Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Sunday, December 29, 2013

Military Commissaries - My 200th Post

Norfolk Naval Base Commissary 2007
When Mary and I married we went immediately (no honeymoon) to my first Duty Station, MCRD San Diego. We had so little money we had to borrow to pay the trucker to deliver our wedding presents from Wisconsin.  One of the first lessons Mary was taught by the other Dental Officer wives was how to save money by shopping at the Commissary, the best of which was a ferry ride to Coronado.  On the first trip she was admonished to continue shopping since they only made the trip once every two weeks.  She had to explain that she had spent her budget and had no more to spend until the next payday.

How she managed to not only put food on the table but develop into a gourmet cook remains a mystery.  She continues to shop at Commissaries to this day.

The idea of a commissary in the United States started as early as 1825 and by 1867 both Officers and Enlisted could purchase groceries for themselves and their families at cost.  The operation was in response to two factors, first from earliest times there were always opportunistic civilian merchants who took advantage of the military stationed in remote areas and second, the variances and vagaries of the cost of groceries in areas where the military was stationed, with no choice in the matter.

In 1899 the first foreign shore commissary was opened in the Philippines, the country were Mary and I had our first contact with an overseas commissary.  The different in off-shore operation was essentially a rationing of the goods available.  While a commissary in a large base in CONUS may stock over 11,000 items, we were restricted to about a tenth of that when we were there in 1963 and not too much more when we returned in 1983.  I do remember on our first tour that one of the items at Christmas time were Christmas trees, a welcome connection to families left at home.

DeCA Logo
In 1990 Congress established the Defense Commissary Agency, which combined the commissary operation of the Joint Services and set a 5% surcharge to assist in maintaining the infrastructure of the operation.  It is important to note that not then, not before and not until recently was any thought given to making the operation self-supporting, in contrast to the Exchange system.  It is estimated that the commissary privilege saves a family of four, $4,000 a year. A savings that allows many to survive on a poverty-level salary.  Mary tells me that it is a common sight to see military wives using food stamps for their purchases.

So I was surprised and hugely disappointed to hear that one of the items in the discussion of how to trim the DoD budget, now that some choice can be made in savings rather than the across-the-board cuts of the Sequester, was to triple the surcharge, close several commissaries, or possible eliminate the system, forcing military families on to the economy!

This is not only greatly short-sighted and a huge betrayal of trust, it is also one more indication that Congress does not understand the motivation that supports an all-volunteer force.  Of course why should that be a surprise when we now have less than 15% of our politicians who have ever served: and that includes many who were drafted.

I am hopeful that when the members of Congress return from their holiday they may reflect of the ludic racy of making a change in a policy set when many of their states were wilderness being protected by the soldiers-in-arms with those who they are now disenfranchising of promised and expected life-style elements.

Recently Bill Cosby was interviewed on NPR and covered how war has changed, in his characteristic, humorous, but thoughtful way.  In my next Post I’ll take off from his reflections with some of my own thoughts and observations.  It should be fun.  Please come join me.

Saturday, December 21, 2013

The Milk Cliff

As I understand it we are poised to go over the Milk Cliff on January 1, 2014, with the retail price of milk likely to double.  Holy Cow!  How did that happen?

Seemingly lost in the media discussion of the ACA, Sequester, and the budget compromise is any discussion of passing a Farm Bill, much less confronting the question of Immigration.

The Farm Bill is a piece of legislation that is presented as a modification of laws controlling all matters regulated by the Department of Agriculture, both foreign and domestic.  The bill is introduced in a soft five-year cycle, which explains why it does not seem to have the urgency of a budget bill.

Interestingly, in 1949 the bill included a component that allowed the government to subsidize dairy farmers by purchasing dairy products at $38.54 per hundredweight, which remains higher than the current price of approximately $18.  The subsidy remained essentially the same through the last iteration in 2008, allowing such programs as school lunches to proliferate.

And therein lays the problem.  Programs like the Title 1 school meals and food stamps have become controversial.  Not that they don’t do good.  As local Chairman of the American Institute of Wine and Food, I was well aware of their Days of Taste ® Program , which in Orange County meant we went into Title 1 Schools for two days, the first of which was spent in teaching food values, how to read labels, and the progression of food from farm to table.  The second day we gave them money and took them to the local Farmer’s Market where they shopped for their families.  I found out that WIC coupons were legal tender at the Market. 

When I surveyed my table of eight, after making the dressing for the communal Harvest Salad that followed out trip to the Market, I found that six of the eight had eaten fast food the night before, one had eaten Chinese (which was probably fast food) and one had eaten nothing.  The School Lunch program was their main source of nutritious meals.


First U.S. Food Stamps - 1939
But dairy also is a large component of the SNAP (Food Stamp) Program allowing the $135 per week to have higher purchasing power on nutritious meal planning.  Review of the 2008 Food, Conservation, and Energy Act was due for replacement by September 2013.  Since the rolls of food assistance has grown to more than 15% of the population or 47.7 million Americans at a cost of almost $75 billion a year,  there were serious concerns about how to control the costs inherent in continued subsidies.  A consequence was a plan to discontinue dairy subsidies entirely in the newly considered bill.

