Monday, September 21, 2009

The Healthcare Debat-cle

A couple of conservative friends recently shared a pair of YouTube videos with me entitled, “Senior Citizen Speaks Out On Healthcare Bill.” In them, John C. Crawford of Texas blasts the bill in a compelling story, but unfortunately, I think at least half of it is built upon misinformation. I've watched these videos several times, and searched the H.R. 3200 document for the "exact excerpts," which don't exist. Some of the citations appear very similar to a viral email that FactCheck.org debunked most of in "Twenty-Six Lies about H.R. 3200."

It's amazing to me how someone can say, with a straight face, that something is not being taken out of context, when that's precisely what is being done. I'll accept that this man is a genuine person, and that his story is real. But what irks me is that he seems to be reading from some right wing interpretive (and creative) document and taking it at face value. Opinions are like epoxy: they start with a combination of basic elements, and harden when a strong catalyst is added. It’s ironic that as humans, we are endowed with the incomparable ability to think for ourselves, but many of us are encumbered by the incomprehensible tendency to avoid doing so.

Mr. Crawford makes a big deal of the "Death Counseling" concept which sounds an awful lot like the "Death Panels" we've heard so much about. The death counseling provisions of H.R. 3200 are as innocuous as a summer breeze and as common sense as coming in out of the rain if you want to stay dry. They merely allow payment to doctors if they provide counseling on end-of-life issues. I recently lost my father after a 5-year battle with lung cancer and its side-effects. He went through so much, and so much of it proved unnecessary. If he, and we, had known what was in store for him and what his options were, his suffering would have been greatly reduced, he would have been more at peace, and it would have cost a whole lot less. He had a living will, but it wasn't really clear. He was lucid to the end, and I tried to have a discussion with him about what kind of care he wanted. His hearing was just about gone, and he asked with a quizzical look, "What kind of stairs do I want?" When we finally cleared that up, he said, "You'll know what to do when it's time." Well, I didn't, and I wish we'd had professional help. A couple of his doctors hinted at things regarding end-of-life, but when we pressed them for recommendations, they backed off quickly.

A couple of things President Obama said in his address to Congress about healthcare reform keep me optimistic. First, he said, "I am not the first President to take up this cause, but I am determined to be the last." Second, he pointed out the obvious, that the spiraling cost of healthcare (like our deficits) is unsustainable. Third, he acknowledged that there are people on both side of the aisle who are obstacles to progress. And fourth, he said, "I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch." I'm very much for healthcare reform, and support the concepts that Obama spoke of in his address to Congress. However, I have a healthy skepticism, and want to know more precisely how things will work, and more precisely how they will be paid for. Being told that it will work and that it won't cost taxpayers a dime doesn't do it for me. The idea of offsetting much of the cost by stopping excesses, abuses and fraud in Medicare and Medicaid doesn’t do it for me either, since we shouldn’t be paying for such waste in the first place. It also doesn’t give me much confidence that government can manage a new program any better.

In reading some of the misquotated citations from H.R. 3200, I actually found that I was impressed with the depth of understanding of the authors. Instead of finding some covert, clever language, designed to create a foundation for socialized medicine, I found some reasonable concepts to allow individuals to make up their own minds (if they'd only choose to do so). For those who find the terms of H.R. 3200 to be deleterious to their health and welfare, I'd encourage them to read the terms of their free market insurance policy. That would be an eye-opener.

I think the root of our healthcare problem is in misapplied incentives. Doctors are incentivized to prescribe unnecessary drugs and perform unnecessary procedures to protect themselves from lawsuits - a perversion of preventive medicine - prevention of lawsuits trumping prevention of disease. Pharmaceutical companies are incentivized to make as much money as they can in the short time that they have market exclusivity, due to the pressures that are building to allow more and earlier generics and foreign sources; as a result of the short term thinking, R&D is suffering, and new products aren't forthcoming. Hospitals and clinics are incentivized to perform unnecessary procedures to pay for the expensive equipment they have and the fancy new facilities they're building to meet the needs of a clientele that wants the very best. And on and on...

I don’t agree with a “government option.” Government has no business running a business when there are plenty of businesses that are capable of providing service. What is needed is regulation - government’s insurance role should be to insure that there’s a level playing field and that nobody is denied coverage; any insurer must provide coverage for high and low risk alike. To allow the greatest competition, purchasing of insurance across state lines should be encouraged, not forbidden. Government should define a minimum (not minimal) standard of care (including end-of-life) that insurance companies must comply with. Beyond that, people can pay for whatever additional services they want, either through additional insurance or out of their own pockets.

