First, review this fine cautionary tale available here, courtesy of the ACLU:

http://www.youtube.com/watch?v=RNJl9EEcsoE

Now, I am no great fan of the ACLU, but credit where credit is due, this piece sums up the dangers of all those clever national IDs, government administered programs, linked databases, and GPS-enabled devices nicely. In fact, just two short years later, much of what is portrayed already exists:

  • businesses use caller-ID to recognize phones and link to customer information
  • even if the government didn’t give it out, businesses would certainly use a national ID number as a key—just as they use the SSN currently
  • your home address, birthday, name, etc. are all already keyed to the current equivalent of a national ID—your SSN
  • where you work is almost certainly on file—didn’t they ask the last time you applied for credit or a loan?
  • cell phones with GPS currently do broadcast your location to services that request that information—unless you configure them not to
  • businesses already assign delivery areas or prices by risk of the neighborhood—as those living near shady areas know—and as crime stats become more instantly available, this can only increase
  • as businesses partner to offer shared customer incentives, exchanging information about recent purchases and coupon offers is becoming commonplace
  • certainly whether your cards are maxed out is easy—a quick query to each card could do that

And some things, which have not yet come to pass (as it were) are terrifyingly likely:

  • currently legislation protects your health care information, but either government-run healthcare or single-payer schemes would require releasing it to the government at the least
  • legislation to allow the government to regulate food and lifestyle choices for health is already proposed—once the government’s actually paying for health-care, what will happen
  • currently the health-care industry and insurance industry would love to be notified about people’s purchases and force them to sign waivers—unlike them, government can actually enforce such desires
  • in our climate of constant fear of terror attacks, does opening travel itineraries to public scrutiny seem farfetched?

Horrifyingly, the only thing which seemed utterly ridiculous was libraries ever voluntarily making your reading choices public. But amazon.com on the other hand…

Clearly some of what is portrayed is fine, even useful, but some is frighteningly Orwellian.

So where should the line be drawn? Where does the scenario presented cross the line from convenience to surveillance? As technology advances it seems increasingly impossible to effectively compartmentalize information, so should we assume that whatever the government knows about us will find its way into private hands? And just how much should the government know about us, anyway?

Discuss amongst yourselves!

It’s official: there’s a health care crisis in America. When all of the major candidates for President spend time talking about it, you know some solution is just around the corner. But, tragically, most of the common wisdom on what the problem actually is and how to fix it is 180° off course.

To understand that this true, why this is true, and how we came to be here, we first need to make a critical—but often forgotten—distinction:

What we care about is access to health care, not access to health insurance.

We shouldn’t give two cents about access to health insurance, except as a means to health care. Listen carefully to what all the politicians actually say: nearly all of the verbiage about universal coverage, universal access, etc. is focused on access to health insurance. Why? Because that’s something that government can actually promise, unlike access to health care. Short of enslaving all doctors, chaining them to desks, and scientifically distributing them around the country, there’s simply no way to ensure universal access to health care.

If you live in the middle of nowhere, for example, all the health insurance in the world does you no good if there aren’t any doctors for 500 miles. This is a problem in a surprising number of areas. In some regions the only neurosurgeons (for example) may be in large cities. The high cost of medical malpractice insurance has combined with natural market forces to increasingly limit specialists to lucrative big city markets. A growing problem in an age of increasingly effective but highly specialized medicine.

Or again, if the government’s brilliant solution to your lack of access to life-saving medicine reduces the available providers by capping what they can earn without capping their expenses (such as the aforementioned malpractice insurance), how exactly will that help you? What good does it do you to have every right to have some procedure only to find that no doctor is willing to perform it?

Or consider the dilemma for many in Canada. There, you have not only universal coverage, but the “right” to free comprehensive care. Unfortunately, you have no right to decide just what “comprehensive care” might be for any given condition. So, in some cases, you will be told to take some pain killers, shut up, and wait to die. In others, your operation may be scheduled in weeks to months due to shortages of facilities or personnel. All the problems, in short, of the worst possible HMO with absolutely no independent legal recourse.

