In the book, Abraham by Bruce Feiler, he tells the story of an American who after winning fourteen thousand dollars on Wheel of Fortune, decided to come to Israel for a year. Fifteen years later he hadnâ€™t left. He tells a story to answer why:
Two brothers live on either side of a hill. One is wealthy and has no family; the other has a large family but limited wealth. The rich brother decides one night that he is blessed with goods and, taking a sack of grain from his silo, carries it to the silo of his brother. The other brother decides that he is blessed with many children, and since his brother should at least have wealth, he takes a sack of grain from his silo and carries it to that of his brother. Each night they go through this process, and every morning each brother is astounded that he has the same amount of grain as the day before. Finally one night they meet at the top of the hill and realize whatâ€™s been happening. They embrace and kiss each other.
And at that moment a heavenly voice declares, â€œThis is the place where I can build my house on earth.â€
â€œThat story is shared by all three religions,â€ David said. â€œAnd our tradition says that this is that hill, long before the Temple, long before Abraham. And the point of the story is that this degree of brotherly love is necessary before God can be manifest in the world.â€
â€¦This is not only the Spot where it is possible to connect with God, itâ€™s the spot where you can connect with God only if you understand what it means to connect with one another.
â€œThe relationship between a person and another human being is what creates and allows for a relationship with God. If youâ€™re not capable of living with each other and getting along with each other, than youâ€™re not capable of having a re1ationhip with God.â€ He gestured up at the Wall, the Dome, the churches.
Then he turned back to me. â€œSo the question is not whether God can bring peace into the world. The question is: Can we?â€
Here’s the rest of our draft ideas about health care reform. See the first part of the list HERE.
- We â€œrationâ€ now; the main question is whether we want to ration by what really works or by running out of money.
- Americans bear some personal responsibility for the rising costs; weâ€™ve gotten heavier & heavierâ€¦70% of all health care costs are lifestyle dependent.
- The current system encourages more treatment over better care; we need to flip incentives to de-incentivize quantity and incentivize quality.
- Reform requires increased power & choice by consumer; has to be patient-centered both in an economic and a clinical sense.
- Consider the concept of incremental improvements. Good results start with imperfect beginning.
- Lose the search for a villain; itâ€™s not helping us address the dysfunctions.
There is no magic bullet; one solution wonâ€™t do it and real change wonâ€™t come easy.
- Everyone â€“ hospitals, insurers, doctors, patients, attorneys, the government â€“ has skeletons in their closet. The solution needs to have many fronts.
At this week’s Dinner at the Square we gave away door prizes by picking cherries with numbers on them out of a bowl. It was our little way of coming down firmly against cherry-picking facts.
Cherry-picking is epidemic these days. People use it as a launching pad for their fury. You see, if you can ignore the context of the many facts surrounding a problem, a situation, a person, an organization – then you can continue in your self-righteous fury unabated. And self-righteous fury is sooo the new lazy.
Gone are the old-fashioned days when more of us sought to understand each other, tried to grasp the facts, and might have even given putting them in context a go. Anger is sometimes the appropriate response after all that, but these days it’s out-of-the-starting-gate-de-rigueur.
Our institutions are beginning to reflect our hair-trigger fury and bent towards preferring only the facts that support how we want to feel. The market-tested-out-the-wazoo-uber-individualized culture we live in knows exactly what we want and we want fury. And they’re all about giving us what we want. Fury is good for ratings. We have whole evenings of programming devoted to cherry-picking in service of fury. It sells newspapers too. (Or maybe it doesn’t because really furious people aren’t usually mollified by being thrown bones. They’re like fury crack addicts who will just want more.) Maybe we’re getting the television, the newspapers, and the Congress we deserve.
Picked cherries lately?
Here is a draft of wisdom drawn from our work learning about health care. It doesn’t yet incorporate last night’s input from our very wise panel. We know it will be hard, but part 2 is tomorrow.
- The current rising prices of health care are unsustainable; doing nothing is not an option. Rising costs hurt us as consumers, they hurt small businesses, they hurt larger businesses competing in global markets.
- It is important to avoid using anecdotes as a basis for reform rather than examining evidence in a more systematic fashion.
