One of my New Year's Resolutions this year (09) was to learn enough about the US health care system to form an opinion. I've read half a dozen books, (Daschle, Herzlinger, Porter & Teisberg, Emmanuel and others) a bunch of articles, had dozens of conversations with people who've experienced different systems and even seen Sicko.
And, six months ahead of schedule, I have an opinion. First, along with millions of others, (but not apparently the honorable representative from Ohio) I think our health care system is majorly broken. I think we need a health care system that:
1. Provides universal coverage. It's a national embarrassment to live in the richest country in the world by far and have 50,000,000 Americans without access to basic care. What they do is go to the ERs which is the most expensive basic care we could imagine.
2. Has everyone who uses the system contributing to it in proportion to their means. Taxing people who have more is a hard sell when illegal aliens and people off the tax roles are not contributing to the health care they get.
3. Preserve choice. Individuals should be able to chose the kind of health care they want.
4. Preserve private enterprise's engagement in the health care system. Americans want to be in business and earn from that. We don't want the government to administer health care. Preserve a multi-payer system to distribute the costs.
5. Remove the profit motive from health care. The problem with mixing profits and health care is that providers avoid the really sick and are encouraged to milk the system to their own advantage so that margins rather than health care becomes the foremost concern.
6. Reduce the litigious nature of medicine so that doctors can practice medicine with less concern about being sued by anyone who seeks a free income.
7. Enhance the development and collection of health records and data that would feed research into health care systems and processes.
8. Reduce the cost of the US healthcare system.
9. Protect the patient from predatory practice.
10. Provide universal healthcare coverage for all people within the United States at a basic level.
11. Snip the connection between healthcare benefits and employers. The cost of healthcare is a major drag on employers.
12. Encourage wellness among the population.
All of that is a tall order. AND here's a system that will do all of the above. It's not mine. I'll give credit at the end.
WHAT WE SHOULD DO THIS YEAR
1. Create a national health care board similar to the Federal Reserve. This national committee would oversee the rules and procedures governing the system. Appointed with a similar process as the Fed.
2. Create twelve health care districts each with a regionally appointed board to make regional application rules, adjudicate disputes, assign patients, collect data including the development of a universal health care record, conduct research, recommend to the national board. Law suits would have to be cleared by the regional board for legitimacy before they could be brought.
3. Anyone who resides within a region who does not have health insurance would be assigned to a private plan by the regional board. All patients would have the option every January to switch systems, preserving choice. Thus, every person is covered, private companies are responsible to their patients and cannot avoid sick people. Inefficient or ineffective companies would find their patients leaving. Effective and efficient systems would attract patients.
4. Premiums are allocated from a federal pool to private insurers according to their roll of patients and their needs. Hence, insurers who had more serious illnesses would receive more funds providing an incentive to attend to the seriously ill as well as to the not-so-ill.
5. Doctors and hospitals and other health care institutions would be compensated by the private insurers through private contracts. The better providers would command higher compensation and the better insurers would be able to pay them.
6. Install a federal sales tax of 8% on all sales of all finished goods and services that goes into, without exception, the federal health fund pool. Funds are allocated to the twelve regions based proportionately on the sales in their regions. In this way, everyone who lives in America is participating in supporting the healthcare system, but only according to their needs. Illegal aliens. Tourists. Diplomats. Drug dealers. EVERYONE who bought something would be contributing to the healthcare system. If you have a big income and want to buy a $500,000 car, you can. It will cost you $540,000. and you'll be contributing more to the health care system than the person who buys a $9,000 car for $9,720. Should the poor be made to contribute to the healthcare system. I believe anyone who uses a service shoudl contibute to it. Our own Ralph Waldo Emerson's SELF RELIANCE you know. This process also snips the connection between employers and healthcare costs (I know, just a minute).
