Tuesday, November 26, 2013

The Mess We Are in (Part I)

A big chunk of my varied career was working in health policy. It’s a field of endeavor that I greatly enjoy.  Basically, health policy identifies health problems and needs and proposes intentional strategies to help address those issues.  I recall a story I heard that helps explain what someone in health policy does.

Imagine people standing by a raging river.  In the river are scores of people who have fallen in the river somewhere, and are struggling, in danger of drowning.  The people along the bank work frantically to pull them out.  Suddenly one of the rescuers stops, looks up-river and begins to walk that direction.  The other rescuers are stunned—where are you going, they shout.  I am going upriver to find out WHY people are falling in the river, and prevent them before they do.

Of course, this is a made up story—but the person who walks up-river to find out why people are falling in the river is a health policy person.  And today the river that people are falling in—nearly drowning or sometimes even drowning—that river is the lack of adequate health insurance.

Some years ago, I heard one of the premier health economists Uwe Reinhardt (http://en.wikipedia.org/wiki/Uwe_Reinhardt) speak.  He opined that if you were to set out to design a system for providing coverage for health care you would NOT design something such as we have in the U.S.

The United States is the only industrialized country that does not provide universal coverage of health care for its citizens.  So how did we get here?  An NPR story, which aired in 2009, gives a good summary of the history of health insurance in the U.S.  You can read the whole article here.

What began as a simple way to attract people to stay in hospital beds (the beginning of Blue Cross) , over time morphed into the crazy quilt approach of today— to have health insurance, you basically have to be employed.  How did that happen?  The short version is that during World War II, when industry needed to attract workers, employers offered health benefits as sweetener for employees.  What began as less than 10 % of the population with health insurance in 1940, grew to 63% in the 1950s, and grew again to 70% in the 1970s.  Health insurance was firmly linked to employment and there was no apparent need for a national mandate for universal coverage.

Before the introduction of health insurance for hospital stays through Blue Cross, there had been efforts to join European countries in providing health insurance.  As early as the 1880s, countries beginning with Germany had introduced types of universal health coverage.  Theodore Roosevelt was the first president to actively support health insurance.  The Progressives advanced the concept of health insurance, and won the support of the American Medical Association.  Ironically, they were opposed at the time by some elements of organized labor who saw it as “an unnecessary paternalistic reform that would create a system of state supervision over people’s health” (See http://www.pnhp.org/facts/a-brief-history-universal-health-care-efforts-in-the-us ). 

Other presidents tried to advance the passage of universal health insurance—FDR, Truman , even Nixon, and before Obama, the effort under Bill Clinton that was headed up by Hillary.  As we know, with the introduction of Medicare, the U.S. finally got health insurance for seniors—during President Lyndon Johnson’s presidency.  By that time, the American Medical Association turned from friend to ardent foe.  Medicare was as controversial when it was passed as the Affordable Care Act (aka Obamacare) is now.

And that, dear reader, brings us to the latest efforts to secure universal health insurance in the United States.  

(to be continued)

Friday, November 22, 2013

November 22, 1963

I am 18 years old.  My sophomore year in college has just begun in the small college I attend.  Friday afternoon, our college debate team of which I am a member will be leaving some time mid-afternoon to go to Fordham University for a debate tournament.

I am standing in Old Main, on a small flight of stairs leading to some classrooms.  Suddenly, the news comes flashing through--whether a student or staff member had heard it on the radio, I do not know.  But the word comes and it is shocking, earth-shattering.  President Kennedy has been shot and killed.

That breathless moment when everything seemed to cease.  Our world suspended. What to do? Not just what to do personally.  But what to do for the whole country, maybe even the whole world.

Television was still in a kind of infancy--even though President Kennedy's appointee as chair of the Federal Communication Commission Newton Minow had pronounced its being "a vast wasteland."  Our small college had only ONE television set available for public viewing.  That television was in the Commons area of Old Main.

For the next few days, while the country plunged into inarticulate mourning, we students gathered around that television.   CBS had made the decision to begin broadcasting and continue until the president had been buried.  So we watched while Walter Cronkite led the country in an extended wake.

