~synthesis~

absurdity

The recent healthcare debate has been angst-ridden to say the least. With something this big, everyone's bound to have issues, and compromise is the word of the day. But there's a limit isn't there?

The New York Times singled out two constituencies today - overweight people, and people who care about abortion rights. The "fat pride" [their phrase not mine] people argue that being heavy is not unhealthy (!?!). According to Linda Bacon, a professor of nutrition at City College of San Francisco, “What we’re doing in public health care policy is harmful. We give a direct and clear message that there’s something wrong with being fat.” The Pro-Life people argue that the government should not fund abortions because they are morally opposed to it.

The Center for Disease Control and the Office of the Surgeon General say that obesity is unhealthy, increases the risk of other diseases, and requires more medical intervention over the life of the patient. These are not guesses, there is data to back this up. Of course we're giving a direct and clear message that there's something wrong with being fat! What kind of moron (other than Ms Bacon) would say that's a bad thing? And yet, we have a huge (sorry) lobby that's now actively pursuing this agenda! Given how politicians whore themselves out to lobbies with voters, I have no doubt that we will see some Congressional panderer put forth a bill making obesity an American right.

IMO societal obesity is a failure - but our focus should be building a culture of health and fitness in our children. That's how we change things.

People are discriminated against based on how they look; obese people are obviously so, and therefore subject to discrimination. This is inexcusable. BUT - let's not mistake anti-discrimination as reason to argue that we should encourage obesity! Jeez!

In 1973, the United States Supreme Court held that a woman may abort her pregnancy for any reason, provided that the fetus is younger than 24-28 weeks (after which it is deemed to be viable - able to survive outside the womb). After 24-28 weeks, abortion must be available when needed to protect the woman's health. 

IMO every abortion is a failure - but our focus should be on preventing unwanted pregnancies. That's how we change things.

The Supreme Court is the law of the land. If the law of the land states that abortion is legal, then how is it possible that the government's health insurance plan won't cover it? If a healthcare bill does get passed, I hope someone appeals this exclusion and that the Supreme Court has the fortitude to hear the case.

But this is all just sophistry. Here's the real absurdity:

The greatest impetus for healthcare reform is neither abortion nor obese people - it is serving the millions of citizens that don't have access to medical care. It is recognition that these un(or under)-insured Americans ought to have access as a matter of societal rightness. I couldn't agree more - a society is formed when people want to live together for mutual benefit; it is when the community works together to care of the one. IMO this is at the core of being human.

Which segment of society is more likely to be obese? Which segment is more likely to have an unplanned pregnancy? I'll give you one guess.

"Democracy" is a powerful word. According to Webster, two definitions are: "a government in which the supreme power is vested in the people and exercised by them directly or indirectly through a system of representation"; and "the absence of hereditary or arbitrary class distinctions or privileges." Both American political parties are supporters of the democratic ideal - this is a big part of American foreign policy - bringing lawful democracy to those that don't have it. But when it comes to their own citizens, elected leaders on both sides of the aisle are flaunting both their own laws and the essence of democratic equality.

The absurdity must end.

define winning

When a good leader embarks on a journey, he knows why they're going, where they're going, and when they'll finish. The goals and outcomes are clear. Achieving them is a matter of execution and circumstance, but beginning with a clear statement and vision of what success looks like is crucial.

Seth Godin wrote about the problem with transoms being that it's too easy to throw stuff out there in the hopes that something sticks. He argues that without credibility you will likely struggle to make yourself heard above the fray, that companies could make it easier for people to share ideas with them, and who knows what could come of that?

It underscores idea that good leaders know their destination when they embark. If you want your idea to be heard, or you want to be open to new ideas, create the circumstances to ensure that you will get what you want. Don't just hope that good things will come.

But in our world, the focus all too often is on the symptoms and processes and not the underlying cause or the eventual outcome. Your odds of blundering into a good outcome this way are infinitesimal. This is why so many people feel like their company or government seems to relentlessly churn over the same ground every bloody day. There is never real progress, just "metrics that show progress." It really does suck to be us, and worse, we don't seem to be able to get past the suckiness.

Take education - what is the goal? Is it happy teachers? Beautiful schools? Quality curricula? More budget? Competition with other countries? Improved assessments? What about healthcare? What outcome do we want to create? Is it happier doctors? Cheaper medicine? One payer? Happier insurance companies? Universal access? Better hospitals? More innovation?

