Doctors Disagree on How, But Most Want To Fix Healthcare

From Kevin MD:

Three out of four dentists recommend this tooth brightening toothpaste — make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger — make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States — make your health care system heal like never before!

But how do we do that?

Do doctors think the Affordable Care Act is the soothing balm for the festering wound that is the economics of the American medical system—paying too much while delivering too little population health? What do our health care experts think about health care reform? Do we think it is a step in the right direction? A step towards doom and damnation?  A small step for insurance companies, a huge leap for mankind?

It goes on to say that they need to read the bill to see what is in it.

Read more here

However, here is what is in the bill  click on it to find out what is in the bill and what rights we the people lose like financial control over our own assets and our own doctors.  We do lose that despite what congress and the POTUS say to the contrary.

Why The Husband Was Banned From Target – Friday Humor

After I retired, my wife insisted that I accompany her on her trips
to Target. Unfortunately, like most men, I found shopping boring and
preferred to get in and get out. Equally unfortunate, my wife is like
most women - she loves to browse.

Yesterday my dear wife received the following letter from our local
Target.

Dear Mrs. S

Over the past six months, your husband has caused quite a commotion
in our store.. We cannot tolerate this behavior and have been forced to
ban both of you from the store. Our complaints against your husband, Mr.
Samsel, are listed below and are documented by our video surveillance
cameras.

1. June 15: Took 24 boxes of condoms and randomly put them in other
people’s carts when they weren’t looking.

2. July 2: Set all the alarm clocks in Housewares to go off at
5-minute intervals.

3. July 7: He made a trail of tomato juice on the floor leading to
the women’s restroom.

4. July 19: Walked up to an employee and told her in an official
voice,’Code 3 in Housewares. Get on it right away’. This caused the
employee to leave her assigned station and receive a reprimand from her
Supervisor that in turn resulted with a union grievance, causing
management to lose time and costing the company money.

5. August 4: Went to the Service Desk and tried to put a bag of M&Ms
on layaway.

6. August 14: Moved a ‘CAUTION – WET FLOOR’ sign to a carpeted area.

7. August 15: Set up a tent in the camping department and told the
children shoppers he would invite them in if they would bring pillows
and blankets from the bedding department to which twenty children obliged.

8. August 23: When a clerk asked if they could help him he began
crying and screamed, ‘Why can’t you people just leave me alone?’ EMTs
were called.

9. September 4: Looked right into the security camera and used it as
a mirror while he picked his nose.

10. September 10: While handling guns in the hunting department, he
asked the clerk where the antidepressants were.

11. October 3: Darted around the store suspiciously while loudly
humming the ‘Mission Impossible’ theme.

12. October 6: In the auto department, he practiced his ‘Madonna
look’ by using different sizes of funnels.

13. October 18: Hid in a clothing rack and when people browsed
through,yelled ‘PICK ME! PICK ME!’

14. October 21: When an announcement came over the loud speaker, he
assumed a fetal position and screamed ‘OH NO! IT’S THOSE VOICES AGAIN!’

And last, but not least:

15. October 23: Went into a fitting room, shut the door, waited
awhile, and then yelled very loudly, ‘Hey! There’s no toilet paper in
here.’ One of the clerks passed out.

Life Isn’t Fair, So What is New? Why Are We Trying To Kill The American Dream?

After reading an article by one of the top economists we should listen to, it occurred to me that life isn’t fair, but that alone is fair.

An excerpt from the article starts us off:

Some years ago, for example, there was a big outcry that various mental tests used for college admissions or for employment were biased and “unfair” to many individuals or groups. Fortunately there was one voice of sanity– David Riesman, I believe– who said: “The tests are not unfair. LIFE is unfair and the tests measure the results.”

If by “fair” you mean everyone having the same odds for achieving success, then life has never been anywhere close to being fair, anywhere or at any time. If you stop and think about it (however old-fashioned that may seem), it is hard even to conceive of how life could possibly be fair in that sense.

Even within the same family, among children born to the same parents and raised under the same roof, the first-borns on average have higher IQs than their brothers and sisters, and usually achieve more in life.

Unfairness is often blamed on somebody, even if only on “society.” But whose fault is it if you were not the first born? Since some groups have more children than others, a higher percentage of the next generation will be first-borns in groups that have smaller families, so such groups have an advantage over other groups.