We students did not spend the entire next four days in front of the lone television.  We went on with our student lives.  The debate team missed any Saturday news--we had agonized over whether or not to go to the Fordham tournament but in the end we went.  On Sunday, the college choir had a church service to attend, and so we were in the house of one of the church parishioners to have Sunday dinner when we saw on that television a man, named Jack Ruby, step up to Lee Harvey Oswald and shoot him.  The dissolution of any meaning in our world seemed complete.

On Monday, when the President was going to be buried, some students with cars drove to Washington, DC.  Most of us stayed on campus and continued our television vigil.  

This 50th anniversary--November 22, 2013--also a Friday.  As the grainy black and white footage from those four days of continuous broadcasting, sometimes interrupted by a few splashes of color footage from film, are replayed--I am transported back.  I am once again a college sophomore, standing on the steps in Old Main, conversing with fellow students on the Debate Team--the President has been assassinated.  

Now, fifty years later, I know how very young eighteen is.  How very innocent.  Yet on that day, November 22, 1963, our world changed.  And we were suddenly older--not old, maybe--but the brightness of life had been dimmed in an inexpressible way.  Things would never be the same.

And, of course, we were right--we still had so many fresh tragedies to go through--Vietnam, more assassinations including Jack Kennedy's brother Bobby, civil rights struggles, dogs lunging at people trying to secure the right to vote, Kent State, Watergate...

On and on.  What was lost that day was bright-eyed innocence. 

November 22, 1963.

Monday, November 11, 2013


The Allied Cemetery in Luxembourg (World War II)

November the 11th is a day for remembering.  Many people in the United States, Canada, the UK, and parts of Europe, those who were former Allies during World War I, remember this day as REMEMBRANCE DAY or VETERANS DAY.

But, there are parts of Europe where this day is not remembered--oh, perhaps remembered but not celebrated.

Several years ago, when we were on a trip through Germany, we visited Cologne.  This lovely city had been heavily bombed by the Allies during World War II.  It is now rebuilt, and even restored in many parts to its medieval heritage.  The famous cathedral stands again in all its imposing glory.  

As we walked around town, we passed a store front which was filled with costumes--you know, as in Hallowe'en type costumes.  We asked our city guide if Hallowe'en was popular.  He looked a bit puzzled and then replied--oh no, these are for Martinstag.  

Martinstag?--now we were puzzled.

Well, he explained--it's like Hallowe'en and harvest festival or Thanksgiving combined. We accepted that--adding a new celebration to our store of knowledge.  And when, we asked, is it celebrated?  He replied--on November 11.

Now, it was our turn to be puzzled.  November 11?  But, that's Remembrance Day, or Veterans' Day, or...Armistice Day.

Once again our guide looked puzzled--so we explained--the end of World War I, the treaty which took effect on the 11th hour of the 11th day of the 11th month.

But, of course, by now it dawned on us that it shouldn't be surprising that the defeated would not celebrate a day when victory came, but so did defeat.

Some people win and some people lose.  On this day, I always remember the sacrifices--those who fight have a cause they believe is right; they have countries they love and die for; and sometimes they are on the winning side, and sometimes the losing side.

Herewith John McCrae's poem "In Flanders Field"
In Flanders Field
In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie,
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.
John McCrae, written 1915

The German Cemetery in Luxembourg (World War II)

Sunday, November 10, 2013

Find a Penny

Here's a test--if you are walking along somewhere and spot a penny that has been dropped, do you pick it up?

I confess I do.  And my reason for picking it up has nothing to do with whether or not I want "good luck."  As in: "Find a penny, pick it up; all the day you'll have good luck."
There is an alternate version as to what luck a penny might bring.  Once when I found a penny lying on the ground and went to pick it up, my daughter, who was a little girl at the time, said  "Don't, Mom" she said--"it's tails--bad luck."

No, I pick up pennies because I figure any found money is....well, money.

I am not a child of the Depression, as my parents were, but I have a healthy respect for not wasting money.  My parent's generation was a model of frugality--emptying their dinner plates, not wasting food, not throwing something away simply because it is out-dated or broken.

