The hook brings you back

The group Blues Traveler had a huge hit with a song called “Hook,” which intentionally says nothing of substance. The chorus is as follows:

“Because the hook brings you back
I ain’t tellin’ you no lie
The hook brings you back
On that you can rely”

The song is about their frustration with MTV or popular music which relies on a “hook” to grab your attention. A hook is a catchy riff, phrase or gimmick used by songwriters. The Blues Traveler song is a tongue-in-cheek criticism of the use of a “hook” while using one.

To me, this song is a metaphor for companies selling products harmful to people’s health. The “hook” is an addiction, that brings people back to buy more.

The vaping industry is repeating the successful sales model of selling smoking to kids and young adults to get them hooked. The tobacco industry knew dating back to 1964 that nicotine was addictive. So, they hid this fact as they added more nicotine. The subterfuge lasted until the mid-1990s when an insider blew the whistle. This was after eight tobacco CEOs sitting at a table in front of a Congressional Committee lied saying nicotine was not addictive. What is troubling about the vaping industry is they are selling these vapes as candy in all kinds of flavors.

An even more dramatic and traumatic sales job relates to the opioid pain killer business. These companies were not forthcoming about how addictive their product is. People have died and families have been ruined by this subterfuge. And, once again we have a heroin and worse drug addiction problem in America, as it is cheaper than the opioid product. Please strongly consider non-opioid painkillers if you have surgery or an injury, if permissible by doctor.

On a more widespread basis, food companies have asked their chemists to make their products more addictive. How? By adding more sugar to their products. The sweeter taste is more alluring and gets people to eat more and buy more. What is the harm in a little more sugar? The US is the most obese country in the world and kids are now getting adult diabetes, not just juvenile diabetes.

So, like catchy songs, these hooks are designed to sell lots of products to unsuspectingly addicted consumers. Please be mindful of when you buy to make sure you are not being reeled in.

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Helping people climb a ladder – a perspective

The following is an edited version of a comment on Hugh Curtler’s (a retired college professor of philosophy) post regarding whether we should help people in need or let them fend for themselves. I provide a link below to his post. I am going to cite the work a charity I used to be a part of that builds off the book “Toxic Charity,” written by a minister who lived with the disenfranchised people he sought to help. His name is Robert Lupton.

Lupton’s thesis is simple: true charity should focus on emergency or short term needs. What he argued for to help others long term and we did (and still do) is help people climb a ladder back to self-sufficiency. That should be the goal. An easy example is he would advocate for food and clothing co-ops rather than giving the food and clothes away. People love a bargain, so let them maintain their dignity while they get discounted help. This dignity thing is crucial – people would rather not have to ask for help.

Note, we cannot push people up the ladder. They must climb it.  A social worker I have advocated with used to say “we walk side by side with our clients.” The folks we helped are homeless working families. We had two keys – they received a subsidy for rent based on their ability to pay, but they had to plan, budget, get financially educated working with a social worker and attending required training programs. Our homeless clients had to be responsible for rent and utilities up to 30% of their income, which is threshold for housing risk. Another key is we measured success. Success to us is being housed on their own without help after two  years.

As a community and country, we need to better identify what we mean by success in our help for people in need. Also, are things like healthcare a right? Is food on the table a right? Is a roof over the head a right? What we need is better measurement of what we spend and how it helps. It actually is cheaper to provide housing to chronic homeless and partially-subsidized housing to those who are more acutely homeless (due to loss of job, reduction in hours,  loss of healthcare, problems with car, predatory lending on a car, etc.) than let them go to the ER or commit petty crimes and be jailed. People should know all homeless are not alike, so the remedies to help need to vary.

My former party likes to argue off the extreme anecdotes – the significant majority of people do not cheat the system, but the perceived thinking of such is much higher in Republican ranks. When I have spoken to church groups, chamber groups, rotary clubs, United Way campaigns, etc., I come across this bias which is firmly believed. Just last month, the US president announced curtailing a rule on food stamps which will put 3 million people at risk, as one man was able to purposefully game the system. Yes, there is a small percentage of folks that do that, but the significant majority do not.

What people like David Brooks, a conservative pundit, tout is a dialogue on what kind of country do we wish to be? Our economy is a fettered capitalist model, with socialist underpinnings to help people in need and keep people out of poverty. What is the right balance? Is it better to pay a much higher minimum wage or have a higher earned income tax credit, e.g. Is it better to have a Medicare for All system, subsidize those in need or have a free market system only? A factor in this decision is many employers now employ a larger part-time or contractual workforce (the gig economy) to forego having to provide benefits. This is especially true in retail and restaurant industries.

