Firstly, Dr. Steve Rennard, of the University of Nebraska has shown that chicken soup activates macrophages( a significant cell in the immune system) suggesting that chicken soup is good for a cold, but that's beside the point here.
I'm a little late on this but I can't let it go without comment. Sue Lowden, Republican candidate for Senator, in Nevada, made some comments on chickens and their usefulness in obtaining health care last month. All is contained on YouTube. If you just search sue lowden, it will be hard to miss. Briefly, she suggested at a taped campaign stop that part of her platform for health care reform would have been pretax savings accounts, which have existed for years, and barter. Seriously. Then she went on television in Nevada and not only stood behind her campaign suggestion but started to suggest patients who pay cash with their doctor may want to bring a chicken instead, 'you're doctor will understand'.
Those of you who know me may think that I'm loud, indiscreet or inappropriate with humor, but I'm usually pretty cool when patients who aren't able to pay. I don't really get that upset. And I have done my share of free care. But to have a politician suggest that people start taking their chickens to the business office of a large group of physicians... it would drive the accountant/s nuts. He or she isn't set up for something like this and that would involve more paper work and perhaps approaching a CEO or COO that would only belittle the accountant since it would seem apparent that accounting school should teach non monetary accounting, including chickens, vegetables, rabbits and ducks. Larger animals become problematic. As an aside, I once had a patient offer me a sperm whale for a bronchoscopy but I turned him down since the bronch wasn't that expensive. We stopped accepting sperm whales though since they are not fish.
In case you missed it Steven Colbert conveyed this anecdote-if you have an emergency cardiac catheterization and stent placement, $40,000 ballpark figure, you can just show up with a chicken, and everything will be just fine. He suggested that a live chicken was $8 dollars which would mean that full payment would include about 5,000 chickens. You better have allergies or a cold.
Also, it only seems fair to expect others to accept chickens if doctors have to accept chickens since the barter system would break down if only some participated. So I would expect when I walked into that GM dealership in Renton, WA and asked for the biggest, blackest Escalade on the lot that dealer better be ready with the chicken coops because those hens are gonna be IN HIS FACE.
If this chicken thing became common would it be necessary to change our financial capitol from Manhattan to Little Rock? Perhaps the financial reports would be broadcast by a big chicken...OK...you are rightfully wondering when this will stop.
BUT,
Two issues: how do you get a chicken into a parking meter slot and how do you deposit a chicken at the bank through one of those security windows?
And of course, I would want to get in on this bartering myself since I think I can haggle with the best. You might see me at the Farmer's Market on a Saturday asking, 'How much for a bushel of snap peas?' and 'Could I offer you a discounted flexible sigmoidoscopy for flock of yams?' And by the way, these chickens are dead. Could I put a deposit on that sweet corn?
Wednesday, May 5, 2010
Saturday, April 10, 2010
In America We Get the Health Care, and Cost, We Deserve
I'm back in Denver again, working on a project regarding surgery in patients who have infection in their lungs. Interesting to me, and National Jewish, but not really a topic of general concern. I took a route from Seattle that went through Salt Lake City and Eastern Utah and Western Colorado. I won't do it again since I ran into dust storms, flat-flat-flat terrain, and billboards against abortion and for marriage through Utah. Two issues that I am in favor of, mostly, but not really familiar billboard fare to me. I prefer the nonreligious stuff on billboards like what kind of car to buy, real estate, and insurance products. Actually, I could do without billboards. I also didn't have XM radio this trip which made the ride less exciting. I resorted to listening to Spanish language tapes.
Well, health care legislation has passed and I am glad. Now there will be some sort of expectation that nearly all will have health insurance in our country and there will be fewer shenanigans by health insurers regarding limiting coverage for people who are actually sick.
But the real discussion in the future will be regarding cost of health care and I would like to propose that we must come to terms with this as a nation, outside of the doctor-patient sphere. As a representative democracy we essentially get what we want, or deserve, and this seems confusing to some. I am in favor of good health care for all but I am a doctor and this is in my blood. Some would also say that it is economically in my interest to see high health care costs since I reap the financial benefit. This is true but I would be a happier person if I made a little less money and saw everyone a little more settled about the issue. We must either accept some limitation in our expectations of the health care system, at lower cost, or accept a higher cost of care to continue our consumption practices. As a friend suggested, in the middle class, do we want two cars a piece or do we want one car and piece of mind that we can get the health care we want? I don't think we can have both. A you-can't-have-your-cake-and-eat-it-too argument.
I recently read a piece on the New York Times Health blog by David Leonhardt titled, In Medicine, the Power to Say No. His thesis seemed to be that until medical professionals can start to say no to patients we will continue to see elevated health care costs. I generally disagree since my experience has been that, as a doctor, I can sometimes direct a patient in their health care economically but often the patient directs me. I have had patients ask me for medically unwarranted tests and I often get them because it will avoid time-wasting hassle with the patient who knows what he wants, despite reasonable alternatives, or indeed will limit my worry about being sued, or at least berated, or late to see the next demanding, irritated patient. I have had patients of means ask me to admit their elderly, nonsick relatives to hospital so they could divert resources to medicare, thus not inconveniencing their time or pocketbook, and I have had a patient ask for my help to arrange a chest CT scan in Singapore, requiring disproportionate logistical and time expenditure, so her potential lung cancer would not inconvenience her Asian cruise. Anecdotes yes, but a tip of an iceberg that suggests something wrong is happening here. As individuals some Americans can't be denied, but this comes at a cost to others.
There is great disparity in expectations of the health care system across the nation. In a recent publication by the Dartmouth Atlas of Health Care they showed that patients receiving care through the UCLA hospital system were hospitalized 50% more than patient's receiving care through the Mayo Clinic system and the UCLA crowd had twice as many doctor visits, many specialists. UCLA spent an average of $52, 911 on each patient in the last six months of care before they died, where the Mayo Clinic spent $28, 763 over the same period with each dying patient. Since the outcome measured was death it is hard to argue that there were differing "severity" of illness scores in these groups. Other statistics show that health care expenditures are high in Miami and Manhattan as well. This is a complicated issue but maybe Denis Cortese, Chief Medical Officer at NYU Medical Center, was onto something when he suggested that their patient population has grown accustomed to an
" aggressive" level of care and the physicians at NYU have obliged. But maybe too passive or generous to the patients since, in my experience at NYU, for three years as a fellow there, I heard more than once about lawyers of patients calling medical residents to ask why a certain test was not being performed on their clients. I just got a lawyer and he just did my will.
It seems possible that expenditures at the Mayo Clinic are lower because those Minnesota farmers know when the jig is up at the end of life, and the patients at UCLA, or other large urban centers, have higher expectations of care that the medical system must oblige, or pay a price. Mortality comes to everyone but some are more or less accepting of it. This does not seem to be a problem of doctors, hospitals or insurers making more money, it's a problem that comes from the kind of people we are.
