Archive for the ‘Public Policy’ category

Random Thoughts About Things That Confuse ME

October 12th, 2015
 People have often asked me, “Where were you when Kennedy was shot?” In fact, I was in gym class. Six years after that, on April 4, 1968, I was in Pittsburgh when Martin Luther King was shot. I was back again in Pittsburgh on June 5, 1968 when Bobby Kennedy was killed. Finally, as a young teacher in Johnstown, on May 4, 1970, four students were killed and nine more were wounded by the Ohio National Guard at Kent State University. Between the riots and civil unrest that followed these events, I was pretty sure that our world was spinning out of control, and I had just graduated from college.

It was during that time of the Vietnam War, the escalation of the Cold War, the race riots and political rallies, that a chasm began to appear between those men who still had crew cuts and white socks, and conservative hippie kids like me with my wire-frame glasses, sideburns, and mustache.

In fact, at my very first job interview, the department head, a man who was still firmly planted in the 50’s, asked me if because I was my college class president, I’d ever been involved in a campus riot. Meanwhile, there had only ever been one small demonstration at my university, and I wasn’t even on campus when it happened. But his question offended me so much that I replied, “Only the one.” Needless to say that job went to someone with a crew cut and white socks.

Throughout my life I held profound optimism that because we were a country that embraced education, espoused Judeo-Christian love, and incorporated tolerance and diversity in our stated beliefs, our philosophies would prevail and the world would become a better place. Wrong.

Because I spend much of my time on the road, Facebook is often the way I keep in touch with my virtual and real families. It keeps me apprised of changes, challenges, and the daily activities of those I both care about and want to be connected to through this last quarter of my life.

Of course, Facebook is filled with puppies, kittens, babies, and opinions, and many of those opinions remind me of the Archie Bunker character who so famously dominated the airwaves in the All in the Family sitcom of the 1970’s. That series, along with MASH and The Jefferson’s attempted to challenge the way Americans dealt with race, war, and general closed-minded prejudices.

It makes me sad when my friends, people that I love and most often respect, write posts that are passionately in support of social beliefs that embrace continued gun violence, racial prejudice, twisted religious beliefs, intolerance, greed and hatred. It would be easy to unfriend them, to write them off, and forget about them, but the teacher in me wants to try to educate them and to help them find their way. That never works because most of them are Archie Bunker’s age and older. All I’m asking is for tolerance, the embracing of diversity, and a non-violent philosophy of loving others. It’s the Golden Rule. Unfortunately, it’s often the Rule of Gold that seems to prevail.

I can tell you where I was on April 20, 1999, April 6, 2007, December 14, 2012: Columbine, Virginia Tech, and Sandyhook. Unfortunately, I can’t even tell you the name of the school or how many kids were killed on January 4, September 14, September 30 of this year. October 1, 2015, however, became more tangible because the hospital that cared for the wounded in Oregon is run by a friend, and Troy Polamalu’s cousin Brandon, a teacher at Umpqua Community College, was on campus at the time of the shooting.

Minimally, as a country, can’t we invest in behavioral health initiatives and enforce background checks.

Meathead really was the voice of reason on so many levels

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What is Real and What is NOT? The Truth, or Maybe NOT . . .

April 30th, 2012

Sixty two years ago, George Orwell wrote the novel, 1984.   He described a society controlled by government where the individual had no privacy, no real freedom, and was literally put into the equivalent of a drug induced state by the pabulum of mass media television.  It was an intimidating forecast.   But now the question; how much dumber can television get with shows like:  “My Big Fat, Obnoxious Boyfriend,” “Real Housewives of  Wherever,” and “Temptation Island?” 

It was Marshall McLuhan, the Canadian educator, philosopher and academician who came up with terms like, “the global village, “medium is the message,” and the concept of the “World Wide Web” almost thirty years before Al Gore said he invented it.  Marshall described the fact that the mass media was quickly taking over our ability to think independently as we rushed into the realities of Orwell’s  Big Brother.  He explained that we would be once again living in a world of tribal drums, total interdependence and superimposed terror as opposed to thought and feelings from rational analysis.  Can you say, “Weapons of Mass Destruction?” 