Opposition was so divided yin the Congress, that an extension was made until the end of the year.  But to the best of my knowledge that means that by the time Congress returns from the Holiday recess, we will have fallen over the Milk Cliff.
G. W. Bush
The House has done no further action since the proposed bill failed to pass in June 2013.  The senate passed their bill in June 2013, but it has received no support from the House, essentially because it does not address the Food Stamp issue.

Before I started on this post, I wanted to find out how much milk costs in today’s market.  I didn’t want to repeat President H. W. Bush, who may have lost his reelection because he didn’t know the price of milk.  Turns out it is about $2.99 a half gallon at the local supermarket and about a dollar less when Mary buys it at the Camp Pendleton Commissary.

Double that and milk is more expensive by far than gas.

While I usually try to keep my observations objective and not political, I find myself less concerned that  Barrack Obama has increased his gray-hair quotient by putting more people on food support than I am about how his actions have increased the gray in my hair since his election.

In my next post I will cover another somewhat political issue:  what about the military commissaries?  I would hope you will find that interesting.

Thursday, December 12, 2013

Navigators

Covered CA Home Page
I had hoped for some content information of what Navigators in Covered California, the California form of the ACA learn to help enrollees find the best plan for their needs in the Exchange, but after 7 telephone calls and one unanswered email, I must depend on what was released to the press about two weeks ago.  On one call I was put into queue as number 456 with an estimated wait time of 28 minutes.  I watched as the queue numbers ratcheted down and the wait time adjusted.  When it got to 5 and then 2 and finally 1 with a 3-second expected wait I suddenly received a message that the phones had stopped working and was encouraged to write the afore-mentioned non-responded email.

But I think I understand the concept.
In their November 30,Press Release Covered CA is pretty specific that Navigators exist.  They say:

SACRAMENTO, Calif. — Covered California™ has reached milestone levels in the number of professionals trained to help consumers, face to face, as they obtain affordable, quality health insurance through the agency’s online marketplace.

“We are adding in-person assisters by the hundreds each week,” said Covered California Executive Director Peter V. Lee. “Our presence in neighborhoods across the state is strong — and growing. Certified Enrollment Counselors, Certified Insurance Agents and county eligibility workers provide consumers with personal, secure and competent help in selecting a health insurance plan that fits their medical needs and budget.”
I have heard Peter V. Lee speak twice and he is exceptionally transparent in his message.  I also serve on several committees in the industry, including AHIP and NADP, both of which are trusted spokespersons for the insurance side of the ACA.

So, I was disappointed that I could not find out more about training than I did.  I am intrigued by several questions:

      1.      What is the potential growth of this group, called Certified Enrollment Counselors in California?

2.      What is the salary, and are there Supervisory and Managerial positions? (Think TSA growth in the years since 9/11).

3.      I know the Brokers involved are arms-length from any insurance company connection, is this true of the Enrollment Counselors?

4.      Is the work seasonal, like Tax Preparers?

5.      How have they recruited 6,000+ counselors, certainly not by fielding requests? Are they political appointments?

Ferdinand Magellan
I am sure the Navigators are not allowed comment on the problems inherent in the Act itself.  Like how can coverage be tailored to one’s lesser needs and still be affordable? How will the Exchanges absorb what is becoming large numbers of people who previously were covered by their employers?  And the big one: How can health coverage that varies so greatly from state to state, including what will be a covered Medicaid population and how will the children’s oral health benefit be defined, be termed a national Health Plan?
Ptolemy's map
It remains to be seen whether the December 23rd deadline will be extended, and how the insurance carriers will be able to handle enrollment.  I hope for the best and expect that the final product will be much different than what was in the 7,000 pages passed into law.

I remain curious as to the certification process for the enrollment counselors.  I believe the Navigators may find the cartography of the process showing the Sea Serpents pictured on the ancient maps.

Thanks to a very active and knowledgeable nephew, I now have four links you might find interesting that answer some of my questions:
1.   How many for how much?
2.   How safe is the Personal Health Information?
3.   How do you get into the system?
4.   How distanced from bias are the Navigators?

Somewhat depressing!

For my next Post I intend to take a serious/humorous look at what is being called the Milk Cliff.  I hope to see you there.

Tuesday, December 3, 2013

Privatization

A few weeks ago I posted on my Blog an article on a process called “Eminent Domain”.  I wrote and cited references for occasions where the conversion of private property to public use, or even the process of making zoning changes to increase public revenues had unintended and often unfair consequences.

San Francisco
Today on NPR there was a feature story regarding eviction of San Francisco residents, some of whom have been at the same location for more than twenty-seven years, in order to increase tax revenues and to upscale the demographics of the residents.

My single sister moved in her early career as an architect to North Beach in San Francisco.  She gave up her car and mid-western life style for the opportunity of life in a legendary urban city.  I visited her several times over the years and her joy was almost palpable.  Eventually she moved across the Golden Gate to the first and last home she would own.

As I listened to the commentator describe the forced exodus that would bring an end to rent-controlled living, I felt the description of “losing the artists and Bohemians who have described the city” was not far off the mark.

