Friday, July 27, 2012

Hark! Some Doctors admit they might be for Obamacare. Oh, Right. Shhhh.

Lately I've been hearing from certain friends that Obamacare is EVIL.  They're hearing it, they say, from their doctors, and I have to believe they're telling me the truth.  I don't understand why any doctor would favor health care profiteers over a plan--watered down as it may be--that at least makes an attempt to bring some relief to health care abuses, but my own dentist seems to be one of them.  He objects to Obamacare for reasons he didn't make entirely clear, but since he was railing against it while puttering around with a drill deep inside my tooth, I wasn't much for talking about it, anyway.

When I asked my own primary care physician (a sweetheart of a small town doctor who gives hugs and makes house calls) what he thought about it, he said there were pros and cons and the jury was still out and oh, wait!  Is that a cyst?

So I'm left with the internet for some insight into the thinking of those in the medical profession who have to deal with insurance companies and with the Affordable Care Act known as Obamacare.  (You'll notice almost immediately that I'm only choosing the pieces that mostly favor ACA.  If you want to find articles against it there are multitudes from which to pluck.  I don't want them here.)

A while back I came across a site that led me to White Coat Underground.  It's written by a physician who prefers to remain anonymous for obvious reasons. He has a knack for keeping his readers  interested by combining medical ethics with common sense and a friendly bedside manner.  He writes on "Health Care Reform:  Who Speaks for Doctors?"  And in this article called "Thoughts on Obamacare", he says:
For now, I’m sticking to my guns. I’m calling the Supreme Court ruling on Obamacare a victory for Americans, and I’m proud to call it “Obamacare” (rather than Romneycare, which would better reflect history). But it’s not entirely clear how ACA’s implementation will ultimately affect us all. Here’s some potential pitfalls:
  • As insurance reform, rather than healthcare reform, it continues to fund the bloated, cash-sucking US private health insurance industry.
  • It’s going to cost us all something. Whether that “something” is more than we’re pumping into health care now, or simply a shifting around of costs isn’t clear.
  • A lot more people will have access to preventative care, but there are not nearly enough primary care physicians available to take care of them due to perverse financial incentives.
  • That’s really about it. That’s the worst I can come up with.
Here are some potential benefits:
  • As insurance reform rather than healthcare reform, it should unify conservatives and liberals. More coverage, but reliance on the public sector. Still waiting for that Kumaya thing, though.
  • It’s going to cost something, but nothing we’re not already paying for. You think paying for insurance for people is expensive? We already tried not paying for it, and we pay anyway, every time someone wanders into an ER, every time an uninsured diabetic gets another leg chopped off.
  • A lot more people will have access to preventative care. This may give us the incentive to reform medical education and practice to encourage more primary care docs.
  • It’s a moral victory. It’s not a single payer, and still allows the insurance industry to steal our money, but it makes a statement that as a nation, we believe that the health of our citizens is as important as fighting fires and keeping criminals off the streets.
  • We get to make people buy broccoli. And Brussels sprouts.

Dave Weigel exposes the poll that says 83 percent of doctors oppose Obamacare so much they might quit:
If a story leads the Drudge Report for most of the day, you're eventually going to hear about it. So, here you go: "Report: 83 percent of doctors have considered quitting over Obamacare," by Sally Nelson.

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.
Intriguing. What's the Doctor Patient Medical Association? Nelson refers to it as "a non-partisan association of doctors and patients." But lots of organizations claim to be "non-partisan." The DPMA's co-founder, quoted here, is Kathryn Serkes. She's "non-partisan" in the sense that she worked for a conservative Republican in the 2010 Washington state race for U.S. Senate, and appeared alongside Republican members of Congress at Tea Party rallies against the Affordable Care Act. Her partner at the top is Mark Schiller, M.D., who's also a fellow at the Pacific Research Institute, and the author of a classic 2009 column about how "Obamacare" would succeed by helping to kill sick people.
(Ed. note: Media Matters calls the same survey "comically awful".)

Making a house call

 Here on Buzzfeed doctors react to the survival of Obamacare (partial snip below):
What it really means. Health care professionals, from an OB/GYN to a therapist to a pharmacist, share their feelings on the law and how they foresee it affecting their practices and patients.

With the law upheld, I will see fewer patients who lose their insurance, don't get birth control, and then come to me with unplanned pregnancies. And a planned pregnancy is a healthier pregnancy, so fewer unplanned pregnancies would also mean fewer infant deaths.

