Don’t miss this fascinating blog post by the WashPost’s Ezra Klein, in my native state for some sort of Cleveland Clinic event, about how that respected health-care institution pulled off this miracle:
With 40,000 employees, the clinic is the second-largest employer in Ohio. Like most employers, it struggles to contain health-care costs. But according to Michael Roizen, the clinic’s director of wellness, over the past seven years a series of reforms instituted by the clinic’s chief executive officer, Delos Cosgrove, slowed and then arrested the growth in employee health-care costs at the clinic. This year, inflation-adjusted spending might actually fall — an all but unprecedented achievement in employer-based insurance.
The clinic took a look at grim reality — 70 percent of health-care costs are connected to smoking, poor eating habits, lack of exercise and stress — and reacted accordingly.
“We want to make it easy for you to do healthy things and hard for you to do unhealthy things,” (the clinic’s director of wellness) said.
Smokers were first banished from campus, then from the work force. (Yes, even doctors were fired for smoking on campus.) The hospital’s food services stopped offering deep-fried and trans-fat options. This part was particularly interesting:
That left fitness and stress relief. The first step was easy: Offer free fitness and stress-management classes. But the clinic still had to get its employees to attend. So they reversed the normal calculus. Usually, you have to pay to hit the gym or attend a yoga class. If you work for the Cleveland Clinic, you have to pay if you don’t.
And so on. But guess what? It worked. Workers are thinner, have lower blood pressure and cholesterol, and barely 6 percent are still smoking. But, as Klein points out, a hospital can get away with this, claiming that projecting a message of wellness, top to bottom, is part of their core mission. Could General Motors? Hmm.
Personally, I’d love to work for an employer that picks up my gym membership, or provides one on site, where the vending machines and cafeteria don’t dispense swill, where smoking isn’t even permitted in the parking lot. But my wellness support looks like nanny-statism to others, and Big Healthy Brother to someone else.
I hear about things like this, and I think about World War II, in which national solidarity was the rule, and we could accomplish anything, and did. But that was only for four years. If the campaign against global fascism had taken as long as the war on terror, I doubt we’d still be happily practicing blackout drills and volunteering for scrap-metal drives. But with the right sort of motivation and a certain take-it-or-leave-it push from behind, we really can accomplish great things.
Here’s something else I read the other day that I found fascinating: Do you know how motorists in the Netherlands open their driver’s-side doors? Think about it. Like almost every driver in this country, when you’re preparing to get out of your car, you probably reach for the door latch with your left hand. I do, certainly. But virtually everyone in the Netherlands gets around on bicycles when they can, and motorists and cyclists must find a way to co-exist on the same roads. Cyclists everywhere know to exercise extreme caution when riding close to a line of parked cars, keeping an eye out for the so-called door-swing incident. Getting doored can shut out your lights quick, and in worst-case scenarios, send you sprawling into the path of traffic with nothing but your ribcage to protect your internal organs. When you’re riding, you always remember that the vast majority of American motorists open doors heedlessly once they’re parked.
But in the Netherlands, drivers are trained to open their doors with their right hands, never their left. Reaching across your body rotates your torso just enough to put your rear-view mirror in your line of sight. It requires you to consider what’s coming up behind you.
I wonder why so many initiatives in this country that ask us to consider the general welfare of others — whether it’s the employer who picks up our health insurance costs or the man on the bicycle — is greeted with a scowl, a shrug and “It’s a free country.”
Y’all think on that today, or maybe you’d rather discuss the OMG story out of central Ohio yesterday, with a great OMG headline: Posse hunts down wild animals on lam. (Kirk, I know space is a consideration in headline-writing, but I really missed the “the” in that one.) Hey Martha, here’s a story for you:
ZANESVILLE, Ohio — Dozens of wild animals — from bears to lions to wolves — were running loose in Muskingum County yesterday, apparently set free from their cages.
Meanwhile, the man who owned the animals was found dead on the wildlife preserve that he ran, authorities said.
The sheriff’s department is roaming the countryside with a shoot-to-kill order, schools have been closed, residents are being warned to stay inside (to avoid the deputies as much as the bears, I’d think) and by the end of this, a Columbus TV station helicopter will crash and burn. Muskingum County is a pretty rural place, full of deer hunters, and my guess is one will shoot another very soon, if they haven’t already. My sister, monitoring the situation from suburban Columbus, says the sheriff has already displayed the amusing accent of almost-Appalachia in his TV standups, talking about going after those “wuffs,” i.e., the doglike creature known as canis lupus.
