Question: How are we supposed to make something of ourselves in a world that seems incredibly un-inviting of new employees?
As an answer to this one, I give you an excerpt from the commencement speech at Wesleyan University this past May, by the always inspiring author, Anna Quindlen. She talks about how even though this may be the most intimidating world to try to make something of ourselves in, perhaps it is the first time in a while where we really get to redefine what "make something of yourself" really means - and that's a good thing. In her words:
We are supposed to apologize to you because it seems that that is no longer how things work, that you will not inherit the SUV, the McMansion, the corner office really ought to mean that you will not do better than we did. But I suggest that maybe this is a moment to consider what “doing better” means.
If you become the first generation of Americans who genuinely see race and ethnicity as attributes, not stereotypes, will you not have done better than we did?
If you become the first generation of Americans with the clear understanding that gay men and lesbians are entitled to be full citizens of this nation, will you not have done better than we did?
If you become the first generation of Americans who accord women full equality instead of grudging acceptance, will you not have done better than we did?
And on a more personal level, if you become the generation that ditches the 80 hour work week and returns to a sane investment in your professional lives, if you become the first generation in which young women no longer agonize over how to balance work and family and young men stop thinking they will balance work and family by getting married, won’t you have done better than we did?
Believe me when I say that we have made a grave error in thinking doing better is merely mathematical, a matter of the number at the bottom of your tax returns. At the end of their lives people assess them, not in terms of their income but in terms of their spirit, and I beg you to do the same from the beginning even if we who came before often failed to do so.
Frankly, I already think of your generation as better than my own as a group. You’re more tolerant, more creative, less hidebound and uptight. You’ve done more community service than any other generation in the history of this country. It is no accident that as all of you finally became old enough to vote we finally became brave enough to have an election process in which Americans were really engaged.
And all this despite the fact that you’ve been bombarded by a culture that sends you so many confusing messages. Let’s see, you’re supposed to live clean, to drink Bud, to be Zen, to work tirelessly, to have sex without guilt but seek enduring love. And maybe because of that you have had to figure out for yourself what matters in a way past generations, with their bright lines of behavior, did not. In the first full sentences she ever uttered, Maggie Simpson took the pacifier out of her mouth and spoke of herself in the voice of all of you, “She did not live to earn approval stickers. She lived for herself.”
You’re the children of the new technology and the new tolerance, of gigabytes and gay marriage, the first generation of Americans who assume the secretary of state will be female, and the huggiest group of people who have ever lived. You are totally qualified to be and create the next great new thing.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
To see the entire text visit the wesleyan website here.
"Long live the flying leap!"
-Anna Quindlen
July 30, 2009
July 29, 2009
Health Care Reform: Changing Physician Incentives
Question: How do we incent health care providers (specifically physicians, because they are the ones in control of care) to provide the best care, not just the most expensive?
This answer comes from a few sources, as everyone seems to be talking about health care reform!
In a new article in the NewYorker, Hertzberg breaks down why we're having such a hard time with health care reform:
"Americans, polling shows, have long been as receptive as Europeans to the principle of universal health care. Six times since 1948, we have elected Presidents committed, at least on paper, to that principle."
He goes on to say that most everyone believes that health care should be a human right, not a commodity - meaning that because you are part of a society and pay taxes to a government, you should be entitled to health care. However, he also says that pretty much everyone believes that a drastic change (say, to a system funded entirely by taxes that treats everyone based on their health care needs, not how much they pay) is not feasible.
I agree with Obama's initial health care reform principles (see them on healthcarereform.gov) and think the basic idea is to (in a way that will not increase debt) cover everyone for the services and procedures that are necessary and feasible, make sure coverage stays with people no matter what their job is or where they move, and in the process, make health care better.
After creating a system where everyone is covered, the immense administration costs for all the people and paperwork to make sure everyone gets reimbursed can stop being the focus, and people who work in health care can focus on what they have be trained to do, as clinicians, scientists, and care givers: provide great care and continue to figure out ways to make it better.
