Special People, Special Experiences

They are unanticipated. You can't know they're coming. But they are welcome, and often exciting, too. And they always make a difference, sometimes a big difference. They are sometimes events or experiences, but most often people. And you're fortunate if one or two grace your life, blessed if more.

They may offer new things, or make old things new. They can even be bearers of ambiguous or bittersweet experiences, but nonetheless change what was into so much more. They can heal you, grow you, strengthen you, even embolden you; they can make you more whole. They can move you toward who you could be, should be, and assure you in that identity and calling. They can move you to accept new and better invitiation to life. Joy and renewal, grace and peace, are more often yours.

These are the special people that, however unexpected, appear fated to come your way. Not often meant to remain or remain long, they play their special role, and move on to other life invitiations. In this time between the seasons of thanksgiving and advent, I am finding time for warm reflection and gratitude for the gifts of these special people and experiences that have passed my way, gifts only God and life could give. Perhaps you have some too.

Greg

A Season of Thanksgiving

It's a season of thanksgiving. And I have a lot to be thankful for. Ginny is feeling her best in 15 months, full of energy and back at her classes and pastimes, thanks to her heart procedure. There's Adam and Nilofer in Spokane, Laura in Portland, all engaging life, their personal and professional joys and challenges.There's Naples and RI, and peace of place. There's existential and spiritual identity, and peace in both. There's quiet time, and seeing and hearing God in more ways, more places, more people. There's direction and peace there, too. There's reading, reflecting and writing. There are old friends, new friends, and friendships renewed. God and life are good when we are grateful.

Blessings to all, Greg

Reducing $Billions in Healthcare Waste: Sounds Easy. Not.

A Thompson Reuters Study:

Proposed reforms could be paid for by fixing inefficiencies, report claims

WASHINGTON - The U.S. health care system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday. The U.S. health care system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of health care analytics at Thomson Reuters, found.

"America's health care system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads. "The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's health care bill," Kelley said in a statement....

One example — a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending. "It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.

Some other findings in the report from Thomson Reuters, the parent company of Reuters:

• Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of health care waste or $200 to $300 billion a year.
• Fraud makes up 22 percent of health care waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
• Administrative inefficiency and redundant paperwork account for 18 percent of health care waste.
• Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.
• Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

"The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada," reads the report, citing dozens of other research papers...

--Reuters, msnbc.com (10.26.09)

They may appear as low-hanging opportunities ready for the picking. But they are not. If they were that easy to address, they'd have been remedied a long time ago. There are entrenched financial interests and structural barriers that protect them. Each will be as much a political battle as any other healthcare policy or significant administrative change. And so, while these opportunities are well known and an adjunct part of the healthcare reform dialogue, initiatives to address them are not part of any healthcare legislation. First things first is the reality. It is proving difficult enough to pass any kind of healthcare reform, however desperately needed and however short of meeting the actual need. Further wrangling and wrestling over necessary, related healthcare cost reduction measures will have to wait for another day--or else nothing at all will be passed. For all have finally learned: this is an incremental process, and if it is to achieve anything, it must proceed one digestible, workable step at a time.

Some friends and others concerned about the stand-alone financial integrity of healthcare reform legislation argue that any cost reduction possibilities to be later addressed should not be counted as savings related to the reform legislation--now or then. I understand the arguments, the logic. Whatever healthcare plan that is passed cannot now deal directly with solving these problems, and so any benefit from separate efforts to solve them should not be counted to reduce the net cost of a new healthcare plan. After all, if we had only taken the initiative, we could have addressed some of those problems and achieved the cost savings earlier. But, then, might not the cost of today's healthcare bill be considerably less in some areas? Many of the issues are directly or indirectly related.

Regardless, the adjunct discussion of these opportunities, the evolving understandings of the absolute need to reduce these costs, will provide the impetus and incentive to next address these problems and opportunities in a way that did not exist before. Surely that much is true, isn't it? And I don't personally care how they format the benefits of the sum total of expenses and savings associated with healthcare or healthcare reform--that associated directly with the legislation, or that which follows indirectly but necessarily from it. The bottom line effectiveness and efficiency for the whole healthcare system is all that really matters, isn't it?