Medicare has now formed an Innovation Center to cull efficiencies that can be made in the system that will limit cost expenditures. There are many intelligent people working to discover how we can deliver care more efficiently but in America we will not be dictated to. It is the obligation of physicians and nurses to attend to the autonomy of each patient which means that paternalism is dead in our country, and perhaps for good reason. But this means that medical professionals are more at the mercy of the patients and the public. Previous attempts to "manage care", to create gate-keepers, or to encourage discussion of limiting care at the end of life among individuals and their families have all been castigated by some in our country as limiting choice.
There are many instances where physicians are accused of acting in their own financial interest but patients in America must accept some complicity. As in all professions there are those that want to maximize financial gain, but many physicians work with clear consciences in this regard. Some obstetricians may perform cesarean sections frequently for their convenience or financial gain but I think this is not the norm. They use technology to avoid being witness to babies with cerebral palsy, and to avoid being sued over this disastrous outcome. If as patients we want to accept responsibility for more babies with cerebral palsy we should argue for limiting cesarean sections but give the doctors a break and accept some of the risk, financial and emotional. This is a decision for society and not the doctors.
If we want cardiologists to do fewer cardiac catheterizations we must accept a higher risk for sudden death, albeit a less expensive choice.
And if we want to spend less on patients at the end of life we must accept limitations on who gets intensive care at the end of life. Until now the legislature, the courts and the American people have been unwilling to shoulder this burden. It is too much to ask doctors to just say "no".
Asking health care professionals to just say "no" seems to be a rather simplistic, and uncomfortable, answer to a difficult question that must be tackled by us, as Americans, through our press, legislatures and courts. Convincing the American people that limitations come with cost seems to be an imperative. We can have limitless care if it calms our emotions or we can have limitations in care if it makes our pocketbooks happy but we can't have both. It is an issue that extends beyond the doctor-patient relationship.
Well, health care legislation has passed and I am glad. Now there will be some sort of expectation that nearly all will have health insurance in our country and there will be fewer shenanigans by health insurers regarding limiting coverage for people who are actually sick.
But the real discussion in the future will be regarding cost of health care and I would like to propose that we must come to terms with this as a nation, outside of the doctor-patient sphere. As a representative democracy we essentially get what we want, or deserve, and this seems confusing to some. I am in favor of good health care for all but I am a doctor and this is in my blood. Some would also say that it is economically in my interest to see high health care costs since I reap the financial benefit. This is true but I would be a happier person if I made a little less money and saw everyone a little more settled about the issue. We must either accept some limitation in our expectations of the health care system, at lower cost, or accept a higher cost of care to continue our consumption practices. As a friend suggested, in the middle class, do we want two cars a piece or do we want one car and piece of mind that we can get the health care we want? I don't think we can have both. A you-can't-have-your-cake-and-eat-it-too argument.
I recently read a piece on the New York Times Health blog by David Leonhardt titled, In Medicine, the Power to Say No. His thesis seemed to be that until medical professionals can start to say no to patients we will continue to see elevated health care costs. I generally disagree since my experience has been that, as a doctor, I can sometimes direct a patient in their health care economically but often the patient directs me. I have had patients ask me for medically unwarranted tests and I often get them because it will avoid time-wasting hassle with the patient who knows what he wants, despite reasonable alternatives, or indeed will limit my worry about being sued, or at least berated, or late to see the next demanding, irritated patient. I have had patients of means ask me to admit their elderly, nonsick relatives to hospital so they could divert resources to medicare, thus not inconveniencing their time or pocketbook, and I have had a patient ask for my help to arrange a chest CT scan in Singapore, requiring disproportionate logistical and time expenditure, so her potential lung cancer would not inconvenience her Asian cruise. Anecdotes yes, but a tip of an iceberg that suggests something wrong is happening here. As individuals some Americans can't be denied, but this comes at a cost to others.
There is great disparity in expectations of the health care system across the nation. In a recent publication by the Dartmouth Atlas of Health Care they showed that patients receiving care through the UCLA hospital system were hospitalized 50% more than patient's receiving care through the Mayo Clinic system and the UCLA crowd had twice as many doctor visits, many specialists. UCLA spent an average of $52, 911 on each patient in the last six months of care before they died, where the Mayo Clinic spent $28, 763 over the same period with each dying patient. Since the outcome measured was death it is hard to argue that there were differing "severity" of illness scores in these groups. Other statistics show that health care expenditures are high in Miami and Manhattan as well. This is a complicated issue but maybe Denis Cortese, Chief Medical Officer at NYU Medical Center, was onto something when he suggested that their patient population has grown accustomed to an
" aggressive" level of care and the physicians at NYU have obliged. But maybe too passive or generous to the patients since, in my experience at NYU, for three years as a fellow there, I heard more than once about lawyers of patients calling medical residents to ask why a certain test was not being performed on their clients. I just got a lawyer and he just did my will.
It seems possible that expenditures at the Mayo Clinic are lower because those Minnesota farmers know when the jig is up at the end of life, and the patients at UCLA, or other large urban centers, have higher expectations of care that the medical system must oblige, or pay a price. Mortality comes to everyone but some are more or less accepting of it. This does not seem to be a problem of doctors, hospitals or insurers making more money, it's a problem that comes from the kind of people we are.
Medicare has now formed an Innovation Center to cull efficiencies that can be made in the system that will limit cost expenditures. There are many intelligent people working to discover how we can deliver care more efficiently but in America we will not be dictated to. It is the obligation of physicians and nurses to attend to the autonomy of each patient which means that paternalism is dead in our country, and perhaps for good reason. But this means that medical professionals are more at the mercy of the patients and the public. Previous attempts to "manage care", to create gate-keepers, or to encourage discussion of limiting care at the end of life among individuals and their families have all been castigated by some in our country as limiting choice.
There are many instances where physicians are accused of acting in their own financial interest but patients in America must accept some complicity. As in all professions there are those that want to maximize financial gain, but many physicians work with clear consciences in this regard. Some obstetricians may perform cesarean sections frequently for their convenience or financial gain but I think this is not the norm. They use technology to avoid being witness to babies with cerebral palsy, and to avoid being sued over this disastrous outcome. If as patients we want to accept responsibility for more babies with cerebral palsy we should argue for limiting cesarean sections but give the doctors a break and accept some of the risk, financial and emotional. This is a decision for society and not the doctors.
If we want cardiologists to do fewer cardiac catheterizations we must accept a higher risk for sudden death, albeit a less expensive choice.
And if we want to spend less on patients at the end of life we must accept limitations on who gets intensive care at the end of life. Until now the legislature, the courts and the American people have been unwilling to shoulder this burden. It is too much to ask doctors to just say "no".
