Apr 302008

Barak Obama thinks we can cut costs on health care by forcing health care providers to move to electronic records systems.

Lowering Costs Through Investment in Electronic Health Information Technology Systems: Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama will ensure that patients’ privacy is protected.

Never mind that one reason we haven’t done more of this already is that it does not make the most effective use of doctors’ time to do so.

And that last sentence about privacy — It seems to anticipate the article in Tuesday’s WSJ titled, “Are your medical records at risk? Amid spate of security lapses, health-care industry weighs privacy against quality care.”

But Obama doesn’t explain how he is going to ensure that patients’ privacy is protected. As it stands, his statement is the equivalent of saying he’s in favor of motherhood, apple pie, and the American flag.

One way to ensure privacy would be to make sure the people who breached the privacy of Linda Tripp’s confidential records for partisan political purposes are brought to justice. But Obama is a member of the same political party as those who made sure those violations went unpunished. Those records were not medical records, but the issue is still the same — such records can be used to intimidate and destroy political opponents.

The WSJ article says some places are trying to limit records on a need-to-know basis. For example, Lab employees only get to see lab results. So much for the stated goal of “coordinated care”.

Apr 302008

Jonathan Zittrain, author of “The Future of the Internet and How to Stop It,”  doesn’t like closed-system devices like the iPhone.  (Network World article here.)

In a way I don’t like it, either.  But isn’t the computer industry following a trajectory parallel to that of others, such as the automotive industry?   Once upon a time there was a place for dozens of small-time car manufacturers, just as once upon a time there was a place for kitchen-table computer software companies.  In both industries, there were consolidations, buyouts, washouts, until only a few big ones were left.  Once upon a time cars were made of parts that were bolted together, and an entrepreneur or even a lone customer with enough money could design something different.  A shade-tree mechanic could make his own bearings.  But then we got unibodies and integrated systems which were less amenable to tinkering.  Isn’t that similar to what’s happening with iPhones?  Cars are now commodities.  One can even buy used ones with far less tire-kicking and under the hood inspection than was needed in the old days.  An iPhone is the computer version of that.  It just works — no assembly required.

Apr 302008

At Sunday morning Bible class I mentioned this article about atheists who feel the need for a church.  Our pastor said I had just given the first paragraph of  the sermon he had prepared for the day.   We compared notes afterwards.  We hadn’t read quite the same article.  Mine was from New York magazine.  His was this one:  “Some atheists go to church too, but not to worship.”

But I wonder if it’s really just the sense of community that these atheists are looking for.  There are all sorts of communities in existence besides religious communities.  If community is what they want, they don’t necessarily need a church.   It will be interesting to see how it plays out.

In the meantime, I have in mind the G.K. Chesterton quote:  “When people cease to believe in God, they don’t believe in nothing.  They believe in anything.”    Maybe it applies, maybe not.

I am not sure if that Chesterton quote is completely accurate, btw.  I thought he said “men,” not “people.”    I can find quite a variety of wordings on the web, but so far I haven’t found anyone who even cites where it came from.   My favorite version, for irony purposes, was this one:  “When people cease to believe in something, they do not believe in nothing: they believe in anything.”

Apr 292008

Some comments on Obama’s health care platform.

Lower Costs by Modernizing The U.S. Health Care System

* Reducing Costs of Catastrophic Illnesses for Employers and Their Employees: Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers’ premiums.

So on the one hand he’s going to modernize. And on the other he’s going to introduce a reimbursement plan that is going to be fraught with ambiguity and corruption.

* Helping Patients:
1. Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure. Obama will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information and lower costs.

“Disease management” is the sort of thing that gave us HMOs. Look how that turned out. And now Obama is going to give us a HMO on a grander scale.

2. Coordinate and integrate care. Over 133 million Americans have at least one chronic disease and these chronic conditions cost a staggering $1.7 trillion yearly. Obama will support implementation of programs and encourage team care that will improve coordination and integration of care of those with chronic conditions.

Pre-paid health care systems such as we have encourage the un-integration of care, by requiring all diseases and treatments to be coded into strictly defined categories. It’s not enough to say Obama will try to break down the barriers between these categories, because that’s something that’s inherently against the nature of government to do. Free markets can sometimes break down existing categories. Obama has a lot of explaining to do if he thinks he can get government to do that.

3. Require full transparency about quality and costs. Obama will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.

There is probably a proper role here for government, in requiring vendors to tell us just what it is they’re selling us. I wish government could be provided to do the same.

* Ensuring Providers Deliver Quality Care:
1. Promote patient safety. Obama will require providers to report preventable medical errors and support hospital and physician practice improvement to prevent future occurrences.

Defining what “preventable” is going to provide a great opportunity for ambiguity and corruption.

2. Align incentives for excellence. Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHBP will be rewarded for achieving performance thresholds on outcome measures.

This is more of the mindset that got us HMOs.

