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Friday, October 30, 2009
Wednesday, October 28, 2009
Darla gets up close with the eventual winner, a Devon Rex dressed up as a Parisian--mais oui--complete with beret.
Why Not Standard Pricing? I don't really understand what's in the congressional health care plan at the moment -- and since it changes daily, I bet most members of the House and Senate don't really understand either. Health care is only the single largest segment of the U.S. economy, so surely there is no risk in passing a 1,000-page health care bill no one understands! Universal access to health insurance is a moral imperative. But huge cost increases are likely to be triggered: Extending coverage will create more demand for services, and rising demand means rising price.
If reform eliminates the dreaded "pre-existing condition" basis for denial of coverage -- which makes sense for individual insurers and is nonsensical for society as a whole -- that will be significant. Denying coverage to people with medical conditions is not only unjust, it causes insurers to waste money engaging in wars with their own customers. If health insurers must sell to anyone who wishes to buy, then their resources can be better invested in providing care. There needs to be a standard-price rule imposed, too, so insurers can't effectively bar pre-existing conditions by saying, "Sure we will insure you, the price is $100,000 per year." My impression is that so much lobbying attention has focused on the handouts, giveaways and interest-group demands for a gigantic new civil-service bureaucracy that not enough attention has gone to a simple change that would remove much of the injustice from health insurance -- standard rates with no denials for existing conditions. This is the key to the successful health care system of the Netherlands.
So far as I know, health care proposals now in the Senate are so utterly fixated on handouts and giveaways that they don't even address a core problem -- the inability of individuals to buy at insurer's prices. This is the PPO problem, and is serious. Most health insurance now operates through some variation on the Preferred Provider Organization. Physicians and clinics sign up with some insurers but not others; they agree to discount their list prices; if the patient goes to someone within the PPO, the provider gets business while the patient and insurer pay less. Sensible? The system is full of crazy disincentives.
Recently, a family member needed an MRI. The clinic had a list price of $1,500 for the scan but was in the insurer's PPO, and so discounted ("adjusted") the price to $690, of which we paid 10 percent and the insurer paid the rest. Clearly, that $690 price allows the MRI clinic to do business, pay its technicians and radiologists, etc., or else the clinic would not participate in the PPO. Yet if I'd walked in off the street and said, "I will buy this MRI myself," the price would have been $1,500. Meanwhile, if the clinic had not been a member of my PPO, the insurer would have paid the same $621 it pays within the PPO, and I would have been on the hook for the rest, $879. The benefits sections of insurance manuals make it appear that if you use a PPO you pay 10 percent and if you go outside the PPO you pay 20 or 30 percent. Not mentioned, or stated in legalese, is that outside the PPO, the insurer only pays its "adjusted" amount -- you pay 20 or 30 percent plus the balance of the list price.
The distinction between list prices and "adjusted" prices prevents health care services from functioning as a rational marketplace. It's not just that many physicians refuse to speak about dollar figures. ("We don't discuss prices over the phone," a doctor's office told me a few months ago when I had the gall to ask what something would cost, adding, "after the doctor has seen you, then we will tell you what the visit cost.") It's not just that many physicians' offices and clinics do not have anyone authorized to discuss prices: They have minimum-wage receptionists and Mercedes-driving docs who expect the max under all conditions, but no one who will talk price with patients. The larger issue is that the system prevents the consumer from seeking the best price. If an MRI makes money for the clinic at $690, any customer should be able to buy at that price. The theory of the PPO from the provider's prospective is that the provider grants a discount in order to get business: The self-pay customer represents business, just like the PPO customer. But the self-pay customer can't get the PPO price, and the PPO price is the true price of the service. This prevents the bargaining-for-a-good-deal seen in the parts of the free-market system that function smoothly and hold down prices.
That the typical person cannot get the best price for health services is the big obstacle to transitioning away from the pass-along mentality that dominates health care. Right now Americans gripe about health insurance costs, but as this fascinating article by Ron Haskins shows, don't directly pay most of the cost -- most is paid by employers or government (which, in the latter case, means billed to the young via deficit spending). If you're not directly paying most of the costs, you have little incentive to make smart consumer decisions. And if you can't buy at the best price, you can't make smart consumer decisions.