Asking health care professionals to just say "no" seems to be a rather simplistic, and uncomfortable, answer to a difficult question that must be tackled by us, as Americans, through our press, legislatures and courts. Convincing the American people that limitations come with cost seems to be an imperative. We can have limitless care if it calms our emotions or we can have limitations in care if it makes our pocketbooks happy but we can't have both. It is an issue that extends beyond the doctor-patient relationship.
Sunday, March 14, 2010
Liberty, population pressure and health care
While I try to figure out how to upload some medical slide shows to this blog I'll lend my opinion on how our heritage has gotten us into our health care mess. It seems time to acknowledge our libertarian good side but give into some communal living. I'm going to get into some history that may be skewed, so please cut me some slack. It is my blog you know. Dammit, I'm a doctor, not a historian.
Please don't read this if you don't like history or if you're tired of the health care debate, and who wouldn't be, so I guess I'll just write for myself.
The population of Europe was thinned by the bubonic plague in the 15th century. After that everyone got along and most had a job and the Church led peaceful, wonderful harmony within Europe (I made this up...). Then people started to read and trouble makers sent people's minds all akimbo. Luther, Knox and Calvin took the right flank and Hobbes, Locke, Kant, and all those other precommunists took the left flank. Governments churned and turned over. There developed a group of individually-minded people interested in liberty and the pursuit of happiness, no matter who suffered around them. They were particularly interested in themselves, perhaps more than their larger community, or the King, or the Church (this is understandable since the leaders here were pretty corrupt... maybe you're not supposed to have wives and vast quantities of gold when your a Pope, and the King should not drink so much or have more than three wives at the same time, and he should leave Celtic people alone (my rules)). The individualists answered to the Lord, their money belts, or to some voice in their head that no one else heard and they didn't feel like fighting in huge armies for no wages, moldy bread, and the privilege of sleeping in the same bed with six other men who smelled like wet horses.
Anyway a group of Puritans couldn't get comfortable in their own skin in England or the Netherlands so they moved to North America to bother the Indians, who themselves couldn't get along with their neighbors, but they lived in the woods and were, as the saying goes, "born in a barn". Others moved to America since business was good here for those that didn't go to Oxford, Cambridge, the Sorbonne, or the Prussian School for Fanatical Military Strength. It was hard to move up unless you were born to some Royal family where your parents were also your brother and sister,or vice versa, or you-know-what-I-mean (?), or unless you were a genius like Napoleon or the guy that created the slinky, later of course. I'm not saying that Napoleon played with a slinky, but I think he would have been good at that, and the hula-hoop ( and all Wham-O products for that matter) just like he was good at controlling most of Eurasia and the Middle East. Nerf basketball would have been hard for this short man though. OK, I was digressing...all those of Europe that didn't want to be bothered by the psycho, in-bred, warlike Europeans thought they could avoid taxes and hassle in the New World. Where it seemed like no one lived, emphasis on "seemed".
So people came in droves to North America, but they soon discovered that where there are other people there could be trouble. So they brought diseases like tuberculosis and small pox with them to act as infectious napalm. To clear the woods as it were. This wasn't their fault though since it was also clearing their own woods, and the European woods, as about 1 in 2 people that died in Europe died of some horrible disease. The others died sleeping with wet horses in fields festooned with uniforms taken from dead sheep. A more pleasant sight could be had by touring a coal mine in the English Midlands circa. the 18th century.
So the religious, the entrepreneurial and a 2:1 mix of sane and insane moved to America. They were looking for a better life understandably. Here the sane and the insane grew in similar numbers leaving the sane in much greater proportion than the insane. But the sane seemed to like their new digs where the insane still felt cramped. And while the population multiplied government grew, as Thomas Hobbes would argue to be a natural phenomenon, and taxes followed them from England. Americans didn't like taxation without representation, as a reasonable person would not, but I think there were some that just didn't like taxes at all, no matter who was imposing them. This was discovered when the new nation was developed. General Washington couldn't pay for the army and the Constitutional Congress couldn't meet without money. But they had trouble raising taxes to pay for these necessities. Revolts ensued and the Constitution become a tough sell. The Bill of Rights was soon developed because, despite the formation of the Constitution, this revolutionary document which codified new freedoms in the world's first representative democracy, there were still those that worried about an individuals freedom from the tyranny of the majority. Slaves were eventually given up but guns, states rights(i.e. local, not federal authority) and individualism became staples of our heritage.
This seems to be a consequence of population pressures, amongst other things. As population increases there seems to be more demand for protections from others and taxes to pay for these protections. The West is still less populated than the East in America, as the New America was less densely populated compared to Europe in the 17th and 18th centuries. Now there is a trend of communality in the Northeast and a persistent desire for individuality in the West (Democrat and liberal Republican v. Republican and conservative Democrat), perhaps because of population density, or a historical lack of it in the West. A common human trait may be for liberty but when one finds a nice place to live and others find it too, which is inevitable, perhaps it becomes more practical to make community compromises. Reasonable sharing is in every bodies interest when population density increases but the hard part comes in deciding how much to share and what's reasonable. Sharing becomes advantageous when everyone benefits. The West is in the grey zone with population, many are diffusing here, as has been happening since the 19th century and population pressure is making people crazy. There are many here that feel entitled to serenity when in fact they will not find serenity until they can deal with population pressure, other people will not go away, and the phrase, "My ancestors did not move here to have to deal with immigrants" won't wash. I "emigrated" to Washington State almost fifteen years ago. There is no where else for the Frontiers people to go except into the Pacific Ocean (call-back to the wet horses reference). A more conservative libertine of our country seems to emanate from the West. I admit that I enjoy living in the West and agree with some of a libertarian philosophy but I don't agree with the self-sustaining individual over health care.
In health care we are crawling all over each other with nontransparent fee structures, unequal distribution that costs everybody directly or indirectly, expenditures that are out of control without added benefit, and that's poor value, again for everybody, and a medico-legal system that seems wacky, and stacked against reasonable practice. The economy of medicine is a wreck that no one understands, and I believe no one! Not the eggheads in think tanks, the President, Glenn Beck or Hannity or your Grandfather who knows everything else. We need some system that will help everyone because this will help us all! We have reached a critical mass of population in this country. We can't be the libertarians that we pride ourselves to be on this issue, or many others, because it is limiting the enjoyment of our other libertarian institutions: enjoying life's tranquility, having our own businesses, and living the pleasant life without worry of health bills or taxes and premiums for taking care of people who have never had insurance, or those kicked off insurance for being too sick. It is making it hard to find serenity. The burden of being witness to many suffering (mentally, emotionally, physically) has become nearly unbearable, at least for me, and for many we read about in the press but some of us would like to put our head in the sand to make it go away. It won't. So let's deal with it, as a nation. Republicans and Democrats, and Libertarians. It's deal with it now or deal with it later.
