Archive for October 26th, 2011

HARRY TRUMAN WOULD HAVE KNOWN WHAT TO DO

October 26, 2011

I had a a screening colonoscopy recently, which went very well.  The process for check in, the procedure, and the departure went smoothly.  It ought to.  This center does thousands a year.

The bill for everything was about $4000.  We know that screening colonoscopies catch early cancers and can be treated at the same time.  It is a great test.  It helped me 10 years ago.  Early colon cancer, as far as we know, is completely treatable, and this is one of the common cancers.  We cannot say that for sure about breast cancer, because it is entirely possible that many of the early cancers might stay that way.  But certainly screening mammography has some value.

Here we are, with an expensive test that clearly can save lives.  You can think of many others.  I had insurance.  If I didn’t, well…. I guess I take my chances and hope.  Many Americans do.

How do we as a country provide better medical care to our citizens?  It is clear that our care is suboptimal.  Nobody counts errors in care, which I tried to know more than a decade ago.  Nobody knows what percentage of people who need screening colonoscopies–those over 50 and those with a family history–get them.  And I am not even mentioning the other cancers and the other biochemical screening that we should do.

Of course, I don’t have time here to mention how we provide after illness care without bankrupting the country.  I just think we should do better than we do.  My detractors will probably say we have the best care in the world.  Perhaps, at some places, we do.  I would like to see good data.  But nobody can convince me we have the optimal care for people given costs and illness burden.  We do not.

And we will continue not to.  I saw what happened during the insurance reform debate.  It was called health care reform by the media, and it had nothing to do with care.  I bet my career on improving care and lost.  This was about insurance reform and little else.  We polarized the country, and those who have not treated as many dying patients as I have (including family members) had the gall and the audacity to call end of life planning, something only 30% of us have, “death panels”.  We polarized the country, in large part because those who had theirs cared not a whit for those who did not have care.  Many decried government’s role in health care, even as they were receiving Medicare or were in the military.  This is a fact.

What is the best answer?  I have my thoughts.  I want my detractors to come up with an answer, and I want it now.  I want it to be put to the House of Representatives and the Senate, and I want it enacted now.  If America can afford a trillion dollars for one war that was not necessary and another that is no longer necessary and cannot be won, then America can afford a trillion dollars for improving what we have now.  We can call it an “emergency authorization,” as Mr. Bush did, and keep it off the budget, so our finances don’t look so bad.  It worked for Mr. Bush, so it should work now.

I’ve offered my solutions to deal with waste and to improve the care we give.  I have been slammed for it.  So to my detractors, I ask, time to stop slamming me.  I have offered my solutions.  You offer yours.  No rhetorical questions, please.  Just tell me, how do we screen people for colon cancer in this country?  How do we screen for other issues?  How do we care for those who do not have 7 or 8 figure net worths and do not have the good fortune to have medical insurance?  How do we prevent things better, and how do we have efficient treatment for the most common medical conditions?  How do we allow people to die when it is time, and how do we deliver good care to those who bodies are failing but whose brains are fine?  How do we deliver good care to those whose brains have failed but whose bodies are fine?  How do we quit when we should, and how do we know we have done this appropriately?

I have offered my solutions to these problems for the past quarter century, without success.  I am now dealing with my own medical issues.  I want solutions, I want them clearly defined, I do not want personal attacks, which are cowardly, I just simply want the country to run better.  That to me is patriotism.  If the Republicans do it and take credit, good.  They should deserve it.  If the Democrats do, then also good.

We would do well to heed the comment by one who cut waste in government, and was called by one of the leading House Republicans as a patriot–Harry S Truman. Mr. Truman once said, “There is no limit to what a man can accomplish if he doesn’t care who gets the credit.”