The Dermatologist
I don't take any insurance. I have a fee for service practice. In the past, a patient would be reimbursed about 80 percent of the bill by their insurance carrier. Now they will only get 140 percent of what Medicare pays. Since that is very little, I believe many of my patients will be forced to switch to an in-network provider. As a result, I could lose a huge patient base. While I truly believe that health care is too expensive, it is still unclear how mandating that everyone is covered will decrease the cost of healthcare.
 The Internist
My practice treats largely geriatric patients and is almost 100 percent Medicare. We have already seen some benefit from Obamacare. Specifically, our patients have better coverage for their prescription drugs, and they are very happy about it, especially our significant percentage of limited-income patients. From our side, as primary care doctors, we have seen a bonus to our pay which was enacted with this law. If it had been struck down completely, that would have affected our patients because of their drugs, and us because of our bonus. It is urgent to get more doctors attracted to primary care, and keeping this bonus is a help.
We are still seeing a lot of people who still can't find insurance and even if they do it is so costly that people cannot afford it, because the provisions for uninsured people will not be effective until 2014.
We need to get the insurance companies to lose total control of healthcare in this country, but whether increasing government control is the answer remains to be seen! The Canadian system would be a good model if we could afford it.

I don't know. Whenever I hear the opposition demand the repeal of Obamacare--recognizing, of course, that they're the ones most likely to benefit from a repeal, I can't help but think of that old Emo Phillips joke:
I used to think the brain was the most wonderful organ in the body.  Then I realized who was telling me this.

Sunday, July 22, 2012

Killers aim to kill, Guns do the killing, the NRA protects the guns, Lawmakers protect the NRA, Killers aim to kill.

Suspected Colorado movie theater gunman James Holmes purchased four guns at local shops and more than 6,000 rounds of ammunition on the Internet in the past 60 days, Aurora Police Chief Dan Oates told a news conference this evening.
"All the ammunition he possessed, he possessed legally, all the weapons he possessed, he possessed legally, all the clips he possessed, he possessed legally," an emotional Oates said.
The chief declined to say whether the weapons were automatic or semi-automatic, but "he could have gotten off 50 to 60 rounds, even if it was semi-automatic, within one minute," Oates said.
Good Morning America, July 20,2012

In the wake of the latest mass murder in America, the Aurora, Colorado theater shooting spree, the usual talk about how insanely easy it is to acquire assault weapons and heavy ammo seems to fill every inch of air and space.  In the wake of the Columbine shooting--talk, talk, talk.  In the wake of the Virginia Tech shooting--talk, talk, talk. In the wake of the Fort Hood shooting--talk, talk, talk.  In the wake of the Tucson shooting--talk, talk, talk.  The analysis of the dozens of mass shootings in the past 30 years--talk, talk, talk. The consensus is that it's too easy to stockpile the kind of weaponry crazy people use to massacre innocent human beings whose only deficiency is that they manage to be in the wrong place at the wrong time.

Immediately upon hearing the outcry, the National Rifle Association goes into defensive mode, taking their usual stance that guns don't kill people, gunmen kill people, so you can't blame the guns and you can't blame the easy acquisition of those guns. because only a few gunmen are nuts enough to go out and shoot up a bunch of people.  (The second most popular NRA stance is that if everyone was armed and ready, things like this couldn't happen.)

Crazy, isn't it?  But here's the craziest part:  The NRA gets away with it.  Every single time.  All of America--or at least those in a position to do something about a runaway gun association--seems to be terrified of a powerful lobby whose only public position is advocating widespread use of all types of guns and ammo, including repeaters, military-type assault weapons, "cop-killer" bullets, the whole shebang.

So here's more talk--not that it'll do any more good than the talk before it, but it has become obligatory now.  We use it in place of actually doing something about the legality of assault weapons, the obligations of gun owners (and their associations), and the rights of those who fall victim to this irresponsible nuttiness:
Brady Campaign to Prevent Gun Violence
The website for the NRA's lobbying arm, The Institute for Legislative Action, is here.  If you can figure out a way to get them to pay attention to you without having to join the NRA, go for it.

And if you can figure out a way to get our politicians to pay attention this time, here is where you can reach them:

James Holmes bought four guns and 6,000 rounds of ammunition and went into a movie theater with the sole purpose of mowing people down.  He might have had those same thoughts even if he hadn't had access to guns capable of mowing people down as swiftly or efficiently as these did, but a madman with a single-shot rifle or even a six-gun couldn't kill 13 and wound 70 people within a few minutes. 

