Article Round Up II: Medicine and Healthcare Policy

Here is another round up of articles I’ve found interesting and telling about modern medicine and Affordable Care Act (ACA) or Obamacare. As I ponder the ACA, potential changes I hope the new president will make and especially the new politicization of healthcare and the all-encompassing ethics associated with that (such as conscience protection and service for the poor), these are some of things I’m thinking about.

The Atlantic – Medical Problems: Patient Responsive Happiness. problems with ACA

“Joshua Fenton, a University of California, Davis, professor who conducted the study, said these results could reflect that doctors who are reimbursed according to patient satisfaction scores may be less inclined to talk patients out of treatments they request or to raise concerns about smoking, substance abuse, or mental-health issues. By attempting to satisfy patients, healthcare providers unintentionally might not be looking out for their best interests.”

This takes some background. Pieces of the ACA reward hospitals for higher patient satisfaction, but patient satisfaction surveys don’t correlate with better outcomes. This is why we see hospitals now with brand new furniture and state of the art entertainment. Granted, we patients matters. There are a lot of cogs going into healthcare now as the government works to incentivize the practice of medicine, as they do with the tax code, and we are starting to see some glaring distortions.

http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/

The Atlantic – The Erosion of the Dr/Patient Relationship

“Today’s physicians, he tells us, see themselves not as the “pillars of any community” but as “technicians on an assembly line,” or “pawn[s] in a money-making game for hospital administrators.” According to a 2012 survey, nearly eight out of 10 physicians are “somewhat pessimistic or very pessimistic about the future of the medical profession.” In 1973, 85 percent of physicians said they had no doubts about their career choice. In 2008, only 6 percent “described their morale as positive,” Jauhar reports.”

http://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/

Carrie Kovarik, M.D. in the Washington Post, Defending her Trump Vote in Academia

“Putting insurance in the hands of people in this country is a small part of the equation that leads to increasing access to care. Once they have access, the bottleneck to care is moved down the line we don’t have more doctors, specialists or hospitals so we need to plan for innovative solutions that will help to provide them care….

Right now, this is not happening to a significant degree so when my counterparts look at me with disdain, I say, “Why not give change a chance?””

https://www.washingtonpost.com/news/grade-point/wp/2016/11/17/its-a-lonely-place-a-conservative-ivy-league-professor-counters-faculty-calls-for-trump-to-denounce-attack/?wpisrc=nl_highered&wpmm=1

Mother Jones – Trump Care Likely to be more Confusing and Costlier

“According to the state [Kentucky], most of those savings would come from people dropping out of the program because they couldn’t manage the premiums and complexity—18,000 people in just the first year.”

http://www.motherjones.com/politics/2016/11/trumpcare-likely-be-more-costly-less-efficient-and-more-annoying-obamacare

This analysis strikes me as largely true–some reforms will probably be aimed at making requirements too complicated so that lower-income people drop out. That is a problem.

There are also however other problems such as a legitimate scarcity of resources that the ACA deals with currently by having enormous (such as $13,000.00) deductibles on the low-premium plans which effectively leave people uninsured. Another glaring problem are the bureaucratic and reporting requirements such as online patient portals and the electronization of medical records. These have some good sides, but doctors’ non-clinical duties have increased substantially, as have the number of administrative work required in offices, which has bloated costs immeasurably. Colleges have entire majors now dedicated to Health Care Administration–not medicine, not nursing, but medical office work.

 

Your thoughts and direction towards other resources are always appreciated!

 

Article Round Up I

Well, Happy Thanksgiving! And welcome to a round of articles that I have found thoughtful and worthwhile over the past few months. It’s really things that I want to save for potential future use or citation.  (Note–unlike re-posts of my freelance work, these are not by me).