The sad truth is that universal health insurance coverage will not solve our problems. Nearly universal health insurance coverage already exists in our system. (In fact, it’s part of the problem.) Out of 300+ million people in the United States, under 30 million citizens lack health insurance. That’s a 90%+ coverage rate, but somehow I suspect we don’t have anything like a 90% satisfaction rate with health care. In part because all of that health insurance actually makes decently priced quality health care harder to get. If you ever want to verify that for yourself, shop around for doctors offering to pay in cash, off the system. You’ll be surprised at the deals you’ll find, especially for routine things like office visits—which account for the bulk of most people’s health needs.

If we’re really serious about providing quality health care to as many people as possible, for the best possible price, we need to leave aside the rhetoric and actually look seriously at the real problems. So I propose to do just that over the next few weeks, examining the problems of consumer health insurance, high drug costs, malpractice insurance, and health care for the poorest Americans. If you’ll join me, I think you’ll be surprised at some of what you find, and I hope you’ll come to agree with me that our focus needs to shift to what really matters: the best health care possible for the most people at a reasonable cost.

Danny Thomas (born Amos Alphonsus Muzyad Yaqoob), Jan. 6, 1912-Feb. 6, 1991.

Success has nothing to do with what you gain in life or accomplish for yourself. It’s what you do for others.

—Danny Thomas

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Many Americans today have probably never heard of Danny Thomas, as he belonged definitively to the twilight of the Golden Age of Cinema (starring in the 1952 remake of The Jazz Singer) and the dawn of the Golden Era of Television (starring in, what else, The Danny Thomas Show and producing such shows as The Dick Van Dyke Show, The Andy Griffith Show, and The Mod Squad). And before all that, he was a stand-up comic touring the Midwest nightclub circuit under an anglicized form of his given name, Amos Jacobs.

In any event, it is not for Danny’s entertainment talent that we honor him today. Of all his long work in the studios, only a couple of his many shows are still shown frequently. But though most do not know him by name, nearly everyone knows him through his greatest legacy: The St. Jude Children’s Research Hospital in Memphis, Tennessee.

At an early moment in his career, when the nightclub circuit was looking particularly grim (he was languishing in Detroit, no less), Danny knelt down in prayer and asked St. Jude Thaddeus (patron of hopless causes) to “show me my way in life.” Soon Danny found himself in Chicago and his career finally moving. When he next went to St. Jude in prayer at another turning point, he pledged to build a shrine if he ever had the means to do so.

His career took off, and Danny found himself wondering just how to fulfill his vow. Working with a group of businessmen in Memphis, he hit upon the idea to build a research hospital dedicated to curing the most catastrophic diseases afflicting children. A key point here: Danny Thomas didn’t just found a hospital—which after all can only treat the children that come through its doors—he founded a research institute dedicated to researching, applying, and publicizing cures for free.

And Danny did more than just found the place, he returned to the community of his birth, Lebanese Americans, to secure ongoing funding. From his efforts, the American Lebanese Syrian Associated Charities (ALSAC) was founded—with the sole purpose of supporting St. Jude. Today, ALSAC—still exclusively dedicated to St. Jude—is America’s third-largest health-care charity. Thus, the efforts of Danny Thomas and the Arab-American community produced a fundraising powerhouse that today transcends ethnicity, geography, and ideology to reach across America.

With an initial focus on pediatric cancer, St. Jude has helped increase the cure rate of acute lymphocytic leukemia from 4% to 80%, seen its budget grow from $1 million per year to $235 million, and branched out to study HIV-AIDS (devastating the children of Africa) and numerous cancers. Today it engages in cutting edge gene and stem cell therapies and is a highly rated scientific institution.

Leaving aside the 4900 patients seen each year, St. Jude has saved the lives of thousands upon thousands of children around the world through its contributions to basic and clinical research. Protocols developed at St. Jude have helped raise the survival rates for childhood cancers from under 20% to around 70%, with several key cancers having survival rates 90% or higher. And now it sets its sights on the diseases and therapies of the 21st Century. In the best American fashion it does not simply treat the symptoms of the ills it fights, it seeks to eliminate the root causes.

All from the vow of a stand-up comic, with help from a few Memphis businessmen and the unstinting assistance of the Arab-American community. Danny Thomas represents precisely what is right about America: he had opportunity, seized it, succeeded, and then stopped to consider how he could use his success to improve the world.