The World Wide Web has placed us in a type of tribal unity for which none of us were prepared.  Why do you think tattoos are more in now than any time before 1500 B.C.?  Piercings and tattoos make you “part of the tribe.”  Hey, the majority of presidential candidate debate issues revolved around turning the clock back to the 1950’s, no web. 

It appears that, because of this tribal unity, many very obvious changes have become accepted by our current culture.  For example, according to columnist Rex Huppke, the fact that someone of any political party can say something that is completely false and stand by it makes facts meaningless and thus, dead. He goes on to theorize that, rumor and innuendo along with emphatic assertion are also part of this new communications standard. 

Dartmouth political scientist, Brendan Nyhan professes that, “In journalism, in health and education, we tend to take the attitude that more information is better, and so there’s been an assumption that if we put the correct information out there, the facts will prevail.”Nyhan says that, “Unfortunately, that’s not always true.”   Facts don’t seem to matter, and those who expose bogus facts are often more highly criticized than the person who misrepresented the truth in the first place.

We all know that the spin can change the view on any subject matter.  In many cases, it’s the quality and persuasiveness of the argument, not the facts which becomes the issue.   If you are on the right side of the spin, or if enough information can be put out there, the mass audience will be distracted from the facts, and confusion will reign supreme. 

Fact:  The United States has one of the highest infant mortality rates in the industrialized

Fact: Legislation has recently been proposed to take away additional funding for prenatal care. 

Fact:  The United States has fallen to “average” in international education scores and our State austerity measures include the laying off of teachers. 

Fact:  The incarceration rate in the United States of America is the highest in the world with only five percent of the world’s population, one-quarter of the world’s inmates are incarcerated in the United States. 

Fact:  Average annual cost per student for a public school education $8500; average annual cost per prisoner, $23,000. 

See, many of you will not know if you should believe these facts.  Some of you will fact check them.  Others will say, so what?   Some of you will look for my prejudices regarding this list, or you may be overwhelmed and say, “I can’t change any of this anyway.”  Most, however, will not bother to read this far. 

Twitter has become the new novelette and everything is a sound bite.   As Jimmy Kimmel said, “What’s back and white and read all over? Nothing anymore.”

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One in Six

September 28th, 2011

The U.S. poverty statistics came out a few weeks ago, and things haven’t been this bad since 1993. Look to your left; look to your right. About one in every six Americans is now considered to be living below the poverty level. In 1993, the average new house was $113,000, the average income was $31,230, the average car was $13K, and tuition at Harvard was at $23,500. By 2010, you could nearly double every one of those numbers except the average family income which rose only to $50,000, instead of the $62,500 it should have been.

African-American Senior Woman Wrapped in US FlagOne of my favorite comparisons has always been that of Harvard’s tuition, which hovered right around $40,000, and the cost to keep a prisoner in jan American jail for one year, by comparison: about $45,000.  Now, if you extrapolate the number of people in U.S. prisons based on the entire population of the United States, it works out to about one in every 31 adults. Between 2.3 and 2.4 million Americans are behind bars. America incarcerates nine times more people than Germany and 12 times more people than Japan. That adds up to nearly $104 billion dollars a year in U.S. prison costs alone.

The folks on Wall Street and in Washington D.C. who so cunningly helped to put us into this financial mess are, by and large, not in prison, and the percentage of inmates that are minorities is staggering. An estimated sixty-eight percent of prison inmates were members of racial or ethnic minority groups.  Are our prisons full because our minorities are bad people, or are they full because their jobless rate is 40% higher than that of Caucasians?

We’re also spending about $700 billion per year on our military. For reference, the rest of the entire world combined spends nearly that same number.  At $1.4 trillion a year, that adds up to $236 per capita worldwide on defense, and we still have 24,000 nuclear missiles lying around; enough to blow up the planet plenty of times.

According to the World Bank, over 1 billion people live in conditions of extreme poverty and 15-20 million people are starving every year.  I saw another set of figures today regarding food subsidies in the United States.  It wasn’t a figure indicating our generosity toward these one billion poor people, it was that between 1995 and 2010, our Congress voted to provide $260 billion to continue agricultural subsidies.  Okay, maybe some of that makes sense, but what about the $17 billion that is going to use the American people’s money to create artificial incentives to produce ingredients that eventually become hydrogenated fats?