Here's where I get to say, "If I were King... I would have three wives, drink too much and I would kick the Celts off my land." OK, that's a joke, I would not drink too much.
(As an aside, I think there has been little resolution on the issue because America doesn't know what it wants and it doesn't want to be led. What's new. We need a crafty leader. Obama seems to be more of a mediator than an advocate. Maybe we could do some dance with LBJs DNA to resurrect the King of the Legislature.)
But if I were King of health care I would:
Argue that the Constitution anoints the government to "promote the general welfare" of its people as stated in the preamble.
Argue that health coverage may arguably be a right but is more convincingly a part of our heritage in that it would level the playing field of opportunity for those who are sick.
Work to transfer responsibility of health insurance to the individual and remove the burden from employers.
Remove tax credits from employers, if they want to offer insurance as means of attracting employees they would shoulder that burden without tax credit.
Work to make fee schedules transparent and knowable by everyone who purchases health care. I would also work with experts to break into the black box that is hospitals negotiating fees with insurance companies and doctors and medical equipment reps, followed by how they decide what to charge to the consumer. If everyone was insured there may be less accounting wizardry that leaves one baffled.
Create health insurance exchanges but leave the government out of day-to-day coverage.
Require everyone to have catastrophic insurance (the original intent of "insurance") or task the federal government to catastrophic coverage. This would mirror the educational system where our kids are covered by public schools but if a parent wants to spend more for private school they can.
Leave entitlements where they are for the poor and elderly.
Make a consumer health oversight body, the Medical
Reserve, much like the Federal Reserve oversees the banking industry, current political position of the Federal Reserve notwithstanding. It's still a good idea. The intent would be to allow the patient from getting screwed as a consequence of transparency deficiency.
Work with professional medical societies, and the legislatures and courts, to create guidelines of care that are reasonable and more firm nationwide since this would alter a "Standard of Care" aspect of our medico-legal system. If avoiding an MRI for everyone who has a headache is considered reasonable, through the guidelines of the professional societies it should then be reasonable in a court of law, or vice versa. Chest pain in the ED? society needs to give some guidelines to those on the front lines. Yes, the one in a thousand missed heart attack is tragic, but is it malpractice? Or do we want to pay more for defensive testing? at least give the doctors a clue what you want America. This is the people's issue, not lawyers, or even doctors.
All right. I'm tired of this. I'm glad I'm not a politician.
Please don't read this if you don't like history or if you're tired of the health care debate, and who wouldn't be, so I guess I'll just write for myself.
The population of Europe was thinned by the bubonic plague in the 15th century. After that everyone got along and most had a job and the Church led peaceful, wonderful harmony within Europe (I made this up...). Then people started to read and trouble makers sent people's minds all akimbo. Luther, Knox and Calvin took the right flank and Hobbes, Locke, Kant, and all those other precommunists took the left flank. Governments churned and turned over. There developed a group of individually-minded people interested in liberty and the pursuit of happiness, no matter who suffered around them. They were particularly interested in themselves, perhaps more than their larger community, or the King, or the Church (this is understandable since the leaders here were pretty corrupt... maybe you're not supposed to have wives and vast quantities of gold when your a Pope, and the King should not drink so much or have more than three wives at the same time, and he should leave Celtic people alone (my rules)). The individualists answered to the Lord, their money belts, or to some voice in their head that no one else heard and they didn't feel like fighting in huge armies for no wages, moldy bread, and the privilege of sleeping in the same bed with six other men who smelled like wet horses.
Anyway a group of Puritans couldn't get comfortable in their own skin in England or the Netherlands so they moved to North America to bother the Indians, who themselves couldn't get along with their neighbors, but they lived in the woods and were, as the saying goes, "born in a barn". Others moved to America since business was good here for those that didn't go to Oxford, Cambridge, the Sorbonne, or the Prussian School for Fanatical Military Strength. It was hard to move up unless you were born to some Royal family where your parents were also your brother and sister,or vice versa, or you-know-what-I-mean (?), or unless you were a genius like Napoleon or the guy that created the slinky, later of course. I'm not saying that Napoleon played with a slinky, but I think he would have been good at that, and the hula-hoop ( and all Wham-O products for that matter) just like he was good at controlling most of Eurasia and the Middle East. Nerf basketball would have been hard for this short man though. OK, I was digressing...all those of Europe that didn't want to be bothered by the psycho, in-bred, warlike Europeans thought they could avoid taxes and hassle in the New World. Where it seemed like no one lived, emphasis on "seemed".
So people came in droves to North America, but they soon discovered that where there are other people there could be trouble. So they brought diseases like tuberculosis and small pox with them to act as infectious napalm. To clear the woods as it were. This wasn't their fault though since it was also clearing their own woods, and the European woods, as about 1 in 2 people that died in Europe died of some horrible disease. The others died sleeping with wet horses in fields festooned with uniforms taken from dead sheep. A more pleasant sight could be had by touring a coal mine in the English Midlands circa. the 18th century.
So the religious, the entrepreneurial and a 2:1 mix of sane and insane moved to America. They were looking for a better life understandably. Here the sane and the insane grew in similar numbers leaving the sane in much greater proportion than the insane. But the sane seemed to like their new digs where the insane still felt cramped. And while the population multiplied government grew, as Thomas Hobbes would argue to be a natural phenomenon, and taxes followed them from England. Americans didn't like taxation without representation, as a reasonable person would not, but I think there were some that just didn't like taxes at all, no matter who was imposing them. This was discovered when the new nation was developed. General Washington couldn't pay for the army and the Constitutional Congress couldn't meet without money. But they had trouble raising taxes to pay for these necessities. Revolts ensued and the Constitution become a tough sell. The Bill of Rights was soon developed because, despite the formation of the Constitution, this revolutionary document which codified new freedoms in the world's first representative democracy, there were still those that worried about an individuals freedom from the tyranny of the majority. Slaves were eventually given up but guns, states rights(i.e. local, not federal authority) and individualism became staples of our heritage.
This seems to be a consequence of population pressures, amongst other things. As population increases there seems to be more demand for protections from others and taxes to pay for these protections. The West is still less populated than the East in America, as the New America was less densely populated compared to Europe in the 17th and 18th centuries. Now there is a trend of communality in the Northeast and a persistent desire for individuality in the West (Democrat and liberal Republican v. Republican and conservative Democrat), perhaps because of population density, or a historical lack of it in the West. A common human trait may be for liberty but when one finds a nice place to live and others find it too, which is inevitable, perhaps it becomes more practical to make community compromises. Reasonable sharing is in every bodies interest when population density increases but the hard part comes in deciding how much to share and what's reasonable. Sharing becomes advantageous when everyone benefits. The West is in the grey zone with population, many are diffusing here, as has been happening since the 19th century and population pressure is making people crazy. There are many here that feel entitled to serenity when in fact they will not find serenity until they can deal with population pressure, other people will not go away, and the phrase, "My ancestors did not move here to have to deal with immigrants" won't wash. I "emigrated" to Washington State almost fifteen years ago. There is no where else for the Frontiers people to go except into the Pacific Ocean (call-back to the wet horses reference). A more conservative libertine of our country seems to emanate from the West. I admit that I enjoy living in the West and agree with some of a libertarian philosophy but I don't agree with the self-sustaining individual over health care.