When new healthcare reform legislation is passed--whatever is passed--cost containment and reduction efforts will surely move to the front burner, won't it? Won't it be on the minds of healthcare providers, and federal and state governments alike--and the likely subject of future regulatory or legislative initiatives? Budget-conscious Republicans, Blue Dog Democrats, even progressive Democrats, will have to find common cause in the effort to rationalize the newly reformed health care system so that it is socially and financially accountable, and operationally efficient by standards of international best practices. It will happen. It will have to. But as already conceded, it will take time and will not be easy.

Walk through each of the identified problems or opportunities in the article excerpt, above. Take out a piece of paper, and next to each item list parties with important financial, ideological or political interest, and how critical it is to their continuing financial viability or power to maintain the status quo. List the structural, organizational and political barriers (including those representing the financial interests), legal and regulatory barriers, capital cost barriers, management and resistance-to-change barriers (regardless of the benefit to be achieved). Then, list the steps that would have to be taken to overcome them. It's all very daunting and tiring, and without a strong popular mandate, legislative will and initiative, and the leadership of the executive branch--the President--it's all a twisted, rocky road over a steep hill.

But it can be done, and it likely will be--at least to some extent. All responsible observers agree that it must be. And examples of many such successes already exist on a smaller scale at one hospital or another, in one medical system or another, somewhere. Take the challenge of a common computer system with all healthcare records. Many hospital systems already have that. The blueprint is there, and the savings are large. It should be a "no-brainer."

But then there is the indefensible, ethically inexplicable genuflecting of the Democrats before the American Trial Lawyers Association. The failure of tort reform in this country constitutes unwarranted support and subsidization of a shameless level of plaintiff's counsel compensation through unlimited contingent fees in medical malpractice suits. It raises to daunting levels the cost of medical malpractice insurance, and is a proven incentive for doctors, hospitals and other healthcare providers to maximize testing and procedures--often unnecessarily--to avoid any possible argument of negligence. The cost to the practice of medicine, as noted in the article above, has been far too great to justify. Reasonable, legal limitations on jury awards, and legally protected standards of medical practice have to be legislated and regulated. Why won't the Democrats--even at a time when cost containment is so critical to their legislative agenda--fail to do what is right and necessary? And what of President Obama? He, most of all, was supposed to be above such things. I'm an Obama fan, as most of you know, but he's been a disappointment on this issue.

So many of these cost-saving initiatives are financially necessary and ethically important to an effective, efficient healthcare system. Regrettably, as easy as they are to articulate and agree with, they nevertheless remain difficult to hold for long in the cleansing sunlight of social, financial and political accountability. But while a season of accountability and reform is still upon us, our public support must remain high and demanding. The government's political will must be buttressed, held firm, and energized by the strong, determination of healthcare consumers--we, the American people, all of us.

http://www.msnbc.msn.com/id/33480141/ns/health-health_care/

Uninsured ER Patients Twice as Likely to Die

Associate Press

CHICAGO - Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study. The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable.

"This is another drop in a sea of evidence that the uninsured fare much worse in their health in the United States," said senior author Dr. Atul Gawande, a Harvard surgeon and medical journalist....

The findings are based on an analysis of data from the National Trauma Data Bank, which includes more than 900 U.S. hospitals. "We have to take the findings very seriously," said lead author Dr. Heather Rosen, a surgery resident at Los Angeles County Hospital, who found similar results when she analyzed children's trauma data for an earlier study. "This affects every person, of every age, of every race."

--© 2009 The Associated Press, on msnbc.com (11.16.09)

Why should we be surprised? When healthcare and healthcare insurance are treated as a commodities mediated by commercial markets, you get what you pay for. And if you can't afford to pay, and your life rests in the balance, then you cannot be surprised if your life is forfeit when someone else with healthcare insurance will likely survive. Isn't it well past the time to join most civilized societies in defining healthcare as a civil right, a human right? But the answer's still no, isn't it?

http://www.msnbc.msn.com/id/33971846/ns/health-health_care/

November 10th. Semper Fi.

November 10th. Marine Corps Birthday. Oogh-ragh! Happy Birthday to all the Marines who have served through the years, the wars and conflicts of times past. And especially to all our younger brothers serving today in impossibly ambiguous and disheartening situations--but serving so well. Semper Fi.

Greg Hudson