Government should also define or adopt medical practice standards for all conditions, which doctors’ practice or malpractice should be measured against. Malpractice lawsuits should be strictly limited to illegal practices and gross negligence. Any punitive damages should go into a fund to pay for insuring those who can’t afford it. As long as doctors adhere to defined standards of practice, they should be protected from suit.

While I share the concerns and skepticism of many, I don't subscribe to the notion that healthcare can't be fixed so we shouldn't try. There is a lot of misinformation out there, on both sides, but the great thing about our country is that everyone gets to have their say. Out of that, I hope, will come a compromise solution that does the greatest good for the greatest number of people. But my hopes will only be realized if we think for ourselves, and “build on what works and fix what doesn't."

Sunday, July 12, 2009

One More Day

Six years ago, my Dad, Wm. Clyde Morgan, was diagnosed with lung cancer. He passed away on July 1, 2009. The gift of the last six years is due to several doctors and nurses who took a sincere interest in him, and the wonderful care that my mother and sisters provided.

He kept his sense of humor to the end – in the week before his passing, he was expressing frustration at not knowing what the plan was for his treatment, and said he was going to call hospital information and ask about the condition of Mr. Morgan in Room 585. I remember telling people how we would know when Dad was getting better – he’d start telling jokes.

When my Dad was sick this last time, I kept thinking I’d see him tomorrow, so I could learn more about his life. He kept fighting to see one more day, out of his deep love for Mom and our family. Sometimes, I’d see him the next day, and he’d look stronger than the day before. He’d lived for one more day, and I’d still think I’d see him tomorrow.

He ran out of tomorrows. Now what we have are yesterdays, the memories of the fine man he was, his infectious smile and laugh, his sense of humor, his great wisdom, and his sense of honor. He’s left a great legacy in our memories, and we’ll always keep him in our hearts.

He fought the good fight. He finished the race. You done good, Clyde.

Eau de Clyde

I find myself remembering an odd but very comforting thing about my Dad, who passed away on July 1, 2009 – when I was a kid, we’d all gather around him when he came home from work, wearing this cologne – a proprietary blend, I think.

I call it Eau de Clyde: one part Mennen Skin Bracer, one part coffee (milk, no sugar), one part sawdust, two parts perspiration, one part Pall Mall, and one part Miller High Life.

Even after 45 years or so, it still lingers…

Friday, June 12, 2009

Facing Your Enemas

Once upon a time, discussions of this sort would have creeped me out. Now that I’ve matured, and learned the facts of life, it’s a lot easier to talk or write about these things – maybe too easy…

Despite dire warnings, the recommendations of doctors, loved ones and numerous celebrities, the very thought of it may be enough to bring the bravest and toughest among us to our knees. The indignity of it, the invasion of privacy, the probing, the pictures… Of course, I’m referring to a colonoscopy, which for many of us is a least-prized 50th birthday present.

At a small party my wife and I attended recently with a group of contemporaries, as conversations with folks our age tend to go, the discussion eventually got around to the subject of colonoscopies. Almost everyone had been through at least one, but two people hadn’t had theirs yet. One had scheduled an appointment, and it was coming up soon, so the taunts and teasing escalated as the night wore on. The conversation was hilarious as several people recounted their close encounters and contemplated posting their pictures on FaceBook, MySpace, or better yet, YouTube! Only my wife and another couple knew that my colonoscopy a month earlier had uncovered early stage colorectal cancer.

For those who haven’t had “the procedure” yet, the prep is the worst part, but for most, it’s not so bad. A handful of tablets or magic powder and a torrent of fluids the night before clears the way for the doctor to perform the exam while you’re in a blissful state of sleep. If it’s any consolation, you can imagine that the doctor’s perspective is a lot different, and that you’re certainly on the better end of things. If you’re employed, it’ll mean a day off, but you’ll need a chauffeur, which may make things a bit more challenging, and a bit less private. But once the procedure is completed, you’ll get over it and reward yourself by gorging and replenishing your system.

