The Fun Theory

My sister, Susan, just sent a link to the Piano Staircase, which combines health, music, and fun, three of my favorite things:

Take the stairs instead of the escalator or elevator and feel better” is something we often hear or read in the Sunday papers. Few people actually follow that advice. Can we get more people to take the stairs over the escalator by making it fun to do? See the results here.

The Piano Staircase is from the Fun Theory, which

is dedicated to the thought that something as simple as fun is the easiest way to change people’s behaviour for the better. Be it for yourself, for the environment, or for something entirely different, the only thing that matters is that it’s change for the better.

The site has all sorts of clever ideas, many of which have been realized, and some with videos.

Health care illogic

Following Rep. Joe Willon’s (R, SC) outburst druing the President’s speech, the Obama administration has scrambled to show that it will guarantee no reasonable means of healthcare for people in the US illegally. That position strikes many people as sensible. But it’s not only cruel, unfair, and unmanageable, it actually undermines the very effort to secure affordable, reliable healthcare for everyone.

No one in power is even talking about government health care for all (that’s a plan that would really work). Instead, the proposal is simply to require everyone to get health care insurance, through a government-managed insurance exchange, employer-provided group coverage, or private insurance. With a large pool of buyers in the exchange, it’s possible that health care costs could be controlled.

Denying undocumented workers and their families access to both the exchange and employer-provided group coverage means that very few will have insurance of any kind. This, in turn, will increase demands on expensive emergency room care, whose costs are ultimately borne by the government and individuals with private insurance.

Rep. Luis Gutierrez (D, IL) put it this way last week:

So, and remember, we’re not talking about government health care, we’re talking about everybody is going to be required to get health care insurance,” said Gutierrez. “And so as we go to this big store, right, where everybody is required. And this exchange, the health care exchange, where if you don’t have health care you are required to go purchase it. When you go and attempt to purchase it, what does the administration say? The administration says, ‘You will have to prove that you are legally in the United States and have a Social Security number and a right to that.’

Some immigrants, and let me say it – hundreds of thousands of them — who have businesses, who are prospering, who are paying taxes— even when they wish to buy because it’s going to be a requirement to buy it, this administration has told them don’t buy. You can’t. You can’t buy.

via Latino Lawmaker Rips Obama for Making It Harder for Illegals to Buy Private Insurance – George’s Bottom Line

One thing that could make the exchange work is to bring in large numbers of relatively healthy people. New immigrants use 55% less health care than native-born Americans, according to a Harvard/Columbia University study (Physicians for a National Health Program, 2005).

Denying health insurance is foolish and spiteful. It’s also absurd: We should demand that immigrants share the burden of paying for healthcare, not exclude them in a way that ultimately endangers not only theirs, but everyone’s health and finances.

See also The bottom line in health care.

References

Physicians for a National Health Program (2005, July 27). Immigrants’ health care costs are low.

The health care plan we can’t discuss

Health care experts agree that switching to a single-payer system would provide better care and sharply reduce health care costs. But that switch won’t happen. Our representatives in Washington won’t even allow the alternative to be discussed.

Our health care system is based on corporate welfare, not individual and family welfare:

“One out of every three dollars in our current health care system goes for corporate profits, stock options, executive salaries, advertising, marketing, the cost of paperwork,” [U.S. Rep. Dennis Kucinich, D-Ohio] said. “If you took the money that’s being wasted and put it into a not-for-profit system, you’d suddenly have enough money to cover every American.”

The quote above is from an NPR story (Single Payer: The Health Care Plan Not On The Table). There are links from there to previous stories on a single-payer system and the resolute refusal of our leaders to talk about it.

Some opponents of President Obama’s health care plan warn that it could lead to a single payer system. Unfortunately, there’s little hope of that happening. The plan is being crafted to ensure that those who now benefit from the bloated health care system will continue to do so, and that those profits, stock options, and executive salaries will be secure forever.

References

Horsley, Scott (2009, July 24). Single payer: The health care plan not on the table. National Public Radio.

Nichols, John (2009, July 27). Hope for health reform? Push single-payer now. The Nation.

Opening the door to single-payer health care

Tommy_DouglasMy previous posts on national health care, The bottom line in health care and The bottom line in health care, and Single-payer health care: Why not?, make the case for a national health program. But Canada established its program in an incremental way.

Tommy Douglas, premier of Saskatchewan from 1941 to 1960, led the province to develop a universal, publicly-funded “single-payer” health care system. It was so successful that other provinces soon copied it, and ultimately, so did Canada’s federal government. In 2004, Douglas was rated by his compatriots as “The Greatest Canadian” of all time.