Of course, as with our other Great Americans Walt Disney and George Marshall, there are detractors. Some point to the sheer impossibility of curing childhood diseases and the tendency of charities to metastasize over time. To these folks the size and scope of St. Jude aren’t strengths but weaknesses—weaknesses that a group of smaller more focused institutions wouldn’t have. Others point out that as nasty as the diseases St. Jude fights are, they’re nothing compared to the childhood deaths from starvation, war, and exploitation. Wouldn’t all those millions be better spent fighting these more lethal, but far less scientifically “sexy” killers? Doesn’t St. Jude commit the classic American blunder of the Big Plan when less ambitious, more targeted efforts would work better?

There’s a point to all the carping, to be sure, but it still misses the point. Here, as always, the perfect is the greatest enemy of the good. Trying too hard to get the perfect solution is a great recipe for doing nothing. While others carp, hopeless cases still find hope at the place Danny built.

Still, I don’t think Danny would mind if those critics of his got busy building their competing visions. They might give ALSAC a run for the money, but I can’t help but think that Danny would just look down and urge them on.

After all, there’s still more than enough childhood misery to go around, sadly.

It is ironic that every time we vote on this legislation, there’s a major scientific study that says you don’t have to do stem cell research.

Rep. Rahm Emanuel (D-Ill.)

 

Truer words were never spoken (as long as you add “embryonic” to the last three words). Even as Rahm and his buddies were pushing their umpteenth attempt to get federal funding to kick-start the Devil’s choice of embryonic stem cell research (to save a life you must take one), Japanese researchers were announcing a major breakthrough using not even uncontroversial adult stem cells but lowly skin cells.

The Kyoto University breakthrough, announced in the prestigious journal Nature and confirmed by scientists from MIT, Harvard, and UCLA transforms skin cells, one of the easiest cell types to harvest, into an embryonic state. Bypassing the difficulties of cloning and nuclear transfer (transferring the nucleus of one cell to another), Dr. Shinya Yamanaka focused on finding genes that would allow an adult cell to regress to its original primitive, pluripotent state.

And he succeeded, at least for mouse skin cells. In that case, he found just four genes which could enable this “Holy Grail” of stem cell therapy. By every test his team—or their colleagues at other institutions—can preform, these regressed cells are the full equivalent of embryonic stem cells. They seem to lack only one thing: the need to kill a tiny embryo to harvest them.

That’s the real scandal of the stem cell debate. Incredibly promising, non-controversial research is being completely neglected—even ridiculed—as the debate rages over highly controversial, difficult, and (so far) comparatively unproductive research. For no legitimate scientific reason. When Sen. Hillary Clinton said:

This is just one example of how the president puts ideology before science, politics before the needs of our families.

she was in fact the one putting ideology before science. If she were really committed to advancing science without regard for ideology, she would be supporting independent efforts to increase funding to non-embryonic stem cell research programs. That would show true leadership and an appreciation for the science involved, and could be done alongside continued efforts to override the President’s veto on embryonic research funding.

No matter what the merits of embryonic stem cell research, or the worthiness of overriding the President’s veto, why should good science go neglected? No matter which side one takes on the embryonic stem cell debate, surely everyone can agree that moving ahead with research into using other stem cells—research which doesn’t push anyone’s buttons—is a good idea?

But neither the Democrats nor their media allies seem interested in stem cell research that doesn’t involve killing humans. Consider this fine example of spin by the New York Times:

“How many more advancements in noncontroversial, ethical, adult stem cell research will it take before Congress decides to catch up with science?” said Representative Joseph R. Pitts, Republican of Pennsylvania, holding up a front-page newspaper account of the scientific discovery. “These have all of the potential and none of the controversy.”

Such techniques, if proven successful, could sidestep heated debates about the research. The technique described on Wednesday works only in mice and is unsuitable for humans. Scientists hope it will prove adaptable to human cells, but cannot say when that may happen.

True enough. But this describes nearly all stem cell research. It is the height of spin to criticize what your chosen approach shares with the alternatives. The fact is that we are merely at the beginning of stem cell research in general, and we have a long road ahead whichever road we take. Why should that be used as an argument against any promising technique?

