Fix Health Care Before I Die, Please!

I've written once before about my concern over the way Health Care Reform is going. Or not going, as it should be more accurately described.

Frankly, it is a sad commentary on our political system that all the time and effort congress has spent on this issue may be wasted if, as now seems likely, no real change in our health care system happens. In particular I blame the obstructionism of the Republicans, though the stunning ineptitude of the Democrats is also a reason.

The Republicans continue to oppose the current health care bill, which no longer contains a government option as an alternative choice to corporate insurance, let alone any kind of proposal for a single payer system similar to France, Canada, Great Britain, and several other countries. Even the present proposal, Republicans argue, will be too expensive and will lead to too much government involvement in health care. The facts don't support either of these arguments.

There is abundant evidence that health care in America is inferior to that of the rest of the first world, and that we need to fix this -- assuming, of course that we believe our country should rank at least equal to other modern nations in providing access to affordable health care. In our local paper, West Hawaii Today, a recent letter to the editor captures much of my view so well I've reprinted it below.

Tuesday, February 16, 2010 8:33 AM HST Revealing the ranking

I'd like to correct Mr. Radmilovich's letter. The U.S. health care ranking isn't around 20th, it's 37th (World Health Organization). France is number one.

You might ask in what ways? How about hospital beds per 1,000 in population? France has 8.4, U.S. only 3.6. Winner France. Number of doctors per 1,000 in population? France has 3.37, U.S. only 2.3. Winner France. Life expectancy? France 80.87 years, U.S. 78.14. Winner again France.

As a matter of fact the only two ways the U.S. beats France in health care rankings is the percent of Gross Domestic Product (GDP), France spends only 11 percent, U.S. spends a whopping 17.2 percent -- and cost per person. The U.S. pays $6,096.20 per person, France pays $3,464.70 per person annually, That's $2,631.50 per person, or about 43 percent less than the U.S. pays, and France is number one and we are number 37. And France covers 100 percent of its citizens, while the U.S. covers about one in six of its citizens, (source, nationmaster.com)

This nation's four decades long experiment with "for profit" health care has been a cruel, inhuman, and expensive nightmare. And I don't see anything coming from either major political party that's going to make it much better.

H.R. 676 is the best way to tackle this mess, and nobody in corporate-owned Washington is saying anything about it.

Mark Stone

Kailua-Kona

So, let's see. France (and other countries with health systems ranked higher than ours) provides more health care to more people for less money. If we're so superior to the rest of the world, as the Republicans insist we are, then surely we can figure out a way to accomplish what .... pittooweey!....France has done. Please, let's get on with it!

I Got My New GPS!

In an earlier post I wrote about why I needed a new GPS. Well, Santa dug into his toy bag and brought me a new one for Christmas. Oh, yessssss! This baby will do practically everything except maybe tie your hiking boots. Speaking of hiking boots, maybe I should get a new pair to go with the upgraded GPS?..... Anyway, my hiking buddy from Oregon and I gave the new toy...er, TOOL, a good test last week, and I'm happy to report it passed with flying colors.

My friend and I are both the same age, which is the time of life when men still have the drive to do stupid risky things but have bodies that can no longer get them out of trouble when they do. For the past couple of years we have been exploring old lava flows here in Hawai'i. This is tough hiking, because lava cools to become razor sharp rock which will shred skin at a touch, particularly skin that now seems to bruise or bleed in a strong breeze. It is also often loose, jumbly, and uneven -- a particular challenge for those with a less than perfect sense of balance.

However, it also cools in some of the most fascinating patterns you can imagine. Like stone browny batter, with drips and drops, tangles and splatters. The patterns are endless, and each flow seems to have different characteristics that make them always fascinating to explore.

One of the features of lava flows here on the island of Hawai'i is that they often form tubes -- channels of lava that are completely enclosed and can be miles long. In fact, this is how lava can travel so far from the source -- the walls of the tubes insulate the molten magma so that it stays fluid. As an eruption dies down, these tubes empty out and leave tunnels that can be a real thrill to poke around in. Of course, it is also a teensy bit dangerous, which can make it all the more attractive!