And no, no one knows what happened to the owner. My guess is, it’s a suicide/liberation, although I’m sure homicide is a strong possibility, too. The second-day story will surely be how Ohio’s lax laws allow yahoos like this to keep wild zoos on private property. (Scowl, shrug, “It’s a free country.”) I recall visiting one of these during my time as a reporter there, a place down in the Hocking Hills run by two stoners who took in retired circus animals, drug dealers’ pet ocelots and other exotics. Their tiger-feeding procedure was for one to enter the cage with the meat while the other stood outside with a .357 Magnum, in case of emergencies.
I assume one or both has been eaten by the big cats by now or, more likely, gone broke feeding them.
As is usually the case in these incidents, I feel worse for the bears than I do the people. Who wouldn’t?
OK, it’s an office-hours day and I still have a story to write before I head out. Have a swell Wednesday, all. Once we’re over the hump, it’s smooth sailing into the weekend.
coozledad said on October 19, 2011 at 9:37 am
My wife worked for a company that had a generous profit share, a gymnasium, natatorium, free day care, licensed physical trainers, onsite medical teams, and a very good cafeteria. The pay wasn’t tremendous, but who the fuck cares? They had break rooms with gallon jars of M&Ms on the counters, and in the early days, kegs of beer (community standards had more to do with the disappearance of this perk than on the job drunkenness).
She left eventually because the 45 minute drive included a stretch on one of the most needle-dick haunted highways in the US, and the daily existential panic wasn’t worth it.
There were people who were resentful that company provided benefits went to things they didn’t use- like the gym, or daycare. This was the libertarian fringe, who could be found most of the day horfing down M&Ms in the break room or burning a couple of spliffs in the parking lot before heading back to the office to crash. I remember having a discussion with one of these entitled pricks, and thinking “You need to run some goddamn mail”.
EDIT: Sandy Underpants has a good question about “the snake flag flyers” and Herman Cain. Sometimes he has titties on his blog. Be warned.
Kirk said on October 19, 2011 at 10:37 am
Gov. Strickland issued an executive order or something like it last year, banning sale and ownership of exotic animals except by full-fledged zoos. Gov. Kasich let it expire, because it might have been “too restrictive.” So I guess small government/libertarianism is worth risking that the occasional lion or tiger might visit your subdivision.
These nitwits who find it necessary to keep lions, alligators, bears and any other kind of exotic animal have always bugged me. If a dog, cat or parakeet isn’t good enough, move to Africa and knock yourself out.
Sue said on October 19, 2011 at 10:44 am
“needle-dick haunted highways”
I have no idea what that means, Cooz.
Nasty cops? Nasty ghosts? Perverted highwaymen?
coozledad said on October 19, 2011 at 10:54 am
Sue: It refers to a commuter highway with too many guys who think their right to drive their Porsche 120 miles an hour trumps any other consideration. I knew the country had dick issues when the state highway commission had to start stringing tank traps down the median to keep flying automobiles from jumping into oncoming traffic.
Dexter said on October 19, 2011 at 11:05 am
My inbox contained stories emailed from friends about the Great Escape. My friend from Troy , New York, forwarded a dispatch from a London paper…it’s viral!
The news and weather guys on Detroit’s WJR-AM 760 were joking about wanting a giraffe to come eat their tree leaves in their back yards.
Years ago my workplace had wellness programs. One exercise class was held in the cafeteria. Only office workers showed up, and only one man in the bunch.
Guys who break their bodies lifting very heavy flywheels into and out of milling and drilling machines had little energy left to work out with pretty leotard/spandex young office girls.
And they took the “good stuff” away and replaced it with baked chips/crisps. Inedible ain’t the word for that shit.
Then we’d break some sales record and the company bought pizzas for all, and coolers of Pepsi, never Diet Pepsi, just always Pepsi and Mountain Dew sodas.
Ann said on October 19, 2011 at 11:06 am
Toby Cosgrove, CEO of the Cleveland Clinic, is notorious for saying he’d refuse to hire obese people if he could get away with it. (See http://www.downeyobesityreport.com/tag/cleveland-clinic/; my favorite is the inevitable “it was meant to stimulate discussion” backtracking). It certainly helps your health care costs if you refuse to hire janitors, food service workers, etc who smoke but I don’t know that that’s really a way to solve the rising cost of health care nationwide. Interestingly enough, there is still a McDonald’s at the hospital. Not surprisingly, they weren’t inclined to give up their long term lease. Equally not surprisingly, there are usually long lines of staff and patients waiting to eat there.
