Failure to communicate

We've all seen the headlines. Some guy in Scotland decided that it would make better sense to 'compassionately release' the man responsible for the bombing of Pam Am 103 over Lockerbie, Scotland in 1993 than to feed, house, and care for the guy over the last 3 months of his life. Hell, besides saving money, you can piss off the Americans a little, make friends with the people that supply you oil, and you know the Americans will still be your friends after a month or so. I can see the gears turning in his fat little skull now.

So, anyway, of course, America's pissed about it. Over 200 of the dead were American college students, and we're still pretty much ready to lynch terrorists after the 9/11 bombings. Even Obama, the apologist, spoke out strongly against the decision - a miracle that shows there is hope after all that he might retain some good judgment after all.

I'm pretty pissed too, but for slightly different reasons. I'm pissed because when a man who killed 270 people walked off the plane in Libya, he was cheered and celebrated. It was like he was a damn war hero or something. I was waiting for Ghadafi to come out with his cheesy-looking sunglasses and pin a medal on the guy. Now, if there's any travesty of justice here, it is found in that welcome. Has the value of innocent human life fallen that low?

So I ask myself why. Why do these people cheer a mass murderer? We cheer murderers too, but we call them soldiers and we pay them to do it on our behalf. However, this man is no soldier, at least, not in the same sense as an infantryman or a fighter jet pilot. He thinks he's a soldier in an undeclared war on America - or more precisely put, a war against what America stands for. Now, that's not Bush administration rhetoric for 'freedom,' nor is it comic book rhetoric for 'truth, justice, and the American way.' What I mean is that this war has been declared against hedonism, greed, debauchery, global entrepreneurism/imperialism, arrogance, and the like. We've all heard the rhetoric in this post-9/11 world.

Whether we like to admit it in this country, whether it's true or not (and it certainly ISN'T), this is how many people around the world see Americans. We're the spoiled rich kids they see on our prime-time sitcoms. We're the hedonistic, egotistical rappers in our music that's been exported worldwide. We're the employees of the company that just bulldozed 10 city blocks to build a factory that pays 22 cents an hour to make shoes and shirts sold at prices the employees who make them could never afford. We're the rich tourists too stupid to recognize the 'American tax' on the prices they offer us, while we tour the beautiful parts of their country, while shunning or ignoring the daily reality most of them face every day. We're the drunken exchange students who come to party and use drugs, and do the stupidest things all while daddy pays for it. These are our ambassadors. These are the influences that speak to what our country is all about. No wonder people hate us.

Truth is, we're notoriously awful at correcting these stereotypes, hell, we rarely even address them as such. Even though the largest part of Americans don't behave in this manner and are quite grounded, responsible, and damned hard-working, we don't get credit for it, because other countries don't see it. Our soldiers in Iraq have been successful in turning the tide for that country because they were damn hard-working. We have poured money into that country, rebuild roads, schools, utilities, markets, soccer fields. We put 150,000 soldiers on the ground in that country and the people there had the opportunity to get to know how many Americans really behaved when they got to know our soldiers. While some will never be swayed, many saw what Americans were really like and now have a favorable impression - regardless of the rhetoric.

The Obama administration responded quickly upon taking office with a global tour of apology. He apologized for all of the wrongs of the Bush administration. He apologized for our arrogance, our... blah blah blah . It was a step. I think it was a weak step. He had no business apologizing for things he didn't do, but it did win a second look from many countries who otherwise wouldn't have bothered to pay attention. Now, however, he's proceeded along with his domestic agenda, stuck his head in the sand, and is essentially ignoring foreign policy. This is a huge mistake. Given our success in Iraq and our committment to Afghanistan, we should be attempting to exploit the successes we had in Iraq. Our foreign aid (and it is considerable) should be accompanied with U.S. soldiers who will oversee it's delivery and manage it, so that we're not handing third-world dictators a huge check made out to cash. We should be buying and distributing food, building roads, hospitals, and teaching people employable skills, so that these countries can grow their own economies without our aid. We need to be making sure that countries who redirect their resources to their military, leaving their people to starve (*cough* North Korea *cough*) are held accountable and our aid withdrawn. If we approach from a position of strength and sincerity, we'll be regarded much better than approaching with guns drawn.