Now, back to my GPS. When I got my new model I noticed one of its features is called "geocaching." I then learned that geocaching has been around for about 10 years, and according to Wikipedia, it is "...an outdoor activity in which the participants use a Global Positioning System (GPS) receiver or other navigational techniques to hide and seek containers (called "geocaches" or "caches") anywhere in the world. A typical cache is a small waterproof container (usually a tupperware or ammo box) containing a logbook. Larger containers can also contain items for trading, usually toys or trinkets of little value. Geocaching is most often described as a "game of high-tech hide and seek", sharing many aspects with orienteering, treasure-hunting, and waymarking .... Geocaches are currently placed in over 100 countries around the world and on all seven continents, including Antarctica.^[1] As of February 8, 2010, there are over 984,900 active geocaches over the world.^[2]"

It turns out that somebody hid a geocache near an unmapped lava tub about 30 miles from where I live and published the coordinates on Geocache.Com, I downloaded the position into my new GPS and my friend and I set out to find it. Yup, the new toy guided us right to the spot, requiring a hike across open lava, of course, and in an area that we would never have thought to look for a tube. When I say it guided us to the spot, I actually mean to the coordinates. As anyone who has had a senior (or junior) moment can attest, just because you're within 15-20 feet of something doesn't mean you can see it. I must admit there was a tad bit of luck in finding the actual box containing the cache -- if we had approached from a different angle we might have stood right over it and not seen it.

We then proceeded to hike through the tube, which required flashlights (next time we have to take extra batteries!) and a smidge of stupidity. Oh yes, and just a little bit of blood.

A Ray of Sunshine

It is easy to be very depressed these days. The economy is in the tank, congress can't seem to agree on the time of day, our country is in two costly wars that seem interminable, global natural disasters seem to occur almost daily, a number of world leaders are irrational and/or seemingly insane, and climate change threatens the future of the planet. In general, things are out of control and no one seems able to offer any workable, effective solutions to our problems.

Occasionally in all this gloom there is a ray of sunshine. One heart-warming example is in the work of a quiet, unassuming man named Greg Mortenson. Mortenson has dedicated the past 17 years of his life to helping people in Afghanistan and Pakistan better their lives in a way that costs very little money, is demonstrably effective, and probably has done more to blunt the power of terrorism than all the bombs and firepower we have expended in that area of the world.

Mortenson's approach is very simple: help local people build schools and train teachers to teach in them. "School" here is a modest 1 or 2 room structure that costs only a few thousand dollars. A local village supplies the land and the labor, and Mortenson's organization, the Central Asia Institute, provides the materials. It is a partnership that has produced 130+ schools, allowing for the education of 58,000 students, most of them girls.

The fact that most of the schools are dedicated to educating girls is remarkable, given that Afghanistan and Pakistan are Muslim countries. Contrary to our common perception that women are universally denied learning opportunities in Islamic societies, village elders have welcomed this and see it as a way to improve their communities. Indeed, there is a great deal of evidence that empowering women through education can be a very powerful positive force for change in third world countries. Mortenson has seen first hand the benefits -- for example in one case a young woman who attended one of these village schools was able to go on to obtain midwife medical training. When she applied her skills in her home region, the number of mothers dying in childbirth dropped to near zero.

Mortenson was initially viewed with suspicion and resentment, but is now highly revered throughout this area for his unselfish work and for his sensitivity to the culture. Last year Pakistan awarded him their highest civil honor, the Star of Pakistan, for his efforts to promote girls' education in rural areas.

Even our own military has come to appreciate Mortenson's unique knowledge and understanding of this region. Admiral Mullen, General Petreaus and General McChrystal have met with Mortenson and seem to be incorporating some of his ideas on how to win the support of the Afghani people. Mortenson's book Three Cups of Tea, is now required reading for senior military staff and Special Forces in Afghanistan.

A ray of sunshine indeed.

You can watch an interview of Mortenson by Bill Moyers for a closer look at this amazing man.

What Do Snow Birds, Humpbacks, and Cruiseships Have in Common?

Ah, winter. Love those change of seasons!