Last week I chatted up a Puerto Rican lawyer, while attending the Greater New York Dental Meeting.  He mentioned that his father, in the export business, had an office/residence only a few blocks from where we were at, near Times Square.  His rent was $75/month until 1985!  The controlled rent was costing the city, literally hundreds of thousands of dollars a year.

San Francisco wants their dollars!

In smaller cities those dollars are the backbone of the education system, the statistics which were released today show little improvement in comparison with other countries and even a serious reduction in math proficiency.

Philadelphia school room
A week ago or so, NPR featured the inner-city schools of Philadelphia and cast a concerned attitude over the privatization of the schools to profit and non-profit entities, many of whom receive their funding from state-supported Charter schools.  True, about one-third of the funding comes from the private sector; much from Foundations, but the consequence has been a serious negative change in the funding of the schools who teach the Black minority.  One single Black mother with three children and a mid-level job says there is no way she could afford to send her children to Charter school.

She also is concerned about the likelihood that entitlements, such as food stamps, are coming under increased scrutiny.

My interest in the subject of Privatization was sparked also by a solution to the California prison crisis, which is privatizing incarceration.  On one hand I find that a promising arrangement, especially since I have a modest investment in the CXW Correction company which has gained more than a third value in the 2 ½ years since I bought it, but it doesn’t bring jobs to California, and it doesn’t address the social problem of whom are we incarcerating?

So, if there is a point to this post, it would be to increase the transparency when changes are made to ownership or use of property, and that we should take a qualified, but serious look at what might be the unintended consequences of change.
In my next Post I plan to research what is happening to the field that has coined a new name since the ACA rollout; namely, what is a “Navigator” and how could I become one?  I think you’ll find it interesting.

Tuesday, November 26, 2013

God Points

Mary and I were on our way to a music concert at the Segerstrom Center and were enough ahead of the start time that I had no problem slowing down and allowing a car coming down the ramp to merge into the after-work rush hour traffic.  That driver soon slowed to allow entry into her lane.

“That’s the true value of God Points,” I said, almost as if inspired.

“God Points?  What are God Points?”

Never one to be without an answer (I have a coffee cup that says, “Have a question?  Ask Dad.  If he doesn’t know he’ll make something up.”) I answered that it was my own concept that when we die, St. Peter will meet us at the Gate and total up our God Points to see which of the “many rooms” we get to occupy.

The concept probably came from my subconscious, which was recently re-treated to an old FatherSarducci YouTube clip entitled “Life Is Work”, which I have linked to this Post.  His concept is that we are paid a certain amount for every day we live, but have to repay for our sins.

My concept is that you get points for every act of kindness or thoughtfulness you do that no one notices, thus inspiring them to give back in kind.  For instance, when I was obviously in pain and discomfort, standing after my hip replacement surgery, a TSA attendant guided me not only to the First Class line, but to the Flight attendant line when we were on our way to New Orleans.

Big God Points!

Standing in line at Trader Joes when I suddenly remember I didn’t get my butter and the clerk says, “Go ahead, I’ll ring it up while you pick it up.” And the first of several people behind me smiles.

Double God Points!

But once I blurted out my theory, I began to reflect on it and, perhaps like Bill O’Reilly who explains his motivation for writing Killing Jesus (Mary’s new favorite book) as inspiration from the Holy Spirit (I still remember when he was the Holy Ghost) I have fleshed out the theory.

My theory now is that you cannot gain or lose God Point opportunities until you reach the age of reason, which used to be better defined by the Catholic Catechism, but has gradually drifted into an age possibly defined with when you start driving or when you stop depending on others to make critical decisions regarding your safety, financial security or marriage.

Once you reach the age where you can collect God Points you collect them at first indiscriminately and later, when you better understand the concept, you collect bonus points by either seizing a choice opportunity or by finding ways to secretly mask your effort so that it becomes less known.  Double points come from your inspiration to the person you gifted, if they in turn provide similar kindness.

In the two weeks following our trip to the theater, I understandably have tracked my progress in gaining points.

Conclusion: I actually have increased the number of points I have gained.  Of course the fact that I am retired and time is on a different scale for me than others helps, but I think I am actually doing better.

Others?  Not so much.

I am besieged by Caucasian women, aged 25-34, who seem recently made aware that an automobile is a lethal weapon for which they hold the trigger.  Lines show a better result.  Even having given up my cane (except for a soon-to-be trip to NYC) I seem to attract compassion from people in line who give way for mall purchases, old age, or the threat that they make have to give CPR.

Whether you subscribe to my theory of God Points or just want to do something to make living in our culture a little more dignified, I solicit your support.

My next post is a spin on my Eminent Domain Post, which I am entitling Privatization.  Please check it out.

Wednesday, November 20, 2013

The Future of Football

Aaron Hernandez
As I write this there are ongoing investigations regarding three NFL players: Aaron Hernandez, from the New England Patriots who is accused of being an accomplice in a murder, and Jonathan Martin and Richie Incognito of the Miami Dolphins who are on opposite sides of a racist, bullying action that seems to be of more concern to the fans than to the players or their teammates.