We are an obese nation, yet we paradoxically continue to publicly subsidize high fructose corn syrup and hydrogenated fats, so that our obesity, diabetes and heart disease epidemics continue unabated. Sheer folly, or is this about some really big businesses, with some really good lobbyists?

Maybe it’s time to look at things a little differently. We all know that testosterone makes us physically strong, but it also makes us more aggressive and competitive. This testosterone overload has continued to result in war and violence being accepted as the normal way to settle things, and, except for the supposed economic benefits of war, we also know that war is just crazy. It kills and maims people, and diverts resources that might be otherwise be utilized elsewhere.

We’ve seen time after time that if you are brutal and retaliatory with people, they will learn to hate and fear you. However, if you give people love, compassion and respect they will eventually return the compliment. Maybe we should take a break from all of this running-the-world stuff, and focus on doing the best that we can for the human ace.  Maybe we should walk the talk of our religious leaders for a change.

We ran a hospital like that for over a decade and it prospered economically and grew. This concept is neither rocket science nor brain surgery.  It’s the most uncommon of things in our current culture, common sense.

We cannot change the human condition – but we can change the conditions under which humans live and work!

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The Food Crisis

May 24th, 2011

Each year American farmers must feed an additional 80 million people internationally.

Food is The New Oil (c) ForeignPolicy.com - Nick Jacobs, FACHE - Healing Hospitals

Image credit: ForeignPolicy.com

During the first two decades of my adult life, it was commonplace to see story after story about the starving people in places like Biafra. Some three decades later, I now understand more deeply the geopolitical ramifications of these tragedies. A friend of mine sent me an article from the May/June Foreign Policy magazine. It detailed the food supply challenges facing this planet’s  growing population. The intensity of concern that this essay raises is palpable.

The article, The New Geopolitics of Food, by Lester R. Brown, opens with an example of what a 75% increase in wheat prices might mean to the average American who spends less than 1/10th of their income at the supermarket.  The answer is…probably a ten cent increase in a loaf of bread. As a result, a $2.00 loaf of bread will become a $2.10 loaf of bread. He then contrasts that difference with the impact it would have in a place like New Delhi where that same wheat is carried home to be ground into flour. The cost of the wheat there is actually double what it was. Consequently, Brown states, the world’s poorest two billion people — who spend 50 to 70% of their income on food — will go from two to one meal a day. His evaluation of this situation is that it can, will, and has already resulted in revolutions and political upheaval.

When the reasons for these shortages are explored, it quickly becomes apparent that changes in our climate represent a major contributing factor.  Be it too much hot dry weather, too many storms contributing to excessive rainfall, or soil that is simply exhausted from a lack of nutrients caused by depleted aquifers, the result leads to food becoming the hidden driver of world politics. As land and water become more limited, as temperatures go up and world food security deteriorates, scarcity is emerging as the norm, rather than than the exception.

Infographic: The Food Price RollercoasterUntil recently, the food supply was primarily in the hands of the world markets which were primarily monitored and sometimes driven by the United Nations’ World Food Program, but because of recent shortages and population growth, several countries have taken it upon themselves to secure their food supply in nontraditional ways. We are seeing unprecedented land grabs in developing countries, and water grabs from geographies where the end result creates shortages and where grain is being directly purchased from U.S. farmers.  All of this is contributing to a global power struggle for food security.

According to Brown, “With grain stocks low and climate volatility increasing, the risks are also increasing.  We are now so close to the edge that a breakdown in the food system could come at any time.”  For example, a 40% drop in grain production in the U.S. would be equivalent to a loss of 160 million tons of grain as opposed to a 40 million ton drop in Russia from the same percentage loss.  This would be devastating to the world food supply. As long as oil is expensive, ethanol production will remain high and corn will be pulled from the food chain to the fuel chain. “Oil exporting countries that import grain would…barter oil for grain, and low income grain importers would [lose] out.”