- Free market forces are not functioning properly in health care to find efficiencies.
- Insurer between doctor and patient pays bill; no incentive for conservative care and no supply and demand curve.
- Patient lacks specialized knowledge and adequate information to function fully as informed customer.
- Who bargain shops for their triple bypass?
- We have a concerning shortage of primary care physicians because it is not financially rewarding compared to specialization. There is potential for other physician shortages with a larger pool of insured subsequent to potential reforms.
- Potential point of consensus: Combine individual mandate for insurance with portability and prohibition for both excluding pre-existing conditions and recision of policies.
- If there is a pubic plan, there has to be a level playing field; it cannot pay 80 cents on the dollar as Medicare does. Better model is federal employeeâ€™s health plan.
- Single payer is not the same as socialized medicine. Single payer replaces private insurance as the source of payment; socialized medicine means all physicians are employed by the government, which also operates hospitals.
- This problem requires long-term thinking. Politicians will always think in 2,4, and 6-year cycles. Itâ€™s us, the people, who have to think 50 years out and insist that they do too.
- The health care industry is full of structural distortions; people respond rationally to the economics created by the distortions.
Tonight we’ll be having a real discussion about health care, with the range of opinion and experience at the table. We’re sorry if you couldn’t join us, but I wanted to take a moment to tell you how you (along with everyone else who is interested) can be there next time.
The Village Square is currently a national finalist in the Knight Community Information Challenge. Our proposal is that we will be a model for the town hall of the 21st century. Imagine instead of just one room of people, we can have a streaming broadcast of the program online, complete with being able to answer online viewer questions as well. You can join us in the slippers, no babysitter required. Imagine if you could participate in solving our problems as we build an information base and decision matrix as a resource to citizens confused by the constant partisan back and forth.
The key to seeing this happen is…. drums are rolling… YOU. Knight will ultimately judge us by how well we meet the local portion of the fundraising goal: $50,000. They want to see that YOU like us, that YOU, support us. If we win (and we think we will) then your donation to us will be tripled. (Beats Wall Street any day.) You can donate to us online HERE. Or you can mail a check to: The Village Square, PO Box 10352, Tallahassee, FL 32302. Donations to The Village Square are tax-deductible.
Our next step will be moving our concept to new cities. We think our model is inexpensive to run and highly effective for the minimal investment. We hope you’ll consider investing in us.
There are always moments amid the wreckage of what is worst in the human race, when we see clearly what is best in it. Even on 9/11.
There were those who walked toward trouble to allow the rest of us to walk away from it – the fire fighters, police officers, and in the case of 9/11, EMTs and Port Authority Police. They, like us on that day, had other concerns. . . kids to raise, bills to pay, oil to change. They put it all down and walked toward the horror to help strangers. There were the people who found themselves on a plane in Pennsylvania with an opportunity to save people they didn’t know. They did.
But there is a story of human kindness from 9/11 you probably haven’t heard yet.
The Masai tribe of Kenya had raised money to send their native son Kimeli Naiyomah to medical school in the United States. He happened to be in downtown Manhattan on 9/11. They didn’t understand the full import of what happened that day until months later when he returned to Kenya.
“What happened in New York City does not really make sense to people who live in traditional huts, and have never conceived of a building that touches the sky,” explained Ibrahim Obajo, a freelance reporter working in Nairobi. “You cannot easily describe to them buildings that are so high that people die when they jump off them.”
What then did the Masai do for the people in most powerful nation on earth? They gave us cows. “They gave what is truly sacred to them,” Obajo said.
Across oceans, across language, across culture, their gift could not have communicated more clearly to total strangers.
Today as we remember the senseless horror of 9/11, I can’t help but think that the task ahead of us has a lot to do with summoning in ourselves the generosity of spirit shown by those who gave “the last full measure of devotion” that day in New York, in Washington and in Pennsylvania. And it has something to do with summoning the kindness of the people who gave us cows. We have to keep walking away from the darkness of human nature exemplified by the terrorists of that day. It will require everything in us to not become the hatred and intolerance we’re fighting.
I think we’re up to the task.