In both cases, we rudderless because there's no clarity about the end goal. Shouldn't education be about ensuring that every child is best-prepared to excel in whatever future they choose? Shouldn't healthcare be about creating the healthiest society possible? Why don't we measure effective education by what students are capable of doing after they graduate? Why don't we measure effective healthcare by how infrequently people need to go to the doctor?

Without clear guidance, a team flounders. Without clear guidance, a nation can flounder as well. Take the "war" in Afghanistan. What is success? Is it the eradication of the Taliban? I despise what they stand for, but that feels awfully like extermination, or genocide. The Taliban are a socio-political faction in Afghanistan. Others might not agree with their principles, but that doesn't mean anyone has the right to erase its member from existence. I know many people who are passionately opposed to President Obama and the Democratic Party, or Gordon Brown and the Labor Party in the UK, or whatever, but I don't see those opponents building a military machine to exterminate them. We are civilized ...aren't we??

Is it the eradication of Al Qaeda? Terrorism is the use of violence to provoke social change - this is a criminal act, requiring a police force not a military. You don't stop violence with violence - you feed it. It is exactly the reaction they are looking for, and exactly what they can then use to recruit more poor and desperate people to their cause. Racism is a form of terrorism, but Martin Luther King Jr. taught us that "Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that."

If the goal in Afghanistan is to exterminate a political party, we should stop and ask ourselves what that says about us. If the goal is to eliminate terrorism, we should stop and ask ourselves how that work began in the United States of America with the (ongoing) elimination of terrorism against black (and other) people.

Frank Rich's OpEd in the NY Times compares (as many others have) Afghanistan to Vietnam - wondering if we will make this same mistake yet again? I see that the President is taking a step back to deliberate. It is true that Al Qaeda attacked America, but they are a band of criminals, not a sovereign nation.

I hope at a minimum the President's deliberation yields a clear statement of the meaning of "winning"; but I really hope he realizes that the only nation that has declared war thus far is America.

dropstop

Eli Broad has put a ton of philanthropic energy and money into education; his foundation's site has some interesting statistics:

1. 1.2 million students drop out of high school every year, 44% of dropouts under 24 are jobless
2. Dropouts pay less taxes (costing the Feds potential revenue), and 65% of US convicts are dropouts
3. It costs $12,956 more per year to house an inmate ($22,600) than educate a student ($9,644)

Assuming dropouts only spend two years in jail over their adult lives, then each dropout costs the government $45,200 + $? in arrest/court costs + $? in lost tax revenue = $100k (guessing $5,000 in arrest/court + $50k in lost taxes). I think the actual costs are much higher, but let's be conservative and say it's just $100,000 per dropout over their lifetime.

This means every year, the American government (American taxpayer actually) takes on an increased burden of $78 billion dollars just from the 65% of dropouts who will become convicts. Just for the dropouts since the year 2000, this burden over their lives is over $700 billion. To put that in context, the annual operating budget for education is $450 billion, which serves almost 50 million students. [See update below.] I couldn't find the data I wanted, but still believe that the burden on society is significant enough to warrant the investment below. 

Why do students drop out of high school? The three most frequently-cited reasons are: family issues ~25% (pregnancy or becoming a parent), employment ~32% (couldn't combine school and work, or needed to get a job), and motivation ~69% (didn't care, no-one pushed them). How about this: two thirds said that they would have tried harder if more was expected from them (i.e. someone cared).

The National Dropout Prevention Center proposes fifteen strategies for improving graduation rates (about twelve too many); if I were to pick three, besides the obvious ones (centralization and teacher improvement), my third pick would be mentorship, or as I proposed, "minternships."

I recall hearing about a Big Brothers Big Sisters study that said effective mentorship requires a minimum 18 month commitment; less can actually do more harm than good. The quality of the mentor is of course also a critical factor. But if you're good and you stick around, the results are strong and positive - the mentee is more likely to complete and graduate school, etc.

Is there a common thread among the three main reasons kids drop out? They're not being counseled well about family planning, birth control, safe sex, etc.; there are no clear options for financial support for children in high school; there's no-one who believes in them, encourages them, and provides them with a model of how to achieve gainful employment. There doesn't seem to be one, but I think we can create it :-).