Living here in Hawai'i for the past 8 1/2 years has given me a different perspective on "seasons" and on what it means for them to "change." My wife and I lived for 30+ years in southern Ohio, near Cincinnati before coming here. Fall and spring were very nice. In the fall the color of changing leaves could be spectacular. In the spring the sudden reawakening of the land and the flowering plants, trees, and shrubs were deeply invigorating. But the weather for the rest of the year was varying degrees of yuck. Summers were hot and muggy, with violent thunderstorms and tornadoes. Winters were gloomy, clammy, and grey, with the occasionally blizzard or ice storm thrown in for good measure. Generally speaking about 3-4 months of the year were pretty nice, 3-4 were just tolerable, and the remaining 3-4 months were miserable.

Visitors from Ohio and other parts of the mainland U.S. are usually curious about what it is like to live in Hawai'i, and often they will ask, "Don't you miss the change of seasons?" Given what I just said about the weather in Ohio, you can probably guess my answer ("are you kidding?"). I understand the basis for the question, though, because the weather here varies so little compared to most other places. Our average shift from summer to winter daily high temperature is only about 10 degrees. In my particular location that means daily highs from upper 70's during the winter to upper 80's during the summer. The year round difference between daily high and low temperatures is only 10-12 degrees. It is rare to have a whole day without sunshine -- no dark and dreary periods. The humidity can vary considerably but averages around 50-60% and is usually moderated by constant breezes (dew is infrequent). It is relentlessly nice, in my opinion.

Actually, though, we DO have seasons here, but (a) they are obvious only if you have lived here a while, and (b) they don't involve changes from grey and lifeless to colorful and vibrant or the reverse.

For example, we know it's Fall when the number of cruise ships visiting our bay increases as they reposition from summers in Alaska to winters in the South Pacific. About the same time the snow birds from the mainland begin to arrive, and so do the humpback whales who migrate each year from Alaskan waters to winter here (smart animals). Various plants and trees that don't bloom during the rest of the year start to do so, like the poinsettias people plant in their yards. The African Tulip Trees and Jacaranda provide a refreshing change of color from...all the other color that we see all year around. The beans on coffee trees mature to a bright red color before they are picked during the fall and winter. A few plants do kind of go dormant, like the plumeria that lose their leaves during the winter (though they often continue blooming).

So, you see, we didn't have to give up changes of seasons when we moved here. We just gave up the cold, grey, nasty part.

It is also the case that we really feel the changes even though the difference might be only a few degrees. One of the downsides of living where the weather is so constant is that after acclimatizing for a few years, our comfort zone seems to shrink. Anything below 70 degrees seems downright cold. One way you can tell the locals from the tourists in the winter is to look for the ones wearing sweatshirts and jackets instead of shorts and t-shirts. Likewise, a degree or two above normal results in locals complaining about the "heat wave."

Yeah, right.

Who IS S. Larson?

My wife and I just canceled our CitiCard credit card. We did this because CitiCard very badly mishandled a dispute over a hotel charge. The whole saga of the dispute, however, is not the subject of this blog (though maybe I'll write about it later).

Instead, the focus is on the CitiCard mystery person who corresponded with us during the dispute process and whom I'd like to blame for screwing things up -- except that I suspect the person doesn't really exist.

As the dispute progressed we received several letters from "S. Larson" at CitiCard. Despite attempts to make the letters seem like they were personally addressed to us, their disjointed obliqueness and lack of specifics unique to our case made us begin to suspect they were composed of chunks of boilerplate. I began to envision S. Larson as some overworked lackey in a CitiCard bullpen cutting and pasting letters to us from a standardized set of approved responses.

We also noticed that the signatures on the letters were always exactly the same. And since they didn't smudge, we decided S. Larson was using a graphic signature file rather than taking the time to actually sign the letters.

At one point in the dispute I became frustrated with the lack of progress and called one of the merchants involved myself. The person I spoke with informed me that a CitiCard representative named Debbie had been in contact with him, not "S. Larson." At this point I began to suspect that S. Larson was a cover name to shield CitiCard's customer service workers from being contacted directly. This might explain why the name is genderless, making it very difficult to even address a letter to S. in personal terms.