Think about a radically different way to attain health care -- in which most people carry only catastrophic-cost insurance, then pay other health costs themselves. No one can budget for a severe illness or injury; every family will always need insurance against catastrophic medical expense. Suppose insurance covered only catastrophes, and you paid the rest. You might think, "No way I am paying some doctor hundreds of dollars to set a broken arm." But today a typical family's health care policy that appears to cost the family $5,000 a year actually costs $15,000, it's just that much of the money is hidden as employer's costs -- and thus, as higher wages the employer can't pay. If you spent $5,000 a year for catastrophic coverage but earned an additional $10,000 a year, you could cover those strep-throat and broken-arm bills yourself, and probably come out ahead. Plus you'd have a keen incentive to comparison shop. Doctors could no longer loftily say, "We don't discuss prices."
Homeowner's insurance is catastrophe insurance. It pays if the house burns down -- the kind of thing no one can budget for. It doesn't cover all costs of maintaining a home; you pay most ownership costs and you comparison shop. If homeowner's insurance worked like American health insurance, it would not only pay for fires but also cover utility bills, replacing broken appliances, baseballs hit into the window and all the food, drink and paper towels that pass through the kitchen. Certainly, a company could offer an insurance product that covered absolutely every expense of living in a home. But such insurance would be phenomenally expensive and full of ultra-complex rules; the insurer would also acquire an incentive to dream up excuses to deny payment. Just like American health care insurance!
Gradually transitioning to a system in which most people carry catastrophic-cost medical insurance but pay the rest themselves could rationalize health care economics while restraining costs, because the wasteful paperwork aspect of the system would decline. The first step would be a standard-price rule -- specifying that providers must offer the same price to all comers, whether insured patients, self-pay or Medicare. And the standard price must be published to allow comparison shopping. Good physicians and hospitals could still distinguish themselves through quality of care; in most of the free market, prices are similar, and quality is the basis of sales appeal. Stipulating that health care providers offer standard, published prices would lay the groundwork for an informed free market in health care delivery -- and free markets control costs. They do it on their own, without layers of agencies and regulations. We've got to control health care costs or the future doesn't work. Yet the current health-care reform plan is to add more agencies and regulations.
Tuesday, October 27, 2009
Monday, October 26, 2009
I think this about sums it up. Todd Haley after yesterday's loss. Photo from www.nfl.com.
Everyone was maybe thinking the Chiefs had turned a corner with a win over the Washington Redskins. However, maybe, not so much. A few thoughts on the Chiefs:
I really thought they had an upset win in them. Now, I am not so sure. They just don't have enough talent.
Rookie head coach Todd Haley is in over his head. He needs to either demote himself to offensive coordinator or delegate play calling to someone else.
Larry Johnson needs to pay the price for his tweets and general idiocy. I vote for keeping him inactive the rest of the year, then cutting him. I think it would be worse for him to sit on the sidelines and have no option to play. If he is released, he will be picked up and play for someone. Either way, he'll make his money. Let's make him sit.
The defense of the New York Giants is in trouble. New Orleans is for real. You, up in Minnesota, don't let Bret Favre throw so much--his arm might fall off. JaMarcus Russell is a really bad quarterback and should try another position. New England is back.
Very interesting football season, even with the Chiefs losing.
Friday, October 23, 2009
If you hang around any group of people, like coworkers, for any period of time, you are likely to hear all manner of opinion with regard to getting flu shots. You will hear some good information, very accurate, and you will hear some complete and utter horse shit. You will hear personal experience that is presented as fact. You will hear rumors of conspiracy and evil doings.
Please take it all with a grain of salt. Or two grains. Oh, heck, bring the whole salt shaker.
I have never heard so much misplaced knowledge, ignorance and just general garbage then on this topic. It's a perfect storm of half-knowledge and no knowledge; of rumor, junk science, and conspiracy. Now, I am no fan of the medical-industrial complex, but immunizations are one of the things we have done well, and have markedly increased the quality of life in our country. Find someone in their 80s. Ask about polio, measles, and small pox. Ask them about typhoid fever and diphtheria. Ask what it was like to nurse a child with whooping cough. Ask them about when an infectious illness would rip through a community. You know what happens when chicken pox gets loose in a group of children, like a school or day care. Imagine debilitating and fatal illnesses running amok like that involving the entire population, including those who do all the vital things we take for granted every day. Let's get started with some basic science. This is by no means a comprehensive review; if you need more, ask your health care provider and/or go to the library and do some research.