Brown concludes:

“If we cannot produce higher crop yields with less water and conserve fertile soils, many agricultural areas will cease to be viable. Each year, 1,400 square miles of land in Northern China turn to desert. If we cannot move at wartime speed to stabilize the climate, we may not be able to avoid runaway food prices. If we cannot accelerate the shift to smaller families and stabilize the world population sooner rather than later, the ranks of the hungry will almost certainly continue to expand.”

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Bhutan’s Philosophy of “Gross National Happiness”

October 3rd, 2010

Not everything that can be counted counts, and not everything that counts can be counted.
—Albert Einstein

At a recent conference I had the opportunity to learn about the Himalayan nation of Bhutan. Most of us had not heard of this country, but we should have, because they have done something that is reminiscent of the Broadway Musical “Camelot,” or possibly “Brigadoon.” Their King introduced a philosophy of living that is intended to shape all of the government’s activities. According to Mr. Kuenga Tshering, Director of the National Statistics Bureau of Bhutan, Gross National Happiness (GNH) was promulgated as Bhutan’s philosophy of economic and social development by the Fourth King of Bhutan as soon as he came to the throne in 1972.

The reason I’m writing about this is because I believe it is an amazing idea, a wonderful goal, and a step toward embracing  idealism.  Many of you have heard my thoughts on change, and know that I do not believe that there is only one route to follow on this journey through life.

Takstan Monastery, Bhutan (image credit: johnehrenfeld.com)

Takstan Monastery, Bhutan (image credit: johnehrenfeld.com)

The Bhutanese philosophy of “living” refers to a set of social and economic interventions that evaluate societal change in terms of the collective happiness of people.  Further, these measures are also applied to the creation of policies that are aimed at that objective. Premised on the belief that all human beings aspire to happiness in one way or another, the concept promotes collective happiness of the society as the ultimate goal of development.  Now that would be a political platform!

The philosophy of Gross National Happiness considers economic growth as one of the means towards achieving happiness, but it also offers a holistic paradigm within which the mind receives equal attention. While GNH recognizes the importance of individual happiness, it emphasizes that happiness must be realized as a collective or societal goal and not be defined as an individualized or competitive good.

The philosophy should also not cause misery to future generations, other societies, or to other  beings, and it is important to the government of Bhutan that the efforts of this philosophy be distributed evenly across all sections of  the society.

They work at strengthening the institutions of family and community; the spirit of voluntarism, tolerance and cooperation; the virtues of compassion, altruism, honor and dignity, all of whose active promotion may be a contributing factor to Bhutan’s low crime rate.

Culture also provides a framework where an individual’s or society’s psychological and emotional needs are addressed. By preserving local, regional, and national festivals, the government attends to these needs and provides a forum for maintaining social networks and promoting the conviviality of public culture.

His Majesty, King Jigme Singye Wangchuck of Bhutan

His Majesty, King Jigme Singye Wangchuck of Bhutan

Bhutan treasures the extended family network as the most sustainable form of social safety net. Aware of the possibilities of family disintegration or nuclearization, the government makes conscious efforts to revive and nourish the traditions and practices that bond families and keep communities resilient and thriving.

Their environmental policy is predicated on the perspective that human beings and nature not only live symbiotically but are inseparable from each other. According to this perspective, nature is a partner in existence; a provider of sustenance, comfort and beauty.

Environmental preservation, therefore, is a way of life in Bhutan. Currently, 72% of the country’s area is under forest cover, 26% of the area is declared as protected areas, and the state has decreed to maintain 60% of its area under forest cover for all times to come. Environmental cost is an essential ingredient of evaluating new development projects in  Bhutan.

Finally, Bhutan launched parliamentary democracy 2008, becoming the youngest democratic country in the world. All this was initiated by the country’s leader – His Majesty, King Jigme Singye Wangchuck, thus fostering people’s capacity to make choices.

Well, we have generally been making choices as a country for some time now that generally do not embrace nature, family, our fellow man, or the environment.  On a recent boat trip up the Caloosahatchee River, I expressed a dream, namely that mankind would embrace a philosophy of “National Happiness.”

Now wouldn’t that ROCK?

Not everything that can be counted counts, and not everything that counts can be counted. — Albert Einstein

Read more: http://blog.rypple.com/2010/06/chip-conleys-ted-talk-on-gross-national-happiness-gnh/#ixzz11MQ5ZTm6

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Evolution or Devolution?