The national sales tax requires some attention. Would it stimulate the development of a black underground market? Perhaps--we also have income tax evasion present in the country today. We'd have to monitor that. Would it create a sea-anchor/drag on sales and the economy? Maybe a bit, but I think it would be a short-term (1-3 years) dip and then we'd be "used" to it. More than the healthcare cost to employers today? I don't think so. Other countries manage a VAT and seem to be carrying on. Would the government try to siphon off the tax for other purposes? Of course. Hang those folks. Publicly. Yes, the ones we elected who steal from the pool--hang 'em. Not really--just throw them in jail for 30 years where they'll get free healthcare.
The biggest sticking point of this system is likely the source of funds--a national sales tax. But wait a minute, what are we paying for health care NOW? We have one of the most expensive, inefficient systems in the industrialized world. And what do we get for that? 34th in the world on infant mortality--for example. We're NOT getting the bang for our buck. The system described above would press relentlessly for improvements in the system by encouraging efficiency and quality without sacrificing the sick. It would allow ALL who benefit from the system to contribute to it retaining a sense of dignity and membership. It would allow us to do much better research on better healthcare methods and procedures. It would reduce frivolous litigation. It would reduce cost. It would encourage the formation of small businesses in healthcare AND release the drag on non-healthcare entrepreneurs.
We need this system NOW. And my thanks to Ezekiel Emanual and his book, HEALTHCARE, GUARANTEED for striking to the heart of the issue(s). I WISH President Obama and Speaker Pelosi would read this book TODAY. How could any of we Americans be opposed to adding 8 cents to our bill the next time we buy coffee or a donut to help get people off the streets and out of the gutters when they cannot afford healthcare? Our current system is NOT taking care of our own. And our economy is three times larger than the next largest one. Shame on us for being so insensitive.
Thursday, July 23, 2009
Monday, July 6, 2009
Universal Human Rights
Are there any universal human rights? This is a really tough question. Have you thought about it?
Eleanor Roosevelt and the UN published in 1947, the year I was born, a list of some 30 what they claimed ought to be (declared to be) universal human rights. See this web site, http://www.un.org/en/documents/udhr/ if you want to check it out. Many of them revolve the core concept of the "dignity" of every human being. Life. Liberty. Freedom. Equality under law. Own property. Trial. etc.
I've been asking this question, "what if any do you think are universal human rights," of people for the last year or so and am amazed at how few people believe there are ANY.
Mother Nature doesn't seem to grant any. No right to live, right to reproduce, right to freedom, speech, mental health, a whole body, or any of it. No right even to dignity. Birth defects, mental illness, a little too much of one of the 300 brain hormones or a little DNA/RNA reproductive malfunction, a missing gene or two, and boom, you have schizophrenia, spinal bifida, cleft palates, and various syndromes. Mother Nature's way is perhaps a harsher way.
So "rights" seem to be granted by cultures not by nature. My philosophy friends may pick this all apart; it seems that almost everything has been discussed before. Nevertheless, what rights should a culture grant its citizens? Clearly this varies across the globe.
Life? Should we do everything we can to keep every human being alive regardless of quality of life? That's a big one. Oregon says not necessarily. It's an important question, though, because it has huge implications for the kind of universal healthcare (more later) that a society might or might not offer. Should every citizen of every country have equal access regardless of wealth to flu shots? Setting broken bones? Blood pressure medication? Cesarean section birth?
What about the right to have children? Consider this dilemma. A man is born with severe birth defects including cerebral edema, webbed hands and feet and diminuitive skeleton. He has fifteen or more operations to be able to function minimally in society. He's unemployed. He marries and has a child who has all of the same defects. The baby girl will go through the same series of a dozen or more operations costing upwards of a million dollars in order to get rudimentary fingers and toes and skull plates inserted so her brain can grow. Her father says he wants to have more children. Should he be allowed to do so?
Should we have a license to become a parent? Does everyone have the right to reproduce? If not, who would decide and on what criteria? Clearly the couple above are making decisions that impose a large financial burden on society. Should society accept that burden? We say one has to have a license to drive, to drink, to bear arms, and to practice certain kinds of professional activity. What about reproduction?
The right to freedom? What does that mean? Freedom to speak? To move to another location? To publish? The American Bill of Rights spells out some. Freedom from poverty? Does every human deserve or rather "have" the right to basic necessities of life?