And maybe while we’re at it, we can save a bit of that generosity of spirit for each other.
(The above poster is from www.artaid.org)
As someone who has dedicated herself to improving the civility of our public debate for about 4 years now, this has been a depressing week. I believe in my DNA that our country is best served when very different people bring very different ideas to the table, we mix and stir and sometimes get downright angry but we stay connected in a higher cause that we share. That higher cause is our country. I think this is what makes America who we are.
This week I found myself wondering if we still share a higher cause. I think that the reaction to President Obama speaking to children was just sad. We have reached a point where the distrust of a sitting president is so deep, some of us don’t even want our children to hear him speak.
As President Obama entered the joint session of Congress last night, I teared up a bit when the Sergeant-At-Arms announced him. I thought: Here we are disagreeing fantastically and we still have a wonderfully stable state, where the president is announced as he always has been, whatever party he is a part of.
That warm fuzzy feeling lasted until “You lie.” Back to depression.
I want to share with you a wise quote I read a lifetime ago and it’s stuck with me… “You can only be as honest with other people as you are with yourself.” Again, “you can only be as honest with other people as you are with yourself.”
I think we suffer desperately now from a whole truckload of being dishonest with ourselves. We’ve isolated ourselves into hermetically sealed ideological groups. Think Shia and Sunni. We really believe what we say, even if we’re jaw-droppingly factually wrong, because everyone in our hermetically sealed jar thinks it’s true. We really believe the other person is a shameful liar, and we don’t trust them, and it’s just a skip and a hop from there to thinking they’re evil.
I often ask myself where this stops and how? Again, think Shia and Sunni.
For my part, I’m inviting you to have a good discussion Tuesday night on health care. Got to start somewhere.
(Feel free to share if you have a different opinion, I’m listening…)
The calendar can’t flip on a new day before I tell you about my grandma. She wasn’t like many grandmas.
She’d get the giggles and couldn’t stop. She’d have us all crying around the dinner table, less that we even understood the original punchline and more that her glee was infectious. I remember many moments of childhood mortification, like when she danced the hula on her return from Hawaii, along with the out-of-tune humming of the appropriate tune. Now the memory makes me proud. My grandma was an imp.
Her family was so much like most American families. We all have our odd birds and crazy uncles. We have our disagreements. We still rush right over if there is a phone call in the middle of the night.
Her father built bridges in Pittsburgh in the industrial revolution. He was conservative. My mother just told me a family story about my grandma’s cousin who played a joke on her dad one day. Her dad hated FDR so much, she thought it would be just the thing to welcome him home one day with a Life Magazine FDR photo gallery splayed around the house. She said he was so mortified that she thought for a moment he’d – literally – have a heart attack.
My grandma was fairly apolitical until she found herself living in Georgetown for a year in 1964 because of my grandpa’s work. By then she had raised her children and I suppose wasn’t your standard housewife (remember she was an imp). She whiled away any spare time sitting on Capital Hill watching Congress in session. She decided then that she was a Democrat (she told her grand kids this story: “I decided the Republicans were just against everything, so I was a Democrat.”) I can’t tell you what she’d think today, I can only tell you that, just as her Republican father would love her no matter what, her granddaughter would love her no matter what. It’s the kind of love you have when you live in a family.
All of our families are a hodgepodge of ideas, crazy uncles and disagreement. But it’s our American family.
We’re in a tough place right now as a family. We’re two days away from the the eighth anniversary of September 11, which shook us to our very core. We don’t seem to agree with each other any more, but maybe it’s because we’re not even talking (except through people who get a lot of money if we keep the TV tuned to them). There is a lot of anger on the right in America’s family, with many expected to march on September 12 to ask that we return to the spirit of that day.
I couldn’t agree more (please look at our founding thesis here). We should return to the American family that we all felt that day, the one where we disagree with each other, the one where we sit around the Thanksgiving table and deal with each others’ quirkiness, the one where we roll eyes, the one where we love each other despite it all. I think that anyone who tells you that the legacy of September 11th is that we should hate each other more is just wrong.
