Curmudgeon's Corner

 

Two generations ago, our grandparents seldom, if ever, questioned the opinion of their doctor.  They may well have had serious concerns, but somehow those were not to be voiced in the presence of the doctor. 

One generation ago, we found that some of our parents would actually discuss their situations with the doctor and ask about other treatment possibilities than that which had been prescribed.  Even then, there was real hesitancy to even think about such a “confrontation”. 

Today, many of us are comfortable in taking a very active role in our personal health even to the point of discussing it with our physician counselors on a proactive basis rather than simply a reactive basis.  We have access to a wealth of knowledge via The Internet; knowledge that was simply not available to our parents and grandparents.  In some cases this has created more sophisticated hypochondriacs, and in other cases it has created informed patients who take a very active role in their health care.  

Some old school physicians are still not comfortable with this new era and with outspoken patients.  Others embrace the involvement of the patient since they had been trying to foster that for years and years recognizing that a willing and compliant patient stood a far better chance of speedy recovery than did a “doubting Thomas”. 

This represents a part of the changing health care scene.  It is a glimpse into the future of health care when we’ll all have the opportunity to take a very active role in our personal well-being…and in which we’ll be very nearly expected to participate as an equal partner. 

The current movement toward “transparency” in pricing and in outcomes is the beginning of a sea change in health care.  Whether or not we like the idea, we will be required to exert more and more personal effort in keeping ourselves healthy.  We’ll take part in health risk assessments; we’ll have personal health desktops; we’ll have personal health care coaches that will monitor our progress toward achieving our predetermined personal goals. 

Our health care costs and outcomes will be favorably impacted by our results.  We’ll be given credit for our accomplishments above and beyond the simple fact that we’ll live longer, healthier and more productive lives than our preceding generations.  Already, health care breakthroughs have accounted for significantly extended life expectancy.  Life insurance costs have been reduced due to this.  We are now on the way to making qualitative improvements in addition to pure quantitative improvements in our lives. 

We must become active patients, however, to assure this outcome for ourselves.  Simply going along for the ride through our lives is not sufficient.  Not from my point of view anyway!

In an earlier blog, I discussed the impending release of Billy Lee Morford back into society with no monitoring by the state. He was still in the system at that point, but it seemed quite clear that he would be released.

He was released from state supervision on December 26th last year and was required to find a new place to live since he had been living in a state-provided home in Milwaukee.

He found that new place on South 26th Street in Milwaukee and has complied with his release requirements by registering his address. He is living in a house that has been converted into four rental units. So who lives in the other three and were they aware of his history?

The other three rental units house families that have a total of eleven underage children. According to news reports, they didn’t learn of his presence until the question was raised by reporters.

So, not only is he no longer under state supervision due to our state laws but he is also within 25 to 50 feet of eleven youngsters! He was formerly prevented from being in close proximity to kids. He was forbidden from participating in the Halloween tradition of Trick or Treat. He was monitored closely.

Now, because the state couldn’t find doctors or psychologists that would testify that Mr. Morford was more likely to re-offend than not, he sits in the midst of three families and their eleven children.

He is ill and has been told that he has a year or so at the most to live. Maybe he is too ill to even think of those youngsters. It is true that he needs to live somewhere. It is true that the state now says he has paid for his crimes and is no longer the threat he was once believed to be. It is true that some seven or eight doctors or psychologists have testified that he is less likely rather than more likely to offend in the same manner again. It is true that the law says the judge had to release him.

All this is true, but is it right? Only time will tell. And, if Mr. Morford doesn’t re-offend before he meets his maker, then that situation will have been resolved with no more anguish to kids or their families. But then what about the next person released in the same manner, and the one after that and on and on?

It doesn’t seem proper but I’m only a citizen and not a doctor or psychologist with the training to be able to tell others what is right. I sure hope their training qualifies them to make these kinds of decisions…even though the “more likely or less likely” test seems very vague and subjective from my perspective.

While this case is situated on Milwaukee’s South side, who is to say where the next will be? Maybe Germantown or maybe Menomonee Falls or...?

We often hear about “special interest groups” trying to influence decisions especially during the debate on the health care “crisis” that I mentioned in my last blog. Special interest groups have gotten the reputation of being somehow improper or part of something almost subversive in nature. Somehow many of us have been conditioned to shudder whenever we hear the term “special interest group”.

There are some special interest groups with which I take exception and there are other special interest groups with whose positions I concur. I am an intentional member of some of these groups. I am also a member of other special interest groups without even being aware of the fact.

Let’s take a look at some of these special interest groups. The list is almost endless, but here are a few examples. If you are a union member, you are part of one or more special interest groups. If you are a member of a local organization such as a Chamber of Commerce, you are a member of one or more special interest groups. Nurses, insurance agents, church members, homeowners, tire dealers, tavern owners, pharmacy companies, police officers, golfers, AARP members, auto club members, teachers, and parents belonging to a parent/teacher organization are part of a special interest group.