July 16th, 2010

There’s a part of me that celebrates each and every day because I’m evolving. For example . . . being a mature person usually feels pretty good.  I’m more settled, less angry, less needy, less . . . well, you get the idea.  On the other hand, I would never want to own a, vintage car.  Why?  They usually don’t have air conditioning, air bags, seat belts, or CD changers. . .with auxiliary jacks for MP3 digital audio players.  Driving one would be taking several steps backwards in safety, comfort, and style.

How else have I evolved?  Let’s see.  I have air bags.  Okay, maybe they’re not air bags,  but I have a protective coating of extra stuff around my organs. (I’ve gained at least one additional pound a year for the past 30 years.)  Oh, and I am a lot smarter, too.  In fact, my IQ test gained at least 10 points over the last few decades.  (It would probably have been 20 points higher if I hadn’t been on cholesterol medication, but I’d probably be dead and that higher IQ wouldn’t help much.)  On the other hand, the fish oil is supposed to make your brain work better.  Mom used to say, “Nicky, eat your fish.  It’s brain food.”  (Forget the fact that it was deep fried and heavily battered.)

Nick Jacobs, FACHE at the beach with his grandchildrenThis evolution thing could all be summed up by saying that I’m finally starting to mature.  Even though I’ve missed it by decades; it’s happening now.  I’m wiser.  Honestly, there couldn’t be that many things left to learn about running stuff; four decades is a lot of  experience.  I’ve learned about politics, human relations, sociopaths and wonderful souls; and I’ve learned about construction, child birth, heart attacks and ground moles.  I’ve lived through the birth of my kids, my grandkids, and my friend’s kids.  I’ve lived through the deaths of every aunt, uncle, and a few cousins; friends, neighbors, mentors and a half dozen family pets, and I’ve held both of my parents in my arms as they passed, too.

Having observed all of this, what is the devolution?

On NPR the other day, there was a short story that the American public’s view of capitalism has deteriorated.  The exact percentage of those still embracing capitalism was about 44% and those who think it’s outlived its appropriateness was around 47%.  (I guess the other 9% might have thought that capitalism had something to do with that white building in Washington D.C.)  Interestingly, before I heard this story, my impression of capitalism had devolved as well.  In fact, the litany of sins observable to me because of the extreme capitalist approach that we have embraced is long and includes:  BP, Enron, Tyco, Bernie Madoff, and the fat food industry . . . I mean, the fast food industry.

But then I read a rant by Jonah Goldberg of National Review Online:

“Every good thing capitalism helps produce — from singing careers to cures for diseases to staggering charity —  is credited to some other sphere of our lives. Every problem with capitalism, meanwhile, is laid at her feet. Except the problems with capitalism — greed, theft, etc. — aren’t capitalism’s fault, they’re humanity’s. Socialist countries have greedy thieves, too.”

So, what’s the answer?  It seems simple enough.  Once again, from Mom, “It’s moderation.”  The far right and far left seem to be providing a daily whipsaw of entertaining cable news shows from Beck to Olbermann and from Hannity to Maddow, but these extreme views are not helping us solve the problems.  In fact their rhetoric contributes to this devolution.  Does Rush really believe everything that he says or does he say it because it’s so outrageous that he can continue to earn nearly $38 million per year?  And Keith? And Glenn?

I like my air conditioning, my air bags, and my computer assisted brakes, but I’m really getting tired of “bags of air,” greedy anybodys and anythings.

Let’s be less angry, less needy, and more settled . . . come on, guys, grow up.

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Settling into what?

July 3rd, 2010

Healthcare reform will be phased in over the next several years, and when you ask the experts what their opinions are regarding this new legislation, the universal answer that I’ve received is, “I don’t know.”  There is one very fundamental reason that leads to this answer, bureaucracy.   Much like HIPAA, the law was actually written by young health policy scholars, 50% of whom will not be in their current positions two or three years from now.  In fact, many of them will no longer be in the Metropolitan Washington D.C. area.  Consequently, the policy wonks will take over and the fundamental premises upon which the program was built will be left for in-depth interpretation by the “bureaucrat du jour.” 