Vaccines work by exposing the body to a weakened or dead form of the infectious agent, thus causing antibodies to that agent to form in the body, which will fight the disease if you are exposed after you get vaccinated. Vaccines are made by growing the infectious agent, then modifying it or killing it. Flu vaccines, among others, are made using eggs as a medium to culture the flu viruses in. (That's why you are asked about egg allergies when you go get a flu shot; there may be stray egg proteins in the vaccine, which would provoke an allergic reaction if you are allergic.) When you take a vaccine, you may experience some very mild symptoms of illness, but nothing that is as severe or lasts as long as the illness itself. Your arm may be sore at the injection site. You may have absolutely no change in how you feel whatsoever; this is the experience of the majority of people. A very few people have some bad reactions. 1 out of 1,000,000 of people getting a flu shot might get a neurological condition called Guillian-Barre Syndrome. Some people discover allergies they didn't know they had the hard way, with a nasty anaphylactic reaction, that will occur within 15 minutes of receiving the shot. A very, very few people will experience some weird adverse reaction that is even more than a one in a million shot, like the cheerleader in Washington .
When you decide to get a vaccine, you are balancing these possibilities against the risk of a full-blown case of the illness, which may cause disability and/or death. In addition, you protect other people, in two ways: one, by preventing yourself from being sick and spreading the illness to others, and two, by boosting the "herd immunity" of the community, decreasing the number of people in a given community who can get sick.
Right now, there is a substantial anti-vaccine movement among parents. This post is not about that topic per se, but if enough kids are not vaccinated against common childhood illnesses, we may see those illnesses again, as our communities lose their "herd immunity". Most of the fear has centered around vaccines causing autism. However, strong scientific studies have shown that there is no connection between vaccines and the development of autism. Despite this, some have continued to insist that vaccines are harmful, and the studies are rigged by "Big Pharma". This is known as a "catch 22" or "can't please these people no how." If I had kids, they'd get their shots, both for their protection and the community's.
So. let's drill down to flu shots in particular, and the situation currently, with both seasonal flu shots and H1N1 (Swine) flu shots. Flu shots, like all vaccines, carry the side effect profile outlined above. Most will experience no side effects. A few will have very mild side effects. A very few will have allergic or adverse effects. The virus in injectable flu immunizations is dead, and cannot give you the flu. The nasal form of vaccine is a highly modified virus that will not make you sick. Now, the vaccine takes a week or two to give full immunity, depending on your immune system. If you are exposed in that time, before full immunity, you will get sick. If your immune system is not working as it should, you may not respond to the vaccine in a normal way, and have a full immunity. In this situation, you will get sick with the flu if exposed to the virus.
H1N1 is a particular flu virus that created epidemic to pandemic conditions in the northern hemisphere during the spring of 2009 and has continued to spread throughout the world during the summer and early fall. Reports from the southern hemisphere, which is just coming out of their winter flu season, indicate continued spread, and no change in the virus or illness profile. It emerged too late to be included in the seasonal flu shot. Vaccines, made in the same manner as the seasonal flu shots, have been fast tracked into production. Clinical trials were done with 10,000 to 12,000 participants without any marked problems emerging. The H1N1 vaccine carries the same side effect and risk profile as the seasonal flu shot.
So, should you get a flu shot? An H1N1 flu shot? It's a very personal decision. It involves a lot of issues ranging from the scientific issues and facts discussed above to the fact that some people will decide based on psychological factors such as disliking being told what to do. Scientifically, it's a balance between the risks of the vaccine and the risks of getting the illness, with a little consideration of the health of the community thrown in. Some people are viewing the H1N1 shot as a little bit riskier than the seasonal flu shot, due to the rapidity of its development and testing. Some just view all flu shots as bad, since they swore they got sick because of the flu shot back five years ago. A few people have decided that all vaccines are bad, causing all manner of problems. And the risk of the flu? Death rates can be hard to pin down but a number closed to 36,000 has been developed. An episode of the flu, especially in those with risk factors and preexisting health problems, can lead to other illness that may ultimately cause death. As the linked article notes, influenza related deaths may be somewhat underestimated. H1N1 has been hard on people under 25, and pregnant ladies, causing bad illnesses and occasionally death.