So, back to our celebration in Libya. This is a country we've all but come to ignore. This is our problem. Omar Ghadafi isn't exactly a nice guy. He's a dictator, and runs a state that sponsors terrorism. He's exactly the kind of megalomaniac we don't want to deal with. There is a fine line between aid and capitulation, and he sees any aid we offer as capitulation. His country needs a political form of 'tough love'. We should offer food, trade skill training, and contracts to build hospitals, roads, and schools. We should offer these under the strictest conditions of American oversight with an eye toward offering security to our citizens in that country. We should place embargos on their oil, but lower the tariffs on imports of their consumer goods, to promote their economy. Our money needs to be funneled into the hands of the people and away from their government. Ghadafi will buy guns, which we don't want him having, but his people will buy food, clothing, and maybe a few comforts, and if we're lucky, they may even buy American.

We need to correct a failure to communicate, but we need to do it by speaking directly to people, because their government certainly isn't listening.

Suggestions on Healthcare

Anyone who knows me knows that it irritates the hell out of me when people complain about something and don't have any suggestions for how to make it better. In my last blog, I listed four reasons why we haven't been able to have a decent discussion on healthcare. I essentially blamed America's short attention span, Congress's complete inability to address facts, and the collossal failure of the people who should be speaking to speak loud enough for people to hear.

I also said that I had read good suggestions, so I'm going to talk about a few of them for your consideration:

Suggestion #1: Get rid of the lawyers

Everyone (even the lawyers) understand that they're essentially vultures in our society. They feed off of the misfortune of others. When a doctor screws up and injures a patient, the lawyer files a suit and takes 1/3 of the settlement plus fees. Juries in the past two decades have been increasingly generous to plaintiffs, enticing more lawyers to try and get their chunk of more and more windfall settlements, to the point where the courtroom has become a casino. The House (doctors) don't like to lose, so they insure themselves against losses at enormous expense, and pass the 'savings' on to their patients who pass the bill to their insurance companies, who then generous distribute that cost to everyone in the form of higher premiums.

Here's the thing. Everyone is human, including doctors. Doctors occasionally make mistakes. It's not out of malicious intent. It's because they, like the rest of us, haven't attained Messiah status. Britain does not allow doctors to sue patients. If a doctor makes a mistake, deal with it and move on. If he was grossly negligent or just a 'bad doctor,' he gets his license revoked and his career ended, just like what happens in the US when a doctor's license is revoked. The only difference is you don't have the casino.

Charles Krauthammer of the Washington Post suggested that we create a government run pool, sort of like welfare, to pay for the care of victims of medical mistakes. We would then create a panel of doctors who would review cases of iatrogenic injury, and determine whether re-education, temporary suspension, or revoking a doctor's license was the most appropriate course of action. This would reduce strain on our court system, remove the middlemen from the equation, and significantly reduce healthcare costs by eliminating the institution of medical malpractice insurance.

Suggestion #2: Learn from mutual funds

Mutual funds are like stocks for the poor. When you don't have enough money to successfully manage a diversified stock portfolio, you buy into a fund with a bunch of other people in the same boat and let someone else manage your collective portfolio for you with less risks and greater access to those with lower incomes.

An article in the NEJM (New England Journal of Medicine) suggested creating 'exchanges' for private health insurance in much the same way. These exchanges would filter various plans available, group them according to cost and benefits, filter the least cost-effective, and offer a reasonable number (6-10) choices at rates previously only offered to large companies who could promise insurers many new subscribers. As it stands, buying a single policy or a small number of policies for a family or small business is the most expensive way to buy health insurance. By lumping all of these people into a group through an exchange and offering larger numbers of subscribers to insurers, they could offer better rates to everyone.

Suggestion #3: Unlink health insurance from employers

Employers complain that their largest cost is incurred in health insurance premiums they offer their employees. Employees complain that even if they hate their jobs, they're forced to stay with a company because they don't have another option to get health insurance. Many elderly cannot afford to retire at the age of 65 because the loss of insurance would mean future care would bankrupt them. Charles Krauthammer suggests that if all insurance were carried privately without employer involvement, people would be more free to leave a job to find one that better suits them knowing they would maintain their coverage regardless of which company they moved from or to.

Now, before you go around screaming about how this is just an argument to reduce cost for big business, simmer down. The catch is that employers would have to pay higher salaries to match the cost of health insurance premiums, or employers could be asked to pay into a government pool of funds that would provide a supplement to all taxpaying citizens towards the purchase of healthcare. If you wanted, you could take this from a national health subsidy to a fully single-payer system. I personally believe that private management of health insurance within the confines of stiff competition is the best way to ensure quality of care at a reasonable cost, but the idea is applicable to either private or a public option.