I can recall times when I did something that resulted in my losing money--no, I don't gamble.  One such occasion was not long after our son was born.  My husband was teaching and, as a new mother, I had cut back my working hours teaching, becoming an adjunct college instructor.  Now, I realize how little adjunct instructors are paid, but at the time I didn't know that going to half-time teaching did not mean earning half my salary--it meant earning far less than half salary.  

Anyway, to be frugal I would buy meat at our local farmers' market--usually in some quantity that meant I repackaged the meat before I froze it.  After I had done up all my packages, and after a day had passed, I looked in the freezer for a flank steak I had bought.  It was nowhere to be found.  I was puzzled--and then it hit me.  In my repackaging, I had obviously missed that flank steak, and carried it out to the trash along with all the brown wrapping paper the butcher used.  I went to the outside trash cans to check--and, sure enough, there it was.  It took me a long time to get over having thrown away a perfectly good cut of meat.  All I could think was--what a waste of money.

Another time, I did in fact lose money.  For more than 20 years, my husband and I went to home football games for Penn State University.  It was great fun to get away, visit a lovely location--as Happy Valley is--and to have time with friends.  Over time, the rules for entering the football stadium got more restrictive and carrying bags into the stadium was forbidden.  So, one time, I tucked a $20 into my sock, thinking I would have a bit of money if I wanted to buy a snack or soft drink.

When we got home, I looked for the $20 since I hadn't bought anything.  GONE. Apparently, it had worked its way out, and presumably fell on the ground.  At least, I managed to get past this loss a little more quickly--I consoled myself by thinking that some student found a spare $20 lying on the ground, and was happy at the sudden "wealth."

So, found money--whether a penny or $20--I'll take it.

Monday, November 04, 2013

Again? It's Happened Again!

What, what?--you must be saying.  What has happened again?

A famous (or at least well-known) person has been caught plagiarizing.  Who, who? -- you say, waiting breathlessly.  Go ahead--breathe--I want to work up to this latest incident.

Now that I am no longer teaching, I do not have occasion to lecture students on the evils of plagiarism.  This topic was a regular cautionary lecture for me to deliver, usually early in a semester, and certainly as part of the instruction on conducting and using research. 

I have written about the topic in this blog--multiple times, I discover when I do a quick search on "plagiarism."  Here's how I railed on the topic previously:

Every semester I try and try to impress upon my students the need for absolute academic integrity. I use several examples of famous people who have been accused of plagiarizing--e.g. accusations made against J. K. Rowling (settled in her favor), against Doris Kearns Goodwin (who indicated that the plagiarism had been inadvertent due to a careless assistant), and against Stephen Ambrose (proven). I even used an essay written by Anna Quindlen about Wayne Newton plagiarizing her, until the students said--who's Wayne Newton, so I abandoned that example.

So, the long and the short of it is--yes, famous people do plagiarize.  And, if they are big enough, they own up to it.

So, herewith--it has happened again.  Rand Paul, Senator from Kentucky, has been caught plagiarizing.  Several times, he has used wording, obviously obtained from Wikipedia, and has not credited the source.  Rachel Maddow has done a fine job in her show of "outing" the senator for his intellectual thievery and dishonesty.

And how does this tough, no-nonsense senator respond?  HE WANTS TO CHALLENGE RACHEL TO A DUEL.  Seriously.  Here's an MSNBC story on his response.  And, again, I have to say SERIOUSLY.  Senator Paul makes it sound as though the only reason he doesn't challenge Rachel to a duel is

"... I can’t do that because I can’t hold office in Kentucky then."

I am flabbergasted practically beyond words. Senator Rand Paul is upset because 1) he was caught plagiarizing; 2) he can't admit that he was plagiarizing; 3) he thinks he is being unfairly targeted and picked on for plagiarizing; and 4) he wants to challenge Rachel Maddow to a duel, but he can't because, then, he couldn't be the senator from Kentucky?

NEWS FLASH to Senator Rand Paul--you SHOULDN'T be a United States senator if you are so intellectually dishonest that you plagiarize, and then refuse to own it, and decide that you should challenge the person who publicized your dishonesty to a duel!