Along the same lines, Walmart was recently in the news for sending the message that stores should focus on hiring younger healthier people–again to save on health care costs. Again, what works for one employer doesn’t necessarily work for the nation.
One of the goals of health care reform is to make insurance accessible to people with disabilities, preventing insurers from charging higher rates based on disability. But the law specifically allows the kind of “wellness programs” that the Cleveland Clinic has instituted, resulting in much higher premiums if you don’t met the stated goals, which include things like losing weight, getting your blood sugar under control, etc. We’re going to see a real explosion of these programs, which were already being heavily marketed to employers (try googling “wellness programs” to see what I mean). But, like most explosions, there will be some fallout.
Bruce Fields said on October 19, 2011 at 11:09 am
Maybe you want to work for UM….:
Heather said on October 19, 2011 at 11:18 am
We have an ongoing wellness initiative at my office, and I usually take part, although I am wary of the Big Brother aspects. I like to stay active, but I hate–HATE–gyms and find weight-lifting and most classes extremely boring, so I bike and swim. I’d be pissed off if one of these programs meant that my biking wouldn’t “count” unless I did it on a stationery bike under the company’s watchful eye.
Oh, and the dooring–I’ve been lucky so far (a few near-misses), but having heard many graphic horror stories from fellow cyclists, I get nervous about it and keep an eagle eye on parked cars. I give anyone that has just pulled in to a spot or is just sitting in their car a wide berth.
caliban said on October 19, 2011 at 11:20 am
Ghost on the Highway. (This is Loud.)
Setting Free the Bears. John Irving’s (excellent) first novel.
There are McDonalds adjacent to hospitals because of the company’s Ronald McDonald House charity, which provides housing and other services for families of long term pediatric patients.
LAMary said on October 19, 2011 at 11:29 am
My employer has started a more aggressive wellness program this year. I get 1000 dollars off my contribution to my HMO premium if I participate, which I am doing. I hate gyms too, and I hope my walking/running count for something. What I hate more is the lame email recommending I “tell two friends about this week’s fitness goals” or “write down three good things about eating more wisely.” Um, no.
caliban said on October 19, 2011 at 11:38 am
The wily manufacturers and purveyors of Sim City are discounting the price of the game by ten bucks, to sell it for $9.99, and there’s a pretty funny video to go along with the sale. I hadn’t realized Cain has the unmitigated gall to call 9-9-9 an “economic growth and jobs plan”. The more I know, the more I think this asshole is Huey P. Long for rich people.
Serfs will pay their own 9, then they’ll pay their employers 9, as the business tax becomes a de facto payroll tax with no matching contribution, and finally, they’ll pay the final 9 on top of the costs of goods and services they consume. Learn your times tables Herman, 3 x 9 = ?.
Two good things about eating more wisely: Tastes good. Less filling.
Jeff Borden said on October 19, 2011 at 11:41 am
As someone who had to frequent Northwestern Memorial Hospital more than he wanted while dealing with prostate cancer and related bullshit, I can vouch for the cognitive dissonance of walking into a massive structure seemingly dedicated to preserving and extending life that seems to be staffed by a majority of very overweight people. I’m not talking muffin tops or a little pot over the belt line, but huge people shuffling around in those loose-fitting hospital scrub outfits.
A physician’s advice to eat healthy, exercise regularly, etc. rings a bit hollow when all the staff around them is clearly not doing those things.
Anybody see the two hairdos getting into it last night at the GOP debate? I’ll never consider casting a vote for any Republican for national office, so I can blissfully avoid this dog-and-pony show, but I see from some websites that Mittens and Gov. Cowboy got into it. Also, Gov. Cowboy called Herman Cain “brother,” so he is clearly down with the urban culture, right?
I wonder if the GOP thinks all these debates are doing much for the party. I can’t see anyone beyond the tea-stained wretches who find this a compelling group of candidates. Ugh.