NFL players problems with crime are nothing new, and the two mentioned are hardly the worst examples. Ray Lewis, recently retired with honors was charged with murder on his own part and escaped with a reduced charge of Obstruction when he finally gave up two “friends”, who were prepared to testify against him.  Probably the most famous was O.J. Simpson, who would be a free man today had he not decided to stage a Hollywood retrieval of his Heisman Trophy.

So what’s the big fuss now?

Helmet testing 1912
Much of it comes from the League’s own actions and rules changes, which are designed to demonstrate that concussions are unnecessary to the sport in spite of the growing awareness that more retired football players have brain injuries than boxers.


Junior Seau
The magnitude of the problem was exasperated by the death last year of Junior Seau whose cause of death was determined to be Chronic Traumatic Encephalopathy. Since then there have been a litany of players and player’s groups expressing their concerns in the media.  One of the more recent was Jim McMahon, a scrambling quarterback who received more than his share of bumps and bruises.


Frank Deford
One of my favorite commentators, Frank Deford recently visited this subject.  While eschewing the brutality of the game he reminded us that this has become a multi-billion dollar enterprise, responsible for much of the funding for colleges and a significant chuck of television programming, with consequent advertising revenue.

My younger son is a Physical Education instructor at a parochial K-8 school, where they have an active after-school program.  The fall sport is flag football, and that suits Tim well.  He believes students should not play serious contact sports until they are sixteen.  Most of the advantages of football: team-building, speed and agility, strategy, ability to be coached can develop as easyly in flag football as in tackle, and he wishes parents would let their children play in diocesan league rather than Pop Warner.

My grandson is in his sophomore year at El Toro high school, which graduates about 600 students a year.  He expressed an interest this year in trying out for football.  The school normally is a champion contender but this year seems to have fallen on hard times.  Ryan grew five or more inches in as many months but still weighs less than 130 pounds at 6’2”.  For whatever reason, he or someone changed his mind and I don’t mind a bit.  I hope he instead stays with basketball.  Even in Southern California the games are more comfortable to watch.

When asked whether he thought football would survive these concerns (sports sales for football gear is down 16% over last year) he opined that if you put 100 mothers in a room and asked how many would allow their sons to play, if  thirteen said “no”, it would only be a matter of time. 

Sixty years ago when I graduated from Mason City (Iowa) high school only one of our high school players received a scholarship from the University of Iowa, which was nationally ranked at the time.  As it turned out, he didn’t make the team, but I think it was largely scholastic-driven.

Nowadays scholarships are real, valuable, and represent a way out of poverty for a large number of players.  But there are true concerns that the “free” education may come at a high price.
In my next post I will share an idea that came as an Epiphany while driving recently.  If Bill O’Reilly can claim that inspiration for Killing Jesus came from the Holy Spirit, I may claim Divine inspiration for what I am calling “God Point”.  Stop on by.

Monday, November 11, 2013

Medal of Honor

It seems appropriate on Veteran’s Day to write a post about the Medal of Honor.  The subject came to me when recently there was news that an Army Captain was invited to the White House to receive the honor for action in Afghanistan.  What made the event newsworthy was that he had been denied a nomination for the medal because he had criticized his superiors for failure to provide requested air support during the 2009 action where he displayed his recognized valor.

The medal was the first medal awarded by the United States and almost half of them were awarded during the Civil War, including the only one awarded to a woman.  There have been almost 3500 awarded since its inception, almost 2/3rds awarded posthumously.  This is likely because two of the required conditions for nomination are conflict with an enemy of the United States and acts performed under conditions of grave personal bodily danger.

At least that is true of those nominations coming up the Chain of Command, which may explain why Captain William Swenson had to wait to get his nomination.  As it was he was the first Officer to receive the medal since Viet Nam, with the caveat that President Clinton awarded in 2001posthumous medals to several Black and Asian soldiers for action during WW II.

The only other living recipient since Viet Nam was Salvatore Giunta who rescued a majority of his platoon from a Taliban ambush, including a Sergeant who was being dragged off by two Taliban.  The other ten recipient’s medals were awarded to surviving family.

Congress also has the authority to nominate candidates for the medal.  Not surprisingly they have done so almost 200 times.  Most notably on the list were Richard E. Byrd for arctic exploration and Charles Lindbergh for his trans-oceanic flight.  Since Byrd was Navy and Lindbergh Army Reserve they received different versions of the same medal.

In some ways it seems unusual that the United States was such a late comer to the bestowing of medals.  Medals have long been a recognized means to honor past exploits and provide a means to form a cadre of elitism.  From my 26 years of service I collected a fair sampling of “fruit salad” ribbons and a couple for distinguishing myself in other areas than combat.  Each of the ships I was attached to had their ribbons also and for many of the crew they were a personal badge of honor.

But, if you follow the links for Sergeant Giunta and Captain (soon to be Major if allowed to rejoin the Army) Swenson, you will note what is almost the universal feeling of the recipients: modesty that they do not deserve what should have been bestowed on so many others in the action.