Let's build a formalized mentorship program (using the Teach for America concept, we could call it "Reach for Americans") where students are able to receive not just counseling and support, but also a stipend (for community service or internships that pays enough to prevent the need to get a job). The mentorship must focus on both family planning/sex ed and of course motivation, support and inspiration to stay in school, graduate and succeed. Let's not make Reach for Americans (or whatever it'd be called) a .org - let's instead make it a .gov, that way it's not beholden to fund-raising, and students can count on the counselors being there always.

The program should begin early - say at age 8, and continue through high school graduation - this would get expensive (but I bet we'd not only improve graduation rates, but also student performance, and hopefully in a generation be able to claim that families were elevating themselves out of poverty because their children were graduating high school (potentially going on to community college or university), and earning a family wage. This organization might also become a student advocacy group, and argue for student rights across the board, but particularly in low-income communities.

The business case is clear, the outcomes could be significant - I think we should pick a state and give it a try.

UPDATE - I realize (thank you everyone for your emails and comments!) that I made a false assumption above - 65% of criminals are dropouts, not 65% of dropouts are criminals. I will correct this this evening.

outcomes!

Have you noticed that in most big projects you're a part of, success is measured by solving symptoms instead of creating outcomes? Off the top of my head the best example of focusing on outcomes is President Kennedy's proclamation: "I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the Moon and returning him safely to Earth."

JFK didn't talk about how it should be done, whether we'd use rockets or levitation, whether we needed bipartisan support, or anything else that reeked of symptoms. The outcome was clear, and while many thought it unattainable in 1961, the nation (and the world) held onto the goal and found a way to make it happen.

Seth Godin's post on positive thinking has a similar feel to it. We all suffer from NIH (Not Invented Here) syndrome, our natural reaction to someone else's ides is "why it won't work" vs. "let's give it a try!" This tendency creates barriers to outcomes that can become insurmountable, because for some reason, it's easier for us to believe in "no" than "yes." It's of course much easier to say why it won't work than participate and help create the outcome. Think of every "official opposition" in politics, and even why more candidates argue against their opponent than for their own ideas.

Health care in America is one example of this. Understandably, there is intense debate on this topic - it's complex, rife with vested interests, political rhetoric, and sadly, outright lies. The difference between health care and putting a man on the moon is that the former has been around for ages, affects everyone, and has a direct effect on each of our wallets. The latter had none of those constraints. These are all of course excuses for why we can't fix it...

What if President Obama's inaugural speech had said: "We will have universal health care in America while reducing overall costs before I complete my second term as President." (Note presumptive close on 2nd term;-))

The mandate does not require that we emulate European or Canadian systems, or that we will have a public option, or that we will cut this or increase that, or anything like that. As with JFK's mandate, the "how" is left up to the experts. The only constraints are what (universal health care), when (in 8 years), and how much (less than today).

Is it possible? I think so. What would this uniquely American health care system look like? I have no idea, Would there have to be compromises? Almost certainly. Does this country have a history of rising to the occasion? Yes.

I'm reminded of the scene from (ironically) Apollo 13 - see video to the right - where the NASA team had a problem to solve. The CO2 scrubbers on the ship were damaged. The team of engineers was essentially locked in a room, given exactly what the astronauts in space had at hand, and a deadline. Guess what as in the movie, they solved it in real life too.

Having no expertise in any aspect of health care (other than being a reluctant customer), I may have some ideas, but don't know enough about medications, insurance, HMO vs. private care, the role of physicians, nurses, etc. to respond intelligently. But I think if you put all these stakeholders in a room, lock the door and give them a deadline, we might get somewhere.

If I were in their shoes, I'd start with this: the system today succeeds when more people are sick than when less people are sick. Rather than figure out how to fix health care, why not look at what it takes to create a substantially healthier America??

uniting divides

Why is abortion such a pivotal and polarizing issue in the United States? Why doesn't the death penalty get the same level of attention? If one is deemed murder, how is it that the other is not?

Pro Life proponents argue that abortion is wrong because life is life; that from the moment of conception, a fetus is alive and human. While I get that capital punishment responds to a criminal act, if life is life, then killing is murder - period. No life (irrespective of how good or bad it is) should be ended, and society is equally guilty of murder if they employ the electric chair or an abortionist. Why then doesn't the Pro-Life movement fight the death penalty with the same vigor?

By the same token, why doesn't the Pro Choice lobby advocate for the death penalty? Why are they not also proponents of euthanasia? Why is their energy not equally applied to all forms of life-related self (or societal)-determination?