Chris in Iowa said on October 19, 2011 at 11:45 am
I’ve never tried to post a link here, but this is worth sharing http://www.youtube.com/watch?v=AcjeUFodYfQ&sns=fb. Hope I’ve done it correctly.
coozledad said on October 19, 2011 at 11:46 am
As the Occupy protests continue, remember a lot of the behaviors on the right will be of the Arville Douglas Garland variety. Keep pumping out those kids, so you can beat ’em up, or even kill ’em if you want!:
Julie Robinson said on October 19, 2011 at 11:52 am
There was a big scandal about plush new digs for the Indiana lottery headquarters, much of it no doubt well-deserved. As a result they are removing the exercise room, which was probably the one good place to spend a little money. That’s why Indiana remains fat.
caliban said on October 19, 2011 at 12:06 pm
The most astonishing thing to me about the gruesome cast of GOPer debaters, is that somehow it doesn’t include the truly insane Alan West and the monstrously crooked Rick Scott. And if Tejas secedes, I sure hope they take FLA with them.
Judybusy said on October 19, 2011 at 12:10 pm
My employer/health insurance company are offering a measly discount on office co-pays if we do an online, self-reported health assessment and 2 other activities. My health insurance also offers a $20 discount if I go to the gym at least 12 times a month. Oddly enough, even though this is documented behavior, it does not count as one of the activities. Watching a video by a chiropractor describe “natural” approaches to menopause counted. He frequently mentioned his clinic. I quit listening when he stated that a “major side effect of Prozac in teens is suicidal thinking.” It was a complete waste of my time.
Even so, I am glad the county–my employer–is working on this. We have high rates of obesity, diabetes and hypertension in our work force. Our smoker’s rate is relatively low. It would be great if it could be even more extensive and _effective_ as the program described above. I am curious: how did the company justify firing the smoking employees? Was it enough they smoked on campus and thus violated policy?
Bitter Scribe said on October 19, 2011 at 12:12 pm
Good for the Cleveland Clinic, I guess, but it’s a little depressing that a health care facility couldn’t think of anything more substantive to reduce health care costs than hectoring employees.
Of course, this is and will ever be the new reality, once the Republitards and the Supreme Court finish shredding “Obamacare.”
Ann said on October 19, 2011 at 12:17 pm
My understanding is that Cleveland Clinic didn’t fire anyone. They banned smoking on campus, offered lots of quit smoking programs, and don’t hire anyone new who smokes.
And I’m appalled by the chiropractor video story.
nancy said on October 19, 2011 at 12:21 pm
The clinic, however, didn’t give employees a choice. “First thing we said was we had to make our institution toxin free,” Roizen said. “The biggest toxin we have in the U.S. is tobacco. So we began offering free tobacco-cessation programs to our employees. Then we banned smoking on campus. You can’t even smoke in the parking lot in your car. The first offense you get a warning, and the second you get fired. We fired two high- profile physicians who refused to quit. Then they knew we were serious.”
Bruce Fields said on October 19, 2011 at 12:24 pm
“I’ve been lucky so far (a few near-misses), but having heard many graphic horror stories from fellow cyclists, I get nervous about it and keep an eagle eye on parked cars. I give anyone that has just pulled in to a spot or is just sitting in their car a wide berth.”
It’s often hard to see whether anyone’s in the driver’s seat. And a parked car can also block your view e.g. of a pedestrian waiting to cross. Instead I’d recommend moving a few feet left and staying out of the “door zone” entirely:
Sue said on October 19, 2011 at 12:38 pm
A small community hospital in my area banned smoking on campus. Since the hospital was in a residential area, the smokers started taking ‘walks’ along the nearby streets, which basically meant hanging out in front of people’s houses, smoking, lots of fun for homeowners when they opened their windows in nice weather. Legally there was nothing anyone could do about it. Needless to say the hospital’s reputation as a good corporate citizen took a little hit. I don’t know how this eventually played itself out but I haven’t heard about it in awhile, so I assume the hospital was able to do some kind of crackdown.
Jeff (the mild-mannered one) said on October 19, 2011 at 12:42 pm
Recycling a comment from my own Facebook account: On the Zanesville animal tragedy; Jack Hanna has been pointing out that his concern with the previous executive order by Gov. Strickland was that it shut down all exotic animal keepers/breeders, and he felt that it was unfair to what he called “many good breeders and owners.” I hear his point, and gather he helped move Gov. Kasich to rescind the order, but extreme cases aside – what public or animal good is served by an assortment of private animal preserves and/or “rescue” operations? Maybe we just need to revisit the whole concept and certification process. I simply don’t see why Licking County should have upwards of two dozen permits for such, for instance.
nancy said on October 19, 2011 at 12:55 pm
Well, I called it right, but jezum crow, what a story:
ZANESVILLE, Ohio — Authorities in Muskingum County say they have recovered most of the exotic animals that were running loose since they were set free, apparently by their owner, last night.