That's what has to stop.  That's what the talk is all about.

Friday, July 20, 2012

What is a contract if it's not a contract, Part 2

NOTE:  I was doing a little housekeeping and found this piece written a while ago (as a companion piece to this one) that, for whatever reason, I never published.  The election to recall Gov. Scott Walker of Wisconsin took place on June 5, 2012, so it's old news now that Walker survived, but the effort to kill public unions goes on.  I hate to waste a rant against the pols and the pundits trying to destroy unions of any kind, so here it is:
Cartoon - Stuart Carlson, UPS

 After Scott Walker survived a massive recall attempt in Wisconsin--an effort based largely on his threats against public employees--Wall Street Journal columnist Peggy Noonan rejoiced at the union-backed failure.
The vote was a blow to the power and prestige not only of the unions but of the blue-state budgetary model, which for two generations has been: Public-employee unions with their manpower, money and clout, get what they want. If you move against them, you will be crushed.
Mr. Walker was not crushed. He was buoyed, winning by a solid seven points in a high-turnout race.
Governors and local leaders will now have help in controlling budgets. Down the road there will be fewer contracts in which you work for, say, 23 years for a city, then retire with full salary and free health care for the rest of your life—paid for by taxpayers who cannot afford such plans for themselves, and who sometimes have no pension at all. The big meaning of Wisconsin is that a public injustice is in the process of being righted because a public mood is changing. 
(H/T to Cracker Squire for WSJ article.)

Wild-eyed notion as this may be, I'll throw it out there, anyway:  Peggy Noonan doesn't get it.  She talks about someone working for the city for nearly a quarter of a century and then expecting a full pension with medical benefits as if that's a bad thing.  What she doesn't get is that 23 years earlier that employee and that employer entered into a contract specifying the particulars--the starting wages, the bump-ups along the way, and future compensation to any loyal employee who stays on the job for a couple of decades or more.  The promise of a decent pension with benefits is more than just implied, it is discussed, with both parties understanding that that kind of loyalty pays off for everybody.

If as Noonan says, those benefits are being paid for by taxpayers who cannot afford such plans for themselves and sometimes have no pension at all, then shame on the system that allows those inequities to happen.  Anybody who works for 23 years of their lives at the same job deserves, at the very least, a decent benefit and retirement package.

Notice, too, that the Noonans and the Krauthammers (see below) never talk about the taxpayer-paid packages public officials receive.  Only the lowly employees--the union folks. Those who do the actual work and expect to be well compensated for it, just as anyone with a lick of sense would expect.  (I've written about taxpayer-paid packages for public officials before.  See the whole revolting compensation story here.)

Washington Post columnist and Fox contributor Charles Krauthammer on the Wisconsin recall:
Tuesday, June 5, 2012, will be remembered as the beginning of the long decline of the public-sector union. It will follow, and parallel, the shrinking of private-sector unions, now down to less than 7 percent of American workers. The abject failure of the unions to recall Wisconsin Gov. Scott Walker (R) — the first such failure in U.S. history — marks the Icarus moment of government-union power. Wax wings melted, there’s nowhere to go but down.
 There is much glee in those circles, and why not?  It's how these opinionators make their living.  We know for a fact that famous opinion-makers like Noonan and Krauthammer are well-compensated for their views.  And if they should work for the same company for, okay, 23 years, one would only hope they were smart enough to negotiate a contract that would provide them some damn fine recompense down the road.

Because that's how it should work in a fair world--for everybody. That it doesn't isn't the fault of the worker, it's the fault of the people in power who see value in devaluing the laborers and try their damnedest to convince those laborers that cutting off their noses to spite their faces is way better than any old benefit package.

Monday, July 16, 2012

A Happening in East Liverpool.

East Liverpool, Ohio has long been known as the center of American dinner-and diner-ware.  For well over a century, from the mid 19th century into the middle of the 1960s, it had been the home of some 300 potteries (partial list here), and included names like American Limoges, Homer Laughlin (across the river in W. Virginia but within shouting distance), Hall, Harker, Taylor Smith Taylor, Knowles, Pearl, Purinton, Royal, Sebring,  Sterling, and Wellsville.

Together, the big potteries, using the fine clay they found on the banks of the Ohio River, churned out hundreds if not thousands of different lines to be sold to department stores and restaurant supply companies.   East Liverpool claimed the title, "Pottery Capital of the Nation", and so far no one has disputed it.