Similarly, the equal access to marriage debate (exemplified by Proposition 8 in California) is also polarizing but flawed. If all men are created equal, then how is it possible for a law to discriminate against some but not others? Moreover, how is it possible for a law (Proposition 8) to exist claiming that it protects the sanctity of marriage, and yet there is a sister law (divorce) that facilitates dissolution of this "most sacred institution"? How is giving people a legal "out" to marriage an acceptable compromise, but allowing "different" people to get married wrong?

What about rape? With mandatory sentencing rules, it is possible for someone to get a ridiculous sentence for a relatively benign crime (like Billy Ochoa a drug addict who at 53 was sentenced to 326 years to life for welfare fraud totaling $2,100.00, yes - a lousy $2k), while David Harold E. Earls was sentenced to one (1) year in jail for raping a 5-year-old girl. [This just makes me want to vomit.]

It feels wrong that these other issues have such relatively small bases of support vs. abortion. Don't get me wrong, I'm not saying abortion is OK or trivial, nor am I advocating for one side or the other. I'm just trying to figure out why this one issue, which for decades has dominated American society, politics and jurisprudence, has no resolution, but rather an ever-rising level of angst and vitriol.

Einstein defined insanity as doing the same thing over and over but expecting a different result. This qualifies - both sides are insane and sadly, appear to have no intention of stopping the insanity.

Thanks to J.R., I first re-read sorry seems to be the hardest word, then read a John Baldoni post that J.R. referenced, and then listened to President Obama's Cairo speech. Like John, I was struck by this statement in response to another insanity:

So long as our relationship is defined by our differences, we will empower those who sow hatred rather than peace, and who promote conflict rather than the cooperation that can help all of our people achieve justice and prosperity. This cycle of suspicion and discord must end.

How true.

Is there anything that unites these two sides (Pro Life - Pro Choice) besides the word "Pro"?

I think there is - the unwanted pregnancy; irrespective of how it came about (consensual or otherwise), I believe both sides would wholeheartedly agree that it is a far, far better thing for all if the number of unwanted pregnancies goes to zero.

Then why not work together - Pro Life/Choice side-by-side - to educate youths and adults alike, to offer free and unencumbered (no strings attached) counseling, and to also provide free contraception to those that need it?

Their precedent is Portugal legalizing personal use drugs, causing overall drug use to fall dramatically.

Both sides would have a productive mechanism through which to participate and channel their passion. They would be able to measure success by helping more and more babies in this country and around the world be born to healthy, happy, willing, and prepared parents, thus eliminating the reason for fighting in the first place.

Imagine that.

Then imagine all of us together putting our energy and focus behind the next big issue, and then the one after that... <-- this is democracy in action.

criminal addiction

Former Seattle Police Chief Gil Kerlikowske was interviewed on the local NPR station yesterday about his recent confirmation as the new head of the Office of National Drug Control Policy (ONDCP). Kerlikowske stated that he was removing the phrase "war on drugs" from the ONDCP's lexicon which is nice, but he will not put decriminalization on the table, which is a shame.

America's obsession with criminalizing everything and putting all miscreants behind bars is well known, and has contributed to this country having by far the largest percentage of incarcerated adults on the planet (only 5% of the world's population, but 25% of the jailed population). The greatest contributor to growing the criminal ranks was President Nixon, who in 1969 declared a war on drugs, specifically against producers, distributors and consumers of substances including marijuana, cocaine, heroin, methamphetamine, and illicitly-obtained prescription drugs.

This morning I read an article in Scientific American on the impact of a change in drug-related legislation in Portugal. I didn't realize that for most of this century, Portugal has had the most liberal drug laws in Europe. I would have guessed the Netherlands; this very religious (mostly Catholic) and socially conservative country would never have occurred to me.

By changing the laws so that personal possession of drugs (including the ones mentioned above) resulted not in jail but the offer of therapy, Portugal was able to reduce the number of teens doing drugs, drug-related HIV infections, and most critically, more than double the number of people seeking treatment for addiction. Portugal has the lowest rate (10%) of lifetime marijuana use among EU countries with those over 15. The most comparable US statistic (for people over 12) is 39.8%. The Portuguese have done all this and saved money - the cost of therapy is lower than imprisonment, and with successful therapy, former addicts are able to become contributing members of society more quickly.

The ultra-hard stand America has taken during its 40-year war against drugs has resulted in four times higher use of marijuana compared to Portugal, who decriminalized drugs in 2001. Despite all of her efforts, America has the highest per capita usage of cocaine and marijuana in the world.