3. Comparative effectiveness research. Obama will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have the accurate and objective information they need to make the best decisions for their health and well-being.

Ah, the politicization of science. I guess the only time that’s bad is when George Bush does it.

4. Tackle disparities in health care. Obama will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities. He will also challenge the medical system to eliminate inequities in health care through quality measurement and reporting, implementation of effective interventions such as patient navigation programs, and diversification of the health workforce.

So some people don’t get good health care because “people like us” aren’t the ones in the health workforce? And that problem is going to be solved by paperwork and bureaucratization?

5. Insurance reform. Obama will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance and will promote new models for addressing errors that improve patient safety, strengthen the doctor-patient relationship and reduce the need for malpractice suits.

Right. “Overcharging.” First the government drives malpractice insurers out of the business, then complains that there aren’t enough of them, so it’s going to control the monopolistic prices they can charge. I can see investors lining up now to put their money into insurance providers regulated by Obama.

And there is so much more in this one that deserves to be mocked, but so little time…

* Lowering Costs Through Investment in Electronic Health Information Technology Systems: Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama will ensure that patients’ privacy is protected.

Yup. More of the sort of thing that discourages ïntegration” of health care. We complain all the time about how insurers are interested only in the bottom line. If this sort of thing was really where cost-savings are going to be realized, wouldn’t insurers do it on their own without the gentle, guiding hand of Obama?

* Lowering Costs by Increasing Competition in the Insurance and Drug Markets: The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. There have been over 400 health care mergers in the last 10 years, and just two companies dominate a full third of the national market. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed by over 87 percent.

Pharmaceutical companies have consolidated over the years, with the winners being not the ones who do the best work in developing new drugs, but the ones who can best schmooze the regulators. With more Obama-regulation, such consolidation will only continue until there is only one insurer — the government. Then we’ll have all the worst aspects of our current system, only on a grander scale.

1. Barack Obama will prevent companies from abusing their monopoly power through unjustified price increases. His plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. His new National Health Exchange will help increase competition by insurers.

This is going to be great, allowing bureaucrats to decide what’s “unjustified” and what’s “exorbitant”. More corruption.

2. Lower prescription drug costs. The second-fastest growing type of health expenses is prescription drugs. Pharmaceutical companies are selling the exact same drugs in Europe and Canada but charging Americans more than double the price. Obama will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. Obama will also repeal the ban that prevents the government from negotiating with drug companies, which could result in savings as high as $30 billion. Finally, Obama will work to increase the use of generic drugs in Medicare, Medicaid, and FEHBP and prohibit big name drug companies from keeping generics out of markets.

I’ve seen how these big buyer cooperatives work on smaller scale. What it usually means is buyer and vendor work out a deal, and the customer is screwed if s/he is required to purchase through that system.

Apr 282008

It’s no wonder Obama doesn’t like to talk specifics.

I went looking for some after I read the article at the Washington Post titled, “Obama links broad ideas to economic specifics.”

Despite its title, the article didn’t give any specifics. It does hint that those are to be found elsewhere, though. It says, “Obama
did not lack proposals for what he would do as president — his
planks took up a whole section of his stump speech.” But it seems
that the Post did not care to inform its readers about those.

So I went looking for myself and found this web page. If it really and truly represents the Barak Obama campaign platform, and Obama ever has a chance to implement it, we’re in for some major problems.

I’ll pick on just one item for now:

Obama believes we need to do more to promote economic development in Mexico to decrease illegal immigration.

If he really meant it, he ought to stop the NAFTA-bashing. And maybe he could show he has a clue about how to develop healthy relationships with Latin American countries by letting the U.S. go forward with a trade agreement with Columbia.

That’s just one. I’ll bash some of the others later. But if these are campaign planks, the lumber yard where he bought them ought to go out of business.

Apr 272008

Ok, I’ll bite. Suppose Obama engaged in some serious discussion. Just how would he bring jobs back to Anderson?

If you watched the last few weeks of this campaign, you’d think that all politics is about is negative ads and bickering and arguing, gaffes and sideline issues. There’s no serious discussion about how to bring jobs back, to Anderson.


From the discussion I’ve heard so far, the following are some possibilities:

  • Beggar our Latin American neighbors and try to hoard our stuff?
  • Raise capital gains taxes on job-producing investments?
  • Take money from other Americans so Obama can spend it in Anderson?
  • Try to create hostility among our Latin American neighbors such that we’ll need to grow the military to defend ourselves, and then spend some of those military dollars in Anderson?

Yes, by all means, let’s have a serious discussion about how to bring jobs back to Anderson.

Apr 242008

Here are more questions that I wish had been asked of Anton and David Treuer:

  • You guys have both been published. Do you get any flak from people who think the language should be strictly an oral language?
  • Is it really possible for someone who speaks Minnesota Ojibwe from Leech Lake to understand someone in central Michigan who speaks Ojibwe?

One web site led to another while I was looking up some of their work, and I found this item at the Red Lake Net News. I liked number 3 the best.