In health care we are crawling all over each other with nontransparent fee structures, unequal distribution that costs everybody directly or indirectly, expenditures that are out of control without added benefit, and that's poor value, again for everybody, and a medico-legal system that seems wacky, and stacked against reasonable practice. The economy of medicine is a wreck that no one understands, and I believe no one! Not the eggheads in think tanks, the President, Glenn Beck or Hannity or your Grandfather who knows everything else. We need some system that will help everyone because this will help us all! We have reached a critical mass of population in this country. We can't be the libertarians that we pride ourselves to be on this issue, or many others, because it is limiting the enjoyment of our other libertarian institutions: enjoying life's tranquility, having our own businesses, and living the pleasant life without worry of health bills or taxes and premiums for taking care of people who have never had insurance, or those kicked off insurance for being too sick. It is making it hard to find serenity. The burden of being witness to many suffering (mentally, emotionally, physically) has become nearly unbearable, at least for me, and for many we read about in the press but some of us would like to put our head in the sand to make it go away. It won't. So let's deal with it, as a nation. Republicans and Democrats, and Libertarians. It's deal with it now or deal with it later.
Here's where I get to say, "If I were King... I would have three wives, drink too much and I would kick the Celts off my land." OK, that's a joke, I would not drink too much.
(As an aside, I think there has been little resolution on the issue because America doesn't know what it wants and it doesn't want to be led. What's new. We need a crafty leader. Obama seems to be more of a mediator than an advocate. Maybe we could do some dance with LBJs DNA to resurrect the King of the Legislature.)
But if I were King of health care I would:
Argue that the Constitution anoints the government to "promote the general welfare" of its people as stated in the preamble.
Argue that health coverage may arguably be a right but is more convincingly a part of our heritage in that it would level the playing field of opportunity for those who are sick.
Work to transfer responsibility of health insurance to the individual and remove the burden from employers.
Remove tax credits from employers, if they want to offer insurance as means of attracting employees they would shoulder that burden without tax credit.
Work to make fee schedules transparent and knowable by everyone who purchases health care. I would also work with experts to break into the black box that is hospitals negotiating fees with insurance companies and doctors and medical equipment reps, followed by how they decide what to charge to the consumer. If everyone was insured there may be less accounting wizardry that leaves one baffled.
Create health insurance exchanges but leave the government out of day-to-day coverage.
Require everyone to have catastrophic insurance (the original intent of "insurance") or task the federal government to catastrophic coverage. This would mirror the educational system where our kids are covered by public schools but if a parent wants to spend more for private school they can.
Leave entitlements where they are for the poor and elderly.
Make a consumer health oversight body, the Medical
Reserve, much like the Federal Reserve oversees the banking industry, current political position of the Federal Reserve notwithstanding. It's still a good idea. The intent would be to allow the patient from getting screwed as a consequence of transparency deficiency.
Work with professional medical societies, and the legislatures and courts, to create guidelines of care that are reasonable and more firm nationwide since this would alter a "Standard of Care" aspect of our medico-legal system. If avoiding an MRI for everyone who has a headache is considered reasonable, through the guidelines of the professional societies it should then be reasonable in a court of law, or vice versa. Chest pain in the ED? society needs to give some guidelines to those on the front lines. Yes, the one in a thousand missed heart attack is tragic, but is it malpractice? Or do we want to pay more for defensive testing? at least give the doctors a clue what you want America. This is the people's issue, not lawyers, or even doctors.
All right. I'm tired of this. I'm glad I'm not a politician.
Thursday, February 25, 2010
Medico-legal education at Penn
First, some comments on music of the East Coast. The Captain and Tenille as well as the BeeGees are big and it drives me crazy. This is one thing that I don't miss about the East Coast. The same lovely music plagues other cities in this quadrant of the U.S. I thought the Kenny Gland of Overlake Hospital was bad but this music is worse...I think I need music desensitization therapy.
Also, I must say, the best news and stories often come from cabbies. Yesterday I took a cab to classes on bioethics at the UPenn Medical School. I got talking with the cabbie about baseball since all of us are ready for Spring. He told me a story of his son growing up. For years he took his family of four to opening day of the Phillies. They usually play the Pittsburgh Pirates and this was a family ritual. But one year recently his fifteen year old son told him that he didn't want to see the Pirates anymore. His son didn't want to go, instead he went skateboarding with his friends. The rest of the family didn't go either, because of the son's unwillingness, and the cabbie was sad because he sensed his son growing up and not wanting to be with him, his wife and his little sister. He told me that he still has those four tickets saved and sometimes looks at them with lament. I hope his son comes back and I think he will. In baseball and religion children may stray but they always come back, in some way, to the game.
Now about medico-legal stuff. This week I have been going to the medical school to sit in on the classes that University of Pennsylvania gives to their fourth year students on medical ethics. Today prosectuting attorneys spoke in the morning and defense attorneys, and the University of Penn Hospital attorney spoke in the afternoon. Here are some salient points:
As physicians and nurses all know, document. But some recommendations include, try not to document opinion if one expects bad outcome. That is, don't speculate, just write the facts, M'am. Speculation is bad for everybody.
Electronic documentation not helpful to doctors if there is no narrative involved. Templates and drop down point-and-click software can be more detrimental for legal issues even though it may fit reimbursement criteria. Always add summary narrative.
Encouraging information for nurses, there have been no lawsuits against nurses (alone) that the chief counsel for UPenn Hospitals, defense and plaintiff attoroneys of Philadelphia knew of. Of the lawsuits that come against doctors, about 10% included nurses and plaintiff attorneys don't like to bring nurses into lawsuits because juries are very sympathetic to nurses, no matter what the circumstances.
It's snowing again in Philadelphia, ugh.
Also, I must say, the best news and stories often come from cabbies. Yesterday I took a cab to classes on bioethics at the UPenn Medical School. I got talking with the cabbie about baseball since all of us are ready for Spring. He told me a story of his son growing up. For years he took his family of four to opening day of the Phillies. They usually play the Pittsburgh Pirates and this was a family ritual. But one year recently his fifteen year old son told him that he didn't want to see the Pirates anymore. His son didn't want to go, instead he went skateboarding with his friends. The rest of the family didn't go either, because of the son's unwillingness, and the cabbie was sad because he sensed his son growing up and not wanting to be with him, his wife and his little sister. He told me that he still has those four tickets saved and sometimes looks at them with lament. I hope his son comes back and I think he will. In baseball and religion children may stray but they always come back, in some way, to the game.