For the past several years, the Bay Area Navy League has hosted a formal Dining-in for survivors of the Battle of Midway.  This year I believe there were still nine, although one invitee was unable to travel.  I try to attend the ceremony, held at the Marine’s Memorial in San Francisco.  In conversation with one of these guests I heard exactly that.  With a wistful look in his eyes, he said, “I remember most of the days and I remember some of the events, but I will never forget any of my shipmates.”

Football seems to be hot news lately.  In my next post I’ll share some of my observations.  I hope you’ll join me.

Monday, November 4, 2013

Eminent Domain

In my general “easy-drive shopping” area of Southern Orange County, there is a small extended leg of the Laguna Hills Mall that houses my Optometrist and one of my favorite unique restaurants, Break of Dawn.  The former is of note because Mary steered me there almost twenty years ago when I was wearing my contact lenses and reading glasses about 18 hours a day.  Dr. Scott Anderson found me a candidate for and provided me with bifocal contact lenses, the technology of which escapes me, but reading glasses have ceased to be necessary and I can read scripts I hold and boarded lines for scenes with equal ease.

The latter because a friend, fellow parishioner and excellent chef quit his job as a chef for the Ritz-Carleton and opened a breakfast-lunch restaurant to be able to spend time with his physically handicapped son, who is thriving, thank you very much.

I never quite understood the detached section of the mall or why it happened in the first place, but both these operations were doing well and serving my, and other’s needs.  So, when I learned that a purchaser, with Venture Capital money had purchased the lot, intending to raze this section and build apartments, I was devastated.  How unfair!

Recently there was a story on NPR about how the Chinese government was forcibly relocating many citizens in an effort to better control the water in the country; a project that has repercussions through Southeast Asia.  Some of the displaced were setting themselves on fire, preferring death to a relocation that would most likely inevitably kill them anyway.

Vaguely I remember this displacement process as coming from a tradition of Eminent Domain, a phrase that varies from government to government, but essentially means property rights of an individual can be superseded by a greater need for public good, or in the case of the United states, public use.

An excellent early example is when William Penn, who was given land to establish the Philadelphia colonies by Charles II to repay a debt, chose to buy the land from the Lenape, who had claim to it, rather than take it for no compensation.  This practice made its way into our constitution in both the Third (quartering of troops) and Fifth (requiring just compensation) Amendments.

For the most part the right is used to provide for public properties, but has often been used to provide access for highways and railways.  The latter was a huge fact in the growth of Southern California when the Southern Pacific Railway annexed huge portions of land to develop access to agriculture.  The practice is very current still, as we see when the new Los Angeles Mayor is attempting to provide access to the LA Airport, which would require relocation of some prime real estate.

And the expansion of the practice from federal/national, to local/municipal, brings into play exactly the issue with my two friends.  If it is perceived there is an economic advantage to the municipality to convert from one business or use to another, the pressure to surrender one’s property, or in the case of these two businesses, cancelling leases expected to be continued, can be overwhelming.

I recently talked to Dee Nguyen, my chef friend, who told me that another property, relatively close will be refurbished with appropriate leasehold improvements and a seven-year lease shortly after the first of the year.  Dr. Anderson is included in a similar arrangement, and the apartments may very well prove to add to their customer base.

So, I am more comfortable now than I was several months ago.  I am also glad that I live in the middle of a block with seemingly no utilitarian use other than residential.

My next Post should be close to two events that are dear to me:  The Marine Corps Birthday and Veteran’s Day.  So I think I’ll see what’s current with Medal of Honor.  Come visit.

Wednesday, October 23, 2013

STD

I was infected with my first and I believe only, STD in my late twenties.  The carrier was my wife of long standing who is still with me and we both have long ago put that condition away in some dim recess of memory.  After all, it is exceedingly common, quite non-debilitating, and treatable.  In fact its name doesn’t suggest any type of social outcast: Herpes Labials, Herpes Simplex, or more commonly termed recurrent cold sores.

The problem with it is that recurrent part.  Once infected the virus hides, most likely in a nerve trunk, and surfaces as a lesion on the lips or vicinity thereof, triggered by a plethora of conditions, including: sunlight, stress, generalized weakened resistance, and sometimes just dumb bad luck, perhaps the day before a photo shoot or an important job interview.

Why this comes to mind at this time in my life is that number two son, recently definitely middle-aged as he is in mid-forties, just had a serious recurrence and, on the recommendation of one of his fellow teachers, asked me to write a prescription for Zovirax.

I was familiar with the product from Dental Meetings over the last several years, and had brought home a few samples, all of which seemed to be in a forgotten place when I had the need to use them.  So I wrote the prescription, and it seems to have been the promised miracle drug, clearing up the lesion from the “aura” stage without recurrence some two months later.

Where was that product fifty years ago?

The first treatment I remember came not from my dental education or even post-graduate education.  It was anecdotal and, as I remember it, called for placement of a red dye on the affected area and exposure to ultra violet light (pretty easy to find in Haight-Ashbury times).  Since the dye and the light are both carcinogenic I feel fortunate not to have traded an innocuous malady for a fatal one.