The way reimbursement works right now does not reward or incent prevention of illness, lifestyle changes (instead of invasive measures), or helping patients navigate through a system that is hard to navigate even when you're not sick. One of the systemic changes that has been proposed is to pay physicians set salaries, potentially with extra bonuses for good patient results. This means that no matter how many procedures a physician orders or how many patients s/he sees, s/he takes home the same salary. In places like the Cleveland Clinic, the Mayo Clinic, and a smaller hospital called Basset where this has been implemented, costs have decreased considerably and the level of care remains some of the best in the country (though I'm not sure what the standards used for that are).
The complaints with this have mainly been along the lines of:
1) physicians wouldn't make as much money, and it takes away from the entrepreneurial side of the professions (says the AMA, some physicians).
2) the model is not replicable. Places like the Cleveland Clinic and the Mayo Clinic receive a lot of federal money for teaching their interns and residents, who perform a significant proportion of the work for a very minimal cost.
Lots to think about - more soon.
To hear more perspectives on the role of physician payment in health care reform, see the following links in the NYT blogs: (thank you NYT!)
*the Well Blog's take (the original article with more details about Cleveland Clinic, Bassett, and The Mayo Clinic deals)
*roomfordebate Blog (perspectives from many people in the field about how doctors are taught to order up more procedures, because they, not coordination of care or explaining things thoroughly so to prevent future hospital trips, are rewarded by our current system)
*economix Blog (discusses what would be the "just" pay for physicians, in economics terms)
~~~~~~~~~~~~~
“It is a model that has taken the pursuit of medicine from a profession — a calling — to a business,” -President Obama in a speech about health care reform
This answer comes from a few sources, as everyone seems to be talking about health care reform!
In a new article in the NewYorker, Hertzberg breaks down why we're having such a hard time with health care reform:
"Americans, polling shows, have long been as receptive as Europeans to the principle of universal health care. Six times since 1948, we have elected Presidents committed, at least on paper, to that principle."
He goes on to say that most everyone believes that health care should be a human right, not a commodity - meaning that because you are part of a society and pay taxes to a government, you should be entitled to health care. However, he also says that pretty much everyone believes that a drastic change (say, to a system funded entirely by taxes that treats everyone based on their health care needs, not how much they pay) is not feasible.
I agree with Obama's initial health care reform principles (see them on healthcarereform.gov) and think the basic idea is to (in a way that will not increase debt) cover everyone for the services and procedures that are necessary and feasible, make sure coverage stays with people no matter what their job is or where they move, and in the process, make health care better.
After creating a system where everyone is covered, the immense administration costs for all the people and paperwork to make sure everyone gets reimbursed can stop being the focus, and people who work in health care can focus on what they have be trained to do, as clinicians, scientists, and care givers: provide great care and continue to figure out ways to make it better.
The way reimbursement works right now does not reward or incent prevention of illness, lifestyle changes (instead of invasive measures), or helping patients navigate through a system that is hard to navigate even when you're not sick. One of the systemic changes that has been proposed is to pay physicians set salaries, potentially with extra bonuses for good patient results. This means that no matter how many procedures a physician orders or how many patients s/he sees, s/he takes home the same salary. In places like the Cleveland Clinic, the Mayo Clinic, and a smaller hospital called Basset where this has been implemented, costs have decreased considerably and the level of care remains some of the best in the country (though I'm not sure what the standards used for that are).
The complaints with this have mainly been along the lines of:
1) physicians wouldn't make as much money, and it takes away from the entrepreneurial side of the professions (says the AMA, some physicians).
2) the model is not replicable. Places like the Cleveland Clinic and the Mayo Clinic receive a lot of federal money for teaching their interns and residents, who perform a significant proportion of the work for a very minimal cost.
Lots to think about - more soon.
To hear more perspectives on the role of physician payment in health care reform, see the following links in the NYT blogs: (thank you NYT!)
*the Well Blog's take (the original article with more details about Cleveland Clinic, Bassett, and The Mayo Clinic deals)
*roomfordebate Blog (perspectives from many people in the field about how doctors are taught to order up more procedures, because they, not coordination of care or explaining things thoroughly so to prevent future hospital trips, are rewarded by our current system)
*economix Blog (discusses what would be the "just" pay for physicians, in economics terms)
~~~~~~~~~~~~~
“It is a model that has taken the pursuit of medicine from a profession — a calling — to a business,” -President Obama in a speech about health care reform
July 27, 2009
Recipe for Ethiopian Fosolia/Lebanese Loubeih Bi' Zeit
Question: What is that delicious ethiopian food I just ate tonight and how can I make it myself at home?