At the end of the day, Gandhi said it best – a community’s greatness is measured in how it takes care of its less fortunate. With so great a disparity in the haves/ have nots in our country, I can tell you we are out of whack as our middle class has declined and far more of them fell into a paycheck-to-paycheck existence. Ironically, even in the age of Trump promises, we have many people who do not realize they are voting against their economic interests. Doing away with the ACA and not expanding Medicaid are very harmful to rural areas, e.g.

So, I agree with Gandhi, Lupton, and Brooks that we need to help people, but decide what is the best way. We should measure things and adjust them when they get out of whack. It is hard to fix what you do not measure. The group I was involved with would alter its model, if the numbers showed less success than hoped. What I do know is over 80% of the people we helped are still housed on their own after two years of leaving the program. In other words, they live without a subsidy.

Finally, what we need most is for politicians to check their tribal egos at the door when they enter the room. Having been a member of both parties, each party has some good ideas, but both have some bad ones, too. I do not care what a person’s party preference is or if he or she is more conservative or liberal than me  (I am fiscally conservative and socially progressive), we need to use facts and data to make informed choices. And, continue to measure the results making modifications, if needed.

Dilemma

Rainy days and Mondays, especially today, get me down

Karen Carpenter sang “Rainy days and Mondays always get me down.” This weekend was a yet another sad chapter in America’s history. Plus, we learned 31 people died in a ferry capsizing in the Philippines. In California, an eroding cliff collapsed next to the shore killing three. And, Russia and China are coming down hard on protestors. These are signals.

In America, we have decided we cannot do anything to stop mass gun shootings. We have decided the politics are too hard to do the needed things that would help. We could start by acknowledging that we average 100+ gun deaths a day even without the mass shootings. Many of those deaths are suicides. Some of them are accidental shootings of kids who find a gun in the house. And, some of the homicides are due to mental health issues, lack of civil discourse, hate crimes, or drug crimes. The common thread is access to a weapon without better governance.

Yes, we must act on these signals. We must call hate speech on the carpet, especially if it comes from someone who is in a position of leadership. Dog whistle racism and xenophobia are fuel to a fire for some extreme thinkers. The ones who want status quo in gun laws will say “now is not the time” for change to gun governance. Apparently, “never is the time.” The ones who want status quo will say “that change would not solve this instance.” Yet, doing nothing at all is not solving much.

There are things we can do that, in sum, will help make a difference. If it saves a few lives, that is good. I want politicians to get in a room and I want them to check their politics. I do not care who wins and loses a political game, but it is obvious the dead people and their families are losing. It amazes me how little we did after Sandy Hook. We even had a conservative shock jock say for years Sandy Hook was not real. He is on trial for his hateful rhetoric for the damage he has caused to Sandy Hook families and should be.

The Philippines tragedy is terrible, but not getting much play here. It seems we don’t pay attention like we should when the weather sends us signals. Overloading ferries can be OK in calm waters, but it is a disaster when waters are rough, especially after two earlier ferries had issues. I think failing to heed signals causes far too many deaths. Here in the US, we are whistling past the graveyard in preface to the next infrastructure collapse. Around the world, we have signals telling us to plan ahead on eroding seashores, increasing floods with stalled and repetitive storm systems, increasing droughts in other areas and elongated and bigger forest fires. We need to act on these signals.

In Russia and China, the signals are telling us that we must not be like that. Civil protest is more than fine, yet we must emphasize the word civil. Yet, a regime that crushes the spirit of those who question things, is one that is sowing more seeds of discord, not fewer. A regime that squelches and controls the media is not one that wants to hear the truth. I am watching the mini-series called “The Loudest Voice,” about Roger Ailes and his creation of Fox News. He purposefully controlled what and how things were said, that he started believing his own BS.

Truth matters. Facts matter. Diligent preparation in the face of those facts matter. When people ignore problems, white-wash or deny the truth, and squash those who are trying to tell you those things, the future is hamstrung. As I say often, I do not care what people’s politics are, as usually they are a mixed bag like me, conservative on some things, progressive on others. What I do care about is when people ignore or massage the facts to make their tribe win. I a more concerned about the people who die, who struggle, who become infirmed, who are jailed inappropriately, etc. That is what our leaders should be concerned about and not spreading fear, hate and division to win an election.

 

Blue Cross Blue Shield of North Carolina ACA premium rate cut request

Earlier this week, Blue Cross Blue Shield of North Carolina (BCBSNC) has announced a request of a premium rate cut for the second year in a row under the Affordable Care Act. They announced a request of a 5.2% rate reduction for their 435,000 members and one of 3.3% for small businesses in the state. It would have been three years in a row, but as I mentioned in earlier blogs, the Trump decision to renege on paying insurers for absorbing co-pays and deductibles for people making less than 2 1/2 x poverty limit caused premiums to increase for all.