Until the 1960s, when the move to foreign goods caused a rapid decline in their numbers, in this little corner of the country, where Ohio, W. Virginia and Pennsylvania meet, these potteries were responsible for more than half of the United States ceramics output. Today, there are only two of those major companies left:  Hall, and Homer Laughlin (still producing Fiesta Ware, their top line).

Designers like Eva Zeisel (she died last year at the age of 105, still designing almost to the end), Ben Seibel and Don Schreckengost came up with new shapes and brought dinnerware into the modern age.
Eva Zeisel for Hall

I collect vintage American production pottery, so I sat up and took notice when, during an interview, Howard Schultz, the CEO of Starbucks,  mentioned East Liverpool. Starbucks has signed a contract with American Mug and Stein, a small pottery in East Liverpool, and they've been producing a few thousand logo mugs a month for their stores.
Starbucks CEO Howard Schultz says the contract with American Mug and Stein is only the beginning.
"There are hundreds of East Liverpools around the country today," he says. "These towns have been left for dead. And even though it's more expensive to manufacture this mug in the U.S. than it would be in China or Korea or Mexico, this is what we need to do."
But McClellan says towns like his can't live only in the past. That's why he and a couple of partners just bought a shuttered pottery factory across town to outfit it with the newest equipment. Meanwhile, the original factory will continue to make mugs the old-fashioned way — by hand.

East Liverpool lives!  And, by the way, the mugs sell for $10 at Starbucks--about the same as a similar mug made in china might cost in a similar coffee shop.  So it can be done, just not as profitably.  And there's the crux of it:  Can companies calling themselves "American" ever give up their obsession with hiring cheap foreign labor to produce cheap foreign goods to sell in America to Americans?   Could this be the start of something big?  I don't know.  But if it isn't, it should be.  And this small step by Starbucks is proof that it could be.  Take the shutters off of those empty factories.  Start up those machines again.  That ridiculous theory that this huge country can thrive without producing goods has been disproved.  It didn't work.  It couldn't work.  It never was going to work.

Some East Liverpool pottery from my own collection.  (Including the Eva Zeisel plate):

Hall Casserole

English Garden, Homer Laughlin
Taylor Smith Taylor Wheat Coffee Carafe
Pearl "Aladdin" tea pots

So here's a story:  I have a habit of turning over plates to see who made them.  I do it in thrift stores, flea markets, and antique shops, but I also do it in restaurants and in peoples' homes. I'm pretty shameless about it.  So I was in a restaurant not long ago, trying to see the bottom of a plate, which, unfortunately, was full of food.  I was sure it was made by an American company--there's a subtle difference in the feel and in the glaze--but  I couldn't just lift it over my head, so I was trying to tip it far enough to see the mark, when the waiter--a young man probably still in college--leaned over and whispered, "Homer Laughlin."

Totally made my day.  

Tuesday, July 10, 2012

The Test of a Great Teacher (This is not a test.)

As a former student who froze at test-taking time, no matter how hard I studied and no matter how sure I was that I would ace it this time (but never did), I was horrified when "No Child Left Behind," a plan linking school funding with student testing, became the law of the land. 

I no doubt learned at least a few things in school, but nobody would ever have guessed it at the time, so lousy was I at test taking.  As a result of my inevitable brain freeze on the very days when I needed it the most, my grades were awful and I spent years feeling dumber than dirt.  (There were 140 students in my high school graduating class and when I found that my grades put me in the exact middle, I was ecstatic.  Really.)
There are people--my grandson might even be one of them--who probably see testing as surefire proof that kids are learning what they're supposed to learn.  He was the exact opposite of his grandmother:  He was a gifted student who loved the challenge of tests and actually looked forward to them.  He was the kind of kid who, just for fun, would ask his grandfather to make up math problems for him to solve.  I never saw him sweat over tests.  There's something unnatural about that.  Every normal human being (except maybe "Jeopardy" contestants) hates tests.

I worked with Psych interns and residents at the University of Michigan long ago in the Way Back, around the time the University began to understand that brain-blockage at test time was a serious problem.  They recognized that many of their finest hands-on students were falling behind because of a fear of tests, so they began to offer classes in test-taking.  But here's the odd thing:  Hardly anybody, even in Psych, wanted to admit they fell short in the test-taking department, so they wouldn't enroll.  One intern did, and he was furious when the news that he was taking the class leaked out.