Rotavirus
The next treatment, also anecdotal is one I still use: daily doses of Bioflavonoids, which must have some effect since I can count on the fingers of one hand any episodes over the last multi-years since I began the regime.  I decided to see if the science supports the results.  What I found is that there are more disclaimers for the generic acyclovir’s effectiveness than are seen on afternoon advertisements for medication during afternoon reruns of Bones or Soaps.  The tablets, which are priced in the mid-teen range as to cost almost list themselves as placeboes.  Antivirals affect viruses but don't cure their effects. The ointment, which is what I wrote the prescription for promises little better, and has a price tag approaching $200, a figure short of the $747 that was on Tim’s EOB.  His copayment was $30.

I found a natural product (maybe my Bioflavonoids) competitively priced with the tablets as a five-day regime.

I thought I would see what the ADA had to say about advances in viral control: almost nothing since 2005, where they were still advising there is no cure for cold sores, and questionable improvement by treatment over letting nature take its course.

Being in the midst of recuperation from a total hip replacement I was impressed that the ADA supports the American Heart Association and the American Orthopedic Associations recommendation to make prophylactic antibiotic treatment for joint replacements elective.  Since I recently had to have my Hygienist confirm that fact before she would clean my teeth, I was pleased to see the ADA on top of that issue.

Later today I will be attending a Webinar on the Dental Quality Alliance Committee and metrics to follow to determine Best Practices for desired Outcomes.  It would seem to me that viruses should be high on the list of what we track, particularly as to how we treat their effects.  I recently wrote about the HPV and how directly it has been connected to Oral Cancer.  Michael Douglas has very recently put himself in the spotlight as being infected by the HPV during oral sex, and we have a vaccine for that virus!

Although my infection was much less specific, I believe there are things to learn from this prevalent condition.

I am intrigued by recent applications of a governmental right called “imminent domain”.  In my next post I’ll tell you why.  Please stop on by.

Tuesday, October 15, 2013

The Fifth Estate

There is a trailer showing now for a soon-to-open film titled The Fifth Estate.  I knew the term but for the life of me couldn’t remember why, or what significance it might have for today’s culture.  I told Mary that I thought the Fourth Estate was the press, but couldn’t remember what the first Three were.  We set off on our respective quests: me, to Google and Wikipedia (to which I contribute by the way), and she to the dictionary in our family room, a wedding present of 53 years, which is used almost every day.

She came up with a definition of the Fourth estate as being scientists.  I came up with the Fourth being indeed the press, but the first Three?

A complete surprise!

Parliament
Turns out the term was coined by Thomas Carlyle who paraphrased Edmond Burke commenting on a change in Parliament procedure that would allow the public to know what was going on in their government by letting the press attend sessions.  The press was termed the Fourth Estate; the first three being respectively, the Clergy, the House of Lords, and the House of Commons.  Prior to 1787, although the public had a say as to who represented them, they had no knowledge as to how well they did so.

William Randolph Hearst
Almost immediately the more liberal United States embraced the concept.  The press was tremendously influential in our politics, as evidenced in the Jingoism and Isolationist fervor surrounding the Spanish-American War.  Influence continued, as did the awareness of the value of the press in garnering public support for Executive agenda.  The press began to flex its political muscle with the rise of William Randolph Hearst, who moved into the large American cities and started what was called “yellow journalism”.  His power began to be used by political machines such as Tammany Hall to unify support from mostly new immigrants.

By the time I became interested in journalism, the press’s political influence was being edged aside by that of science, since the Cold War and the fear of The Bomb were making the populace concerned with the race between the U.S. and the Soviet Union for science mastery: hence Mary’s definition as to what constituted the Fourth Estate.
Julian Assange

Whoever chose the title for the film that explores the rather convoluted and interesting life of Julian Assange made an apt change.  The creator of WikiLeaks has certainly brought the influence of the press into perspective by morphing into what Social Media brings to the table.  Of all the changes we see in the print media: movement toward online reading, streaming, podcasts, news on demand, Yelp-like critical comment, and content condensation, none would seem to have gained more power faster than sharing information in a real-time manner.

Whether in the populist “spring” movements, Facebook and Twitter political influence, the whys and wherefores of drone attacks, or negotiating through the media, as we watch argument about debt ceilings and the ACA, there is no doubt that social media such as WikiLeaks have a profound effect on the political scene, not the least being how money is raised.
Benedict Cumberbatch

As one who has no dog in the fight, I am content to watch from the sidelines and marvel at the pace of change around me.  I am anxious to see what Benedict Cumberbatch does with the role.  I have been very pleased with what he did to reinvent Sherlock Holmes.

My next post is going to touch on a subject without being salacious: a STD.  Curious?  Come visit.

Thursday, October 10, 2013

Hip, Hip, Hooray!

similar to my right hip
Two weeks ago Wednesday I entered Saddleback Memorial Hospital at 1:00 PM for 3:00 PM surgery to replace my right hip.  Am I glad I had it done?  A definite yes!  Was it the “Sunday in the Park with George” experience, friends had suggested?  Not so much… It has, however given me some perspective on the procedure, elective surgery in general, and how the ACA may dramatically change our healthcare delivery system, some elements for the better.