This is why the rush to focus nearly exclusively on embryonic stem cell research is so puzzling—and troubling. In a world of limited resources, surely a case can be made to prefer promising approaches which a large portion of the population does not find abhorrent? And shouldn’t even proponents of embryonic stem cell research see the benefits of separating the two? Since one branch of stem cell research is not controversial, why not pass specific funding for it separately? Why conflate the two in the mind of the public and on the floor of the Congress. There’s only one reason: because embryonic stem cell proponents want to make it an all or nothing proposition. “Either you embrace all stem cell research—with no restrictions at all,” they seem to be saying, “or we’ll prevent funding for any research.”

And that’s why it’s the Democrats and the media who are putting “ideology before science” every time they fail to clearly distinguish embryonic stem cell research from other stem cell approaches. Considering the promise of numerous adult stem cell therapies, the Senate Democrats’ constant campaign to derail funding for it is the true scandal of the debate. And the Democrats need to be held accountable for it, and for the harm it threatens to do to those awaiting cures across the world.

A member of my family has a jaw related problem where the little pads behind the mandible bone are displaced upwards causing mal-occlusion of the teeth, popping, and some significant pain. Unfortunately this is classified as TMJ which is not covered by either dental or medical insurance. (I never have figured why this particular body part is unique.) It tums out that there is a surgeon in Florida who fixes this by taking a bit of belly fat and transplants it behind the bone where it transforms into new cartiledge relieving the problem. Success rate is 100%. Cost is $50,000 not counting travel and lodging for the week in Florida. (Remember—not covered by insurance.)

Anyway, diagnosing this problem leads me to my latest rant. In order to identify that TMJ was indeed was the culprit, a MRI was used. Imaging my surprise when when I got a bill for $1890.00. ( They didn’t have my insurance information and somehow this procedure slipped through a crack in the authorization process—I guess discovering that the problem is TMJ related IS covered—at least once.)

After giving them the revised insurance information, the new bill was about $200.00. Fascinated, I delved into the explanations of benefits—that fine printed gobbly-gook that insurance companies send to you that makes very little, if any, sense. The original $1890 was discounted by $920 since this was part of the agreement with the insurance company. 80% of the balance was then covered leaving me with a portion of the deductable and the 20% to pay.

I asked about the $920 discount. If I paid cash for the entire original amount minus the discount, the hospital could receive their money 6-9 months earlier (this is Illinois and our Governor is balancing the budget by not paying the State’s obligations.) No. Not allowed. If you actually pay for the procedure you have to pay the full $1890.

So why the hell does a MRI cost $1890 in the first place. The reason stated is that the machines cost over $3,000,000 and they have to recover the cost. Well, the hospital cost $48,7000,000 and the cost isn’t allocated over the 295 beds in one night. A night in the hospital isn’t $165,000. A MRI system should remain serviceable for at least 10 years.

Unfortunately hospitals are all about competition. The replacement cycle for a MRI seems to be about 18 months. They want the entire cost of the equipment fully amortized in that period, so they can buy a new one to keep patients from going to “that other hospital”. That, and the fact that the State is entitled to “most favored rate” in clauses in State insurance contracts, insure that paying cash will always be more expensive than going through the insurance paperwork mill. The system is definitely broken!

Imagine if the Government, seeing as how they are so hot to get into health care, funded the acquisition of MRI machines for hospitals. The logic would run somewhat along the lines— the [insert your favorite agency] will purchase an MRI machine for the hospital, but will assume a 12 year service life. You are eligible for a new machine only after 12 years. Hospitals could of course pony up the $3 million for a new machine if they wanted, but with the cost borne by the Government (read taxpayer), the other hospitals in the program would be able to offer MRI scans for around $50-$100. This would cover the electricity and the skilled operator labor.

One benefit of this would be that they would be used more (further reducing the allocation of recurring costs and making them cheaper still) and serious diseases would be identified earlier reducing heath care costs. This strikes me as a more reasonable Government intrusion into health care than doling out benefits in accordance with the folks that brought you the IRS in all its simplicity.

Some units actually do MRI for a business. These businesses amortize over 10-15 years and sell MRIs for a fraction of the cost hospitals do. True, government subsidies to hospitals might drive these small busines owners out of business, but that should be icing on the Congressional cake.

Maybe if we start chipping away at the stupid stuff in healthcare insurance, we can actually make it better without becoming Sweden or Canada.