Saskatchewan has been a leader in many areas of health care, but that happened over many years. The Saskatchewan Government site lists six reasons why the province was able to do what it did. These are worth thinking about for the US health care debates today:

  • There was a vision of health care for all.
  • Citizens showed a co-operative spirit, trust, and a willingness to help one another.
  • Municipal politicians were forward-thinking and innovative.
  • Provincial governments responded quickly to needs.
  • Medical doctors were altruistic, with service to sick patients as their primary goal.
  • Economic hardship, particularly during the 1930s, meant that virtually everyone was in the same predicament.

A US House committee recently approved an amendment allowing states to create single-payer health care systems. Doing so might be a way around entrenched, moneyed interests that have thus far thwarted every attempt at health care reform in the US, but only if we can find a similar vision and co-operative spirit. Could we do it without the economic hardship of the 1930s?

References

Nichols, John (2009, July 17). A real win for single-payer advocates. The Nation.

Physicians for a National Health Program.

Stewart, Walter (2003). The life and political times of Tommy Douglas. Toronto: McArthur. Gripping, humorous, and revealing story of Douglas’s amazing life.

The bottom line in health care

healthIn my previous post on Single-payer health care: Why not?, I talked about our family’s experiences with health care in France, UK, Ireland, Italy, China, Australia, and other places in comparison to that in the US. This included health care for children and the elderly, and both minor (blood donation, physicals, skin growth removal) and major (broken hip, eye infection) procedures.

Thinking a bit more about this I realized that there were four essential facts that emerged from this wide variety of experiences. In every industrialized country except the US,

  1. Equitable: Everyone has the right to health care.
  2. Effective: People live longer, healthier lives.
  3. Economical: They spend less on health care, as much as 50% less.
  4. Efficient: There is much less bureaucracy, fewer forms, less running around, less waiting.

dollarI might add a fifth point, too: The scare stories that we hear (“you have to wait forever!” “you can’t choose your doctor!”) are simply false, or they index issues that are the same or worse in the US. The information we get about health care promotes profit, not health.

There are many issues–changing demographics, new technologies, new medical knowledge, changing standards, globalization, and more–which affect health care. But the fundamental difference in the current US situation is that health care is driven by the bottom line. Insurance companies, pharmaceutical companies, media corporations, hospitals and clinics, doctors and other health care professionals, and all others involved in health care operate in a system in which rewards bear little relation to the overall quality of care or efficient use of resources.

One can debate each of the points above, but the evidence from OECD, UN, WHO, WTO, and other international organizations is overwhelming in support of them. Other systems offer health care that is more equitable, more effective, more economical, and more efficient.

So, why is single-payer, or national health care not even worth discussing? Why does the Obama plan dismiss it? Why does even public broadcasting ignore it?

Single-payer health care: Why not?

180px-Roma_-_FatebenefratelliI’ve been fortunate to have traveled many places, and to have lived for extended periods in China, Australia, France, and Ireland. During those travels, my family has received health care on many occasions, including for our small children in China and Asutralia, my wife in Scotland, and my 87-year-old mother in Ireland.

This health care has come in a variety of forms, including treatment for my ten-year-old daughter’s eyes at the Hospitaller Order of St. John of God or Fatebenefratelli (see left), located on San Bartolomeo, the only island in the Tiber River in Rome. That hospital was built in 1584 on the site of the Aesculapius temple.

clontarfWe also faced emergency surgery for my mother’s hip at Beaumont Hospital in Dublin, Ireland and subsequent rehab at the Orthopaedic Hospital of Ireland in Clontarf (right). In China, we were served in medical facilities with separate queues for Western medicine (our choice) and traditional Chinese medicine (below left). I donated blood many times at the Hôtel-Dieu de Paris, founded in 651 on the Ile de la Cité (below right). I’ve also observed, though not had to depend upon, health care in Russia and even in economically oppressed places such as Haiti.

beida_hospitalOn the whole, I’ve received excellent care in a variety of conditions. Individual health providers have been courteous, knowledgeable, and dedicated to their professions. For myself and my family, the experience of care did not depend on the setting or language, but rather on the ailment or the specific people providing care.

And yet, one thing stands out: Among the industrialized nations, the United States is the only one without universal health care. All of the others provide health care for all. They also do it primarily through single-payer systems.

The United States operates instead through a complex bureaucracy of insurance policies, doughnut hole prescription drug coverage, forms and regulations galore, massive administration, unnecessary and excessive procedures, complex and confusing tax codes, leading to escalating costs and unfair coverage. The inequity of care actually costs all of us more in the end, because of lack of preventative care, inefficient delivery (e.g., emergency rooms), and lost productivity. Our system costs much more, even double that found in other countries.

hotel_dieuIf we were to find that spending a few dollars more gave us better care, there might be little room for argument. But in comparable economies, people spend much less, yet have longer, healthier lives (American Health Care: A System to Die For: Health Care for All). Why then, is the system that works in Canada, Japan, Europe, Australia, etc., not even under consideration here?