If you have questions, ask your health care provider. Do research on the internet, but stick to sources of information that are well known and/or are documented with reliable sources. Read skeptically, with a questioning mind. There's a lot of junk out there, don't let it scare you. Your decision needs to come from a rational mind, satisfied that it understands. Not a mind full of fear, hearing rumors, not fully understanding, just running from something unknown or poorly understood.
And whatever you decide: to get the seasonal flu immunization and the H1N1, to get just one or the other, or none at all, practice good hygiene. Wash your hands before eating or touching the eyes, nose or mouth. Wash your hands after touching your eyes, nose, mouth, or coughing/sneezing. Wash after using the restroom. Wash hands after using a public surface, like a communal computer keyboard. Cover the cough or sneeze with the inside of your elbow. Stay home, out of public circulation, if you are sick with fever, chills, and having a lot of secretions. No vaccine is 100% protective; these simple measures will protect you and others from illness where the vaccine falls short. As well, take good care of yourself during the flu season. Get the sleep you need. Eat good food. Watch your stress level. Work on keeping your body and immune system strong.
You expected that I was going to give you a definitive answer: yes, no, maybe--did you expect that? Sorry, nope. This is one aspect of health care that has changed a lot: providers will advise, educate, maybe even encourage or cajole. But when it comes down to the nitty-gritty, health decisions are the patient's to make, not the provider on behalf of the patient. I'm not even going to tell you what I'm doing; that's between me and my doctor.
Wednesday, October 21, 2009
Tatiana says I like the sisal scratching post. Note the light undertones at the base of her tail.
Wayside Waifs is at 3901 Martha Truman Road in Kansas City. Feel free to call ahead at 816-761-8151 to check on the road and for directions as needed. Hours are Wednesday through Friday 2 pm to 8 pm and Saturday and Sunday 12 noon-6 pm. Closed Monday and Tuesday. On the web at www.waysidewaifs.org.
Saturday, October 17, 2009
And they play hard! There is nothing easy for anyone on a high school gridiron. Play goes on until the whistle blows. But in all the high school football I've watched, I have rarely seen dirty play. And unsportsmanlike conduct is not tolerated. Just ask the Ruskin player who got ejected earlier this year for poor conduct. (Burlington and South Burlington Burlington Free Press photo. Note the charming weather.)
Sometimes, you see some sweet football. The great catch (here are two examples), the play perfectly executed, the sack exactly when needed. It's amazing to watch the kids rise up to the occasion. (Essex and Burlington Burlington Free Press photo)
Sometimes, of course, they don't quite meet the needs of the situation: a critical penalty, a fumble, a blown assignment, and victory is lost. But that is something to learn too, how to respond to adversity, how to come back from defeat, how to know that you can contribute even when the situation looks bad. (Lone Jack and University Academy Kansas City Star photo)
Friday, October 16, 2009
On another note, you may have noticed an absence of the usual "local crime" type posts on this blog over the past few days. Last week was the last time I covered any type of local crime. Nothing would make me happier than to say crime has taken leave from Kansas City, nobody has been killed, raped or robbed, we are now living in the land of Love, Peace, and lollipops, free unicorn rides and cotton candy are the theme of the day, but that wouldn't be the truth. The truth is, I was starting to sound like a broken record, and frankly there are already more than a few of those around these parts. The truth is, I've given that shit a rest because at some point it just becomes lip service. Folks are still killing one another, there's a rapist loose in Waldo, and Quik Trips are still ATM's for petty crooks. So I decided to give it a rest, at least for a few days until something extra heinous occurs. A person can only express so much outrage, there are only so many words one can write on a subject, until those words just become repetitive self serving horse shit. So it's not that I've lost my concern or my contempt, I'm just looking for a new angle, or a story that makes me feel something other than, the same old same. In the meantime, I'm putting together a multi part story from my sordid past and should have the first installment up come Monday. (Link to the full post here. The bold is from me.)
So, unless breaking news demands it, I am giving racial issues a rest for a while.