Again, Mother Nature does not grant any of these. But some cultures grant some of them.
For me, there is an intersection somewhere between human dignity and self reliance and social compassion. That intersection is a large gray area obviously--as people try to figure out how much to emphasize each one. If you push on self reliance, then some will go without healthcare. If you push hard on social compassion, then some will abuse the system and get a 'free' ride. If you push hard on the equal human dignity dimension, then someone has to pay for health care and prisons.
In nature, it seems, that birth defects, variation in talent and ability, variation in sexual orientation, variation in appearance, in susceptibilty to disease, even social attributes (see Nigel Nicholson's book, Executive Instinct for example) are facts of life. How do we collectively, culturally, respond to these variations? Do we/should we do all we can to keep everyone alive artificially? Some might argue yes on the one hand and then condemn stem cell research on the other.
I want to believe that every parent to brings children into the world should accept responsibility for the well being of that child. If they cannot care for them, they should not bring them in and then "dump" them on society. Clearly, not everyone does accept that responsibility. I think society should hold biological parents accountable for their offspring. If the children are not able to become self reliant, then the parents should care for them. We shouldn't, I say, make it easy for parents to reproduce and then abandon.
Every child, it seems to me, should have the best chance it can to survive and grow. I no longer believe that the natural parents necessarily know best what to do for those children. I've seen too much abuse and mistreatment even in the name of religion to continue that mythological belief. The problem is who should decide? Not facists. Not communists.
The reality is that our local sub-cultures decide whether we want them to or not. Hence a rapee in Asia might be stoned. A woman sold. A female child in Africa "circumcised" (sewn up) while the community looks on in approval. A street person in Los Angeles dies alone in the gutter.
The concept of "rights" also implies we might infer the concept of "responsibilities." If a society is going to grant me some "rights" (since Mother Nature does not), then I must have some responsibilities to that society in return. If I ask about my rights, should I not also ask about my responsibilities?
What's your list of "universal human rights?" What about the related "universal human responsibilities?"
Mine would include the following:
1. Right to choose life or not.
2. Right to choose to sustain another's non-viable life or not.
3. Right to basic health care in my society.
4. Right to a basic education.
5. Right to move, to speak, to believe, to work where and how I want.
6. Right to know the whole deal--not just what you choose to tell me. We should not profit from the ignorance of others.
7. Right to own things.
8. Responsibility to be self reliant. I "should" be able to take care of myself and my family.
9. Responsibility to care for those I bring into the world.
10. Responsibility to contribute to my society from which I benefit. This might be in taxes or service or both.
11. Responsibility for the consequences of my actions especially as they affect others.
12. Responsibility to behave in ways that if all participated in, society would be enhanced, not degraded. (Kant's universal imperative)
Eleanor Roosevelt and the UN published in 1947, the year I was born, a list of some 30 what they claimed ought to be (declared to be) universal human rights. See this web site, http://www.un.org/en/documents/udhr/ if you want to check it out. Many of them revolve the core concept of the "dignity" of every human being. Life. Liberty. Freedom. Equality under law. Own property. Trial. etc.
I've been asking this question, "what if any do you think are universal human rights," of people for the last year or so and am amazed at how few people believe there are ANY.
Mother Nature doesn't seem to grant any. No right to live, right to reproduce, right to freedom, speech, mental health, a whole body, or any of it. No right even to dignity. Birth defects, mental illness, a little too much of one of the 300 brain hormones or a little DNA/RNA reproductive malfunction, a missing gene or two, and boom, you have schizophrenia, spinal bifida, cleft palates, and various syndromes. Mother Nature's way is perhaps a harsher way.
So "rights" seem to be granted by cultures not by nature. My philosophy friends may pick this all apart; it seems that almost everything has been discussed before. Nevertheless, what rights should a culture grant its citizens? Clearly this varies across the globe.
Life? Should we do everything we can to keep every human being alive regardless of quality of life? That's a big one. Oregon says not necessarily. It's an important question, though, because it has huge implications for the kind of universal healthcare (more later) that a society might or might not offer. Should every citizen of every country have equal access regardless of wealth to flu shots? Setting broken bones? Blood pressure medication? Cesarean section birth?