TRYING TO EQUALIZE THE RESULTS HAS LESS CHANCE OF SUCCESS THAN CREATING AN ENVIRONMENT TO SUCCEED

I propose that Life isn’t fair, now get over it and try harder.   The American dream is to work hard, be successful and get ahead.  We shouldn’t kill that dream which is what is being proposed for those making over $250,000.  Further, it was said that “cursed is the ground because of you; through painful toil you will eat of it all the days of your life.  it will produce thorns and thistles for you, and you will eat the plants of the field.  By the swat of your brow you will eat your food until you return to the ground, since from it you were taken; for dust you are and to dust you will return.”

Some are richer, some are born into more prosperity than others, some are smarter, some have more ambition….the list goes on forever.

Here are two good examples of those that exemplify that some have it easier than others, just for being born into the right family.

To try and make it otherwise is usually a result of envy or jealousy of others success.  There is no way to legislate tenacity to succeed, one’s ability vs. others, familial or environmental factors and many other causes.  Some have more and do better than others, GET OVER IT.

We live in a country where people have come to because of the American Dream defined as:

The American Dream is a national ethos of the United States in which freedom includes the opportunity for prosperity and success, an upward social mobility achieved through hard work. In the definition of the American Dream by James Truslow Adams in 1931, “life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement” regardless of social class or circumstances of birth.[1] The idea of the American Dream is rooted in the United States Declaration of Independence which proclaims that “all men are created equal” and that they are “endowed by their Creator with certain inalienable Rights” including “Life, Liberty and the pursuit of Happiness.”[2]

Any effort to equalize things by wealth redistribution is socialistic and doomed to failure.  I beg for someone to show me an example of where communism or socialism has succeeded.  Ask Greece, the USSR, most European countries….

Why?

Margaret Thatcher once said that ‘The trouble with socialism is that eventually you run out of other people’s money’?
Frank Zappa said “Communism doesn’t work because people like to own stuff.”

TO TRY AND MAKE IT EQUAL ALWAYS FAILS

There has been some talk during regarding those who make over a certain amount should give more, also called redistribution.  This is directly from the mouth of a famous person in history:

From each according to his ability, to each according to his need (or needs) is a slogan popularized by Karl Marx in his 1875 Critique of the Gotha Program.

Socialism in general has a record of failure so blatant that only an intellectual could ignore or evade it.
Thomas Sowell

Politicians love to say things like, “We’re just asking everyone to pay their fair share.” But government is not about asking. It is about telling. The difference is fundamental. It is the difference between making love and being raped, between working for a living and being a slave. The Internal Revenue service is not asking anybody to do anything. It confiscates your assets and puts you behind bars if you don’t pay.
Instituting wealth re-distribution, taxing folks who make over $250,000 and then waxing poetically that it is “fair” is no more than an attempt to kill the American Dream.  I have a belief however that folks will find a way around it, the disadvantaged will still want to come here for success and
Governments aren’t invested with moral qualities; only people are. This basic understanding of the world is one of the distinctions between the progressives/socialists and conservatives.

A free market will create big differences in wealth. That wealth disparity is simply a byproduct of freedom — vastly diverse individuals competing to serve consumers will arrive at vastly diverse outcomes.

That disparity is not unfair — if it results from free exchange.

The free market (which, sadly, America doesn’t have) is fair. It also produces better outcomes. Even “losers” do pretty well.

A more astute observer than Moore might show how unfair government intervention is. Licenses, taxes, regulations and corporate subsidies make it harder for the average worker to start his own business, to go from being a “little guy” to being an independent owner of means of production. Most new businesses fail, but running your own business is the best route to prosperity and — surveys suggest — happiness, too.

So the conclusion is that Life isn’t fair and there will be some Warren Buffetts, Bill Gates and Mark Zuckerbergs that get richer and they should.   If the Government would stay out of the free market, more would prosper.  A rising tide floats all boats
Nikki Newman and Mark Ehrnstein have plenty in common. They both work at Whole Foods’ headquarters, and they share a passion for the Earth-friendly, healthy and egalitarian values the company espouses.Ask them why they work at Whole Foods, and you get a lot of the same answers.Ask them about their paychecks, though, and you get two different stories.

Newman, the receptionist at the company’s corporate offices, has worked for Whole Foods for six years and now makes about $17 an hour. She lives comfortably in a rented duplex, but she admitted money can get tight on occasion – like the time her dog needed a surprise $750 worth of dental care.

Ehrnstein, on the other hand, is Whole Foods’ global vice president for team member services, a position that pays him a six-figure annual salary. He and his wife, Renee, have worked more than 30 years combined at Whole Foods. They own a 3,151-square-foot home, according to Travis County Central Appraisal District records.