Thursday, October 15, 2009
Wednesday, October 14, 2009
Here is a link to 980 KMBZ. I imagine seats are going fast, so you better get on the stick.
I am hugely tired of the weather we're having. Grey and cold, 20 degrees below the average, often drippy. Had to turn on the heat and this is at least two weeks earlier than I usually start using this much heat. Argh!
Lewis Diuguid was a good columnist when I first moved to KC two decades ago. Now, he is a one note Charley, always writing about racism and how the Black people are dragged down and how much help they need and how the world is against Black people. As stated before in this blog, racism is not a done deal in America, but it also is not the source of every evil and ill that befall Black people. Here's a link, so you can be annoyed too. Or maybe you won't be annoyed. But chances are high you'll be annoyed. Read the comments, too.
A complaint was filed against the Kansas City Police Department by the mom of a young man who got pulled over while dropping his kid sister at Martin City Elementary. KSHB has the details. I wish these things would not come to light until investigated. Then we can see the dash cam video, and hear all points of view, because the police cannot comment publicly until the investigation is complete. The complainers can blather all they want, poisoning the well. Personally, I need more details. For example, was there loud music in the car that impeded the young driver from hearing the siren? Was he texting or talking on the phone? It also concerns me that our young drivers, with the best sensory equipment are so situationally unaware when they are driving out on the road. (The general crappiness of young drivers is a subject for another rant.) Police officers will react in a predictable way to people getting out of a car at a traffic stop. For their own safety, they are ready to defend themselves. The spokesman states in the report that the officer did not draw a weapon. We will wait for the dash cam video. So here is the lesson: If you are stopped by a police officer in a patrol car, do not get out of your vehicle unless requested by the officer to do so. Keep your hands visible and wait for instruction. Cops operate on a hair trigger; they do this, because there are bad people out there who want to kill them. These bad people are not labelled, so cops operate on a basis of caution with everyone. They want to go home at night.
There, got that off my chest...
Maybe it's because I'm a cat owner that I like dogs with pricked ears. Or maybe I just like the way they look, I'm not sure. But I like this fellow, Salvador, a border collie mix. Interestingly, he has a dark tongue. He is of a medium size, and won't grow much more than the 35-40 lbs he is now. He is very smart, as most herding breeds, and their mixes are. So he'll need involved owners who can put in some training and play time. He already knows some tricks that the trainers at Wayside have taught him. His pointy ears are not completely rigid; as you can tell from the photos, the cartilage at the tips is flexible and moves when he does. It is a completely cute and endearing look!
Tuesday, October 13, 2009
Monday, October 12, 2009
The original AFL refs wore these red striped shirts instead of black stripes. The ref is still the "white hat" but the other officials are "red hats" instead of "black hats". In this picture, we have the ref and another official talking with the Denver coaches. I think Champ Bailey does not like the way the conversation is going! (photo from nfl.com)
Those throwback Patriots unis are really nice--I wish they were their regular unis. The only bad news in all this: The Broncos won in OT to go 5-0 for the season, thus making Bronco fans even more annoying than usual. (photo from nfl.com)
Saturday, October 10, 2009
Friday, October 9, 2009
SAN DIEGO, California (CNN) -- Those of us in the U.S. can be so smug about what we think we know about why some teenagers turn into bloodthirsty predators -- even when it turns out that we don't know much.
Frankly, we might know more if we didn't jump to conclusions and let our prejudices get in the way.
After the videotaped beating death of Derrion Albert, a 16-year-old African-American honors student in Chicago, Illinois, I criticized President Obama for avoiding public comment about the tragedy and thus blowing the opportunity to have the first African-American president address the issue of black-on-black crime.
Instead, the White House dispatched Education Secretary Arne Duncan and Attorney General Eric Holder to Chicago to stand in for the president. Even that gesture further enraged the local African-American community when the Cabinet secretaries -- in a boneheaded move -- convened their meetings with local officials not on the South Side where the beating took place but downtown at the Four Seasons Hotel.
But, even as I blasted the Obama administration, I would never have dreamed of criticizing the entire black community, its value or its culture. However, others did that freely.