This shows the ACA is stabilizing for insurance carriers who have been at it a few years. It would be nice to get more carriers back in for members to have choices. Many left when the Senate, led by the GOP defunded the risk corrider payments to the tune of 89% of the adverse selection cost. These carriers left the markets with the US government owing them money.

These two efforts to dampen the ACA have gone largely unreported. But, there is one more which is critical that impacts premiums and threatens the entire ACA. The tax bill passed by the GOP led Congress eliminating an unpopular feature of the ACA, which required individual coverage. It was called the individual mandate. By obligating people to have coverage, it lessened the risk on the insurers which will keep premiums lower than they would be otherwise.

Here is what BCBSNC said in their announcement as reported by The Charlotte Observer.

“The rate of decrease requested for 2019 would have been larger, the company told the Observer in 201, if the GOP tax reform legislation signed by President Donald Trump hadn’t repealed the ACA’s individual health insurance mandate.”

Further, several GOP led-states are suing the federal government to rule the ACA unconstitutional due to the elimination of the mandate. The tax laws are complex, but it is going to end up at the Supreme Court. It is thought by experts this case is weak, but the Trump Justice Department has decided to not defend the law which helps so many. Ironically, this is happening as it stabilizes even more, the GOP lost seats because of their ham-handed efforts to repeal it and when some Democrats want Medicare-for-all.

The art of exaggeration

The following are paraphrases of actual quotes from a person known to exaggerate and even prevaricate. A famous comedian from the same area as this person noted three years ago that this was “schtick” used to improve your image.

  • I am the least racist person in the world,
  • I am a stable genius.
  • I know more about taxes than anyone in the history of taxes.
  • They love me in England.
  • My gut is smarter than an expert’s brain.
  • No one has treated Black people better than me.
  • African-American people love the job I’m doing.

These are just top of mind from a longer list of exaggerations. Often, these are said following scrutiny that he has brought om himself.

This last point is important as I have said repeatedly this person is his own worst enemy. Through exaggeration and prevarication, he is the biggest purveyor of fake news by far. Even when the news is good, he must make it better or the “best.” Things he must change are “disasters.”

Yet, exaggerating and lying is bad enough, in and of themselves, but become  far more serious when policy is set off one of the two. Here are some real examples that should concern us all.

  • He said eliminating the subsidy to insurers under the Affordable Care Act to repay them for co-pays/ deductibles they absorbed for people making less than 2 1/2 times the poverty limit would only effect their profits – this is not true, as the CBO said it would increase the US deficit by $10 billion per annum and increased premiums for all members.
  • He said the illegal immigrants were taking all the jobs and are the reason for the malaise in certain areas – this is a gross exaggeration, as the primary reason for job loss is technology gains and CEOs chasing cheaper profits by offshoring manufacturing plants.
  • He said to reporters in front of the Pakistan PM, the India PM asked him to mediate the conflict in Kashmir – this is not true and statement was made by the India PM within an hour to state “no such request was made” as well as the White House staff going silent on the issue. India is an ally and experts noted this was a slap in their face as Kashmir is hyper-sensitive.
  • He said it is OK to have trade issues with China as we are raking in tariffs from them in our treasury, a statement he has repeated multiple times, including yesterday – while tariffs are being collected, this is a lie that China is paying them; US importers are paying the tariffs and passing much of the cost to US consumers.

I could go on as there are many examples to choose – he promised a better and cheaper healthcare program than the ACA in the election, but it has yet to materialize, and he is advertising it again for 2020. What is it Mr. President?

Politicians, business people and marketers tend to exaggerate and even lie to sell their message. Yet, the people who track lying say the incumbent has lapped the field. By the way, a key message from the Mueller report is the president is not very truthful and his staff knows it. And, Mueller testified that Trump was “generally” untruthful in his responses to his questions.

Medical errors are a problem – here are some thoughts on how to reduce them

Earlier this week, a US health news piece entitled “In a review of 337,000 patient cases, this was the no 1 most common preventative medical error” by Meera Jagannathan was made available on msn.com. This article echoes the findings of two pieces I have referenced previously, the first, a book called “Internal Bleeding: the truth behind American medicine’s terrible epidemic of medical mistakes,” written in 2004 by two internists Dr. Robert Wachter and Dr. Kaveh Shojania. The second was the Leapfrog Study which looked at deaths caused by medical errors toward the turn of the century. A link to the recent article is below.