The owner of the exotic animal farm, Terry Thompson, was found dead yesterday in his house. Sheriff Matt Lutz said Thompson apparently opened the cages to release all of the animals, then committed suicide. He wouldn’t say how Thompson killed himself. He did say the body was “bothered” by the animals.
Lutz announced that authorities believe only three animals remain missing this morning — a mountain lion, grizzly bear and monkey.
A GRIZZLY BEAR. IN OHIO. I bet the monkey is riding on its shoulder, telling it what to do.
coozledad said on October 19, 2011 at 1:03 pm
If you ask me, we need to return to pre-contact levels of large carnivores. This helps keep human populations within a sustainable range, and encourages a kind of humility, as well as aerobic exercise.
Suzanne said on October 19, 2011 at 1:04 pm
“He did say the body was “bothered” by the animals.”
There was a guy not a 1/2 mile from my kids elemantary school (out in the netherlands) who reportedly had bears and wolves or something on his property. It caused me some worry.
Jolene said on October 19, 2011 at 1:11 pm
I’m pretty sure that the Cleveland Clinic, like the Mayo Clinic, pays doctors salaries rather than using a fee-for-service reimbursement system. Most health policy analysts think that the fee-for-service system is one of the biggest drivers of health care costs, so making that change shows that they’re doing more than hectoring employees.
There’s a lot of money to be saved in the practice of medicine, and large high-profile organizations are in a good position to lead the way.
Jolene said on October 19, 2011 at 1:12 pm
Cooz, was your wife at SAS?
coozledad said on October 19, 2011 at 1:22 pm
Jolene: Yep. For five years. I got to use the gym, too. That was back when nutritionists had foisted the whole low-to-no-fat obsession on the country, and I bought into it, thinking the bastards actually knew what they were talking about.
I did lose thirty pounds, some of it dura mater.
Jolene said on October 19, 2011 at 1:31 pm
I saw a 60 Minutes feature about SAS some time ago. It looked like a wonderful place, plus lots of smart people and interesting work.
caliban said on October 19, 2011 at 1:33 pm
Regarding Chris’ Grayson video: Gutdom, PJ O’Rourke is a self-righteous asshole, less than half as humorous as he thinks. I’d like to see PJ and Hitchens in a Saw movie situation. Difficult to say which is more annoying.
Jolene, many doctors’ groups are making that point about salaries vs. fee for services, and including it in contract negotiations with hospitals and HMOs but people will continue to blame docs for ballooning health care costs instead of HMOs and insurance companies (which love the fee for services arrangement because it increases their markups to insurers), and, most absurdly, malpractice awards and litigation. The latter is a last bastion straw man for greedy corporatist jerks, and is actually a ridiculous claim that wins over no-nothings that are probably envious of doctors’ and lawyer’ incomes. When California capped malpractice awards, malpractice insurance costs grew by about 50%. So much for that myth. In all, malpractice litigation costs, even including insurance payments, account for no more than 1.5% of total American health care costs.
Judybusy said on October 19, 2011 at 1:50 pm
Cooze, I got dinged on my health assessment for not eating a lower-fat diet. Guess they didn’t read the meta-analysis from the mid-2000s showing the low-fat diet had little impact on heart disease….also, still laughing about your suggestion for pre-contact levels of predators!
The hospital I used to work for had Micky D’s locked in a 25-year contract. At some point, they banned smoking on campus, so smokers just went in the bus shelter a few feet off the property. That was nasty, waiting for my bus.
Brandon said on October 19, 2011 at 1:51 pm
On a related note: Nancy, what do you think of this?
Jolene said on October 19, 2011 at 1:52 pm
Another systemic approach to cost-cutting is hotspotting, which the always wonderful Atul Gawande has written about recently. The idea is that certain patients consume much, much more than average amounts of care and that identification and careful management of these patients could dramatically improve their circumstances and also reduce the burden they impose on the healthcare system. This approach was featured on Frontline not too long ago.
I love the idea of combining the data analysis that helps to identify these healthcare “frequent fliers” with the very hands on approach to addressing their problems.
nancy said on October 19, 2011 at 2:04 pm
The mysteries of men and their need to chew, spit and otherwise masticate disgusting stuff — and yes, I include bubble gum in that assessment — is a topic better left for another day.