Top 10 Things To Say To A Non-Indian Upon First Meeting

10. How much white are you?
9. I’m part white myself, you know.
8. I learned all your people’s ways in the Boy Scouts (Order of the Bullet).
7. My great-great-grandmother was a full-blooded European princess.
6. Funny, you don’t look white.
5. Where’s your powdered wig and knickers?
4. Do you live in a covered wagon?
3. What’s the meaning behind the square dance?
2. Oh wow, I really love your hair! Can I touch it?
1. What’s your feeling about river-boat casinos? Do they really help your people, or are they just a short-term fix?

Apr 242008

Tonight my youngest son mailed me a link to this page from NPR, “Letter Men: Brothers Fight for Ojibwe Language.” It was an interesting interview.

I have one of Anton Treuer’s books. It’s the one he read from during the interview: “Living Our Language: Ojibwe Tales & Oral Histories” (2001). It’s a bilingual book, with Ojibwe on one side and the English on the other. When I pulled it down from my bookshelf, I found that the page he had read from was bookmarked with a yellow sticky-note. But I don’t know why the bookmark was where it was. It has been at least a couple of years since I looked at the book. I did recognize a few Ojibwe words as Mr. Treuer read, but not enough to catch any meaning.

I do not yet have his book, “Omaa Akiing,” but one thing I already like about it is the title, because I know what it means just from what I learned on the Pimsleur Ojibwe course. At least I think it means approximately “Here on Earth.” Maybe it has some other, more subtle meaning, too, that I don’t know about.

I wish the interviewer had asked some additional questions, like what does Mr. Treuer think of outsiders learning the language? Do any non-Anishinaabe people take his course at Bemidji State? If so, what do the elders and other speakers think of that.

One reason I would ask is because I used to take part in a Ojibwe discussion group on Yahoo groups. But it seemed that the ratio of non-Anishinaabe to Anishinaabe was pretty high, and it was resented by some of the people on the list. There were those who thought the language should be learned orally, from the elders. I decided to withdraw, rather than contribute to the problem.

I would like to learn more Ojibwe, but right now I’m more interested in learning Russian. If there was anyone to talk to, it might be different.

I might also be interested in reading some of David Treuer’s books. I read very little fiction, but it was fascinating to read some of what I found on his blog, such as this:

Q: You’ve drawn some fairly critical attention for your nonfiction book, Native American Fiction: A User’s Manual. To what extent do you think Native American identity shapes your—or anyone else’s—literary endeavors?

A: Well, charting the exact ratio of “identity” to “influence”—that is, the degree to which the author’s identity matters and the degree to which the books we’ve read, the people we know, the schools we’ve attended, the jobs we’ve had, the TV shows we like, the tragedies (communal and individual) we’ve endured, the hearts we’ve broken, the times our own hearts have been bruised matters—seems kind of pointless after a certain point. Obviously one’s personal identity (largely a fiction of our own making “drawn from life”) is hugely important . . . to the person. As for books, as for literary endeavors, well that’s the strange magic of books, isn’t it? They somehow exist inside us and outside us at the same time. They are of us, but they are always “of” other books, too. I think it would be tragic to only or even mostly interpret Hamlet as an expression of “English-ness” or of Shakespeare’s identity as an “English man.” It would rob Hamlet of its magic and wouldn’t help explain in any lasting way why the play is important and moving to many people. The same goes for Beloved. And The Magic Mountain. And A Boy’s Own Story. And The English Patient. But this is exactly what happens more often than not to Native American stories. The result: “red-faced minstrelsy.” Speaking of the book I am working on now: it is as much a mixture of my self, my love, my ambition, my people, my tastes—running from Thomas Mann to Christina Aguilera and back again—and my devotion to my craft as anything I’ve ever written.

Fascinating to find him speaking of just taking the work for what it says. Seems to me that C.S. Lewis had some things to say like that.

Apr 232008

I certainly know who Robert Conquest is, but I must confess I’ve not read any of his work.  It’s time to do something about that, I think.  He tells about a new “re-published” version of his work here, and also mentions some other things I maybe should read.

Coincidentally, today I got another e-mail from the Russian Cycle Touring Club, reminding me that there is still room on one of their August tours.   And I see they’ve added a new type of tour to their repertoire, a “self-contained” tour in which there is no support vehicle.  What they provide is a bicycling guide or two.  The riders carry all their camping gear and take turns cooking.   I think I’d like any of the means of accommodation they offer, from self-contained to staying in decent hotels, so long as I could see a lot of the rural countryside.   But it probably won’t happen, unfortunately.

Apr 212008

We’ve all heard of waffling politicians, but Barak Obama takes the concept to a new level.

“Why can’t I just eat my waffle?” the Illinois senator said as he ate breakfast in Scranton, Pennsylvania, according to MSNBC television pictures.

Pressed again for an answer, he replied: “Just let me eat my waffle.”