Now about medico-legal stuff. This week I have been going to the medical school to sit in on the classes that University of Pennsylvania gives to their fourth year students on medical ethics. Today prosectuting attorneys spoke in the morning and defense attorneys, and the University of Penn Hospital attorney spoke in the afternoon. Here are some salient points:
As physicians and nurses all know, document. But some recommendations include, try not to document opinion if one expects bad outcome. That is, don't speculate, just write the facts, M'am. Speculation is bad for everybody.
Electronic documentation not helpful to doctors if there is no narrative involved. Templates and drop down point-and-click software can be more detrimental for legal issues even though it may fit reimbursement criteria. Always add summary narrative.
Encouraging information for nurses, there have been no lawsuits against nurses (alone) that the chief counsel for UPenn Hospitals, defense and plaintiff attoroneys of Philadelphia knew of. Of the lawsuits that come against doctors, about 10% included nurses and plaintiff attorneys don't like to bring nurses into lawsuits because juries are very sympathetic to nurses, no matter what the circumstances.
It's snowing again in Philadelphia, ugh.
Sunday, February 21, 2010
New York and Friends
Another travel section. I hope to present my bioethics "thesis" on this sight soon, with a little lead up from my take on the Declaration of Independence (it took me three stabs to spell independence correctly, just so you know what you might be getting in my analysis), the U.S. Constitution (got that right first stab) and liberty. Please don't be afraid. I also want to propose an anthropologic explanation for why we are the way we are in America. But first...
Last week-end my friend John came out for a visit. I've known John since I was fourteen and I was best man at his wedding. We are best of buds and we had a lot to talk about. For those of you who don't know John, he is someone who autographs the Gideon Bible when he travels..."Hope you like my book, Jesus H. Christ"... and that's his level of humor, which I love. But he also has scruples and knows a joke is a joke. He's a great guy. We went to Atlantic City, Gettysburg, and toddled around Philly.
This week-end I went up to New York and saw my friends Fabio and Yuk Ming, two others who have great senses of humor and good souls. I always like getting together with them. Yuk and I went to the museums together and then we got together with Fabio, his wife Lorna and their friend Dominique. Three hours havin' a great time at an Italian restaurant, Trattoria Del Arte, with plaster art of human parts on the walls. Great laughs and catching up. By the way, the art is done very tastefully, like one might find in Roman ruins, not like one might find in a barn in Wisconsin.
Some other stand out moments of my sortie to New York: I managed to put my foot in my mouth with Yuk once or twice like the time that I was dissing Atul Gawande's latest book, "The Checklist Manifesto" only to find that she was friends with his wife, and the time that I used a Chinese dialect to make an attempt at a joke at dinner. I apologised for both and I still hope she was not deeply offended, as she assured me she was not. As my Mom has said(this is her parental obligation), I have to watch my mouth, and she is very correct on this one. Mea culpa.
This reminds me of a talk that I gave in Bellingham about the discovery of antibiotics. I accused Fleming of being a messy person, allowing his bacteria ager plates to sit open, and it was only this that allowed him to discover penicillin after he discovered mold growing on the open plates. It was a comment made without expectation of rebuttal since Fleming lived in Scotland and died long ago but there was a personal acquaintance of Fleming in the audience, Who would have expected that!, and he took umbrage with my remark. I was agog, apologised for my tone, but did comment that I had references. AND, science is sometimes made from mistakes and serendipity.
On the train into New York City I got a glimpse of the sky line from the New Jersey side. I was struck by the lack of the World Trade Center's signature rising above the downtown district, since this was the first time that I had seen the sky line from this vantage since living in Manhatten in the nineties. All that remains is the Empire State Building and the assorted downtown mess and the midtown mess of buildings. I felt sad and reflected on the "still hard to grasp" aspect of the WT Towers' demise.
The smell of New York is always noticeable. It seems a combination of sweet, bitter and exhaust. Winter is a time when vendors have chestnuts roasting, yes, like in the song, and I think this contributes. There was a lot of street construction making traffic a snarl. I wonder if federal stimulus money has something to do with this?
I was going to go to Dia:Beacon, an art installation in an old Morton Salt factory in Beacon, NY on the Hudson, but I got so caught up in taking pictures that I bagged that idea. I got to Rockefeller Plaza, walked along 5th Ave. and Madison Ave. and spent time in Grand Central Station, a building I love to visit. I took the Grand Central shuttle to Times Square, where I took a picture of a very attractive shoe, and made my way to the original Barnes and Noble bookstore on 18th St. and 5th Ave. I spent some time there and finished my day taking pictures of the Flat Iron Building. Went out for Italian after watching the New York news station, the One, and got up to return to Philadelphia a happier man. I love New York and consider it a great place to visit. I'm glad I don't live there though for reasons too cumbersome to enumerate. Three years seemed enough. Sometimes I think that I have graduated from the Life University of New York City. I enjoy the alumni connections but am glad that I have moved on.
Last week-end my friend John came out for a visit. I've known John since I was fourteen and I was best man at his wedding. We are best of buds and we had a lot to talk about. For those of you who don't know John, he is someone who autographs the Gideon Bible when he travels..."Hope you like my book, Jesus H. Christ"... and that's his level of humor, which I love. But he also has scruples and knows a joke is a joke. He's a great guy. We went to Atlantic City, Gettysburg, and toddled around Philly.
This week-end I went up to New York and saw my friends Fabio and Yuk Ming, two others who have great senses of humor and good souls. I always like getting together with them. Yuk and I went to the museums together and then we got together with Fabio, his wife Lorna and their friend Dominique. Three hours havin' a great time at an Italian restaurant, Trattoria Del Arte, with plaster art of human parts on the walls. Great laughs and catching up. By the way, the art is done very tastefully, like one might find in Roman ruins, not like one might find in a barn in Wisconsin.
Some other stand out moments of my sortie to New York: I managed to put my foot in my mouth with Yuk once or twice like the time that I was dissing Atul Gawande's latest book, "The Checklist Manifesto" only to find that she was friends with his wife, and the time that I used a Chinese dialect to make an attempt at a joke at dinner. I apologised for both and I still hope she was not deeply offended, as she assured me she was not. As my Mom has said(this is her parental obligation), I have to watch my mouth, and she is very correct on this one. Mea culpa.
This reminds me of a talk that I gave in Bellingham about the discovery of antibiotics. I accused Fleming of being a messy person, allowing his bacteria ager plates to sit open, and it was only this that allowed him to discover penicillin after he discovered mold growing on the open plates. It was a comment made without expectation of rebuttal since Fleming lived in Scotland and died long ago but there was a personal acquaintance of Fleming in the audience, Who would have expected that!, and he took umbrage with my remark. I was agog, apologised for my tone, but did comment that I had references. AND, science is sometimes made from mistakes and serendipity.