Suggestion #4: Mandatory legal documents

Wait, what? You want more legal involvement, Jon? Yes, and after we get the tort reform I suggested passed, then we can hire back those lawyers to help people write legal documents defining what patients want doctors to do for them in the case of an emergency. Only 20% of Americans have a durable Power of Attorney, a Living Will, or Advanced Directive documents. These documents are used to guide healthcare teams when a patient cannot make decisions for themselves (unconsciousness, judgement impairing drugs given, lack of mental capacity, etc). Our healthcare system defaults to assume everyone would want everything possible done to save their lives without having thought through the possibilities.

Would you want to die with tubes coming out of every hole in your body you were born with and some that you weren't? Would you want to be kept alive in a persistant vegetative state after brain trauma? Would you want to spent $5000/day for months in an ICU if your heart and lungs were too weak to ever work without mechanical assistance? If you had a terminal cancer, would you want an expensive chemotherapy drug that would give you six more months to live but had horrible side effects? If you were badly injured and could not make decisions regarding your medical care, who would you want to speak for you? These are the types of questions that must be answered by these documents. They require thought, consideration, time, and frank discussion with family, friends, and your doctor. And they have to be written when we least want to think about these scenarios - when we're perfectly healthy.

If we had a system where these documents were mandatory for every adult and where all of these legal documents could be made available to hospitals in the case of an emergency, we could reduce costs while at the same time providing a higher quality of care that was more consistant with the wishes of each individual patient.

Why we can't have an honest debate about healthcare

The answer to this question is so fundamentally obvious that it amazes me all the brilliant people out there working on this have still failed to answer it. We can't have a debate because no one understands it well enough. Listen to Obama, or your favorite Congressman or Senator speak on the issue. They babble, bouncing for soundbite to soundbite without actually saying anything substantive. Numbers? huh? Statistics? what? Actual facts? you mean, you actually wanted those? This is the sort of ad lib filler that I usually see on 24/7 news channels on a slow news day. You know, the days when they start talking about the Sri Lankan baby born with 7 toes and an elephant's trunk or when they start reading off of Twitter like it's a legitimate source of information to report. That kind of garbage. I'm frankly tired of it.

So here's problem #1: There's only one option on the table.

If you have only one option on the table, the discussion quickly reduces down to 'take it or leave it.' Given the average person's inherent psychological need for routine and resistance to large changes, Obama's plan has hit like a sucker punch and the gut reaction to it is to push back from the table and leave.

People appreciate simplicity. Our government produces most of its documents and publications intended for the masses written at a third grade reading level. Even our under-educated, grade-inflated, ego-stroked, cracked out high school drop outs need to be able to understand what they're getting and navigate it, so the government simplifies things to a picture book level. When Congress put together a 1000 page desk ornament and stamped it 'Obamacare,' people took one look at it, saw it wasn't a Harry Potter book extended their middle-fingers, and went back to playing solitaire on their computers at work. Even intelligent people knew that they didn't want to read the thing, even if Congress had titled it 'The Great American Novel on Healthcare'.

Now, there are a lot of talking points out there, so obviously some poor bastard had to sit and attempt to wade through the legal labyrinth found between pages 1 and 1000. We hear people say everyone is going to get healthcare (Great!). We hear it's going to cost money (Not so great). We hear the rich are going to pay for it (Great, unless you're rich). Then we hear that there aren't enough doctors (Oops?), the costs were underestimated (Oops again?), and that the government is going to tell poor Grandpa he can't have a quintuple bypass next time he has a heart attack and will be sent to hospice care (I smell politics!). So, clearly, there are a lot of promises being made about a perfect system (no such thing) and a lot of people who haven't read the bill telling other people who haven't read the bill that it's not going to work. At this point, we're too busy arguing over what He said and what She didn't say to actually see that we're not debating anything.

So, the situation here is that we have a 1000-page paperweight no one wants to read on one hand, and a system that's already in place and for the most part, managing to take care of Aunt Sally when she's sick. Most of what we hear about the plan is bullcrap, so no one listens. People are choosing the status quo because for whatever reason, they haven't been convinced that reform is going to be a positive change.

Problem #2: Doctors are collectively awful publicists

There are good alternative suggestions out there. I've read them. Some in the New England Journal of Medicine. Some in the Journal of the American Medical Association. Some in the Wall Street Journal, and one very interesting idea from the opinions page of the Washington Post. So why aren't we hearing about them? Doctors who have the experience and time to treat patients don't have the time to do interviews, lobby Congress, or pose in Playboy (or Playgirl?) to get the attention necessary to present their thoughts on a national stage. There are academic doctors at major teaching hospitals and medical centers all over the country suggesting alternatives, or at least thinking through the potential ramifications of Obamacare, but they publish their thoughts where only other doctors will ever see them and in language only another Ivory Tower champs can read.