On Voting’s Significance (I know the time frame is sort of done on this one)

“I don’t plan to tell you how to vote, but I do want to establish a few basic principles:

  1. No well-formed Catholic should feel comfortable with Trump or Clinton;
  2. Thus, voters face a difficult decision this fall;
  3. The Church gives some guidance on this, but this guidance is limited;
  4. You, as a potential voter, have the final decision to make as to who to vote and who to support;  and
  5. Your salvation could well hang in the balance.”

http://shamelesspopery.com/worth-more-than-your-vote/

Why We Can’t Just Get Along— a disagreement, often unseen, on first principles, renders modern/faithful disagreement unsolvable

In Paradise Lost,

“Satan and Adam begin alike from a point of ignorance—they know nothing prior to (the precise word is “before”) the perspective they currently occupy; and the direction each then takes from this acknowledged limitation follows with equal logic or illogic. Adam reasons, since I don’t remember how I got here, I must have been made by someone. Satan reasons, since I don’t know how I got here, I must have made myself, or as we might say today, I must have just emerged from the primeval slime.

In neither case does the conclusion follow necessarily from the observed fact of imperfect knowledge. In both cases something is missing, a first premise, and in both cases reasoning can’t get started until a first premise is put in place. What’s more, since the first premise is what is missing, it cannot be derived from anything in the visible scene; it is what must be imported—on no evidentiary basis whatsoever—so that the visible scene, the things of this world, can acquire the meaning and significance they will now have. There is no opposition here between knowledge by reason and knowledge by faith because Satan and Adam are committed to both simultaneously. Each performs an act of faith—the one in God and the other in materialism—and then each begins to reason in ways dictated by the content of his faith.”

https://www.firstthings.com/article/1996/02/001-why-we-cant-all-just-get-along?utm_source=First+Things+Subscribers&utm_campaign=639cc6d14a-Sunday_Spotlight_Two_Essays_on_Gifts&utm_medium=email&utm_term=0_28bf775c26-639cc6d14a-180480817

David Brooks on Modern Toughness

“In short, emotional fragility is not only caused by overprotective parenting. It’s also caused by anything that makes it harder for people to find their telos.” (a Greek word meaning “end ” or  “purpose” in moral philosophy).

 

The End of Identity Liberalism

A good diagnosis I think of what went wrong for progressives in the election:

“In recent years, American liberalism has slipped into a type of moral panic about racial, gender and sexual identity that distorted liberalism’s message and prevented it from becoming a unifying force capable of governing.”

So, that’s it, readers. Enjoy and as always, feel free to send any thoughts!

 

Mr. Trump’s Language Problem, and Mrs. Clinton’s Worse One – Lying

Two unacceptable candidates for presidential office will be on the main-party ballots in a just a day or so. A quick look at how the two of them speak clarifies the troubling nature of Mr. Trump’s  views, but also why Mrs. Clinton’s history of lying is an even more severe abuse that undermines authentic communication itself.

The Purposes and Functions of Language

Two basic functions of language are discussing ideas and speaking to one another.

This first purpose, the formal use of language is the language of law, of documents like the Constitution, of logic, of philosophy and academics. It uses specific vocabulary and concepts in an effort to name truths such that we can all understand them and converse about them. The second purpose is basic interpersonal communication and often uses the casual register. It is more colloquial, relying on shared understandings and implications. The vocabulary is much smaller and is non-specific. These two overlap of course, especially in high level conversation such as debates. (I draw these two basic categories: formal and casual, from the five registers discussed in Ruby K. Payne’s A Framework for Understanding Poverty.)

Trump’s Triumphs and Tribulations from Casual Speech

A point of distinction for Mr. Trump is his use the casual register, even in debates. He calls things “tremendous” and “great” or “messes” and “disasters” without further specification and expects to be understood. Meanwhile, the moderator, his opponent, and much of his audience are left with their jaws hanging wondering why he failed to answer the question. He exemplifies the non-specific language of the casual register which functions on shared understandings and implications.

Trump’s casual speech opens him to easy lampooning in the media, but is has also allowed him to connect with a deep well of untapped support from the working class. When asked if he would accept the results of the election in the third debate, Mr. Trump replied that “I’ll keep you in suspense,” which is a vague answer intended to tap into a shared understanding that the election process is somewhat suspect. All he likely meant is that he might sue, as Al Gore did in 2000, and that he might otherwise sulk in his penthouse.

But his comment met with media consternation and uproar about undermining the foundations of our democracy which rest on the peaceful transfer of power. Many commentators construed Trump’s comment as seditious because they do not share the implication that his speech relied upon. To them, “accepting election results,” means accepting the foundations of the rule of law and legal proceedings that govern America. The two assumptions undergirding the question missed each other and led to miscommunication, a danger often present in casual speech. This line bothered the media, but was likely less problematic than many assumed.