I was definitely lacking in coping well with the three major adaptations involved in the procedure: loss of driving privilege and consequent dependency; change in sleep patterns, and change in routine.  My personal view is that the medical staff could have better prepared me for these before the procedures, which might have made for less stressful scheduling and smoother conditioning for my, euphemistically termed “Coach”.

Cobalt, Ceramic and Titanium
My recovery was complicated by a “bout with gout” that gave me serious pain in my right ankle, both knees, and my right big toe.  I have medication that is quite effective for my out and when I started taking that I rapidly got back to comfort in doing my exercises.  My goal for today is to use my walker, not for support as I walk, but for security, as I gain strength and balance to eventually move to a cane, and soon after, to normal, if cautious walking.

The first I learned about sleeping was at a class orientation where half of us were scheduled for hips and half for knees.  We hip people were shown tools to assist in dressing, eating and reaching, and our “wedge”;  a three-foot long by one-foot wide Styrofoam piece with Velcro straps that would be our new bed companion, for about four weeks.  Our old bed companion would soon find better accommodations, since sleeping exclusively on my back brings out the snoring in me.  The second night was the worst since Mary, now on the fourth level couldn't hear my cries for assistance.  She solved the problem the next night by adding a night light to help me orient myself, and by retrieving the Bosn’s pipe I used to call our children in for supper when they were young.

Last night for all intents and purposes I slept through the night, with no need to get up.  And I have adapted well to the changes in my routine.  Much of what I do is virtual, from home, on the computer with a few exceptions.  On the day of surgery one of those exceptions came in the form of a call from my agent for a CarMax commercial in LA.  The 11:30 audition didn’t fit with the 1:00 PM procedure and my agent seemed ok with that.  The next day, however, I got a callback for a Hyatt commercial.  I let them know I could make the shoot, but not the callback and asked for a reschedule.  Didn’t happen…

That experience made me realize how much the driving thing would affect my routine.  I usually try to go to my consulting job (about 50 miles away) once a week, although there is no contract or requirement to do so.  The commercial thing is another matter and to have Mary drive me for three hours for a 5-minute audition is unfair to her.  The driving she does with me as a passenger is predicted to be a month, although I’m hopeful for acceleration.  It has been mostly for social, with a couple exceptions: my driver’s license yesterday, a haircut on Tuesday, and some shopping, masquerading as Physical Therapy.

The vagueness of predicting of how long I will be a dependent passenger is understandable since the starting point of the patient varies significantly, as does the procedure, appliance, and recuperation from doctor to doctor, but I would think that planning the timing of an elective procedure should take into account the availability of the caregiver for an anticipated length of time.

Which brings me to one of my observations: I had no idea of the number of knees replaced in a year in the U.S. (about 600,000, with an almost equal number of knees).  I had been told that the procedure is bankrupting Medicare as people live longer and have desire, and perhaps productive need to have the procedure.  Cost containment has directed post-surgical home visits and disallows one I think would be cost effective: i.e., a pre-surgical visit my a Physical Therapist to the site of recovery, where one’s routine and environment could prepare the patient for recovery.  Even if this had to be paid for by the patient, it would be money well spent.

Perhaps this could be a Silver or Gold upgrade under the ACA.

My experience prompted me to look into what exists in books to prepare.  Most are very technical and I ordered two to read on my iPad.  I might write a book if I find a good illustrator.  The working title is, “Grandpa got a new hip, and boy, are we glad!”  But that will wait as my monthly Writer’s Club meeting on Friday complicates tickets we have to see Bernadette Peters.

There is a film opening soon called, The Fifth Estate, which reminded me that the Fourth Estate was very important to me in college.  Read my next Post to see what is the Fifth Estate and why we should shake the dust off from our notions of how important are the influential processes of our government.

Wednesday, September 25, 2013

ObamaCare

A year and a half ago I presented a lecture on the Affordable Care Act to a group of retired military officers.  It was full of uncertainties, but was timely since my position as a National Dental Director put me in close contact with the movers and shakers dealing with the newly passed law.  At the center of the presentation was an explanation of the Exchanges, which were scheduled to begin assigning members to health plans on October 1, 2013.

That date is one week from today and sadly to say I don’t believe there is one state or federal Exchange or one health plan prepared to meet that goal.  Let me explain what happened and what is likely to happen in the near and not-so-near future.

If you look at the diagram of what is an Exchange (attributes to Jeff Album of Delta Dental) you’ll see that the focus of the Exchange was on Small Group (businesses with more than 50 and less than 100 employees).  There was a reason for this.  The U.S. Health Care System kicked off with Kaiser in the late 1940’s as an incentive to provide tax-free income to prospective workers.

And, when you looked at the 56 million uninsured employed, persons in the United States, most of them were employed in Small Businesses.  So, if we want to expand the pool, and by the way, expand the risk pool to avoid healthy people choosing to be uninsured, we would need to put some teeth into requiring Small Business to insure their members.  That was the original intent of the ACA.

Then it got screwed up.