Having spent a decade working in a government related, subcontract situation, this fact alone sends cold chills down my spine at the rate of thousands per second.  Recently, it was my distinct displeasure to sit across from two of these individuals, detail splitters, at a meeting on Capitol Hill.  Prior to the “opening bell,” they had formulated their opinions regarding their preferred outcome of the meeting, and they had dug in to ensure that none of the facts presented by the opposing side would be considered relevant.  They had made up their minds that the greater good would be served by their pre-meeting decision making.  Interestingly enough, their decisions in fact would result in hundreds of families being destroyed as their loved ones were forced to languish so that studies of the studies could be performed over the next several years. 

In HIPAA,  the Health Care  Insurance Portability and Accountability Act, the “wonks” took its well-intended core values and distorted them into a nightmare of implementation that forever changed health care in the United States, and, after literally billions of dollars of required implementation changes for thousands of hospitals, doctors, and health professionals, all one has to do to experience the absurdity of most of these privacy attempts is stand on the other side of a curtain in a surgi-center, a semi-private room, an emergency room, or even a registration area and listen.  What you will hear is hundreds of facts about the person beside you; condition upon admission, detailed diagnosis, phone numbers, et al, at which point you can lean back, smile and say, “HIPAA my A**. “

So, conceptually, is healthcare reform what needed to be done?  The answer is an unequivocal, “Yes.”  Was it the right thing to do to reach out to the uninsured?  Absolutely.  Should we as a country move toward electronic medical records?  Yes.  Does it make more sense to bundle payments so as to encourage physicians and hospitals to work together more closely?  No question.  Finally, was the system broken?  Beyond a doubt. It was completely broken. 

As a country we have slipped out of first place now in so many categories that it is embarrassing to delineate those statistical changes, but healthcare should improve now that this legislation has passed.  You may have detected that the operative word is SHOULD.  Will it?  On PBS’s Nova last evening I watched the day by day analysis of why we were not ready for the attacks on 911.  It was because of the bureaucracy.  It was because the NSA (which now has about 35,000 employees and has a budget well over $20B annually.) was NOT willing to share the information that they were obtaining with the FBI, and the FBI was not working with the CIA, and the CIA was not working with the FAA, and the FAA was . . .  Well, you get the picture. 

Healthcare reform?  We’ll see.

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So, it passed. Now what?

March 22nd, 2010

The very essence of the fabric of our society has changed today and forever.  The questions that arise from the passage of health care  reform are endless in number and the answers will be both evolutionary and revolutionary.  Not unlike those dark or bright days following the passage of Medicare back in the 60’s, the naysayers are predicting the end of the United States and those individuals who will be positively impacted are finally able to sleep through the night without feeling the steady stream of their own tears flowing across their cheeks because they either couldn’t get care or couldn’t afford to pay for the care.

It is more than a cultural change, it is a humanity change.  The key to both, however, is the word change. Those who have wonderful, sustainable, well-financed lives with adequate health insurance are concerned that their hard-earned dollars will go to support an inefficient welfare sate.  Interestingly, many of these people clearly may benefit tremendously by these changes, but  they are unsure as to what that change will represent to them personally.

When Medicare passed, those who did not or could not embrace it quickly enough did have significant life changes.  On the other hand, those who could ended up doing better than they could have ever dreamed.  The same was true of the managed care movement of a dozen years ago. The real question here seems to be one of  “The Greater Good.”  Will it be worth it to help our fellow man?

The bigger issue in my mind is the question of our ability to shift from sickness to wellness care. Wellness and prevention, Tort Reform, Big Insurance, Big Pharma, were all part of the dance.  What will their involvement be in this new healthcare plan?  My insurance friends are predicting the end of their world. Will it be the end or just a different model?

What do we need to do to make it work?  We need to end two wars, decrease the DoD spending accordingly, and monitor those who abuse the system.  We still need Tort Reform. We need to reimburse our physicians for counseling their patients about wellness and prevention as well as for end of  life choices and options.

