calamity or not. There is now a genetic marker for some types of breast cancer and in my field, dentistry there are salivary tests showing promise for diagnosing everything from Periodontal disease to ovarian cancer, so soon many of us will have to make choices of “to know” or “not know”. I am a bit of a fatalist and believe what God has in mind for me is what I should accept, and knowledge helps us prepare for those we will eventually leave behind so I think I would probably get the tests..

What would you do?

My next post will share with you an unlikely event that happened to Mary and me when we were dining the other evening.  Check in and see.

Sunday, July 8, 2012

Spoiled Kids

Mary is my clipping service: for the OC Register, the LA Times, and for, among other of the several magazines we subscribe to, The New Yorker.  Last week she dog-eared an article that she thought “(I) “… might like”, from the July 2 issue, titled, “Spoiled Rotten” by Elizabeth Kolbert.

She was correct.

Very thought provoking, Ms. Kolbert explains two studies an Anthropological friend was engaged in: studying how children are taught responsibility in different cultures.  She contrasts a six year-old Peruvian girl who assists a family, not her own, on a trip down the Amazon by, among other things, catching and cooking crustaceans, with one of thirty-two middle class Los Angeles families, where an eight year-old girl, sitting down to her place with no silverware complained, “How am I supposed to eat?” and her father got up and fetched her a spoon.

She quotes an author who coined a word called “Adultesence” to describe the delay in entering adulthood that is a consequence of parental indulgence, a delay that Ms. Kolbert feels may result in a generation ill-prepared to operate practically in the world they will inherit.

Los Angeles Public Radio features a program called “To the Point”, hosted by Warren Olney.  Mr. Olney must have been as impressed by the article as I was because he featured Ms. Kolbert and three other authors or educators on the show.  I have linked the show to this Post and it is worth the 43 minutes it takes to listen to it.  Mr. Olney prides himself on a balanced presentation of timely issues and he provides balance here.  For instance, his guests make the point that one of the reasons our children do not raise their children the way they were raised is because as two-income families, they find the efficiencies of doing things themselves rather than teaching their children to do them practical, because they cherish their own private time too much to waste it educating their children.

However, I find that an insufficient explanation as to why my grandchild was breast-fed until he was seven, nor why five year-olds cannot tie their shoes (when they wear them).

One of the “To the Point” guests was Steven Mintz of Columbia University.  I found one of his points particularly interesting.  Asked why the Peruvian natives are taught to cut grass with a machete by the age of three, he observed that Abraham Lincoln was helping his father clear land in Indiana when he was two, but so few people in the U.S. live agrarian lives that there are no current comparable opportunities.

One of my goals when writing my book:”Harnessing aHeritage” was to provide tools to allow our children or grandchildren to begin collecting memories of meaningful events in their lives.  After reading Ms. Kolbert’s article and listening to Mr. Olney’s show, I realize now that I should have had loftier goals: providing opportunities to ready our children and grandchildren for life itself.  Perhaps we are putting so much emphasis on education for education’s sake, that we are forgetting the practical side of life-preparedness.  Perhaps there is a reason that something like 65% of college graduates cannot find education-centered jobs the first year after graduation.

I know I am now approaching my relations with my grandchildren a little differently.

Do you have any comments on this topic?  Please share them.

In my next post I am going to visit a recent guest on another Public Radio Show, “Prairie Home Companion”: Arlo Gutherie.  I hope you will find it interesting.

Sunday, July 1, 2012

Ray Bradbury



Ray Bradbury - circa 2009
About four and a half years ago I attended a fundraiser put on by the Friends of the Laguna Beach Library.  The speaker was a then 87-year old bespectacled unimposing man who was wheeled into the room and apologized for not standing. 

The man was Ray Bradbury, down from his Los Angeles home and to this library in an affluent California beach city because budget cuts were threatening the continued ability of libraries to remain open: libraries that for him were self-described alternatives to college for those who had no money.

As he spoke in generalities and specifics about why he wrote every day since Mr. Electro touched him on his nose with an electrified sword and told him he would “Live Forever” in 1932, and what he wrote on those daily excursions, and how writing is in most of us if we just remained observant of what goes on around us, I found myself drifting back to my memories of reading what he had written, some in school as assignment, more in discovering life around me, in college, in marriage, and in life itself as it developed.

Both Mary and I were Bradbury fans before we married, probably for different reasons.  I had gone through what might be described as a Science-Fiction phase, devouring Robert Heinlein and Isaac Asimov and discovering the "Martian Chronicles" along the way.  She had felt a closeness with his loosely autobiographical stories about his early years in Waukegan, Illinois, since many of his experiences mirrored her upbringing in nearby Janesville, Wisconsin.


Early in our marriage we began attending a group that discussed The Great Books and books and the discovery of books became a topic of conversation.  We both found ourselves attracted to the background that led Bradbury to write “Fahrenheit 451”, namely that possession and reading of books could be considered a crime.  Bradbury said the inspiration for the theme was given him one night when he just began to walk aimlessly on a city street and was stopped by a policeman who seemed suspicious that someone would walk without a definite purpose or destination in mind.  If walking could be considered a crime; why not reading?

In researching this post I found many interesting facts; not surprising when you consider the man’s age and a career that produced more than 300 stories, numerous plays and screenplays, radio and television writing for giants like George Burns, Alfred Hitchcock, and Rod Sterling, and occasional poems and essays.

Basement Office
For instance, one of his fondest memories was being asked to write the screen play for John Houston’s “Moby Dick”.  His basement office, where he wrote until the last weeks of his life has memorabilia galore, which he claimed inspired many of his stories.  Paramount in prominence are items from his time in Ireland, where he would spend evenings keeping Houston company while drinking Irish whiskey and telling stories.

He was fond of contrasting the idyllic peace of his youth in, what he called Green Town with the adventurous and exotic environs of places like Africa or even other worlds.  One of my favorite stories is “The Veldt”; set in Africa where a house has so many features it can raise the children without parents.  Mary and I share a famous favorite, “Dandelion Wine”, which linked together several short stories set in the Midwest, recalling for us our own youth.

I found two items that are still available that I intend to buy: a DVD titled “Ray Bradbury’s Chrysalis” that came out in 2010 and a CD titled “Bradbury 13” recorded that same year: an audio book featuring, among other stories, “The Veldt”.  As I make my way through those, I’ll remember the pleasant evening at the Laguna Library and the memories evoked by a wonderful, prolific, man.  You’ll find links in this post that will allow you to find your own way to rediscovering Ray Bradbury.  You also might enjoy the link to his “100 Short Stories” where you will find reflective reviews from many readers of all ages.

In my next post I’ll share a recent article in The New Yorker that looks at how American middle-class families are raising their children.  What this Anthropologist found may surprise you.

Do you have a favorite Bradbury story?  If so, comment me what, and more importantly, why.