On the train into New York City I got a glimpse of the sky line from the New Jersey side. I was struck by the lack of the World Trade Center's signature rising above the downtown district, since this was the first time that I had seen the sky line from this vantage since living in Manhatten in the nineties. All that remains is the Empire State Building and the assorted downtown mess and the midtown mess of buildings. I felt sad and reflected on the "still hard to grasp" aspect of the WT Towers' demise.
The smell of New York is always noticeable. It seems a combination of sweet, bitter and exhaust. Winter is a time when vendors have chestnuts roasting, yes, like in the song, and I think this contributes. There was a lot of street construction making traffic a snarl. I wonder if federal stimulus money has something to do with this?
I was going to go to Dia:Beacon, an art installation in an old Morton Salt factory in Beacon, NY on the Hudson, but I got so caught up in taking pictures that I bagged that idea. I got to Rockefeller Plaza, walked along 5th Ave. and Madison Ave. and spent time in Grand Central Station, a building I love to visit. I took the Grand Central shuttle to Times Square, where I took a picture of a very attractive shoe, and made my way to the original Barnes and Noble bookstore on 18th St. and 5th Ave. I spent some time there and finished my day taking pictures of the Flat Iron Building. Went out for Italian after watching the New York news station, the One, and got up to return to Philadelphia a happier man. I love New York and consider it a great place to visit. I'm glad I don't live there though for reasons too cumbersome to enumerate. Three years seemed enough. Sometimes I think that I have graduated from the Life University of New York City. I enjoy the alumni connections but am glad that I have moved on.
Wednesday, February 10, 2010
Am I in Philadelphia, or HELL?!
Churchill apparently said, "When your going through hell, just keep going." so without further hyperbole I will say that the 2010 snows of Philadelphia, and the East Coast, have been trying so far. Today we will get another foot of snow on top of 28 inches we got five days ago. The federal government has been closed for 3 days without relief in sight. Here, I got up at my usual 7:30A and watched Morning Joe while brushing, shaving and showering. A ritual I have settled into. I put my parka on, walked out of the apartment, forgot some things as usual, so I went back, but finally got to the train at 15ht St. with my Starbucks, half-caff venti drip, and stopped at the Dunkin' Donuts for the usual two jelly donuts from the team of Indian women behind the counter. Walked past the cadre of street guys and buskers as well as a flock of sleeping pigeons. Got on the subway to the 34th St. stop and went to the third floor of the Science Center at 34th and Market where the Center for Bioethics has its command center. But today it was dark. The University closed, but there wasn't any snow yet. Should've checked my emails before leaving for the day.
Mona, the security officer at the Center's entrance said, "It's never going to stop". I said that I was locked out of my office and couldn't go home, so I was cast onto the street. Maybe I could recover some of the money I had given away over the last few days.
Slogged over to the Biomedical library at Penn realizing that every intersection was an event as it has been for days now. The walks are reasonably clean but at each intersection there are ponds of slush and snow that require acrobatic skill to navigate. I feel that I am in an eternal Dristan commercial...the kind where the poor sod is standing on a corner sniveling and sneezing only to have a car throw a wake of slush on him from the waste down.
I got into some kind of dance with a Penn snow plow. I moved from one unstragegic postion at the intersection to another while he seemed to move to plow exactly where I had moved. He was having fun with me. I was trapped. He plowed slush all over me. What kind of person...City of Brotherly Love?
Got some papers on the philosophy of humor at the library. My only refuge mentally and physically. But they were closing. Went to the Penn Book store, but they were closing. Got back on the train and went to Barnes and Noble to read, but, yes, they were closed. The blowing snow and slush and general miserableness wouldn't be so bad if things could just stay open, but no way. Grocery stores are closed but a shoe store is still open, what the...?
I am back in my 200 sq. ft. palace which is warm and open. The consolation is that people are talking to each other and still have a sense of humor. Nice! Tomorrow, will be different? Maybe.
More than any other time in history human kind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let us pray that we have the wisdom to choose correctly. -Woody Allen
Mona, the security officer at the Center's entrance said, "It's never going to stop". I said that I was locked out of my office and couldn't go home, so I was cast onto the street. Maybe I could recover some of the money I had given away over the last few days.
Slogged over to the Biomedical library at Penn realizing that every intersection was an event as it has been for days now. The walks are reasonably clean but at each intersection there are ponds of slush and snow that require acrobatic skill to navigate. I feel that I am in an eternal Dristan commercial...the kind where the poor sod is standing on a corner sniveling and sneezing only to have a car throw a wake of slush on him from the waste down.
I got into some kind of dance with a Penn snow plow. I moved from one unstragegic postion at the intersection to another while he seemed to move to plow exactly where I had moved. He was having fun with me. I was trapped. He plowed slush all over me. What kind of person...City of Brotherly Love?
Got some papers on the philosophy of humor at the library. My only refuge mentally and physically. But they were closing. Went to the Penn Book store, but they were closing. Got back on the train and went to Barnes and Noble to read, but, yes, they were closed. The blowing snow and slush and general miserableness wouldn't be so bad if things could just stay open, but no way. Grocery stores are closed but a shoe store is still open, what the...?
I am back in my 200 sq. ft. palace which is warm and open. The consolation is that people are talking to each other and still have a sense of humor. Nice! Tomorrow, will be different? Maybe.
More than any other time in history human kind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let us pray that we have the wisdom to choose correctly. -Woody Allen
Sunday, February 7, 2010
Snow in Philadelphia and the Super Bowl
Wow, a Super Bowl that was exciting, what a treat. The New Orleans Saints win a thrilling game in Miami. I got to watch from my room in Philadelphia after snow disrupted the Dish TV at my room earlier in the day. Apparently a chunk of ice fell into the dish on top of the building almost disrupting the "big game". And what a game. New Orleans came back from a first quarter deficit of 10 point. By kicking an on-side kick to start the second half and playing great pass football the New Orleans Saints won the game. Drew Brees, who won the MVP, was shown talking to his infant son at the end while his son was wearing ear protection against the noise. I don't know what he could have been saying to his infant son with ear phones on in a Super Bowl full of noise but it seemed endearing.
Peyton Manning, whom I like and respect, may have thrown an interception that will knock him from the discussion of "who is the best quarterback of history" at the hands of the Saints, just as Brett Favre threw an interception two weeks ago that may leave him a broken man at the end of his career. The same Saints player made both interceptions. My only concern about the post- game is that Len Dawson of the Kansas City Chiefs, who beat the Vikings in Super Bowl IV, brought out the Vince Lombardi Trophy. As a Vikings fan I had to muster energy to accept this but I have now come to terms with it. Damn him!! Oh, I have zen, yes I do. As an aside, is there no running in the NFL any more? It seems that the game is now a quarterback and receiver's game.