LAMary said on October 19, 2011 at 2:16 pm
It’s horrible that they had to kill so many of the animals. I mean, I know they had to. There was no choice. But why did that guy have all those animals in the first place? I think he was one sick puppy. The sherrif’s department had to kill Bengal tigers, one of the truly endangered species. I’m bummed.
caliban said on October 19, 2011 at 2:23 pm
Are the animals being killed because it is cheaper than tranquing them and providing veterinary services? That’s disgraceful if true. The bears and wolves should be left to their own devices. Native Americans.
And how ’bout them idiots that release their boas and pythons in the ‘Glades, where FLA wildlife officials estimate there are as many as half a mil invasive constrictors preying on indigenous wildlife.
Dura mater, my favorite anatomical term. When I taught HS anatomy a few years ago, it gave me great pleasure to explain to these AP seniors that the Latin means, literally, “tough mother”. The effect was like telling middle schoolers that pogue mahone means “kiss my ass”. Had ’em in the palm of my hand. Of course it was a 7:30 am class, so the couch and Mr. Coffee I furnished our lab with helped a bit, too.
Andrew Sullivan, who presumably, though I’ll never understand why, has a dog in this fight, on the latest debate:
9.57 pm. The bottom line: Cain trod water, but his plan sank. Santorum excelled at forensics but probably shouldn’t be touting his skill at winning swing states when he lost Pennsylvania the last time around by 16 points. Ron Paul outdid himself by bringing up Iran-Contra. Bachmann seems to have one decibel level, around 11, and seems to assume that it is now a given that an incumbent president equally polling his major rivals is already a dead electoral letter. Gingrich made sense on Yucca Mountain, I think. Perry gave petulance a whole new universe of meaning, and was so personal with Romney he lost the crowd. I wonder if Romney will appeal to Western Republicans more than Southern ones. But this felt to me like a settling. On Romney. And learning to like it.
Didn’t see it, but Sullivan strikes me as the smartest GOPer commentor around, even though the current GOP must be nearly unrecognizable to him.
What’s wrong with bubble gum? Bubble gum is not a male thing, any more than any sort of gum. That’s a slander on half the human race. I’d say female gum chewers are much more likely to make a lot of noise with their mouthfuls. Chaw, on the other hand is one of the most revolting things on the face of God’s earth. Then again, I have known dainty Tri Delt types that would chew and dip smokeless, with proper Bud can spit cups. Chaw can have its purpose:
Jolene said on October 19, 2011 at 2:44 pm
More on hotspotting. Gawande addresses critics of the hotspotting approach. Supporting evidence from pediatric medicine. A small number of sick children experience multiple readmissions, which could be prevented w/ better care delivered earlier.
What kills me is that there really are intelligent approaches to addressing the healthcare cost issue, but the public conversation is all about death panels, rationing, what’s going to be cut, and whether, despite multiple votes to the contrary, someone will find a way to spend a federal dollar on an abortion.
The stupidity, the irrationality overwhelm everything.
Jeff (the mild-mannered one) said on October 19, 2011 at 2:59 pm
I don’t think it’s stupidity as much as anxiety about change, which often looks similar from a distance. People can know something’s broken (Congress, say) but dislike changing their own end of the problem (polling shows 70-90% satisfaction with one’s own House/Senate folk wherever you go).
The panels of any sort are an inevitability, and their existence, and the reality of some form of cost-control and/or rationing (I’m guessing “and” will tend to be the correct choice for the future), lend themselves to political grandstanding and demagoguing. The counterpart of that debate is that it’s not a question of a national health care policy or not — we have one, largely tied up in mandates to publicly funded ERs to admit all comers, CHIP programs, and Medicaid. As a national health care policy, it’s neither medically efficient nor cost-effective, so it has to change; also, the change has to make sense in how it applies to people who often are not able to manage their own treatment in any meaningful way.
Some churches are taking a leadership role in getting more people to talk, openly and specifically, in end-of-life care/DNR issues. We need more of that, because frankly the energy around NOT talking about these issues rationally is rooted in death-denial and a sunny, medically-assisted insistence on extending life (measured by heartbeat) at all costs. The approach that just keeps saying “we’re spending too much in the last six months of life, and we have to stop that” is too easy to tangle up in the thorny euthanasia issue, and doesn’t need to be. Talking about quality of life and “a good death” along with reminding people that their loved ones are not in the best place to make hard decisions when you’re standing in the ER/ICU waiting room — that’s how you get more living wills, DNR orders, medical powers of attorney, and ultimately, an appreciation of the Wisconsin amendments to Medicare to cover time spent discussion these things with your medical professionals.