Mr. Trump’s Unrespectable Views

Unfortunately, many of Trump’s casual, off-hand remarks are actually as problematic as left-leaning writers say they are because of the the shared understandings that he relies upon do tend to be discriminatory and disrespectful. Mr. Trump’s comments on women are a uncontroversial example

Leaving aside his outrageous 2005 recording, in August 2015 Trump dismissed journalist Megyn Kelly, wondering aloud whether she had “blood coming out of her wherever.” The reference to her menstruating accessed the stereotype that due to the hormones accompanying this bodily process, women are not rational during it. In so speaking, Mr. Trump claims power to dismiss Ms. Kelly’s comments as potentially non-rational. Because menstruation is private, this logically extends to all women being dismissable all the times. Trump’s comments about a judge of Hispanic descent being unable to try an immigration case fairly functioned similarly, as did his comments about imposing a religious test for people coming into America.

Mr. Trump’s temper and reliance on harmful stereotypes pervade his campaign and leaves us with a candidate who holds severely problematic views against a majority of Americans (since non-whites and females together constitute a majority of citizens), attributes which are hardly fitting for someone who is campaigning to lead all these different groups.

Clinton Promulgates Lies

In contrast to Mr. Trump’s blatant sexism and racism, Hillary Clinton appears to occupy a moral high ground. She has command of the formal register, that specific speech we use to explain reality, and she trounced Mr. Trump in debate. But Mrs. Clinton abuses language by unaccountable lying and in doing so, she turns formal speech into propaganda, undermining the end of truthful communication. Continue reading

3 Modes of Impartiality/Personal Engagement

Reading and reflecting recently on how people talk to one another, here are some recent observations of mine on how people share and address the impartiality/personal aspect of conversation. Most of David Brooks’ people of character, from his new book The Road to Character, likely fall into the “Quiet” category of mine.

The academic gold-standard is impartiality– to appear impersonal and objective, presenting only the facts. But this is not the mode that most of us interact in, which is perfectly reasonable.

Most of us are affected by and drawn to personal stories, things that resonate with our own experiences. In books, these are novels and memoirs.

I’ve noticed that there are (seem to be) three ways most of us deal with impartiality/personal when speaking, and I think most of us shift between each one though one may tend to dominate.

  1. The Know it All – Impartial as attempt to impress, appear objective and knowledgeable
    1. This is so evident in young people, especially ambitious young people (I can get pretty embarrassed when I think about how often I’ve here) who will happily prattle on about all the things he or she knows or has done or plans to accomplish.
    2. Other times, this surfaces through excessive criticism.
    3. The goal, often unconscious, is to appear learned and accomplished from an objective point of view while hiding the inner self.
    4. Ironically, it stems from a place of insecurity, of wanting very badly to be liked and appear well before others.  Older and mature people see through it right away, but are often very charitable and encouraging.
    5. That being said, the insights and criticisms can be very accurate, though not always.
    6. The Know-It-All is less a fault than a stepping stone in a path of growth.
  2. The Personal – When we becoming willing to show our selves
    1. At some point, most of us become willing to share our true selves, our actual opinions and experience without overt regard to its appearance to others.
    2. Here or elsewhere, we realize that even objective information is filtered through our own experience, so even when we try to be impersonal, it is often more revealing and personal than we realize.
    3. This is how we share with those close to us. Sometimes, public figures will share in this way. But most often, actors and politicians will keep it to the Know-it-All or be a totally the closed-book.
    4. Sometimes, this personal share loses an appropriateness filter and we can ramble on and on about ourselves and our experiences without enough regard to the actual subject of the conversation
    5. This is a normal mode, at least sometimes, in most people. It can be both deeply illuminating or shallow and myopic.
  3. The Quiet – Speaks when necessary
    1. The quiet person has learned that wrongly-placed or careless speech can be incredibly damaging.
    2. This person weighs the entire situation: the participants, their temperaments, the social setting, before adding his or her voice
    3. This quiet one is no longer concerned with the approval of others and uses his or her speech to clarify necessities, put others at ease, or add something edifying without regard for getting credit for it
    4. The quiet person may actually speak quite a lot if it is called for in the situation, but it will always be in balance.

Continue reading