For the heck of it I Googled the name S. Larson. Go ahead, I'll wait while you try it yourself. It turns out S. Larson is quite the continuing hot topic and nearly all of it very negative. One of the Google hits I found particularly interesting was the long-term discussion going on for several years regarding the existence of S. Larson on Daggle, the Blog of Danny Sullivan, who has had a CitiCard for about 20 years.

He's been getting letters from S. Larson the entire time, always signed the same way, and always impersonal. Beginning to suspect S. wasn't real, Sullivan went to great lengths to investigate, and his sleuthing efforts are documented in the blog -- really fun reading. Bottom line to his probing is that even if S. Larson does exist, it is quite likely that he or she is NOT the author of each letter and instead underlings send them out with the signature file attached. Most of the posts responding to Sullivan's blog give similar stories and similar frustrations in attempting to communicate with CitiCard. A couple of posts are from people who say they were employees of CitiCard and knew S. Larson (referred to as Sue, Sandy or Sandi, depending on the post) personally. However, aside from identifying her as female, not much information is given that might put this to rest.

The idea of signing all letters regarding customer relations issues with a genderless, computerized signature (even if the signer exists) is just plain bad business practice. And if the signer does not exist at all, or actually doesn't have any personal involvement in the issues addressed in the letter, this is deceptive and insulting to customers. But I guess we've now come not to expect much more than this from the financial industry.

I wonder if S. Larson got his/her bailout bonus this year?

Hanging Out, Messing Around, and Geeking Out

Many adults have a rather negative view of the younger generation's involvement with technology. We puzzle over groups of teenagers in malls walking and talking as much to their cell phones as to each other. They twitter, text, and surf the net constantly, to the point where we fear they spend as much time online as in "real" interactions. We regard most of this activity as wasted time devoid of any positive value. We blame the dependence of youth on technology for their lack of social skills, their resentment of authoritative structure, and their difficulty staying with just one task.

For adults with this dim view of youth's reliance on technology a recent British study seems to support the adults' conviction: A survey of 16 to 24 year olds found that 75% of them feel they "couldn't live" without the internet. The author of the study, Professor Michael Hulme of Lancaster University, concluded that "For young people the internet is part of the fabric of their world and does not exist in isolation from the physical world." A good part of negative adult thinking may stem from not really appreciating this integration of online and offline worlds -- to many of us they are separate, distinct, and unequal in legitimacy.

Over the past ten years or so considerable research has investigated the impact of new technology on young people's development. Most of it doesn't support the strong negative view outlined above. Some of the earliest findings were those of Don Tapscott, which he presented in a book titled Growing Up Digital: The Rise of the Net Generation. About ten years ago some of my students carefully evaluated Tapscott's data and created a Web tutorial (still available online) to present their findings. My students' conclusion, which I agreed with, was that although Tapscott was perhaps overly optimistic in his interpretations, there were indeed both positive and negative aspects of the net's influence.

More recent research has tended to confirm this balanced assessment. An important example of this is a 2008 study funded by the MacArthur Foundation as part of a large scale Digital Youth Project, which attempts to determine "... how digital technologies are changing the way young people learn, play, socialize, and participate in civic life." The report's lead author, Mizuko Ito at University of California, Irvine, summarized the findings by saying, “It might surprise parents to learn that it is not a waste of time for their teens to hang out online ... we found that spending time online is essential for young people to pick up the social and technical skills they need to be competent citizens in the digital age.”

The research revealed that today's youth uses the new technology to enhance and maintain social networks of friends and acquaintances, and also to gain knowledge and skills in self-directed learning activities. "Hanging out" with friends, for example, is an activity that all generations have participated in, but young people have simultaneously incorporated face to face interaction with various forms of electronic interaction. As the researchers noted, there are additional implications to hanging out for the younger generation because of the merging of online and offline social worlds: "Through participation in social network sites such as MySpace, Facebook, and Bebo (among others) as well as instant and text messaging, young people are constructing new social norms and forms of media literacy in networked public culture that reflect the enhanced role of media in their lives. The networked and public nature of these practices makes the “lessons” about social life (both the failures and successes) more consequential and persistent."

Another type of activity identified in the study is "messing around" with new technology. "When messing around, young people begin to take an interest in and focus on the workings and content of the technology and media themselves, tinkering, exploring, and extending their understanding. Some activities that we identify as messing around include looking around, searching for information online, and experimentation and play with gaming and digital media production."