During an interview on a conservative radio talk show, I was informed by the host that the problem was rap music and how it had coarsened the culture in the black community. Many readers pinned the blame on the breakdown of the black family as brought on by the advent of the welfare state or the mean streets of the inner city. You get the gist.
I wonder what these folks will say now that four white teenagers in the small town of Mont Vernon, New Hampshire, are accused of a horrific home invasion that left a mother dead and her daughter hospitalized. Prosecutors say the youths randomly picked a home to burglarize and -- armed with a machete, knife and other weapons -- planned to kill anyone who was home.
The ghastly episode occurred early Sunday morning. Christopher Gribble, 19, Steven Spader, 17, William Marks, 18, and Quinn Glover, 17, allegedly stormed into the home of 42-year-old nurse Kimberly Cates, whose husband was away on business.
Prosecutors say that Gribble, armed with a knife, and Spader, wielding a machete, attacked and killed Cates in her bed. Then they attacked her 11-year-old daughter, Jaime, and cut her throat. Miraculously, the girl survived and, after hours of surgery, remains in stable condition.
Both Gribble and Spader face charges of first-degree murder, attempted murder and conspiracy to murder. Marks and Glover, who were also armed during the break-in, face counts of burglary and armed robbery, but they aren't charged with murder. Still, prosecutors are leaving open the possibility of charging Marks and Glover as accomplices to murder.
They should do so. They also should seek life sentences for Spader and Gribble, and show them as much mercy as they showed their victims. Our society has no use for these creeps.
Meanwhile, local townspeople are shocked.
Spader was described in media accounts as living in "an upscale area" of town while Gribble was reportedly studying to be a Mormon missionary. One has to ask the same question many people were so quick to ask after the Chicago beating: Who raised these savages, and how do we strip them of their license to parent?
In an interview with NBC News, Marks' father came across as utterly clueless. James Marks recalled how he had seen his son with Spader, who was showing off a knife, but he said the weapon looked like a toy, so he didn't tell anyone. He assured a reporter that his son didn't intend to commit murder. "I know my son," he said. "I don't think he went there to kill."
Great. Not to kill. Just to rob? To assault? To wound? That father should be very proud.
The rest of us should be questioning our assumptions. Meredith Vieira, co-anchor of NBC's "Today Show," discussed the tragedy with some local townspeople. What made the story even more frightening, Vieira said, is that "in a small town like this, these things aren't supposed to happen."
You're half right, Meredith. This kind of barbarism isn't supposed to happen anywhere -- not in small towns, or big cities, not in the suburbs or the inner city, not anywhere.
And yet it seems to be happening more often than we think -- and in more places than we realize. A recent study by the Department of Justice found that 60 percent of children had been exposed to violence in the past year, and nearly half of them had been assaulted at least once. That is not the mark of a civilized society.
We think we know so much about what causes young people to turn into monsters. But our conclusions go out the window when we discover that evil lives next door.
Evil is beyond race. Evil is present in all races of humanity. Evil is...evil. Evil is sin: deliberate disobedience to God. Evil is among us everyday. Sometimes, I think we are under the delusion that we can "fix" evil. We can't. Sometimes we can help people with some of the conditions that create crime: give them a job, help them get off drugs, teach conflict resolution, among other measures. Make good things and actions better options for people. But we cannot fix sin. We cannot fix humanity's proclivity towards sin and evil. However, things are not hopeless. First, all the things I noted above that can be done are all under the grace of God--one theological term for it is "common grace". It's the continued favor that God gives all humanity to be able to do good even in the face of original sin. The other is the complete remedy for a sin sick world: the grace and forgiveness through the cross of Jesus Christ. Sometimes, the Holy Spirit is the only thing that will turn a person from doing sin and evil to doing good, that will free them from the bonds of sin.
The Apostle Paul wrote to the church in Ephesus: "Finally, be strong in the Lord and in his mighty power. Put on the full armor of God so that you can take your stand against the devil's schemes. For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world, and against the spiritual forces of evil in the heavenly realms." (Ephesians 6:10-12 NIV. I encourage you to read the rest of the paragraph through verse 18)
We would do well to remember that in some situations, there is more to it than meets the eye. When we cannot find ready explanation for evil deeds, the explanation is spiritual. To come against that, we need spiritual tools, mainly the love, grace, power and forgiveness of God's Holy Spirit.