My point is this: each of us, whether we know it or not, is likely part of at least one special interest group. Some of us are members of such groups because we chose to be and, as mentioned before, others of us are members of such groups unknowingly.

When you hear a news commentator or a radio talk show host talk about special interest groups, remember that you’re probably part of such a group whether or not that is a specific group or family of groups.

What does all this have to do with the health care debate? It means that just about every position that is advanced will favor one group over others. It means that the members of a particular group are trying to protect their interests. This often also means that the interests of other special interest groups will be subverted. It means that politicians who have accepted donations from one or another of these groups may have more at stake then you or I understand.

When more than 15% of our country’s gross national product is in play, there will be some very tough fighting going on behind the scenes. This is really brought to light by the recent combination of several special interest groups that have heretofore been opposed to each others' position. These groups include an insurance company group, a labor union group, and a “family values” group. What are we to make of this alliance?

For one thing, we can safely conclude that not only does politics make for strange bedfellows, money does as well! Remember that, in spite of the rhetoric, the bottom line is about the money and in whose pockets it will be found when the dust settles. That is not to say that the health of we Americans isn't an important part of this debate, it is just that money is always a part of each position that we see staked out. We risk being greatly disappointed if we are not constantly aware of this truth. There are indeed times when to be a cynic is a wise thing.

We in America spend more on health care for every person in the country than does any other country in the world. Arguably, we have the best health care available to us although in certain other countries some outcomes are better and some techniques are more efficient. We have heard the drum beat about a “health care crisis”, yet our health care is the envy of the rest of the free world.

Our state and our nation are re-entering the arena of debate on both health care reform and on the reform of the health care delivery system. These are two different issues although they tend to nearly always be framed together in the press and by the politicians seeking to make the changes.

Health care, from my perspective, is about how our care is delivered. It is about who provides the care and in what setting using what tools. It is about what medicines and therapies are employed, and at what cost with what effectiveness.

Health care delivery, from my perspective, is about who owns the facility. It is about the proliferation of health care facilities even where it seems the need is being satisfied. It is about the insurance policy (if any) and who pays the premium. It is about what appears to be the cost to the end-user and what it actually costs the end-user. It is about “out-of-pocket” expense, how long we wait for appointments and so on. It is about health care for the uninsured whether they’re uninsured by choice or by circumstances beyond their control.

These two pieces of the “health care” pie are very much separate and distinct. Sometimes those who speak or write will combine or confuse these things based on ignorance. Sometimes those who speak or write will combine or confuse these things based on knowledge and their attempt to twist a certain outcome in the minds of the audience. The "health care crisis" is more about cost and covering the uninsured than it is about health care.

Our job, yours and mine, is to understand the difference, and to learn how best to get to the bottom line as it concerns us. Our job is to avoid reflexive reaction, and to study and hold our tongues until we’re pretty sure we understand the subtleties and nuances. We’re going to need to know who the speaker is and who is being represented by the speaker. Not everyone in this debate will be someone whom we can all take at face value. To do so would be to play the fool…and none of us can afford to be fools in the discussion of something so important.

The recent Wisconsin Policy Research Institute (a not-for-profit institute established to study public-policy issues) report points out that our health care system is complex. It is an imperfect market that relies largely on third parties for payment thus eroding the incentive for both consumers and providers to economize. This is likely a better definition than any other of the "health care crisis".

To help you understand my biases, I operate a company that serves insurance agencies, employers and employees with online enrollment services for employee benefits. I am a licensed insurance intermediary in Wisconsin and have been for a long, long time. I do not sell insurance although I maintain my license to stay aware of what is happening. I do have “skin” in the game just as you have. I am a consumer of health care.

I intend to spend some time in this blog over the coming weeks to discuss this subject and the things that are newsworthy at the time. I invite your e-mails so that we might establish a dialog. Your questions are as important to me as are your comments. Please let me know who you are so that I may be as informed about you as are you about me.

In the final analysis, changes are very likely to be made and we all should be participating in the process since we’ll all live with the results.

As a sometimes passenger on Midwest, I am in love with the two abreast seating profile and the extended leg room I get on every flight. The cookies are nice but I am one of the very few who actually refuse them more often than eating them. Now you understand just how confused I am.

I could not help but see the full page advertisement from the president of AirTran telling us how great they are and thanking all the local folks who are supporting their attempt to take over Midwest. I presume the list of local folks is relatively small although Midwest stockholders could see an opportunity for a cash-out that would pay something of a premium.

And just today, January 11th, the all out assault has begun. AirTran is now going directly to the stockholders to force the take over. They have issued another offer of cash and stock equivalent to $13.25 per share. And the buzz has picked up considerably. Talk radio was all over the latest offer. Local business leaders were consulted and opined as to the situation. Some resented the take over attempt and others seemed poised to take their profit and run…after a few more run ups of the offer.

Instead of the monetary side of the equation, I find myself thinking about what Midwest might become if it were acquired by AirTran. The obvious things would be seating changes (and not for the better), loss of the major local presence with some of the jobs (even though AirTran professes otherwise at this time), loss of the wealth of direct flights that are the envy of every city the size of Milwaukee (we’d be connecting through hubs that are hundreds or thousands of miles away if AirTran succeeds), and so on. A bleak picture indeed!