To my grandma. And to yours. Grandmas would tell us to mind our manners. So let’s roll up our sleeves and disagree where we need to. But let’s be partners in the disagreement, because we will sink or swim together. Let’s really listen to each other and speak respectfully. Let’s be an American family again. And when you’re feeling the impulse to hate, remember that on the other side of the aisle is undoubtedly someone who – no matter what – you’d rush to in the middle of the night.
Happy 100 years grandma. (And for goodness sakes, keep them hula dancing up in heaven.)
David Frum on Bill Moyers Journal:
Look, a lot of the conservative movement in this country is conducting itself in a way that is tremendously destructive. Both of the basic constitutional compact of the requirements of good faith and of their own good sense. I mean, when you were going on the air and calling the President of the United States a Nazi as Rush Limbaugh has repeatedly done. When Mark Levin — you mentioned him — he said the President of the United States is literally at war with the American people.
And then people begin, unsurprisingly, showing up at rallies with guns. Well, obviously, if the President were– I mean, folks, if I believed the President of the United States were a Nazi, were planning a Fascist takeover, it would be contemptibly cowardly of me not to do everything in my power, including contemplating violence, to resist such a thing. Every decent person should do that.
That’s why you don’t say it when it’s not true. And I mean, one of the ways that the constitutional system works is with some understanding that the people on the other side have slightly different priorities but they share your constitutional values. They have invested in the same system. The problems they’ve got are hard problems. And even if you don’t like their answers, you have to have some restraint in the way you talk about them, as you would hope they would have about you.
And I think it’s just outrageous. It is dangerous. It’s dangerous for the whole constitutional system. Now, I’m absolutely prepared to fight with them. And by the way, it’s dangerous to conservatives because the effect of the talk of people like Levin and Rush Limbaugh is to kill our cause with voters who are under 65.
You make that man the face and you say let us contrast him to Barack Obama who is maybe too expensive but who seems calm and judicious? That’s an ugly comparison.
Find David Frum’s New Majority website HERE.
Dr. Ray Bellamy (one of our September 15 “Take 2 Aspirin” panelists) in today’s Tallahassee Democrat on health care:
When I was a teenager, Blue Cross came along as a nonprofit and offered health insurance, which wasn’t all that common back then. The insurance spread the risk of expensive medical encounters over a wide group.
Then the for-profit insurers saw opportunity. Big bucks could be made in health care if they could control risk. They did this by selectively insuring working people, who are generally healthier, as are those with higher incomes.
Blue Cross had to change its business model to compete with the for-profits, and it has been a race to the bottom ever since. As Nicholas Kristof recently commented in the New York Times, the insurers “changed their business model from spreading the risk to dumping the risk.”
Now it is all about profit, not about health. Those with higher risk of illness are on the outside looking in. Administrative costs have soared as the multiple private insurers spend a lot of money on marketing to the healthy, contesting claims and denying authorization for procedures.
The public plans insure the worst risks. Medicaid insures the poor, who are less healthy, and the uninsurable. Medicare and veterans programs have a sicker pool because of age and disability. Their costs also have risen, and this bad risk pool means their costs keep soaring. Others without insurance wind up in local emergency rooms, usually at taxpayer expense.
Meanwhile, the private insurers reap the benefits of their lower-risk pools while dumping the higher risks on the government. That’s not some scary future conjured up by the opponents of reform. That’s reality right now.
Read Dr. Bellamy’s entire article HERE.
Consider joining Dr. Bellamy and the rest of our excellent and diverse panel on September 15.
Dr. Neal Priest (my brother-in-law), an emergency room physician in Athens Georgia, makes his recommendations on health care reform. Read Neal’s whole article HERE.
â–º Just as everyone must have auto insurance, health insurance must be a requirement. People who cannot afford a policy would be offered a subsidy or be enrolled in a public option that would incentivize preventative care and the appropriate use of health care services.
â–º Insurance must be portable across state lines. Patients should not be denied coverage on the basis of “pre-existing conditions” or be dropped from the rolls when they become seriously ill or injured. This would encourage health insurance companies to keep their enrollees healthy, screen widely for serious illnesses, and aggressively treat them at the first sign of significant problems in order to minimize overall expenditures.