This answer comes from a brilliant recipe I found on another blog about vegan cooking for a cross between ethiopian fosolia and lebanese loubieh bi'zeit:
ingredients:
5 cups stringbeans, cut in half and ends removed
2 normal-large onions, diced
2 cloves garlic, diced
half a bag of baby carrots
16-oz can stewed tomatoes, crushed (squish in your fists)
olive oil
1 cup white wine sweetened with agave (to approximate tej, ethiopian honey wine - don't use anything too dry)
1-2 tsp salt
berbere to taste (2 tbsp or 3tbsp if you like it really hot)
cook your garlic and onions in oil over medium heat until the onions are translucent; then add your stringbeans. get them coated in oil and saute until they turn bright green, and add the rest of your ingredients (start out with a teaspoon of berbere, add more as you go). bring the mixture up to a boil, and basically, let it stew and reduce. if you boil off the liquid before the carrots and string beans are nice and soft, add extra wine or water; if it starts to burn, add a little more oil. it takes a LONG time to cook down, but requires pretty much no monitoring, so this is a good one to put on the stove right when you get home, and then read a book/play with your dog/do your dishes/drink the rest of that tej.
the mixture is done when the liquid is pretty much gone, the onions and tomatoes are undetectable in a sort of red sauce, the green beans are soft and way way smaller than they were, and the carrots can be cut with a spoon. it looks like nothing on earth, but tastes SO good, with a hint of caramel from the tomatoes, carrots, and agave. i recommend eating it with crusty bread.
This answer comes from a brilliant recipe I found on another blog about vegan cooking for a cross between ethiopian fosolia and lebanese loubieh bi'zeit:
ingredients:
5 cups stringbeans, cut in half and ends removed
2 normal-large onions, diced
2 cloves garlic, diced
half a bag of baby carrots
16-oz can stewed tomatoes, crushed (squish in your fists)
olive oil
1 cup white wine sweetened with agave (to approximate tej, ethiopian honey wine - don't use anything too dry)
1-2 tsp salt
berbere to taste (2 tbsp or 3tbsp if you like it really hot)
cook your garlic and onions in oil over medium heat until the onions are translucent; then add your stringbeans. get them coated in oil and saute until they turn bright green, and add the rest of your ingredients (start out with a teaspoon of berbere, add more as you go). bring the mixture up to a boil, and basically, let it stew and reduce. if you boil off the liquid before the carrots and string beans are nice and soft, add extra wine or water; if it starts to burn, add a little more oil. it takes a LONG time to cook down, but requires pretty much no monitoring, so this is a good one to put on the stove right when you get home, and then read a book/play with your dog/do your dishes/drink the rest of that tej.
the mixture is done when the liquid is pretty much gone, the onions and tomatoes are undetectable in a sort of red sauce, the green beans are soft and way way smaller than they were, and the carrots can be cut with a spoon. it looks like nothing on earth, but tastes SO good, with a hint of caramel from the tomatoes, carrots, and agave. i recommend eating it with crusty bread.
July 21, 2009
the price for a year of life
I think that extending a life by one year is worth $________.
This is the question Peter Singer, professor of bioethics well known for his utilitarian views, wants us to add to the debate on health care reform. In a recent op-ed in the New York Times he argues that we should not shy away from incorporating a structured rationing of health care because we ALREADY ration health care - just not in a good way. He argues that our current form of rationalization is based on who (or whose employer) can afford to pay for insurance (or for good insurance) whereas the type of rationing he would like to see is in the form of deciding what treatments and procedures are or aren't worth the cost (and therefore should or should not be covered by insurance plans). While I am certainly not a strict utilitarian (I'm not sure there are any physicians or people studying to be physicians who really can be, but I'll save that argument for another post) and often do not agree with the extent to which Singer applies this philosophy, in this case I think he is absolutely right.
The current debate about health care reform, and really, any debate about health care reform, has to include 3 phases: 1) figure out how to get everyone covered and what that coverage will mean, 2) figure out how to pay for it, and 3) make it better.