I happened across the AirTran “on time” arrival statistics on the Department of Transportation’s website some time ago. I noticed that Midwest was not included and asked them to provide me that information for comparative purposes. They had no idea of my position and, in spite of that, they worked for several days to get me what I’d requested.

The time period in question was October, 2006. The numbers, using the same comparative basis look like this:
All Carriers: 72.91% On Time
AirTran: 67.12% On Time
Midwest: 73.30% On Time

Now there are a variety of reasons for late arrivals such as the “domino effect”, Air Traffic Control-induced delays, maintenance problems, weather-related delays and so on. And, in fairness, AirTran flies more daily flights than does Midwest. However, this simple comparison illustrates what I’ve come to expect from Midwest and no other airline. They care and they prove it!

I cringe at the thought of losing Midwest and of having it replaced by AirTran. Maybe it will happen and maybe it won’t. Too often, however, the initial suitor in these take-over attempts simply succeeds in putting the unwilling victim “in play”. Once in play, Midwest is swimming in troubled waters. They become the target for the rest of sharks closing for the kill. I am troubled that, sooner rather than later, one of our great local assets will disappear.

Every time something like this happens our state takes a hit and our community takes a hit. Our direct flights will go away. Jobs will go away in spite of the conqueror’s protestations to the contrary. Fewer new employers will seek their futures here.

I am a fiscal conservative, but I still hurt when I see a travesty such as this dressed in the clothing of “we’ll make improvements” and of “there’ll be no job losses” and of “we’ll improve your flight experience”. AirTran, and its president, know better but that does not stop them from the proclamations that seduce the buying public and cause the stockholders to revel in new found profit.

And at what cost?

As I course through each day, I recognize those about me (they’re easy to identify) who exemplify the adage you’ve probably heard before: Be the Best You Can Be.

Be the best you can be at whatever is your calling at that particular time in your life. It matters little what you find yourself involved in, so long as it’s legal.

What matters is what we make of that particular opportunity. Some recent examples have stuck with me for a couple of weeks and needed to be acknowledged:

…the Waste Management driver who saw me at curbside on “pick-up” morning after Christmas and who gave me a cheerful smile, a wave and a “have a great day”. He was doing his best to be the best.

…the young lady who was my waitperson at the local Uno’s establishment, who bubbled over with enthusiasm, was obviously excited to be serving my wife and me, and who enjoyed who she was and what she was doing at that particular time.

…the local custard stand owner who is the epitome of the adage.

…the tellers at my local MidAmerica Bank who always have a smile and a warm welcome as I walk up to their window or see them through the drive-thru window.

…the young lady at our local Post Office who has a cheery “good morning” or “good afternoon” coupled with a genuine smile as she does whatever it was that I requested.

All of them remind me of what I was admonished by my father, and of what I constantly tried to drive home to my loved ones as well as to those I’ve had the good fortune to be associated with over these many years…it makes no difference what you are doing so long as you strive to be the very best you can be while doing it.

It shows and it ought to be welcomed by each of us, even though we may not take the time to respond in a similar manner.

Why not take that extra minute to acknowledge him or her the next time you meet one of our local “best”?

I gave up on the classic resolution many people make at the start of each New Year. Why? Because, I didn’t keep the vast majority of the resolutions I made and only felt guiltier after breaking each resolution than I did before making it.

Instead, I adopted the “all things in moderation” approach to living. I try to live life one day at a time. I don’t always succeed, but at least I don’t beat myself up over it as I once did.

There is a reasonably new Website that I find of great value. It is called Real Age and is found at www.realage.com on the Internet. I am told it was a feature of one of Oprah’s shows. I was introduced to it by a speaker to whom I listened at a recent convention.

There is a little work involved. If you choose, you can answer a series of questions. As you answer those questions, you’ll see a “real age” indicator beginning to appear periodically. When you’ve completed the full questionnaire you will be given this site’s estimation as to your “real age” versus your chronological age. Some people will be older in “real age” while others will be younger in “real age”.

As you make some lifestyle modifications, if you choose, you can go back and change some of your answers. As you enter these changes, your “real age” either increases or decreases. I find this is the sort of scorecard that makes me aware of self. I’m not the best role model in terms of my habits, but I am shown as about 10 years younger in “real age” versus my chronological age. Whether or not that is factual makes little difference since I feel younger and, therefore, I act younger. I don’t complain so often about aches and pains. I find myself actually thinking about some of the things I do to and for myself each day. I exercise on a regular basis. I did little of this before.

Beyond the age reference, the site generates e-mails to each participant based upon the needs they’ve identified during completion of the questionnaire. I identified three particular areas and now receive e-mails concerning one or more at least weekly. It helps me to keep these things in my consciousness.

Maybe you, too, can eliminate the guilt of broken resolutions by visiting Real Age and adopting the “all things in moderation” approach. If it has worked for me, I assure you it can do so for you.