In my case, I had put the procedure off for several years, and finally ran out of excuses. The doctor who performed the routine examination removed a small non-suspicious growth, and as a matter of routine, sent it to the pathology lab, where it was found to be cancerous. Although surprised by the results, she felt that she had gotten it all with the initial excision. This was substantiated with additional testing performed at a cancer center that she recommended. While the doctors are confident, there’s no certainty that it’s gone. However, all indications are good, and with (ugghh!) more frequent ‘oscopies, the doctors feel they can effectively monitor for recurrence. I suggested that with training, since I spend so much time with my head up my butt, I could keep a close eye on it myself. Ever the professionals, they felt that an expert (second) opinion would be more beneficial than just relying on my own point of view.

The reason that colonoscopies are such a good idea is that they are relatively simple to perform, very effective at detecting disease, and don’t require hospitalization. Colorectal cancer is the third most prevalent, and the second most deadly form of cancer in the US. In 2015, an estimated 135,000 new cases were diagnosed, and approximately 49,000 lives were lost to the disease. Almost 1 person in 20 will be diagnosed with it during his or her lifetime. If the procedure is performed in time, doctors can detect many colorectal cancers early, when the cure rate is very high. If not caught soon enough, colorectal cancer is one of the more insidious forms of cancer, showing few, if any, symptoms. If caught in mid- to late-stage, the prognosis is equivocal, and the road ahead is potentially painful and debilitating, and very expensive.

Take it from me - denial is an ineffective preventive or defensive strategy, and avoiding the unpleasantness of a colonoscopy and its prelude is not a wise course of action. Some things are best dealt with head-on (pardon the metaphor), and the consequences of inaction or procrastination can be fatal. And as I’ve learned, having your head up your butt doesn’t provide as good a view as a trained professional can get. So, if you’ve been depriving some doctor the joy of examining your nether region, park your excuses and make the call. It could just save your life – it surely saved mine.

Thursday, May 07, 2009

Saved by the Ax (Things Could be Worse)

This is a piece I wrote that was published as an op-ed in the Trenton Times on April 5, 2009. Beware of the jaw-dropper at the end of the first paragraph, and know that I'm fine.

When I received word late last year that my executive position in engineering and support operations at a local biopharmaceutical company was being eliminated as part of a reduction in force, I was understandably disappointed, but moderately optimistic. Since then, I’ve seen the bottom drop out of the job market and the ranks of the Brotherhood of the Vocationally Detached swell to almost unprecedented levels. Mom always told me, “Cheer up, Bob, things could be worse.” So I cheered up, and sure enough, things got worse. The colonoscopy that I’d been putting off for several years while I was too busy at work revealed early stage cancer.

My purpose in writing this is not to garner sympathy. I’m writing in hopes of a catharsis for myself, and possibly to encourage someone else who might be faced with similar circumstances. So here’s my advice in a nutshell: Learn from the past; deal with the present; and plan for the future. You can’t change the past; you live in the present; and your future will be what it is, but can be guided by how you prepare for it.

With regard to my medical condition, the lesson is a hard one: I should have listened to the expert advice (including my wife’s), and had a colonoscopy five years ago. There’s no certainty that it would have uncovered my problem, but it certainly would have reduced any anxiety about the procedure itself. For those who haven’t had it yet, the prep is not so bad, and the procedure is done while you’re in a blissful state of sleep – the doctor definitely has the worst view. So for the present, I’m dealing with it fairly well - gathering information, aggressively pursuing treatment, and now, announcing it to the world! As for the future, I’ve awakened to my mortality, and am taking the time to organize notes and records so that it won’t be such a chore to figure out where things are or how circumstances should be dealt with whenever my time is up.

The road ahead is not clear yet, but with age and otherwise good health on my side, the prognosis is excellent. Also a comfort, my wife’s medical plan is a good one, so loss of coverage with my job wasn’t a double-whammy. It may be a defense mechanism, but I’m even able to see humor in the situation, although most of it is probably too graphic to recount here. Odd as it may seem, I’m feeling pretty lucky. Usually, this type of cancer isn’t found until it’s further advanced. Ironically, if I was still working, I might have continued to make excuses for not having the procedure until it was too late. As such, I’m offering myself up as somewhat of a poster-boy, although anxious to know what the poster will ultimately look like, especially in light of pending healthcare reform.