Jeff (the mild-mannered one) said on October 19, 2011 at 3:07 pm
Oh, I forgot to post: a friend from this town where I live is one of the veterinarians at The Wilds. They were out there with dart guns as soon as they knew what was going on, but it was dark and raining by the time they got word and got to the site. They’d dart a cat, and it would bolt — they had no way of knowing if the dart hit, or if it stuck, and the homes and neighborhoods nearby left them telling the officers “bring ’em down.” If they were wounded, and then went unconscious, they might be able to save them, but that didn’t happen in the couple of cases like that they had.
The bulk of loose animals were shot by the deputies right at the beginning, who drove into a scene from a very odd dream, with an array of big animals walking down a drive towards the road, and no good options with a wooded area all around. I’m told it was a fairly quick, but considered decision, done before more animals slunk off into the brush. Those that stayed near enclosures, like the giraffe, were allowed to stay put, until some carrots and such showed up, and it was thrown into the enclosure where they were secured after returning. But bears and tigers heading for a public road as evening is falling — I’d hate it, but I would have done what the three deputies did.
Kirk said on October 19, 2011 at 3:24 pm
Jeff (the mild-mannered one) said on October 19, 2011 at 4:04 pm
Somebody works fast.
Dexter said on October 19, 2011 at 5:28 pm
caliban, do you subscribe to The New Yorker? If so, go to Archives and find the article about the invasive constrictors in the Florida Everglades. nance referenced it here, also, when it was published in the magazine a while back.
A “half-mil” is way on the high side. When the experts say “thousands”, they mean it, but now it’s a few thousand, not five hundred thousand.
Sherri said on October 19, 2011 at 6:04 pm
My husband’s employer has very good healthcare, and a pretty good wellness program too. Gym membership is paid for (at a particular gym, convenient to campus, and a shuttle runs from the gym to campus). There are weight management program and smoking cessation programs that are paid for, but not mandated, nor are your benefits affected if you don’t take advantage of them. There’s a 24/7 health line for advice, and if necessary to keep you out of the emergency room, they’ll actually send a doctor for a house call. For now, our health care premiums are fully paid, and there’s no co-pay (except for prescription drugs if you get brand name when generic’s available.) There’s change coming in 2013, as the company is moving to a model where the employee will have to pay more, but even in an industry that generally has good benefits (software), this is by far the best insurance we’ve ever had.
The employer? Microsoft. Apparently, Gates has always cared about health care, even before he decided to become a philanthropist.
caliban said on October 19, 2011 at 6:42 pm
Dexter, I read that in a column by Carl Hiaasen, who is a pretty knowledgable eco-sciences geek and, of course, from South Florida. The giant snakes figure prominently in some of his novels. It seems the snakes make meals of basically every animal species in the Everglades, including alligators. I suppose I must have misrembered and he was talking about projections, based upon these snakes ridiculously fecund reproductive capacities and the fact that if people don’t go after them, there are no predatory pressures, not even gators, whose eggs and young are game for the snakes. Anyway, I always picture drunken UF fratboys with mullets and jorts and tank tops that don’t cover their bellies, driving big wheel pickups out to the Glades when they no longer want responsibility for big snakes. Florida sanctions and licenses alligator hunting and it seems that pretty soon they’ll have to do the same with boas and pythons, which may be helpful to gator populations diminished by human greed and poaching.
Jolene said on October 19, 2011 at 7:31 pm
Jeff, I’m sure you’re right that fear of change is part of the deal. In fact, one of my biggest complaints about Obama is his failure to explain our real circumstances w/ regard to healthcare. When he was pushing healthcare reform, he made a big point of saying, over and over again, that if you liked your healthcare insurance you could keep it. The new law was meant to provide coverage for people who couldn’t get it. By and large, that is what the law does, but I feel he missed an opportunity to create what social psychologists call a “felt need for change”.
Instead of emphasizing the stability of the existing system for most citizens, he’d have done better to emphasize its fragility–to reflect what we know to be true, i.e., that the employer-based system is on the way to collapsing of its own weight with higher deductibles and larger co-payments as the early warning signs. Instead of presenting the ACA as the solution to our problems, it should have been portrayed as the first step toward a system that could eventually be made available to all Americans.