“I feel very grateful to be in the role I’m in, but most of all I feel grateful to work for a company that aligns with my values,” Ehrnstein said. “I feel connections with our team members in that sense. But certainly, the compensation affords different opportunities.”

This is not the stereotypical story of the gap between rich and poor. Few would criticize the wage disparity between Newman and Ehrnstein given their tenures and responsibilities at the company. Plus, the gap from top to bottom is much narrower at Whole Foods than other large grocers because it pays higher entry-level wages and caps executive pay at 19 times the salary of its lowest-paid employee.

To which I say so what.  The higher up in the company they are or the more responsibility one has, the more they should earn.  Their actions will bear the legal responsibility and shape the course and success of the company. 

I don’t give a rats rump that someone has the chance to make more than me.  We should have the opportunity to make the most money we can possibly make without the government restricting that chance.  That is why we compete, innovate, work and strive for success.  I say screw the idea of socialism because that is what makes America great.  We compete to be the best and try to out do the other guy.  It’s how we (the US) beat the Soviet’s to the Moon, *(humans) invented cars, trains, planes, computers, telephones, cellphones and is also the reason there is Apple, Facebook, Ford, steel, iPads and every other success that has been invented.  We have the cure for polio, vaccines and advancements in medicine that socialized societies would never have had the incentive to create.

The planet Neptune has never been seen by anyone looking at the night sky through just their own eyes. So distant is it from the sun that the light it reflects toward the Earth is so faint that the planet is effectively invisible in the darkness of night. And yet, the outermost large planet of our solar system was discovered by astronomers who knew exactly where to look….

Following William Herschel‘s discovery of Uranus in 1781, the world’s astronomers went to work to observe and describe the seventh planet of the solar system, taking detailed measurements of its trajectory in space.Illustration of the Pull of a More Distant Planet Forty years later, French astronomer Alexis Bouvard published detailed tables describing Uranus’ orbit about the sun. More than that however, his tables incorporated the lessons learned about planetary orbits from Johannes Kepler and Sir Isaac Newton to chart the path Uranus would follow into the future.

But then, something strange happened. Significant discrepancies between Bouvard’s projected path for Uranus and its actual orbit began to be observed – irregularities that were not observed in the tables he had created to describe the orbital paths of the planets Jupiter and Saturn using the same methods. Soon, observations and detailed measurements confirmed that Uranus was moving along a path that was not described by Bouvard’s careful calculations.

These irregularities led Bouvard to hypothesize that an as yet unseen eighth planet in the solar system might be responsible for what he and other astronomers were observing.

Voyager 2 Image of Neptune, emphasizing the 'Great Dark Spot' Over twenty years later, astronomer Urbain Le Verrier was working on the problem, taking a unique approach to resolving it.

What made Le Verrier’s work unique is that he applied the math developed by Sir Isaac Newton to describe the gravitational attraction between two bodies to solve the problem. Here, he used Newton’s theory to anticipate where an as yet unknown, but more distant planet also orbiting the sun would have to be to create the effects observed upon the position of the planet Uranus in its orbit.

Le Verrier completed his calculations regarding the position of the hypothetical eighth planet on 1 June 1846. A little over three months later, on 23 September 1846, the planet Neptune was observed for the first time at almost exactly the position in space where Le Verrier predicted it would be, confirming Newton’s gravitational theory in the process.

We’re going to do something similar today to explain why household income inequality in the United States has increased over time, even though there has been no change in individual income inequality.

From Darkness to Discovery

Our first chart below is based on data taken from the U.S. Census’ data [Excel spreadsheet] on the inflation-adjusted median and mean income for all Americans from 1947 through 2010, which we’ve presented in terms of constant 2010 U.S. dollars. For reference, we’ve also indicated the NBER’s official periods of recession in the U.S. during this period with the shaded red vertical bands on the chart:

U.S. Individuals Real Median Income with Recessions from 1947 through 2010

Next, we took the U.S. Census’ breakdown of inflation-adjusted median income for both men and women for each of these years [Excel spreadsheet] and used the math that applies to log-normal distributions to construct the combined median income that applies to individuals. Our results are shown in the chart below, along with the actual median incomes reported by the U.S. Census so we can compare our calculated results with them:

U.S. Individuals Real Median Income by Sex with Recessions from 1947 through 2010

As you can see, our calculated results in creating a weighted median from the subsets of median income data for men and women are very close to the actual real median income numbers for all individuals. Here, because per capita income has been demonstrated to follow a log-normal distribution, we are able to use this math to either combine or extract subsets of data that have never been officially presented.

As an aside, we achieved the results above by treating the reported median income data the way we might calculate a weighted average. The beauty of the log-normal distribution math is that we can do this with medians, which we ordinarily could not do otherwise.