â–º A comprehensive electronic medical record (EMR) that includes pharmacy usage – either online or on a computer chip card similar to the very successful “Carte Vitale” in France – would save tens of billions of dollars per year. The EMR would streamline billing procedures, avoid redundancy in testing, limit prescription errors and drug allergies, and – importantly – help prevent the rampant fraud and abuse present in our system today.
â–º Create a comprehensive approach to tackling the enormous problem of rampant obesity in our society, which costs billions of dollars each year because of the awful health consequences. Just as we tax cigarettes and alcohol, we should tax foods known to cause ill health down the road – products with high sodium content, high sugar content, saturated fats and/or cholesterol.
â–º Alter the corporate food marketplace, including farm subsidies to huge corporations, so that healthier foods have a chance of competing with high-fat, high-sodium, calorie-dense items that are causing us to eat ourselves to death.
â–º Create incentives for physicians to go into primary care specialties. We need a lot more preventative care and expert management of chronic diseases.
â–º Fix the medical malpractice system. Regional or statewide “malpractice panels” comprising lawyers, judges, medical experts and patient advocates would save billions of dollars per year.
The President has released his prepared remarks for the speech to school children tomorrow. You can read them HERE.
Fact check on previous presidential speeches to school children:
On November 14, 1988, President Reagan gave a speech from the White House and answered questions from junior high school students from the Washington, D.C. area, in an appearance that was distributed to schools via an educational television network and also broadcast on C-Span. You can read Reagan’s speech HERE.
On October 1, 1991, President George H.W. Bush made an appearance that was broadcast live on radio, CNN and PBS, and funded by the Education Department. The full text of the speech is available online HERE.
It light of the din of indoctrination accusations by the right about a lesson plan suggesting school children think about how they can help President Obama, it is worth noting that President Bush’s speech ended: “Write me a letter â€” and I’m serious about this one â€” write me a letter about ways you can help us achieve our goals (emphasis added). I think you know the address.”
According to CBS News, “Prior to the appearance, Education Secretary Lamar Alexander sent letters to every elementary and secondary school in the country â€” 110,000 â€” urging them to allow students to watch the President’s speech.” (We had to work hard before the internet.)
There was some squawking by the Democrats:
“The Department of Education should not be producing paid political advertising for the president, it should be helping us to produce smarter students,” the New York Times quoted House Majority Leader Richard A. Gephardt (D-Mo.). “And the president should be doing more about education than saying, ‘Lights, camera, action.'”
Here is Florida Republican Party Chair Jim Greer’s statement, in which he called Obama “the Pied Piper:”
I am absolutely appalled that taxpayer dollars are being used to spread President Obama’s socialist ideology. The idea that school children across our nation will be forced to watch the President justify his plans for government-run health care, banks, and automobile companies, increasing taxes on those who create jobs, and racking up more debt than any other President, is not only infuriating, but goes against beliefs of the majority of Americans, while bypassing American parents through an invasive abuse of power.
One of the overwhelming conclusions we’ve had to draw on health care, as we studied hard to prepare for the September 15 Dinner at the Square “Take 2 Aspirin, Fix Health Care & Call Me in the Morning,” is that the incentives in our health care system are fantastically broken. Here’s what we mean:
The incentive for doctors, especially in the litigious climate of bazillion dollar malpractice awards, is firmly for more treatment to protect themselves.
There is no supply and demand curve where customers (patients) interact directly with suppliers (doctors, hospitals) to drive prices down and quality up as our economy has otherwise functioned. Insurance companies stand between them (they’re like a parent with an unlimited credit card to both patients and doctors.)
Toss in physician ownership of some testing facilities, so that more testing doesn’t only mean covering liability, but it means increased income and….
Voila, you’ve got skyrocketing costs with no end in sight.
Here are two great articles on incentives. They’re long, but well worth a read if you want to understand what’s wrong. The first offers a patient-centered market-based solution, the second leans toward a Mayo clinic managed care patient-centered approach.
How American Health Care Killed My Father, by David Goodhill in The Atlantic.
The Cost Conundrum, by Atul Guwande in The New Yorker.