With regard to my vocational detachment, the lesson is also a hard one: I had a good run, and my company treated me well, but I focused too hard on the job and didn’t prepare adequately for the inevitable changes that were occurring as the company shifted focus and was sold several times. The present is rife with challenges, but opportunities as well, and I’m reaching out in many directions to find the right mix of both. For the future, the networking I’m doing now (and have neglected in the past), will continue to pay dividends for both me and those in my network.

The current job market is daunting, and with so many layoffs being announced, the competition for relatively few job openings is fierce. The flip side, though, is that many companies are not only downsizing for the sake of reducing costs; the smart ones are learning from the past, and dealing with the present by reorganizing to realign themselves for the future. They’re also realizing that experienced people who have seen ups and downs before can provide an immeasurably valuable perspective to help focus their vision. The opportunities that result are ripening for those of us who understand where we can truly add value to a company as the economy recovers, as it surely will. For those of us whose finances are drowning in the perfect storm of unemployment coupled with tanking retirement investments, adding value is also the best hope for our own economic recovery.

Some would regard these life events as an emotional roller coaster. They’re actually more like the stock market or the current financial crisis – you never know when there’s going to be a rise or fall (opportunity or challenge), but you know something’s going to happen. As an engineer with an MBA, I’ve learned that meeting a challenge or solving a problem requires an understanding of the situation, identification and analysis of alternatives, planning for the chosen solution, implementation of the plan, and follow-up with adjustments when needed. The challenges that I and many others are faced with require a thoughtful and diligent problem-solving process, and the opportunities are there for full recovery for all of us.

Learn from the Past. Deal with the Present. Plan for the Future. And for goodness sake, if you’ve been putting off seeing your doctor, schedule that appointment now!



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Okay; if you're still with me, check out this companion piece, which won't be published in print for reasons that will become obvious.


Turning the Other Cheek

My recent essay, “Saved by the Ax,” is really about Making Your Adversity Something Special. That’s a bit of a mouthful, so an acronym is in order: MYASS. That’s right, “Saved by the Ax” is really about MYASS, so this story is just another way of looking at it.

As MYASS was developing, I had trouble keeping my thoughts from wandering and my ideas focused. In other words, I was having difficulty keeping my head in MYASS. As hard as I tried, I just kept putting more stuff in MYASS, and eventually had to take some out, because MYASS was just getting too big and ugly.

When I was nearly done, I had several people look at MYASS to see if it was okay. Several responded that I should Keep It Short & Sweet. In other words, using another acronym, they were actually saying, “KISS MYASS!” While that may sound harsh, I appreciated their advice, and now MYASS is in better shape than it ever was before.

So now MYASS is ready for primetime. I’m trying to get MYASS in print or on the radio or on TV. If that happens, MYASS will be around forever. In fact, you’ll be able to google MYASS. Yes, you’ll be able to look up MYASS on the internet. Perhaps MYASS will develop a following, and have a Facebook identity, or show up on YouTube, or even better, LinkedIn. If it gets established on LinkedIn, you’ll be able to pull all kinds of things out of MYASS whenever you need them.

MYASS features two Circumstances Having Equally Exacting Kickers, again begging an acronym: CHEEK. When you put my two CHEEKs together, you can see MYASS whole! One CHEEK relates to my unemployment, where I’m out on MYASS, and the other CHEEK relates to my early stage colon cancer, where I’ve got a bug in MYASS. While each CHEEK is clearly separate, they come together to a point that is both simple and profound.

As MYASS has developed, I’ve become rather attached to it, partly because MYASS embodies my intelligence. Although MYASS isn’t very deep, if you have a slow computer, MYASS might freeze. You may have to get out of MYASS at that point, then boot MYASS again, then get back in to MYASS and pick up where you left off. MYASS gets backed up every time I change something, so if you’re interested, you might want to take a fresh look at MYASS once in a while. I hope you’ll treat MYASS with a little respect, and once you’ve had enough, I’ll promise not to ask you to look at MYASS again!


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Editor’s note: MYASS was found on the internet, and is attributed to Derek Iverson’s, Millenium Year Application Software System. A few of his analogies have been adapted, but most are fresh. I used it previously in a parody about a Multiple Year Analytical Spreadsheet that I developed at work, which I referred to as “Raw Material Inventory – MYASS.” I was working on its companion modules, “Accounts Payable – MYASS,” “Customer Relations – MYASS,” “Project Management – MYASS,” and “SOX Compliance – MYASS.” Each would be a single user per version of MYASS.