In the chart above, you can see the effect of the changing composition of the U.S. workforce, as the relative share of women earning incomes in the United States has increased since 1947. In 1947, the median income for individuals is much closer to the median income for men than it is for women. By 2010 however, we see that the median income for individuals is about halfway in between the median incomes for men and for women, reflecting that nearly equal share that both sexes now have among all individual income earners in the U.S.

Extracting The Unseen

The U.S. Census Bureau provides the median income data for individuals (or persons), men and women. It also reports median income data for both male and female wage or salary earners [Excel spreadsheet], whom we’ll simply describe as Working Men and Working Women.

Using the math we demonstrated above with this data, we can extract the median incomes for two categories of people for whom the U.S. Census has never reported median incomes: men and women with incomes who do not earn wages or salaries, or as we’ll describe them from now on, Non-Working Men and Non-Working Women! Today, we’re putting what we found for all U.S. individual income earners together for the first time:

U.S. Individuals Real Median Income by Sex and Working Status with Recessions from 1947 through 2010

Constructing Households

Now, let’s combine our median income earners into two-person households, pairing working men and women, working men and non-working women, non-working men and working women and finally non-working men and non-working women. We’ve shown our results below, along with the U.S. Census’ official median income for U.S. households:

U.S. Couples Median Real Income with Recessions, 1947-2010

Well, look at that! The households formed by our single-wage and salary income earning couples from 1947 through 2010 closely parallels the actual real median income for U.S. households with a working man and non-working woman over that time (except for the years 1974 through 1977, where there seems to be an anomaly in the Census’ data for working men – and here, the actual median splits the difference!) Also keeping in mind that the actual median household income might include the income contributions of additional people (say individuals between the ages of 16 and 24 who might be working part time at minimum wage jobs while also attending school and living at home with their parents), which likely accounts for the difference between the two, we’ve pretty much just demonstrated that we can successfully model basic U.S. households using just the data that applies for U.S. individuals.

But wait! What about single person households? Our next chart throws them into the mix as well!

U.S. Households Median Real Income with Recessions, 1947-2010

Using the figures for 2010, we approximated the income percentiles for each of our single and two-person median income earning households. The table below reveals our results (our model should put each approximated percentile within 0.2 of the actual percentile!):

Household Type 2010 Median Income Approximate Income Percentile
Working Men and Working Women $64,075 61.4
Working Men and Non-Working Women $50,026 50.7
Working Women and Non-Working Men $49,344 50.1
Non-Working Men and Women $35,295 36.7
Working Men Only $37,102 38.6
Working Women Only $26,973 27.7
Non-Working Men Only $22,371 22.4
Non-Working Women Only $12,924 11.5

It occurs to us that all we would need to increase the income inequality among households in the United States is to increase the nation’s percentage of single person households among all households. That would work by increasing the number of households at the lower end of the income spectrum, even though it would have absolutely no effect upon the measured income inequality for individuals. The U.S. Census Bureau shows the change in the number of single person households since 1960:

U.S. Census Bureau: Percent of Single Person Households, 1960-2011

Here’s the U.S. Census Bureau’s Gini index measure of the amount of income equality among U.S. households for the years from 1947 through 2010:

Phil Wendt's Studio: Figure 1. Gini Index of Income Dispersion, 1947-2010

And here is the Gini index measure of the amount of income equality among U.S. individuals for the years from 1947 through 2005 (the data since 2005 is presented here – it’s similar to all that recorded since 1960 in the chart below):

The relevant data in the chart above is the Gini measure indicated with the hollow circles, which is based on the “fine”, or more detailed, income bins reported by the U.S. Census in its annual Current Population Survey. The other data in the chart, indicated by solid diamonds, represents income distribution data reported by the U.S. Census in larger, or more “coarse” income bins, which are less detailed and are therefore a much less accurate measure of the nation’s level of income inequality in any given year.

Intersections and Connections

Looking at where all the data in these three charts intersect and overlap, What we find is that since 1960, the level of income inequality for U.S. individuals as measured by the “fine” Gini index is nearly constant, but has increased significantly for U.S. households. What has changed over that time is the composition of U.S. households, with a steady increase in the percentage of single person households.

Without a corresponding increase in the measured income inequality for U.S. individuals, the increase in the measured income inequality for U.S. households has been almost entirely driven by the increase in the number of single person households over time.

So income inequality among U.S. households isn’t increasing because the rich are getting richer. That means that policies intended to right this situation by going after the rich in the name of “fairness” are guaranteed to fail, because the real cause of the increase in income inequality among U.S. households over time is something that cannot be fixed by such actions.