What about the right to have children? Consider this dilemma. A man is born with severe birth defects including cerebral edema, webbed hands and feet and diminuitive skeleton. He has fifteen or more operations to be able to function minimally in society. He's unemployed. He marries and has a child who has all of the same defects. The baby girl will go through the same series of a dozen or more operations costing upwards of a million dollars in order to get rudimentary fingers and toes and skull plates inserted so her brain can grow. Her father says he wants to have more children. Should he be allowed to do so?
Should we have a license to become a parent? Does everyone have the right to reproduce? If not, who would decide and on what criteria? Clearly the couple above are making decisions that impose a large financial burden on society. Should society accept that burden? We say one has to have a license to drive, to drink, to bear arms, and to practice certain kinds of professional activity. What about reproduction?
The right to freedom? What does that mean? Freedom to speak? To move to another location? To publish? The American Bill of Rights spells out some. Freedom from poverty? Does every human deserve or rather "have" the right to basic necessities of life?
Again, Mother Nature does not grant any of these. But some cultures grant some of them.
For me, there is an intersection somewhere between human dignity and self reliance and social compassion. That intersection is a large gray area obviously--as people try to figure out how much to emphasize each one. If you push on self reliance, then some will go without healthcare. If you push hard on social compassion, then some will abuse the system and get a 'free' ride. If you push hard on the equal human dignity dimension, then someone has to pay for health care and prisons.
In nature, it seems, that birth defects, variation in talent and ability, variation in sexual orientation, variation in appearance, in susceptibilty to disease, even social attributes (see Nigel Nicholson's book, Executive Instinct for example) are facts of life. How do we collectively, culturally, respond to these variations? Do we/should we do all we can to keep everyone alive artificially? Some might argue yes on the one hand and then condemn stem cell research on the other.
I want to believe that every parent to brings children into the world should accept responsibility for the well being of that child. If they cannot care for them, they should not bring them in and then "dump" them on society. Clearly, not everyone does accept that responsibility. I think society should hold biological parents accountable for their offspring. If the children are not able to become self reliant, then the parents should care for them. We shouldn't, I say, make it easy for parents to reproduce and then abandon.
Every child, it seems to me, should have the best chance it can to survive and grow. I no longer believe that the natural parents necessarily know best what to do for those children. I've seen too much abuse and mistreatment even in the name of religion to continue that mythological belief. The problem is who should decide? Not facists. Not communists.
The reality is that our local sub-cultures decide whether we want them to or not. Hence a rapee in Asia might be stoned. A woman sold. A female child in Africa "circumcised" (sewn up) while the community looks on in approval. A street person in Los Angeles dies alone in the gutter.
The concept of "rights" also implies we might infer the concept of "responsibilities." If a society is going to grant me some "rights" (since Mother Nature does not), then I must have some responsibilities to that society in return. If I ask about my rights, should I not also ask about my responsibilities?
What's your list of "universal human rights?" What about the related "universal human responsibilities?"
Mine would include the following:
1. Right to choose life or not.
2. Right to choose to sustain another's non-viable life or not.
3. Right to basic health care in my society.
4. Right to a basic education.
5. Right to move, to speak, to believe, to work where and how I want.
6. Right to know the whole deal--not just what you choose to tell me. We should not profit from the ignorance of others.
7. Right to own things.
8. Responsibility to be self reliant. I "should" be able to take care of myself and my family.
9. Responsibility to care for those I bring into the world.
10. Responsibility to contribute to my society from which I benefit. This might be in taxes or service or both.
11. Responsibility for the consequences of my actions especially as they affect others.
12. Responsibility to behave in ways that if all participated in, society would be enhanced, not degraded. (Kant's universal imperative)
Saturday, November 15, 2008
Future BLOG Agenda
Over the last several months, I've been in so many stimulating conversations in various parts of the world, I'm eager to begin capturing and commenting on many of the issues facing us today in the hopes that these essays or comments will stimulate your thoughts and comments.