I suppose those in favor of current policy would argue that it would be worse if the laws were more lenient, that we should have even more stringent rules, and they'd dismiss the Portuguese results as an aberration, or those of a much smaller country that doesn't compare to the USA.

I think the current approach has failed; there are not only more addicts in this country, but we're spending increasingly more money only to achieve increasingly worse results. Change is required, and should have two parts:

I. Decriminalize

The US must decriminalize personal use of drugs. This must also apply to (and hence release) all those currently in jail for what is now legal. Like the Portuguese, panels (a psychologist, social worker and legal adviser) must be formed to handle every case, and the government must also ensure adequate treatment capacity for everyone who seeks it. This will end up costing less than the current cost of finding, arresting, prosecuting and incarcerating drug users. It will also free up the criminal courts to handle other cases, and reduce their backlog. The only losers will be the lawyers, and on this I agree with Shakespeare.

II. Control

This might be a tad more controversial. Paul Atreides (main character in Frank Herbert's Dune series) once said of another drug (the spice melange), "He who can destroy a thing controls a thing." In the same vein, the American government needs to think of alternative approaches to enforcing the production and distribution of drugs. Much of this begins outside the borders of America, which makes it very difficult.

What if the United States government became the largest (and only) domestic marijuana, cocaine and heroin producer and distributor in the country? They would be able to regulate production, quality, distribution and pricing. Imagine the impact. By out-pricing foreign suppliers, they could reduce the impact of players like the Central American and Afghan drug cartels. By controlling quality, they could reduce health risks; and by controlling distribution, they would eliminate a whole other tier of criminals.

Then we must use the profits to pay for therapy and addiction centers; contribute to national health care, education; and maybe even lower the deficit :-). I'm not saying the motivation for this should be revenue, rather, that the revenue should be put to good use, first to reduce the effects of drugs in the society, second to reduce addiction, and then to contribute to other worthwhile efforts if possible.

After blindly failing for 40 years, it's time we opened our eyes. Addiction is not a crime, but treating addicts as criminals is. We need radical approaches to solving the problem.

social darwinism

I'm not a fan of protectionism. I think that every business or industry must either thrive in the global marketplace or die. This is how we ensure sustainable businesses and a vibrant economy. You only have to look at the auto industry to see how protectionism and creating a false-economy (one, two, three) solely to support an expensive, unionized labor force were not sustainable, caused or perpetuated uncompetitiveness, and eventually resulted in failure.

Yesterday was a beautiful, warm, cloudless day here in Seattle. Hanging out at a nearby park/marina, I noticed two sets of parents with their infants - one was using an anti-bacterial wipe to sterilize a restaurant highchair, the other was feeding their child (overhearing this part) ultra-organic, home-prepared, "pure" baby food. Both parents had expensive strollers; bragged about their infant's already hectic schedules; and talked about how they were already looking at schools (or even home-schooling); and (this blew me away) bemoaning how careful one had to be to pick the right kids for play-dates. Next to them was a family that had just plopped their infant down (no autoclave in sight), and were feeding him restaurant-prepared junk food. The latter child seemed happy, energetic, inquisitive, looked around, laughed, etc.; the former two were both placid.

Assuming these "super-parents" succeed, their kids will never touch "imperfect" food, never inhabit "unclean" environments, have ultra-busy schedules (playing with the "right" kids in "appropriately-designed" play spaces), enjoy ultra-managed electronic access, and ideally never have an uncontrolled exposure to anything.

This is not new; a large class of baby-boomers have been raising children like this for more than a generation.

How are these kids acclimatizing to the real, post-pubescent, high school world? Being around people with different opinions, potentially more confrontational, competitive, angry, etc. will have an effect. Will their systems have the antibodies, immunity and resilience to eat in the real world? Will their bodies accept a non-hypoallergenic environment? Will they be able to adapt to dealing with "raw" situations containing stress, angst, happiness, lust, greed + alcohol, drugs, cigarettes, etc.?

Exposing children to the world suddenly, and now without the parental protection safety-net has resulted less healthy, uncontrolled, immature, binge-driven behavior in high-school and university (and beyond). Academic performance has declined generation over generation, as has the motivation to excel. Children today aspire to be so much less than their grandparents and parents - you only have to look at relative academic performance to confirm this.

Can it be because their parents coddled them to the point where they have no motivation to achieve, nor do they fear failure?? After all, their parents have always been there - haven't they?? They expect to be happy, successful and healthy, because they've never known any other reality.