The answer is unfortunately all too obvious: Americans, unlike citizens in other countries, have ceded control of their own health care to profit-making insurance companies, hospitals, clinics, laboratories, pharmaceutical companies, and other entities. The best we can do is an occasional feeble cheer when someone asks why our government can’t even consider a single-payer system. Then we listen to an answer that mostly obfuscates and lays the blame for it back on our own timidity:

Why I like to use walking poles

leki_polesOK. I know it looks strange, but here are a few reasons I like to use walking poles:

  1. If I don’t have a baby or a dog with me, it provides something to talk about with strangers.
  2. It add ten years to the usability of my knees (and ankles, hips, back, feet,…).
  3. Even in the short run, my knees don’t hurt so much after a long walk.
  4. I can fend off small animals.
  5. A stick can be handy for opening gates, picking up objects, making an impromptu tent, or hoisting a flag. See more reasons to carry a walking stick.
  6. I get upper body exercise while walking.
  7. I burn more calories, but don’t even feel that I’m exercising.
  8. I walk faster.
  9. I’m less likely to fall when crossing a stream and stepping on slippery, unstable, rounded rocks, or even just stepping on a wet leaf or going down a bumpy sidewalk.
  10. I can use the same sticks for x-country skiing.
  11. They remind me to get more exercise, and to be outside more, providing a partial escape from the computer screen.
  12. They’re reflective, which makes it much safer to walk at night, especially since they move rapidly in the normal walking motion.
  13. They make me feel that I’m in Finland again.
  14. Using them is similar to using a bicycle or roller blades in that walking is suddenly easier.
  15. Cars slow down and avoid me more. I’m not sure why. Do they think I’m disabled? that I might strike them with the poles? that I look larger? that I look strange? Whatever it is, I appreciate their response.
  16. They’re a big help going up a steep hill, because you can use your arms to push up.
  17. They provide a measure of safety going downhill.
  18. They’re handy for retrieving a frisbee stuck in a tree, a hat that fell in a stream, or a ball that rolled under a cabinet.
  19. When you’re tired of walking, you can lean on them to rest.
  20. And they’re especially useful for canoeing!

Why you should not run on the ice

humerusAre you one of the few people in the world who know enough to surf the web in order to read this blog post, but not enough to tread carefully on the ice?

If so, please note the small, line fracture of the humerus in the x-ray image on the left. That’s where the rotator cuff attaches. It’s reminded me every day for the past month why running on the ice is a bad idea.

Appropriating technologies: Nets for fish or for mosquitoes?

Appropriating TechnologiesThe notion of “appropriate technologies” is familiar; it’s similar to saying we should use the right tool for the job. In developing countries, this usually implies that we should find tools that fit with the local culture, knowledge base, environment, and existing technologies, for example, donkeys might work better than automobiles when the roads are in poor condition or non-existent.

There’s a related idea, in which the user is not just a passive recipient of some technology, but an active (re-)creator of it. People can actively appropriate technologies, interpret, use, and even re-design them to fit their needs. An excellent example of this is the alternate uses people have found for insecticide-treated nets:

Insecticide-treated nets (ITNs) are a simple, cost-effective way to fight malaria and are distributed to pregnant women and children in Kenya, often for free. But when Noboru Minakawa of the Institute of Tropical Medicine in Nagasaki, Japan, and colleagues surveyed villages along Lake Victoria, they found people were using the nets for fishing or drying fish, because the fish dry faster in the nets than on papyrus sheets, and the nets are cheaper (Malaria Journal, DOI: 10.1186/1475-2875-7-165).

In Zambia too, ITNs are being used for fishing, straining fruit and even for wedding dresses, says Todd Jennings of non-profit health group PATH in the capital Lusaka. “An ITN in the water is one not hanging in the fisherman’s home protecting his children,” he says.

It would be tragic if these uses of the nets mean that children are unprotected. Can we imagine a day come when people are not forced to choose between providing food and preventing disease?

References

Bruce, B. C., & Rubin, A. D. (1993). Electronic Quills: A situated evaluation of using computers for writing in classrooms. Hillsdale, NJ: Lawrence Erlbaum. See especially Chapter 9.

Eglash, Ron, Croissant, Jennifer L., Di Chiro, Giovanna, & Fouché, Rayvon (Eds.) (2004). Appropriating technology: Vernacular science and social power. Minneapolis: University of Minnesota Press.

New Scientist (2008, December 23). Malaria bed nets’ usefulness is their downfall..