Best commercial goes to the one where Betty White gets tackled in the mud. The Google one where some schmo- googles his way to marriage in Paris wasn't bad.
The Who played the half-time show and did an OK job with the usual montage of hits. The question is whether this was really the Who since John Entwihistle and Keith Moon are dead and Pete Townshend can't hear. Roger Daltery looked like he had some arthritis in his neck but I'll let that go since his voice was there. Peter Townshend was almost boycotted by descendants of the Abolitionsts (alright, different subject, different cause, but the zealotry was there) since he was officially listed as a sex offender in Britain in 2003 but never charged. He said he was doing "research" when he was caught with kiddy porn on his computer. I tried to do a web search on the issue and didn't get very far except to find out that he had a friend from childhood that was abused and he has said on multiple occasions that he has tried to be an activist in pedophilia, against it that is.
In other news, Philadelphia got 28 inches of snow this week-end, and Washington D.C. got more. It has been a helluva winter in this area. I have been concerned about the number of street people that I have to pass on my way to work each day in Philadelphia. So much so that I took the effort to try to help this week-end. A purely selfish move on my part, mind you, since I want to assuage myself of some of the guilt I feel passing up many of these guys on a daily basis. I have traditionally been against giving to people on the street since I don't know if I would be an enabler or not. But the Philadelphia scene seems particularly bad, i.e. I think many on the street guys(and most are guys) are legitimate and not all drug users or crazies that can't find their way to the Salvation Army or a job, so with my extra time, being snowed in, I wanted to help. I searched the web for some food bank sites but found that my research left me going to places that were abandoned. Eventually I just bought a bunch of food, slogged through the blizzard that Philly was experiencing and ended up passing through the train station, where the police had cleared out the street folks, and got on the subway to West Philadelphia, beyond the University of Pennsylvania. I was told of a Salvation Army at 69th and Market but couldn't find it and no one knew what I was talking about when I asked around. I was a tall white guy with a bunch of food and no where to go. Eventually, I was asked to stop taking pictures of birds and headed back to my apartment on the green line, out of a place where I felt rather uncomfortable. At the 15th St. station, my home base, I tried to give away some food in the terminal. I interrupted some gentleman in a dank corner of the station with sparrows and many wet smells around him, reading an old newspaper, and asked him if he wanted some food. He looked at me like I was interrupting him and asked what I had. I said, "I have some cheese and bread". He said, "No thank you...don't you have any money? I said, "No". He said, "What else do you have?" I said, "Do you want some cashews?" He said, "Nope" and went back to reading his paper. So I moved on. Fickle people these guys. Or maybe he wasn't a reasonable representative of who I was looking for. What I did know is that I was cold and I had wet feet and I was lucky enough to have a warm place to stay so I headed back to my room with a boat load of food. As a last effort I tried to pawn some cashews off on someone else and he sincerely admitted that he couldn't eat them since he had no teeth. He was a real guy and took some cheese. I felt good about that and he seemed happy. I'll try to find a food bank in the light of day and with less snow blowing around, this week.
Peyton Manning, whom I like and respect, may have thrown an interception that will knock him from the discussion of "who is the best quarterback of history" at the hands of the Saints, just as Brett Favre threw an interception two weeks ago that may leave him a broken man at the end of his career. The same Saints player made both interceptions. My only concern about the post- game is that Len Dawson of the Kansas City Chiefs, who beat the Vikings in Super Bowl IV, brought out the Vince Lombardi Trophy. As a Vikings fan I had to muster energy to accept this but I have now come to terms with it. Damn him!! Oh, I have zen, yes I do. As an aside, is there no running in the NFL any more? It seems that the game is now a quarterback and receiver's game.
Best commercial goes to the one where Betty White gets tackled in the mud. The Google one where some schmo- googles his way to marriage in Paris wasn't bad.
The Who played the half-time show and did an OK job with the usual montage of hits. The question is whether this was really the Who since John Entwihistle and Keith Moon are dead and Pete Townshend can't hear. Roger Daltery looked like he had some arthritis in his neck but I'll let that go since his voice was there. Peter Townshend was almost boycotted by descendants of the Abolitionsts (alright, different subject, different cause, but the zealotry was there) since he was officially listed as a sex offender in Britain in 2003 but never charged. He said he was doing "research" when he was caught with kiddy porn on his computer. I tried to do a web search on the issue and didn't get very far except to find out that he had a friend from childhood that was abused and he has said on multiple occasions that he has tried to be an activist in pedophilia, against it that is.
In other news, Philadelphia got 28 inches of snow this week-end, and Washington D.C. got more. It has been a helluva winter in this area. I have been concerned about the number of street people that I have to pass on my way to work each day in Philadelphia. So much so that I took the effort to try to help this week-end. A purely selfish move on my part, mind you, since I want to assuage myself of some of the guilt I feel passing up many of these guys on a daily basis. I have traditionally been against giving to people on the street since I don't know if I would be an enabler or not. But the Philadelphia scene seems particularly bad, i.e. I think many on the street guys(and most are guys) are legitimate and not all drug users or crazies that can't find their way to the Salvation Army or a job, so with my extra time, being snowed in, I wanted to help. I searched the web for some food bank sites but found that my research left me going to places that were abandoned. Eventually I just bought a bunch of food, slogged through the blizzard that Philly was experiencing and ended up passing through the train station, where the police had cleared out the street folks, and got on the subway to West Philadelphia, beyond the University of Pennsylvania. I was told of a Salvation Army at 69th and Market but couldn't find it and no one knew what I was talking about when I asked around. I was a tall white guy with a bunch of food and no where to go. Eventually, I was asked to stop taking pictures of birds and headed back to my apartment on the green line, out of a place where I felt rather uncomfortable. At the 15th St. station, my home base, I tried to give away some food in the terminal. I interrupted some gentleman in a dank corner of the station with sparrows and many wet smells around him, reading an old newspaper, and asked him if he wanted some food. He looked at me like I was interrupting him and asked what I had. I said, "I have some cheese and bread". He said, "No thank you...don't you have any money? I said, "No". He said, "What else do you have?" I said, "Do you want some cashews?" He said, "Nope" and went back to reading his paper. So I moved on. Fickle people these guys. Or maybe he wasn't a reasonable representative of who I was looking for. What I did know is that I was cold and I had wet feet and I was lucky enough to have a warm place to stay so I headed back to my room with a boat load of food. As a last effort I tried to pawn some cashews off on someone else and he sincerely admitted that he couldn't eat them since he had no teeth. He was a real guy and took some cheese. I felt good about that and he seemed happy. I'll try to find a food bank in the light of day and with less snow blowing around, this week.
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