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MANY CHILDREN LEFT BEHIND, ONE TEACHER, TOO

October 26, 2011

 When I was 18, I guided four canoe trips into the wilderness of Ontario’s Algonquin Park.  I was in charge of several other teenagers for six days, navigating, choosing the campsite, cooking and first aid, 1-2 days travel from the nearest adult.  When the campers swam, I counted heads.  At night, anybody’s crying out made me wake up.  When a camper couldn’t carry his pack, I carried it and the canoe together–140 pounds–a half mile along the slippery shore of the Tim River.  I guided four times that summer, amazed I was given such responsibility at 18.

When I was 61, with far more real-world experience, I was not allowed to teach full-time with the nearest other adult a few yards away.  For 9 years, I was an active volunteer in math at two local high schools.  At least 20 times, I taught when a substitute did not know the material.  I wanted to be busier, and I saw a huge need.   I finally gave up, because I was not busy enough.

My father was a public school teacher, principal and superintendent.  I believe in public education; with liberty and the National Park Service, it is one of the three greatest gifts America has given the world.  If public education fails, and many hope it will, we will destroy the middle class and America.  There are 60 million school age children in this country.  I am open to other solutions, but for profit charter schools in the new pay as you go America do not seem to be workable.

Perhaps it is hopeless, and many of these children will be uneducated, given up on, not voting, and subject to the sharks and those who will take advantage of their money, and talk radio hosts, who will sway their opinions with outright lies.

In elementary school, I wrote a paper about Horace Mann.  His six principles are still valid today:

  1. The public should no longer remain ignorant.
  2. Such education should be paid for, controlled, and sustained by an interested public.
  3. This education will be best provided in schools that embrace children from a variety of backgrounds.
  4. That this education must be non-sectarian.
  5. That this education must be taught by the spirit, methods, and discipline of a free society.
  6. That education should be provided by well-trained, professional teachers.

I now have a substitute certificate.  But I wanted to create a statistics course at a high school that didn’t have one.  I have a Master’s in statistics; I taught it for many semesters as a graduate student at New Mexico State, Pima Community College and other venues.  For four years, I graded the free response portion of the Advanced Placement Statistics exam; only 3 of 400 graders were from Arizona, which in itself is a statement about how well we are doing.  I know how to develop a statistics syllabus, how to prepare lessons, teach and grade it.  I would have done it for free, too, because I could afford it, and I felt so strongly about the need.

Unfortunately, I was not allowed, because of No Child Left Behind (NCLB), even as children are being left behind in droves.  I encountered them every day I tutored.  I didn’t see the many others who needed help and didn’t get it, the ones who need to be pushed, or those who drop out.  With many teachers also dropping out physically or mentally, we have a major problem. With appallingly inadequate funding, many schools nationwide disenroll problem students, gaming the system to survive.  Our per capita funding is $2500 below the national average.  I told that to a friend, who said, “You can’t fix education with money.”  I replied, “You can’t fix defense with money, either.”  He was silent.

NCLB is like Clear Skies, Healthy Forests and Clean Coal:  all have titles that are purposely the opposite of their intent.  NCLB’s intent was to close schools and have more for profit charter schools,

As a neurologist, I saw many practicing in my field, who could do everything I did without my 9 years of post college training and military service.  But I couldn’t teach full-time unless I obtained 22 credit hours.  I went back to school when I was 50, ending up as a non-paid de facto volunteer in Tucson’s medical community.  I choose to volunteer in the schools, but I will not pay to get more education at age 60.  In emergencies, substitutes can be hired long term, making the rule inane.  Frankly, I consider the current situation an emergency. The America I served once used innovative approaches to solve problems.

Public education–an American invention– is in trouble.  We funded the poorly conceived Iraq war with an off budget emergency authorization.  Public education needs an emergency funding authorization, too, and thousands of volunteers.  Schools need to open their doors to volunteers, and both schools and public libraries need places for tutoring during lunch, evenings and weekends.  Parents need to be involved.  We need money, too, but with a concerted national effort, the money wouldn’t be an outrageous sum.  I don’t want to hear “children are our future,” until we start trying to achieve the six principles articulated by Horace Mann, whose credentials to lead reform were also questioned, 175 years ago.

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