I think well-intentioned "super-parents" (like their NHTSA & EPA counterparts) may be doing their children more harm than good. I hope modern American children are not already down the path of suffering the same fate as General Motors, that like GM they're so close to action, and have so much social inertia that they are unable to see the forest through the trees.

We must expose our children to the real world; build up the physical, intellectual and emotional antibodies and resistance that will enable them to participate; and create the stress, team-orientation and competitiveness that will best-prepare them to not just survive, but aspire and thrive.

A Heathy Earmark

Harvard Business Publishing's recent Daily Stat was one of those that amazed; it quotes a McKinsey report that 34% (yes, more than one-third!) of Americans are considered obese. This represents over 100 million people! Worse, this has doubled since 1980; so in the last 30 years, the number of obese people in the United States has gone from below 50 million (bad) to more than 100 million (horrible).

I wrote about preventative health a little while ago, where I related that we spend $2 trillion on health care in this country.  Someone who is morbidly obese (40+% Body Mass Index) is part of the fastest growing segment of the obese (mind-boggling) requires about $7,500/year in health care costs, almost twice what a non-obese adult costs. If we were to go back to the obesity rates of 1980 (just below 17%), we'd save the country $60 billion! That's on top of the $40 billion that Americans spend on trying to get thin in 2004. I'm guessing it's higher now.

In many cases, obesity is involuntary, due to medical causes. I figure (and I'm just guessing) that accounts for 15-20% of the population. Which leaves 80+ million people who are able to do something about their weight, and avoid the fate of being unhealthy, having a poor quality of life, and maybe even being unhappy.

Most of the 80 million people are adults; they are set in their ways, and would struggle mightily to alter their lifestyles and diets to regain their rightful shape, though this is not to say they shouldn't try. But I bet there are at least 15 million children who are obese or morbidly obese in this country, and for most of them, habit is not a problem. They can be helped.

What can be done? How can it be done at scale?

One obvious place to start would be the schools. And there, three things come to mind:

1. Improve the quality of food in the cafeterias and vending machines - only natural, healthy food allowed.
2. Change the rewards that teachers give students for doing good work, no more candy or sweets.
3. Require extensive physical education curriculum, and make it mandatory for all grades in every semester - every student must get exercise for at least an hour/day.

Each of these can easily be implemented, and end up saving money! The problem is, they will cost the education system money but save the health care system more. While this creates a net positive effect, the problem is that the education system is already strapped, and are over-budget already, and simply can't afford to add new dietary programs and physical education classes.

Well, can the health care system (public and private insurance carriers, etc.) just pay to do these three things in all public schools in the country? Think of the PR boost they would get, the amount of focus this would get in the national ethos, and hopefully how it might inspire those not in school to also evaluate their lifestyles? Remember that they'd actually come out ahead by doing this.

Imagine

Imagine if kids didn't need to bring lunch from home because a healthy lunch was available at school. Imagine if each child graduating from secondary school could run a 10K, play a team sport or do something else that demonstrated their fitness.

Imagine that after graduating, young people hate the idea of not exercising every day, and abhor junk food? I know that some restaurants (if you can call them that) would not be happy, so be it. Imagine a situation where we didn't have the incidents of diabetes, obesity, heart conditions, cholesterol problems, etc. that beset so much of this country today!

Now imagine if despite doing all of this, the nation's economy was made stronger because we were spending less on health care, and our citizenry was healthier and more productive?

That's something worth fighting for.

How does one lobby Congress to put earmarks for education diet and fitness in health care bills?

A Pound of Cure

Newsweek reported last week about the work Senator Tom Harkin is doing to focus the Presidential Transition Team's healthcare portfolio on preventative care and wellness. Bravo to him!

The United States spends $2 trillion (yep, "2" with 12 zeros!) annually on healthcare, more than any other nation on earth (according to the WHO). And yet the US ranks 37th among nations in citizen health, and 20th out of the 21 industrial nations.

Some reasons:

1. Americans are about the unhealthiest people in the world
2. Americans are horribly lazy and believe that pills can cure bad behavior
3. Physicians in this country are paranoid about lawsuits and over-test, over-prescribe, and over-treat
4. Pharmaceutical companies know how good a thing they've got
5. Insurance companies are mind-numbingly stupid
6. The policy and regulatory machine is embarrassingly out of touch

I'm thinking that #2-6 have caused #1.