Here's my tentative agenda of issues. If all goes well, I'll be adding some thoughts and questions for your consideration.
Unalienable Rights
Immigration
Population
Health Care
Education and Pedagogy
Limits to Growth
Self Confidence
The #1 Question in Life
The role of feel in performance
Greed
Energy
Poverty
Gay Rights
The United States Contribution to the World
The nature of success
The Limits of Tolerance
If you have other topics that you think are important to consider, please reply here and I'll add them to the list.
Here's my tentative agenda of issues. If all goes well, I'll be adding some thoughts and questions for your consideration.
Unalienable Rights
Immigration
Population
Health Care
Education and Pedagogy
Limits to Growth
Self Confidence
The #1 Question in Life
The role of feel in performance
Greed
Energy
Poverty
Gay Rights
The United States Contribution to the World
The nature of success
The Limits of Tolerance
If you have other topics that you think are important to consider, please reply here and I'll add them to the list.
Saturday, November 25, 2006
How to Make Career Decisions
I've been teaching a career management course for 30 years, first at HBS and then here at the Darden School, UVA. I'm surprised at how important career decisions are to people and at how little rigor they bring to those decisions. The result is a modified trial-and-error methodology that unfortunately leads to current statistics of something like 5-8 career changes for most graduating MBAs. People use a variety of techniques for making career decisions: serendipity, opportunistic, creation, and peer pressure. Given the high proportion of habitual behavior among most people, a matching approach seems to be the obvious best approach. By matching approach, I mean making decisions based on goodness of fit between personal habits or enduring life themes and the demands of any particular job, career or organizational culture.
The problem is that most people don't know themselves well enough and in enough detail to make a good decision based on goodness of fit between themselves and the demands of a job. Well, you might say, I know myself well. Really? What are your habitual ways of thinking? How do you prefer to process information? What's your preferred social structure and style? Have you analyzed your preferred lifestyle? What about your analytic skills? Energy level? Biochemical brain balances leading to or away from ADD, OCD, BPD, etc.? The danger with any degree of self awareness is what we might call "benign self deception." If you make career decisions based on your momentary reflections of who you are and what you want, be careful! You may overlook some key factors (habits or themes) in your life that will surface after you've taken the job--and then you'll be looking again.
Those who make career decisions on a rigorous self assessment are likely to make better decisions than those who don't. So then the question is, "how can I get a good self assessment to use in my career search and decision making?" There are thousands of self assessment tools out there, some of them trash and some of them quite helpful. But consider this premise: no single instrument is accurate enough or comprehensive enough to give you confidence in making career decisions.
There are just too many variables to consider in one instrument and too many variables in the answering of the questionnaire items to trust your career future or even a part of it to one instrument. The answer is to take several self assessment tools and look for the repeating patterns or themes or the tips of iceberg habits that appear across instruments. This requires some time and effort and some skill at inductive logic (looking at the data and generating the principles). Too much time and effort your say? Compare that with the cost of time and effort in working in a job that doesn't fit you and then doing it all over again in 1-3 years. Why not invest up front and narrow your career search to the band of jobs that would likely fit you better?
My colleagues and I have ported the text I used (and was the lead author on--Self Assessment and Career Development) to the web to offer this kind of service. You can preview it at www.CareerNextStep.com. There are more than a dozen instruments there for you to use in your search for a rigorous listing of your career defining personal characteristics. But whether you use Career Next Step or not, whenever you approach your next major personal or professional decision, please, consider carefully (preferably data-based) your dominant Life Themes (cognitive, interpersonal, social, professional, etc.) before you decide. If you choose ignoring them, the odds are you'll be unhappy and be making the same decision again shortly. Save yourself a boat load of time and effort by investing in a good self assessment up front.