And while doctors are too busy to communicate properly, all we're hearing at the public level is the White House's and the GOP's talking points. And trust me, I'm not taking advice on how to make 1/7th of the country's economy financially solvent from a bunch of guys who send their kids to private schools, can't balance the budget, and think nothing of spending millions of dollars every four years trying to get a job that pays $200 grand. And neither is anyone else. So what happens is that 'debate' continues without any real facts or good ideas being considered because so few people who actually need to hear them in fact are hearing them.

Problem #3: Healthcare is boring

It's true. As much as we all know we need it, we don't want to deal with the specifics. Just like when you buy a computer, most people don't really care what the front-side bus is or whether you have 184 or 200 pins on your RAM chips. When we buy healthcare, we don't really care about the specifics. We pay a doctor so they can worry about that. So when we're listening for suggestions and 60% of them involve details that read like a drug formulary or a new insurance policy, we switch over to Desperate Housewives or 30 Rock. Obama, for all his charisma and charm has failed to be able to parlay that into a vibrant discussion on healthcare in this country. Change is an easy message to sell to a country that hates the course it's ship of state has taken. It's not so easy to sell when people aren't convinced they need to pay more attention to healthcare than they do to which new starlet is flashing her unmentionables.

Problem #4: We're asking the wrong people

When we consider the problem of healthcare reform, the people we hear talking are politicians. These are the same people who outsource their research, outsource their media releases, and in general don't do much but take other people's work and present it as their own. Don't believe me? Check out how Congressional Subcommittee's work. Your Congressman/Senator is a manager with a megaphone. They know squat about medicine.

So, let's ask the doctors, right? Well, kind of. Just like your Congressman is managing his army of researchers, your doctor is managing an army of nurses and technicians who are providing the care they order. Doctors aren't thinking about cost efficiency very often, unless it's with regards to their bottom line. If you want to get good feedback, you need to talk to the nurses and technicians who are ordering supplies, handling the technology, maintaining the hospitals, and see where they can cut costs. Doctors are going to tell you a very simple answer when asked about cost: "I don't care how much it costs, because a human life is more valuable." That's exactly what I expect of my doctor. If my leg is broken and I need it fixed, I want them thinking about how to fix it, not how much it costs to keep a C-arm running so they can get additional views while they work. When doctors think about cost, they think about how much they have to try and talk insurance companies out of in order to cover their overhead.

So, that said, we need to have more suggestions on the table. We need to have a nationwide brainstorming session where everyone who works in healthcare from the orderly to the CEO of Kaiser Permanente throws out suggestions. We need to consider what is working well, so we don't screw it up by making changes that aren't necessary, but most of all, we need to have moderation at the level of the national media to filter the mudslinging. If the media can't be intellectually honest in it's reporting, we'll be forced to take the mangled, dog-chewed remains of post-Congress Obamacare whether it's any good or not.

Militant Islam

If you're not completely blind to the world around you, you've heard on the news about riots in France that have gone on almost 2 weeks now. They started when 2 teenagers found themselves in an electrical transformer station, some say running from the cops, the cops say they were there of their own accord, found themselves choosing extra crispy - and I'm not talking about chicken. The kids were Muslim, and their Muslim community said "aw, hell naw!" to the French government and started breaking stuff. Buildings were trashed and looted, and cars were burned. Apparently, these guys really like weiney roasts and S'mores, because they're turning every car they can find into a bonfire.

Now, my good friends the reporters have classically divided themselves politically and have altered their reporting to match. FoxNews was all over this story like white on rice from the moment it broke, giving it coverage on their cable news briefs on putting links to the story on their homepage. They sensationalized it like it was a 1968 race riot in Detroit or something. CNN conveniently ignored this story, opting instead to put headlines about botox, and the daily soaps ahead of anarchy in one of the most hostile anti-US nations in the world. The BBC mentioned it, but in such a watered down fashion, it's questionable as to whether the story as it was published was even newsworthy. So, the question is... well, was it newsworthy?

I think so, but probably not for the same reasons the reporters do. They want conflict, something to sell papers. I see a shining example of the influences of religion on people who are willing to listen. Islam is very much like Christianity, in that it's strongest believers are those who are in greatest need of hope in the spiritual, those who possess little worldly wealth. It is also similar is basic teachings, as well as in extremist teachings. However, where Christian extremists tend to become separatists or suicidal, Muslim extremists become homicidal, using "jihad" as an excuse to murder people and call it the "will of Allah". Yes, Allah created all human beings, but he also created infidels for you to murder for points, redeemable for cash prizes and vestigal virgins in the afterlife! Get yours today!