Senator Harkin is right - something needs to be done. It's a combination of health-conscious behavior with appropriate incentives for the machine. It surprises me that insurance companies won't pay for preventative care, but will happily cover the result of bad behavior. How bizarre!

I'm sure the insurance companies realize that if people are healthy, they will still get premiums but won't in aggregate have to spend as much? Wouldn't it be better to spend a little bit on everyone (assuring preventative healthcare across the population), and then benefit from not having to spend so much on the vast percentage of the population that gets sick because of bad behavior?

It's similar to the drug problem in this country. We spend $billions on the so-called war on drugs in the name of being tough on crime (another ridiculous concept), but don't realize that if we spent those $ on reducing demand by helping and curing drug addiction, we'd end up starving the suppliers. All without having to put people in jail, and instead helping people eliminate their dependencies and lead better lives.

This is classic of a system that is not interested in cause and effect, but simply patching symptoms.

This is an endemic problem, ranging from failing bridges, levees and air traffic control systems, to starting wars without thought to how they'll end, to badly-designed school systems, to borrowing without considering financial capacity, to poor health, to crime, to everything.

Oddly the population of this country seems sanguine about all this. There's no sense of urgency about fixing any of this. Why is that?

I wrote a while ago about how breast cancer can be managed through early detection and about how we're presently governed by a stunningly short-sighted leadership. It feels like this society only lives in the present, and is completely oblivious to anything that might happen tomorrow as a result of indifferent or bad behavior today.

What does it take to open our minds to the reality that you can only paint over the cracks so many times before the walls fall down?

I think the first step is for this entire society to abandon the idea that there is a free lunch for weight-loss. This (yet another) multi-billion dollar industry preys on people that think there's a quick fix.

Let us once and for all recognize the fallacy of fried chicken, pork rinds, french fries with gravy, apple pie and a diet soda?

No Breast Left Behind

Marisa Acocella Marchetto is a person I admire deeply. She's a brilliant author, she draws beautifully, and she's a breast cancer survivor with a sense of humor and a huge heart.

I happened to be in the right place at the right time in August, and met Marisa on the patio of one of my fave joints in New York, Da Silvano. She was kind enough to autograph a copy of her new book, Cancer Vixen.  If you have or know someone who has breast cancer (and lets face it, this is basically everyone), this book is a must for you. I read it and have shared it, though I want to keep my copy 'cause she signed it for me:).

We had a connection on that patio. When Marisa talked about her efforts to provide free mamograms via St. Vincent's Hospital in New York to women who can't afford it or whose insurance won't cover it, and how she wanted to take her program national, I did a smart thing for once, and offered to help.

And have I learned a lot!

More than 200,000 women are diagnosed with, and 40,000 die from breast cancer in the United States every year. Mammograms can detect a tumor up to two years before a breast exam would. If detected and treated early, 96% of women are cancer-free after five years.

What does this mean?  Simple: 38,400 women in America die needlessly each year from breast cancer.

That's just messed up.

You have to believe that early detection = less-expensive treatment cost too - that just make sense. I'm going to invest some energy over the next few weeks to find data to back this up.

Now what does this mean? Simple: if every woman in America gets a free mammogram, we will not only save lives, but also save the insurance companies and the government money!

What to do about this?

As a starting point, we need to raise awareness and make it possible for every woman in America (including the 13 million women over 40 that have never had one) get regular mammograms. Marisa and I came up with this tag line: No Breast Left Behind. Here's Marisa's blog entry, and here's the link to the American Cancer Society site where you can buy t-shirts! 

But this is just the beginning.

 Neither Marisa nor I view this as a philanthropic mission.  That's just a stop-gap. What we really need is a national mission to eliminate or eradicate preventable diseases. Breast cancer the first; it's prostate cancer for men [ASIDE: our tag line for this one is: Keep Your Eye on the Ball and I have no doubt Marisa will come up with a suitably irreverent design! ;-)]; for both genders and people young and old, we MUST address diabetes, especially type-2 diabetes, which is totally preventable!

I intend to write more about this as we learn more, but believe that with the new administration about to move into the White House, the economic crisis, the ever-rising costs of healthcare, and the fact that most Americans will suffer one of these (and other preventable) diseases, the time is now for us to get started.

This is not about raising money. In fact, this idea has the unique characteristic of actually saving this country and our heathcare system billions of dollars.  All it takes is an institutional willingness to listen, and a social culture of prevention.