Telemedicine technology

In a recent article in the Harvard Business Review by Gardiner Morse, The Ten Innovations that will Transform Medicine, we see a stimulating list of opportunities that could make this all work better:

1. Evidence Based Decision Making
2. Payment Innovation (based on outcomes and volumes)
3.  Patient Portals for access to personal health information
4.  Behaviorial Economics
5.  Protocols that work for specific treatments
6. Accountable Care
7. Regenerative Medicine (incl. adult stem cells)
8. Virtual Visits  (telemedicine)
9.  Genetics
10.  Robotics

Regardless of your personal view of healthcare reform, it was clear that the system has been broken for a very long time, and whatever religion or spiritual belief you embrace, it has to be supportive of an effort that will potentially stop destroying the lives of others due to either a lack of available healthcare or a lack of finances.  Stay Tuned.

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Healthcare Reform. . . It’s only just begun

March 10th, 2010

This week’s Bloomberg Business Week magazine featured a phenomenal and very personal story of healthcare that actually captures many of the challenges around healthcare reform.  The author, Amanda Bennett, takes us on a journey that she has titled, “Lessons of a $618,616 Death.”  The true title, however, should have been, “How Do You Put A Price on 17 Months?”  In this article, Ms. Bennett takes us on the step-by-step, blow-by-blow journey that ended with her husband’s death.  She and a friend painfully reconstructed every page of his medical records, every dollar paid by her insurance companies, and every charge made by the various doctors and hospitals that treated him during the last years of his life.

Business Week end-of-life issue - Nick Jacobs - healinghospitals.com
Amanda Bennett and Terence Foley

She showed 1.) the grand total of charges, $618,616, 2.) the actual monies paid by the insurance companies to the hospitals after contractual negotiations, $254,176, and 3.) the total paid by her family, $9,468. In the article, she described the 30% overhead/administration costs, the costs of experimental drugs inside and outside of trials, and the 4,750 pages of medical records that were amassed during this time. For those of us who have “spent our time” trying to live within, cope with, and better understand America’s healthcare system, there were no surprises.  For those of us who have watched a loved one take this cancer journey with all of its mysterious unknowns, there were also no surprises. Ms. Bennett’s quote, “The system has a strong bias toward action,” was, I believe, the most poignant in the entire piece.

A few weeks ago, I had lunch with a very healthcare-savvy individual who, when I jokingly referred to death panels, almost came across the table at me.  She did not believe it was funny.  To say that she was passionate would miss the point.  Only the day before, I had spoken with another very intelligent healthcare reform advocate who indicated that the entire concept of death panels emanated from a payment code that reimbursed physicians for simply (or in some cases finally) talking to patients about their alternatives.  I had heard other explanations, but neither mattered.  What matters is that, in many instances, we are not discussing appropriate alternatives or revealing the quality-of-life issues often overlooked before beginning long courses of experimental drugs, or oncology drugs that may not have any positive impact on the health outcome of the individual.

Interestingly, Ms. Bennett did indicate that for all of the time, money, and pain invested in this journey, no one could confirm that her husband’s life was actually extended by these medical experiences.

Someone once described America’s healthcare system to me like this:  You walk into Nordstrom, order several three-thousand-dollar suits, a dozen shirts and some handmade, silk Italian ties, then turn to the person beside you and say to the clerk, ‘”He is paying for this.”  Our heroine Ms. Bennett did mention the fact that her husband would probably have questioned the use of all of these funds in this manner and the relationship that these expenditures might have had on all of the other people in the world who might have been helped by these dollars.

Taking the Hell Out of Healthcare by Nick JacobsWhen healthcare reform is discussed, it is personal.  It is also deep, and it is costly, but the bottom line always comes back to this: “How do you put a price on 17 months?”  In my book Taking the Hell out of Healthcare, I discuss the journey that my father and our neighbor took together over about a 17 month period.  Both diagnosed with lung cancer, my father decided to go for it all.  He had surgery, chemo, radiation, more radiation, and more chemo.  My neighbor, a man without significant health insurance coverage, decided to spend his time with his family.  They both died on the same day.  My father died in a cold, tertiary care hospital where no clergy was present, his family members were not all able to be there with him, and it was over.  In contrast, our neighbor died peacefully in his home, surrounded by his entire family.