The ideas circulating around congress assume the first part (that everyone should be covered) without changing too much from the current system in terms of how), which is what Singer questions in his op-ed; not that we should not cover everyone but to the extent to which we all need to be covered. Congress is mostly focusing on the 2nd part: of how to pay for a system that will include an additional 50 million people, many of whom were not insured because they were considered too ill to be insurable by companies providing insurance. This is critical because without figuring out how to pay for it, no plan can go into effect.
While the first two parts are fascinating and I will be writing more about perspectives in both - I'm most interested in the third part: how to make it better, because I think it could make both the first and second parts easier. Implementing a system that effectively creates positive changes in people's health will alter A) how we cover people and B) how much it costs us to do it. It affects the first because if you make health care more effective, there will be fewer people in the high risk category whose care the rest of us will have to supplement in our premiums. Better practices affects how much it costs because often the most effective medical procedures (e.g. regular check-ups and screenings, early treatment, asking questions, active listening) are the least costly.
An excellent example is the cost effectiveness of mamography, or breast cancer screening. In an article publishes in the Journal of the National Cancer Institute in 2006...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“The greatest threat to America’s fiscal health is not Social Security, though that’s a significant challenge. It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”
-President Barack Obama
This is the question Peter Singer, professor of bioethics well known for his utilitarian views, wants us to add to the debate on health care reform. In a recent op-ed in the New York Times he argues that we should not shy away from incorporating a structured rationing of health care because we ALREADY ration health care - just not in a good way. He argues that our current form of rationalization is based on who (or whose employer) can afford to pay for insurance (or for good insurance) whereas the type of rationing he would like to see is in the form of deciding what treatments and procedures are or aren't worth the cost (and therefore should or should not be covered by insurance plans). While I am certainly not a strict utilitarian (I'm not sure there are any physicians or people studying to be physicians who really can be, but I'll save that argument for another post) and often do not agree with the extent to which Singer applies this philosophy, in this case I think he is absolutely right.
The current debate about health care reform, and really, any debate about health care reform, has to include 3 phases: 1) figure out how to get everyone covered and what that coverage will mean, 2) figure out how to pay for it, and 3) make it better.
The ideas circulating around congress assume the first part (that everyone should be covered) without changing too much from the current system in terms of how), which is what Singer questions in his op-ed; not that we should not cover everyone but to the extent to which we all need to be covered. Congress is mostly focusing on the 2nd part: of how to pay for a system that will include an additional 50 million people, many of whom were not insured because they were considered too ill to be insurable by companies providing insurance. This is critical because without figuring out how to pay for it, no plan can go into effect.
While the first two parts are fascinating and I will be writing more about perspectives in both - I'm most interested in the third part: how to make it better, because I think it could make both the first and second parts easier. Implementing a system that effectively creates positive changes in people's health will alter A) how we cover people and B) how much it costs us to do it. It affects the first because if you make health care more effective, there will be fewer people in the high risk category whose care the rest of us will have to supplement in our premiums. Better practices affects how much it costs because often the most effective medical procedures (e.g. regular check-ups and screenings, early treatment, asking questions, active listening) are the least costly.
An excellent example is the cost effectiveness of mamography, or breast cancer screening. In an article publishes in the Journal of the National Cancer Institute in 2006...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“The greatest threat to America’s fiscal health is not Social Security, though that’s a significant challenge. It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”
-President Barack Obama
July 20, 2009
metrosexual package
Question: What is the best description of a public figure you have heard or read lately?
this brilliant answer was sent from a friend: (I love it)
From Mark Leibovich's Times Magazine article on the gubernatorial race in California, a fantastic quote about Gavin Newsom:
"There is indeed about Newsom something of that quintessential California type, the overgrown and hyperactive child. Immensely gifted but flawed, he is a jumble of self-regard, self-confidence and self-immolation — potential greatness and a potential train wreck in the same metrosexual package."
http://www.nytimes.com/2009/07/05/magazine/05California-t.html
this brilliant answer was sent from a friend: (I love it)
From Mark Leibovich's Times Magazine article on the gubernatorial race in California, a fantastic quote about Gavin Newsom:
"There is indeed about Newsom something of that quintessential California type, the overgrown and hyperactive child. Immensely gifted but flawed, he is a jumble of self-regard, self-confidence and self-immolation — potential greatness and a potential train wreck in the same metrosexual package."
http://www.nytimes.com/2009/
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