If only the people pushing such policies could see that….

Self Help Healthcare

I checked in with KevinMD for this piece of helpful information.  The free market will produce a better product than the government will ever be able to handle.  Capitalism always provides competition which drives DOWN prices and drives UP services.

f you cannot measure it, you cannot improve it.
-Lord Kelvin

Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.
-Nassim Nicholas Taleb

Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the Quantified Self blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. Most of us do not keep track of our moods, our blood pressure, how many drinks we have, or our sleep patterns every day. Most of us probably prefer the Taleb to the Lord Kelvin quotation when it comes to living our daily lives. And yet there are an increasing number of early adopters who are dedicated members of the quantified self movement.

 

They are an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers, and patients suffering from a wide variety of health problems. What they share is a belief that gathering and analysing data about their everyday activities can help them improve their lives.

According to Wolf four technologic advances made the quantified self movement possible:

First, electronic sensors got smaller and better. Second, people started carrying powerful computing devices, typically disguised as mobile phones. Third, social media made it seem normal to share everything. And fourth, we began to get an inkling of the rise of a global superintelligence known as the cloud.

An investment banker who had trouble falling asleep worried that his concentration level at work was suffering. Using a headband manufactured by Zeo, he monitored his sleep quantity and quality, and he also recorded data about his diet, supplements, exercise, and alcohol consumption. By adjusting his alcohol intake and taking magnesium supplements, he has increased his sleeping by an hour and a half from the start of the experiment.

A California teacher used CureTogether, an online health website, to study her insomnia and found that tryptophan improved both her sleep and concentration. As an experiment, she stopped the tryptophan and continued to sleep well, but her ability to concentrate suffered. The teacher discovered a way to increase her concentration while curing her insomnia. Her experience illustrates a phenomenon that Wolf has noticed: “For many self-trackers, the goal is unknown … they believe their numbers hold secrets that they can’t afford to ignore, including answers to questions they have not yet thought to ask.”

Employers are becoming interested in this approach in connection with their company sponsored wellness programs. Suggested experiments include using the Jawbone UP wristband to see if different amounts of sleep affect work performance such as sales or using the HeartMath emWave2 to monitor pulse rates for determining what parts of the workday are most stressful.

Stephen Wolfram recently wrote a blog illustrating just how extensive these personal analytics experiments in self-awareness could become when coupled with sophisticated technologies. Wolfram shares graphs of his “third of a million emails I’ve sent since 1989” and his more than 100 million keystrokes he has typed.

Anyone interested in understanding just how far reaching this approach may become in the future should examine the 23 pages of projects being conducted by the MIT Media Center. My favorites from this fascinating list include automatic stress recognition in real-life settings where call center employees were monitored for one week of their regular work; an emotional-social intelligence toolkit to help autism patients learn about nonverbal communication in a natural, social context by wearing affective technologies; and mobile health interventions for drug addiction and PTSD where wearable, wireless biosensors detect specific physiological states and then perform automatic interventions in the form of text/images plus sound files and social networking elements.

It is easy to get caught up in the excitement of all this new technology and to start crafting sentences about how the quantified self movement will “transform” and “revolutionize” health care and spawn wildly successful new technology companies.

Jackie Fenn’s “hype cycle” concept has identified the common pattern of enthusiasm for a new technology that leads to the Peak of Inflated Expectations, disappointment that results in the Trough of Disillusionment and gradual success over time that concludes in the Slope of Enlightenment and the Plateau of Productivity. Fenn’s book, Mastering the Hype Cycle: How to Choose the Right Innovation at the Right Time can help all of us realize that not all new technologies becomes killer applications.

Jay Parkinson, MD has also written a blog that made me pause before rushing out to invest in quantified self companies or predict the widespread adoption of this approach by all patients. Parkinson divides patients into three groups. The first group is the young, active person who defines health as “not having to think about it until they get sick or hurt themselves.” The second group is the newly diagnosed patient with a chronic illness that will affect the rest of their lives. After a six month period of time coming to terms with their illness, Parkinson believes this group moves closer and closer to group one who do not have to think about their disease. The third group are the chronically ill who have to think about their disability every day. Parkinson concludes that “it’s almost impossible to build a viable social media business that focuses on health. It’s the wrong tool for the problem at hand.”

The quantified self movement should be closely monitored by all interested in the future of the American health care delivery system. The potential to improve the life of patients with chronic diseases is clearly apparent; whether most people will use the increasingly sophisticated tools being developed is open to debate.