Although adults often see this as haphazard and lacking in commitment, there are important positive outcomes identified by the study. "Whether it is creating a MySpace profile, a blog, or an online avatar, messing around involves tinkering with and exploration of new spaces of possibilities. Most of these activities are abandoned or only occasionally revisited in a lightweight way. Although some view these activities as dead-ends or a waste of time, we see them as a necessary part of self-directed exploration in order to experiment with something that might eventually become a longer-term, abiding interest in creative production. One side effect of this exploration is that youth also learn computer skills they might not have developed otherwise."

For some youth, a third activity can be extremely important because it is often ostracized by peer groups in face-to-face worlds. "Geeking out" is "...an intense commitment to or engagement with media or technology, often one particular media property, genre, or type of technology. Geeking out involves learning to navigate esoteric domains of knowledge and practice and participating in communities that traffic in these forms of expertise." It is important to note that although this activity often involves social interaction in online communities, the peer groups are often different from those in more friendship-oriented situations, and this can allow a young person to develop knowledge and skills that might not be highly valued by face-to-face peer groups.

There are other differences that are also important for understanding how some young people view traditional institutionalized learning. "Interest-based communities that support geeking out have important learning properties that are grounded in peer-based sharing and feedback. The mechanisms for getting input on one’s work and performance can vary from ongoing exchange on online chat and forums to more formal forms of rankings, critiques, and competition. Unlike what young people experience in school, where they are graded by a teacher in a position of authority, feedback in interest-driven groups is from peers and audiences who have a personal interest in their work and opinions. Among fellow creators and community members, the context is one of peer-based reciprocity, where participants can gain status and reputation but do not hold evaluative authority over one another."

There is much more to the findings of the MacArthur study, and I urge you to read the report. For example, I haven't dealt with the study's analysis of the negatives that face today's young people as they confront their technology-loaded lives. I'll just say that they may not be the negatives that many adults think .

2.4+112+26.2 = ?

No, this isn't going to be another installment in my "Banker's Math" series. The numbers above are the lengths of segments in the annual Ironman Triathlon held in Kona, Hawai'i each year. Imagine swimming in the ocean as fast as you can for 2.4 miles, then without a break hopping on your bike and riding 112 miles, then (again without stopping), dropping your bike and running a 26.2-mile marathon. That's the Ironman and you can see why its name is appropriate.

Of the roughly 1,800 athletes who compete all but about 150 are amateurs ranging in age from mid-20's to 80 (!). The older athletes aren't competing realistically against the young pro's, but rather within their own age group. Not just anyone can enter the Hawai'i Ironman. With only a few exceptions, all athletes must have finished in the top of their age group in at least one qualifying triathlon in the last year.

This is truly an endurance test. The professional triathletes complete the race in about 8-9 hours. Most of the amateurs take 12 to 14 hours, with some going right up to the cutoff of 17 hours. Imagine 17 hours of constant physical effort !

In case you're wondering, I haven't done the race and never will (but thanks for thinking I might be capable of it). However, since my wife and I live in Kona, we volunteer most years to help put on the event. It is really quite an experience, one that I find very inspiring and rewarding.

One reason I like it is that our normally sleepy little tourist town is transformed for about a week each October into an international festival. The athletes come from over 50 countries, and besides hearing them speaking different languages, they are easy to spot -- just look for the slender hardbodies zooming around on their hi-tech bikes and effortlessly jogging up the steep streets. Another reason is that some of our volunteer duties give us an opportunity to meet athletes and talk with them one on one. This can be particularly rewarding and inspirational, because we learn that in many respects they (not the pros, those in the older age categories) are fairly ordinary -- they have families, jobs, financial worries, etc., just like the rest of us. But they are also very different in their level of commitment to a goal where the main reward is deeply personal and the sacrifice to reach that goal is tremendous.

It would be very wrong to conclude that what these people are doing doesn't benefit anyone but themselves. They provide a positive model of dedication and effort in an age where positive models are in short supply. Inspiring others is a benefit to society we should recognize and appreciate.