There is a stigma attached to failing tests of any kind.  The word "loser" hangs over the results, and if it happens often enough, the one taking the tests can't help but be marked by those failures.  But that's not to say there is no place for tests.  There's nothing wrong with testing to gauge how well a student grasps lessons (she says now), but when the emphasis is on tests and not on learning, it skews the entire process.

And now, when public schools are under constant attack by the Right, there's something more insidious going on:  Now, if test scores fall short, it's not just the fault of the students, it's the fault of the teachers and ultimately the schools. Whatever else gets done in the classroom becomes increasingly meaningless if a student can't answer questions on a test. "No Child Left Behind" has become a vehicle for downgrading public schools and the teachers who serve them in order to promote privately operated schools funded with taxpayer money, often formulated by the states to do nothing more than side-step the demands of the teachers' unions. It's the perfect weapon.  It's near impossible to teach to the test and still produce students who can broaden their learning skills outside of the classroom.  So kids fail, teachers fail, and schools--public schools with open enrollment where all can attend--fail.  And those who have been waiting for public education to keel over and die gain yet another foothold.

Rebecca Mieliwocki, 2012 Teacher of the Year
 So when Rebecca Mieliwocki, 2012 Teacher of the Year, said this in her speech before the NEA last week, I sat up and listened:

When great teachers are asked to focus on test scores and push them to the forefront of our priority list we give kids a warped and weird education that honors neither the depth nor breadth of human knowledge, but it is an absolute turning of our backs on the uniqueness of each individual child we teach and I refuse to do that.
She went on to try and bolster the waning spirits of teachers who find themselves ready targets in the battle over public education.
It's so striking to me that in our ferocious and noble zeal to not leave even one child behind we may have accidentally left all the teachers behind instead.  If we want a transformation in education, if we truly want innovation and reform, we have got to stop talking about testing and start talking more about developing, supporting and celebrating teachers.  Teachers are the architects of the change we've been waiting for.
At that, she got a standing ovation, but remember--she was in a room full of teachers.  Outside that room there await multitudes who think every word coming out of her mouth is hogwash.  Teachers are the new pariahs.  They want to get rich off our kids and want us to pay for it.  They only go into teaching so they can get three months off in the summer.  They're dumb. They're socialists.  And they insist on belonging to unions.

In any profession there are good and bad players. Teaching is no exception.  But teaching as a whole doesn't deserve the reputation it's been getting, and our kids don't deserve the residual backlash. There's nothing subversive about developing, supporting and celebrating teachers.  There is something subversive about turning education into yet another private enterprise.

 So hooray for public schools and warrior-teachers like Rebecca Mieliwocki.  Teaching our kids to think, to create, to be caring, to be bold can only come about when teachers themselves are allowed to be thoughtful, creative, caring and bold.

They know and I know and you know that can't be taught with a test.


Wednesday, July 4, 2012

Our Dependence on Independence Day

There are many who complain that our Independence Day (now, sadly, just called the Fourth of July) should be observed not on the actual July 4 but on the Monday closest to it in order to have that long weekend we so cherish here in America. That's like saying Christmas should be celebrated on the Monday closest to December 25.  Some things are sacrosanct.  The day our founding fathers signed our Declaration of Independence from England is one of those days.

It is also the day almost all of us leave our workplaces behind and get together for parades and barbecues and fireworks.  That it happens to fall on a Wednesday this year is a bummer for some, but that's the way it flies.  It's not close to either weekend and confusion reigns over which days to take off in order to travel to the Fourth of July destination.  For many more this year, it's a one-day holiday and then it's over.

In our remote area, Wednesday Fourths are deadly to the merchants.  People just aren't arriving in crowds large enough to keep them going through the summer and beyond into winter.  I feel sorry for them, of course, but I hope they don't notice that I'm not hanging around, either.  I'm taking off today to spend the day in the city where the parade will be larger and the fireworks will be flashier, and I have to admit I'm feeling a little guilty about not staying put in the place where my few dollars might actually make a difference.

But I'm going, anyway.

So here is my contribution today:

The actual Declaration of Independence, word for word.

Norman Lear's paean to this day, Born Again as an American.

Some actual good news from the State of Michigan. (Thrown in because actual good news for my state is so rare.)

The DAR makes amends and Marian Anderson can at last RIP.

Fourth of July recipes.

And how it looks from here:

Enjoy your day, stay safe, be happy, and be ready to report to work again tomorrow, when we take up the cause for saving this battered country.  Those freedoms they fought for so valiantly more than two centuries ago haven't exactly been won.

But we'll get there yet.