You'll have to pardon my cynicism, but any religion that preaches peace in one breath and in the next calls for the extermination of other human beings is straight up, effed up. The scary part of this is that it's spreading. It's not just a middle eastern problem now. There are Muslim extremists outside of Iraq, Iran, and Saudi Arabia. They're in Indonesia blowing up hotels and assassination political leaders. They're in Malaysia calling entire countries (the US) infidels. They're in France blowing up everything that'll ignite under a Molotov cocktail. They're even here, in the US, driving airplanes into buildings with the intent to kill thousands. Now, you can parade a million imams in front of a TV camera to say that Islam is peaceful, but I don't believe one word of it, when I see five year olds in their moms' arms wearing the same garb as Hezbollah suicide bombers.

And that's the reason why this story is getting such mixed reviews in the press. The evidence is very clear. Islam is spreading worldwide and it's pissed off and willing to fight no holds barred. Women? Call them whores and kill them. Children? Already corrupted by their infidel parents, so they gotta die. Jews? Stole your homeland and need to die. Americans? Helped the Jews, kill on sight. French? Helped the Americans in a couple of wars, but sell us stuff and give us money, kill em last. This is their logic. This is the kind of logic that can't be reasoned with, because it is in fact, illogical.

These French rioters are poor, jobless, and looking for free stuff from the French government that the French government can't provide. Funny thing is, the French government for a century hasn't really been able to do much of anything. They tried and failed to influence the Spanish Civil War, were occupied twice by Germany, followed the United States in the last half of the century begrudgingly because we took back and rebuilt their country, then gave them an important seat in the UN. Chirac's government has only exemplified this trend. It fed Iraq guns, weapons, and money. It hid some of it's leaders as they fled the second US attack on their country. They've apologized for everything, and have exemplified "political correctness" to the point where it has paralyzed their country from taking any controversial action. Hate the Muslims, but can't turn away the brown-skinned people you secretly despise because you'd be called racist, welcome them in, then turn your nose up to them. Call them French citizens, then give them last access to jobs, tax them, and don't offer them education - socialism lets them do this. Well, now the Muslims are all fired up for war worldwide (thanks, Bin Laden, ole buddy, ole pal) and they can hurt the strongest country in the world by getting the whiners and bleeding hearts to take up their cause, surely they can do it in a weak country with an apologist administration, especially one that's already corrupt.

I still get a kick out of France's response to the rioting. What would China do? Roll in a tank division and demand some respect. What would Zaire do? Sic the Bantus on them and make a bloody (literally) mess. What would the US do? Call in the National Guard to restore order with Jarheads packing M-16s. What does France do? Publish their "plan" 12 days into the rioting after having countless committee meetings I'm sure to finalize it's wording and make sure it's in a pretty font. They order curfews to be enforced by their police (who're doing a spectacular job of quelling the riots, so they have time). Curfews?! Is that the most authoritative these people can be? No wonder they're losing. They're responding to people driven by faith to murder with curfews.

Chirac apparently missed the memo on Islam. These people are desperate and have no fear. They feel no remorse, and consider it a great honor to blow themselves up in restaraunts, hotels, at weddings, in buses, and on playgrounds. These people are evil and unreasonable and driven by hate that is preached to them at mosque. You can't discuss anything with them or hope to change their minds. They only respond to people who approach them more aggressively. And France has failed to act aggressively, which is why it is now burning. In the interests of keep their government functioning, France needs to very quickly step it up, or it'll merely embolden these people to hit harder somewhere else.

Needed a Change

As you can see, I'm using a slightly different template on my blog now. It's still basically cookie-cutter, but I'm working on it =) It was time for a change.

And now for the real topic. ER is a fantastic show! I hadn't watched in months, and it's a real shame. Been missing it either for work, TKD, or whatever. Anyway, they kicked Susan's character out of the show and brought it John Leguizamo to play the new doc who comes in under the premise of being a hatchetman "to improve the efficiency of the department." It's funny because when our hospital does that, they hire a new CEO, fire a bunch of people, and try and pick up the peices, and it seems that losing two of our most active docs hasn't helped. Back to ER, they seem to mix drama and fact very well, and I think that's why I like it so much. There's a damn cool storyline, but with a background that requires a little thought and insight to understand. I'm sure to most people, when they bring in a patient and start barking out orders for this drug and that procedure that it really all just sounds like when the Nazi guards in old WWII movies yell "Schnell!", but usually they're right on with their treatment!

Maybe I just like it, cuz I'd like to think I'd be capable of doing that one day. Hey, the blog's called "Needed a Change", eh?