Ms. Bennett did say that she was glad that she was not a bureaucrat having to deal with these issues.  Frankly, I wish that she was!

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Congressman John P. Murtha

February 9th, 2010

Yesterday’s phone call from the Somerset Daily American caught me off guard.  “Hi, Nick, have you heard?  Congressman Murtha passed away this afternoon.  Could you give us a quote?”  the reporter said.   Truthfully, I was not ready for this call.  Having talked to friends who had been with him only a week earlier, everything seemed like it was going to be okay, but obviously, okay was not what it was.  He had one of the 500,000 or so laparoscopic cholesystectomies performed each year to remove a gallbladder.  This surgery has a .05% complication rate, but the call proved that, regardless of the percentages, there is always risk from human involvement.

The Late Rep. John Murtha I’ve decided to dedicate this as a very personal look back at my journey with Jack Murtha.  Ironically, we had grown up practically as Pennsylvania neighbors in Westmoreland/Fayette Counties.  My first real meeting with Mr. Murtha was during the 1977 Johnstown Flood.  I was a young teacher and volunteer who was mopping the floors of the relief centers,  getting things ready for survivors who had lost their homes when I heard a helicopter come flying in and saw a tall, impressive, 44 year old Congressman deplane.  He had only been in Congress for a few years, but had clearly learned enough about the  System to keep then-President Carter on his toes and get legislation passed to help his home district.

My very next encounter with Mr. Murtha wasn’t until about three years later, when his Washington office called me to see if they could help my employer at that time, Laurel Arts of Somerset, with a bill that was going through the House before Ronald Reagan took office.  Nothing came out of that call except for the fact that I realized that his employees were parents of former students and people who liked and respected my work from those days.

Then the big encounter hit.  Mr. Murtha was looking into bringing the National Park Service into Cambria County to start what became the America’s Industrial Heritage (Tourism Development) Project.  He and several other Congressmen came to the University of Pittsburgh in Johnstown to hold a Congressional hearing on the project, and, as the newly-elected President of the Laurel Highlands Convention and Visitors Bureau, I testified against the plan and explained that if they didn’t include Westmoreland, Somerset, and Fayette Counties, we would not display any literature promoting it at all of the tourist sites that we controlled.  They agreed, and not many months later, he ended up representing Fayette County as part of his district.   It worked out for both of us.

A few years later, I had transitioned into healthcare senior leadership and  invited Mr. Murtha to introduce Bob Hope at a fund raising event for the Mercy Hospital of Johnstown.  Approximately 6,000 people were in attendance and Mr. Murtha got as much applause as Mr. Hope.  The following year he helped us bring in Henry Mancini and his orchestra for a similar event and our respect for each other began to grow.

Rep. Murtha speaking at Biotechnology expo (2004)

Rep. John P. Murtha speaking at Biotechnology Expo (2004)

In 1997, when I became the President of Windber Medical Center, Mr. Murtha and I were seated near each other at a dinner party.  It was there that we  began to discuss healthcare, and his vision for the future.  Anything that would help the soldiers stay well, prevent illness, or stop it before it became an issue was his goal.  I heard him speak at the opening of one of his many health center initiatives at Walter Reed Army Medical Center, and he said, “I have 13 honorary degrees, hundreds of awards, and am well known as for my work in defense, but I want my legacy to be healthcare, prevention, and wellness.

His contributions to healthcare, however  small they may seem compared to what he has done for the world and for mankind, through his tireless and dedicated work were where his heart was.  His strength and vision made him the most impressive human being that I have ever known, and my love and respect for both him and his wife, Joyce, cannot be calculated in mere human measurements.  I am proud of him, his work, and his commitment, and I know that the seeds that he has planted in Breast Cancer Research will go on to save thousands of lives someday.

Ironically, it was healthcare that took his life.  No one can ever replace Jack Mutha; his knowledge of the system, his guts and determination, his singular efforts to help a district that had been devastated by natural disaster, his kindness and great personality.  No one.  So, today, I write with great sadness that our great friend is gone, but at the same time, I vow that his name, his contributions to humanity, and his memory will never be gone.

Look at wriwindber.org or windbercare.com, and see what Jack Murtha built.  We loved you, Jack.

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