The article reveals the results of four medical studies that analyzed medical death rates from 2000 – 2008. Of the just over 251,000 medical deaths, 9.5% of the deaths could be attributed to medical error. In other words, 1 out of 10 deaths could have been avoided as they resulted from a medical error.

The article focuses on nine things that should be done to reduce medical mistakes. I will just list them, but please click on the article link below.

  1. Make sure you fully understand the procedure and why it is necessary.
  2. Brief the doctors on your allergies, health conditions and medicines.
  3. Don’t assume every provider has access to your records.
  4. Bring a friend or family member if the patient is not good with asking questions about what is happening.
  5. Keep close track of your medicines and results.
  6. Make sure the doctors and nurses wash their hands.
  7. Research wisely.
  8. Don’t be afraid to speak.
  9.  Ask providers what they are doing to prevent  mistakes.

The Leapfrog study noted three things to reduce deaths due to medical errors.

  1. Have complex surgeries performed in centers of excellence where they have done multiple hundreds or thousands of the procedure.
  2. While dated, poor handwriting of prescriptions or instructions caused mistakes. Most hospitals now have electronic orders, but be sure you understand what is being asked or prescribed.
  3. Make sure there are doctors on site and not just residents in intensive care units.

I wrote earlier about the book “Internal Bleeding,” so I provided a link below. Reviewing that summary and comparing to the above, here are a few more thoughts from that post as well as a few others thrown in.

  • write a summary of your and your family medical history
  • write down what your symptoms are – people see the white coat and forget.
  • if you are not sick or injured, the hospital is the last place you should be; some hospitals incent ER doctors to admit patients; ask questions about this.
  • know your environment; if you have bladder or some other cancer it may be environmental not familial. Bladder cancer is a bellweather environmental caused cancer.
  • ask for other pain medications beside opioids; they should be only used for severe pain and for short durations.
  • introduce yourself to all providers; make sure they know who you are.
  • Complete the prescription regimen and don’t stop when you are feeling better.

Medical professionals do not want medical errors either. So, help them help you. And, if you have trouble advocating for yourself, take a trusted person with you.

https://www.msn.com/en-us/health/health-news/in-a-review-of-337000-patient-cases-this-was-the-no-1-most-common-preventable-medical-error/ar-AAEGPVF?ocid=spartandhp

https://musingsofanoldfart.wordpress.com/2012/07/28/internal-bleeding-be-your-own-health-care-advocate/

A plea for progressive Democrat voters

The following plea is made by an Independent voter who has been a member of both parties. I am fiscally conservative and socially progressive. I am an advocate for the disenfranchised, environment and debt education. What all this means is I believe in helping people climb ladders, equal opportunity and rights, protecting our environment, but recognizing we have to pay for things.

My plea for progressive Democrat voters is as follows: If someone

  • cares about our global reputation and trade,
  • cares about good healthcare options,
  • cares about fighting climate change,
  • cares about protecting the environment and bee pollinators,
  • cares about our growing debt problem made worse by this president,
  • cares about civil rights and liberties for all,
  • cares about common decency,
  • cares about data-driven analysis, and
  • knows that our economy has been growing for over 120 months, only 30 of which have been under this president,

then please vote for Donald Trump’s opponent.

But. you must vote and not phone it in. Trump won in 2016 because he got people who were not crazy about Hillary to stay home or vote for Jill Flynn.

As for the Democrats – beating Trump truly is the major consideration. He is a clear and present danger to our democracy, our planet and even his own party. Please do not nominate a candidate that will not appeal to moderate Dems and Independents. Trump should not win this election if Dems do this. He can win if he continues to resonate with his race baiting and fear mongering of perceived evils of socialism and Dems nominate a George McGovern or Walter Mondale like candidate (please research how they did in the general election).

I am writing this to any progressive readers. We cannot be stupid about this election. Trump is beatable, but he can also win. Watergate was all about making sure Nixon ran against McGovern and not Edmund Muskie and getting dirt on McGovern once they got Muskie to drop out of the race (please research Nixon’s dirty tricks and Muskie’s tears of anger). Trump is more corrupt than Nixon, per conservative writer George Will – I agree. He will do everything in his power to lie, cheat and bully. Take that to the bank.

Finally, a note to all Democrat candidates – get every fact you can correct. Trump uses facts and truth as commodities – sparingly and only when they help him. But, even then he is prone to embellish his own role in good news. Fact-checkers have reported all candidates fudge the truth, but they also show no one comes close to Trump’s rate of lying. Do not be like that. Argue facts, diplomatically and forcefully. And, if anyone or group promotes violence in reaction to the hateful rhetoric, be quick to condemn it. Violence has no place in political discourse.