A larger number of uninsured were the Medicaid population.  These are individuals and more commonly family living below that “poverty level”.  In an earlier Post I covered how the “poverty line” was established but suffice it to say that there are two important components: first, the cost of common items included in a normal life style vary dramatically from region to region and particularly are greater in urban areas, resulting in a greater need for subsidies in our cities.  Second, most subsidies, such as food stamps and even cell phones, are not included as “income” in determining whether a family earns enough to advance beyond the poverty level.

The result is that the Medicaid eligible population in many states was financially untenable to support.  So, when the federal government, through the ACA, demanded that the states expand the health care offered through Medicaid, many states said, “No.”, even though the first few years would be paid for by federal dollars.

State options also came into play with the establishment of Exchanges.  Only about a dozen states, including my California, chose to set up their own Exchanges.  The rest fought the edit, demanding that the federal government set them up (or saying they would fight to the death the establishment of them).  And the feds have been slow in meeting that demand.

What can we expect?

A new occupation is the Navigator, a term used to define methods to steer members through the Exchange choice process.  Much money has been allocated for this function and none of it is going to actual health care.  One is reminded of how many are now employed by the TSA and how that has resulted in higher air fares with greater delays and poorer service.

One can also expect an early increase in premiums as the insurance companies cope with the new tax levied on the to support ACA subsidies.  We will definitely see huge variances in premium and coverage from state to state, since the definition of essential health benefits is all over the place.

And unintended consequences are already occurring: large employers (more than 100employees) are casting out expensive programs, such as Retired health, providing set amounts to place these people in the Exchange.  This population, by the way is exactly counter to the healthy population needed to make the Exchanges work.

And major health plans, such as Aetna, are choosing to stand on the sidelines to see how this plays out, lessening the competition among the big players that was expected to curtail costs.  My old company, WellPoint/Anthem, id a player in 12 states and in all 19 regions of California, but they are almost the exception, rather than the rule.

Regardless of how Congress settles the Fiscal Cliff and defunding of the ACA this week, rollout of the ACA will be delayed from the January 1, 2014 deadline, and the animal that we will eventually see is going to be exceptionally different from that expected in 2010.

Later today I am going under the knife for a hip replacement.  Sounds like a topic for my next Post.  Join me to see how it all turns out.

Thursday, September 19, 2013

Encore Careers

About seven years ago, when I was a willing casualty of an M & A, and found myself facing retirement.  I actually tried that for a couple of years, printing cards that said “Consultant” and waiting for the phone to ring.  My chosen avocation was Acting, and I did about three plays and got a new Agent, but I found my greater satisfaction was in independently joining the Trade Associations my companies had supported and working on committees to accomplish worthwhile goals in the Healthcare industry.  I spoke of this on my websites: www.deefitzgerald.com and www.DrDeeKay.com as “giving back”.

The concept has become quite popular; the most well-known celebrity being Bill Gates, who in 2008 gave up his business to a supporting staff and went full-time into saving the world from Malaria and other deadly diseases.  It turns out that there are literally millions of Americans aged from 50+ who have done similar things.  The term has been defined as a “second career attempting to help in a field understaffed, with little concern for financial gain.”

In my case the financial gain, if any, was the ability to write off travel and registration to meetings as a business expense, since I was making modest income from consulting.  Then, about the same time as Bill Gates left Microsoft, my consulting opportunities dramatically improved.  The beauty was that I still had ample time to devote to my Encore Career of committee work.

I spent some of that time writing my first book, Harnessing a Heritage, and subsequently a Blog, www.DoctorEclectic.com , and recently getting a new, more aggressive Acting Agent, MZA.  I have already been on six major project auditions and am hopeful something good will come soon.

The New York Times article referenced above was written before the bottom fell out of the financial market, so I assume the movement has slowed somewhat, but I thought I would test that theory when I returned to Mason City Iowa for my 60th high school reunion.  As a schmoozed my way around the room, noting that there was an increasing amount of sitting in my age group than at the 20th, I did fid a few interesting Encore Careers.  One gentleman, Brian Birch was showing his 2009 book, Highlighting the Good News, a 150 page synopsis of the Bible.  He also had the most recent translation, Arabic, with a rather unique tab system, allowing opening to certain favorite passages.

Peace Corps Swearing in 2008
A second attendee had completed three tours with the Peace Corps, but most were involved with family, a worthy endeavor, especially for those who have remained involved with the mid-western farms.  Very few children could remain on farms, many in their third or fourth generation, without financial assistance.

I can relate to that as, without my setting out to do so, I have become a financial resource for family in education, health, and housing.  And Mary has been volunteering as her Encore Career for more than twenty-five years, in teaching ESL, assisting in the library system, and raising funds for the Performing Arts.

I hope that reading this might stimulate some of my followers who have not done so, to look at opportunities for Encore Careers.  And, if you are so inclined, please comment to this Post of what you have done or are planning to do.

In my next Post, I plan to share some of my involvement with rolling out the Affordable Care Act and how that might impact us in ways we do not imagine.  My Encore work gives me a detached perspective that I think you will find interesting.