I keep thinking that we need something on the order of a national seminar on healthcare (and probably other things too), but our media environment is too fractured (and, perhaps, our society too divided) to make something like FDR’s fireside chat work.
There’s lots of ignorance about what is actually covered by both private and public health insurance. For instance, apparently, many people believe that long-term care is routinely covered by Medicare, which it isn’t. (As I understand it, it pays for nursing home stays pursuant to hospitalization, but not for custodial care–although one can stretch into the other.)
Anyway, that’s just one example of what people don’t know that has important implications for personal decisions and public policy. Of course, in wishing for a national seminar, I am placing my bet on rational decision-making, but, really, what’s the alternative to fear and the influence of stakeholders with big sums of money at stake. There must be some way to get beyond shouts of “death panels” and “socialism”.
Jolene said on October 19, 2011 at 7:38 pm
From last Sunday, an important article in the times re the problems we already have re what Medicare does and doesn’t cover. There’s a lot of bad news in it re how things are currently, with more to come as we baby boomers age.
Kirk said on October 19, 2011 at 8:21 pm
on the wild-animal rampage . . .
“We’ll get this fixed. This is unbelievable that
this even existed, and what’s
hard for me to understand is
why Ohio over time didn’t
deal with this,” said Gov. Kasich, the hypocrite who also didn’t deal with it, allowing state regulations barring sale and ownership of exotic animals to expire. He’s such a duplicitous punk.
coozledad said on October 19, 2011 at 8:29 pm
Now that BOA’s business model has failed utterly, they’re dumping all their shitty derivatives into the FDIC. It’s past time for firing squads. These people deserve lingering deaths. Labor camps. Little-eases.
As a civilized nation we could at the very least take every fucking piece of poseur crap they own and auction it off: cars, watches, wine cellars, and snotnosed children, all for veteran’s programs or public health.
caliban said on October 19, 2011 at 10:10 pm
Well, you know, Kasich’s last paying gig was running Lehman Bros. into the ground for big bucks.
Kirk said on October 19, 2011 at 10:41 pm
And a paid windbag for Fox TV.
caliban said on October 20, 2011 at 12:29 am
From the Columbus Dispatch:
An executive order that Gov. John Kasich allowed to lapse after taking office would have prevented Terry Thompson from owning exotic animals.
The order, issued by Gov. Ted Strickland but permitted to expire by Kasich last spring, prohibited anyone who had been “convicted of an offense involving the abuse or neglect of any animal pursuant to any state, local, or federal law” from owning exotic animals.
Thompson, the owner of the more than 50 animals set free in Muskingum County, had an animal cruelty and two other related convictions in 2005.
Kasich let the order die because he claimed it gave regulatory power to a state agency that was beyond it’s legal charter.
Yeah, shitheel, just like those pesky financial regulations that would kill jobs.
Kasich’s reaction to the catastrophe:
Well it’s just animals and they can’t vote or have their votes stolen by Diebold. Well, really what he said was:
This is unbelievable that this even existed, and what’s hard for me to understand is why Ohio over time didn’t deal with this, but we’ll deal with it now.
He just can’t understand how state government could allow something so terrible to happen. Were you drunk or oxyed up, mofo peckerwood? This was just a small blow for deregulation, in the midst of your grand crusade to destroy public employees unions on the way to trashing the middle class. Randy Newman wrote a song about this turd:
Aside from the slaughtered animals, he’s also headed straight for eternal perdition for his predation on behalf of Lehman selling horrible investments Ohio public pensions to create a phony budget crisis, but that’s probably giving more credit to this flamer than he merits. Shoulda stuck to the Wisconsin plan of just giving rich people all their taxes back, because this one is gonna get you time in Club Fed, and your bank accounts forfeited. this fuckhead obviously went to the “Helluva Job Brownie” School of Public Management. A died-in-the-wool Republican dick.
It just occurred to me watching clips from the debate that Romney only dealt with his employment of undocumented landscapers because he was running for President and it would look bad. He actually came right out and admitted it. What a buffoon.
Dexter said on October 20, 2011 at 12:35 am
The wildlife people don’t fuck around with those snakes in Florida. They kill them, right now. Those damn snakes are so good at hiding. The workers stand there just feet from the snakes and they can’t find them.
I’d go looking for an update but that’s enough for one day…I hate those damn snakes.