The problem is that most people don't know themselves well enough and in enough detail to make a good decision based on goodness of fit between themselves and the demands of a job. Well, you might say, I know myself well. Really? What are your habitual ways of thinking? How do you prefer to process information? What's your preferred social structure and style? Have you analyzed your preferred lifestyle? What about your analytic skills? Energy level? Biochemical brain balances leading to or away from ADD, OCD, BPD, etc.? The danger with any degree of self awareness is what we might call "benign self deception." If you make career decisions based on your momentary reflections of who you are and what you want, be careful! You may overlook some key factors (habits or themes) in your life that will surface after you've taken the job--and then you'll be looking again.
Those who make career decisions on a rigorous self assessment are likely to make better decisions than those who don't. So then the question is, "how can I get a good self assessment to use in my career search and decision making?" There are thousands of self assessment tools out there, some of them trash and some of them quite helpful. But consider this premise: no single instrument is accurate enough or comprehensive enough to give you confidence in making career decisions.
There are just too many variables to consider in one instrument and too many variables in the answering of the questionnaire items to trust your career future or even a part of it to one instrument. The answer is to take several self assessment tools and look for the repeating patterns or themes or the tips of iceberg habits that appear across instruments. This requires some time and effort and some skill at inductive logic (looking at the data and generating the principles). Too much time and effort your say? Compare that with the cost of time and effort in working in a job that doesn't fit you and then doing it all over again in 1-3 years. Why not invest up front and narrow your career search to the band of jobs that would likely fit you better?
My colleagues and I have ported the text I used (and was the lead author on--Self Assessment and Career Development) to the web to offer this kind of service. You can preview it at www.CareerNextStep.com. There are more than a dozen instruments there for you to use in your search for a rigorous listing of your career defining personal characteristics. But whether you use Career Next Step or not, whenever you approach your next major personal or professional decision, please, consider carefully (preferably data-based) your dominant Life Themes (cognitive, interpersonal, social, professional, etc.) before you decide. If you choose ignoring them, the odds are you'll be unhappy and be making the same decision again shortly. Save yourself a boat load of time and effort by investing in a good self assessment up front.
Friday, November 24, 2006
Living with Bilateral Quadriceps Tendon Tears and Repairs
This POST is intended as a forum for those who have or have had bilateral quadriceps tears (and subsequent repairs). You can post here or e-mail me at JimClawson@virginia.edu . My new friend, Jim Falvo, has also had this. Here's Jim Falvo's Amazing Story .
(The short introduction) On 9/2/06, I was descending a flight of stairs in Istanbul, Turkey, and both my legs gave away. I heard a distinct "pop, pop, pop" in both legs as they collapsed. The next day, MRI's confirmed the diagnosis, bi-lateral quadriceps tears. It was very painful, terrifying, and confusing since I had no sense of weakness, fatigue, or advance warning. Getting home from Istanbul was a grueling experience made possible by a generous client and the warm flight attendant staff on a Delta flight. Since then I've learned that this is a relatively rare event; the first surgery on bilateral quadriceps ruptures (BQRs) was only done in 1949, two years after I was born. If you've had or are in the middle of a BQR event, I hope my experience here will help you. And if you're willing, I hope you'll write and share your experience with me and others. I couldn't find any blogs on-line that covered this kind of experience. So I wrote a "BLIARY" (non-interactive) which if you want more details and recovery history, you can find at:
(The short introduction) On 9/2/06, I was descending a flight of stairs in Istanbul, Turkey, and both my legs gave away. I heard a distinct "pop, pop, pop" in both legs as they collapsed. The next day, MRI's confirmed the diagnosis, bi-lateral quadriceps tears. It was very painful, terrifying, and confusing since I had no sense of weakness, fatigue, or advance warning. Getting home from Istanbul was a grueling experience made possible by a generous client and the warm flight attendant staff on a Delta flight. Since then I've learned that this is a relatively rare event; the first surgery on bilateral quadriceps ruptures (BQRs) was only done in 1949, two years after I was born. If you've had or are in the middle of a BQR event, I hope my experience here will help you. And if you're willing, I hope you'll write and share your experience with me and others. I couldn't find any blogs on-line that covered this kind of experience. So I wrote a "BLIARY" (non-interactive) which if you want more details and recovery history, you can find at:
If you've had a BLQT, I hope you'll share your experience with Jim Falvo and me. Cheers.
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