Archive for August 12th, 2007
Best health care in the world: not the US
The NY Times editorial linked to in the previous article is well worth reading in its entirety, especially by those who continue to believe that US healthcare is the best in the world. On one of the forums, I’ve actually had discussions with people who believe this, and who instantly dismiss any statistics or measurements that disconfirm the idea. The NY Times:
Many Americans are under the delusion that we have “the best health care system in the world,” as President Bush sees it, or provide the “best medical care in the world,” as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.
Michael Moore struck a nerve in his new documentary, “Sicko,” when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.
Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.
Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.
Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.
Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.
Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.
Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.
Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.
Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.
That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.
Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.
Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.
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With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.
Bush takes 9 weeks of vacation per year
Bush has clocked in 418 days of vacation so far—more than 2 months vacation each year:
President Bush tries to set an example for Americans whenever he can, in terms of physical fitness, faith, optimism and a certain overall moral rectitude. He also sets an excellent example on taking vacation.
On Thursday, Bush left for a weekend in Kennebunkport, Maine, and his family’s summer compound, Walker’s Point. On Monday, he heads to his Crawford retreat, where he has spent all or part of 418 days of his presidency, according to Mark Knoller, a CBS News White House correspondent and meticulous record-keeper.
Never a fan of Washington’s more cosmopolitan pleasures, Bush will be in Central Texas for about two weeks, with an overnight trip to Ottawa to meet with the leaders of Canada and Mexico.
At a White House press conference Thursday, Bush appeared to be already inhabiting his vacation mode, shedding the businesslike, sometimes grim demeanor he’s had of late to slouch against the podium and be avuncular.
US healthcare: we’re number 42!
The AP reports that while Americans are living longer than ever, they are not living as long as people in 41 other countries, including Japan, Guam, Jordan, and most nations in Europe. “A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier.”
A New York Times editorial today writes that the “disturbing truth” is that “by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.”
From the first link above:
For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles.
Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.
“Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.
A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.
Andorra, a tiny country in the Pyrenees mountains between France and Spain, had the longest life expectancy, at 83.5 years, according to the Census Bureau. It was followed by Japan, Macau, San Marino and Singapore.
10 steps toward better research
Although this post was directed at students, it also applies to anyone who has to do research and report the results—including many who do this as part of their job.
The list is here, but let me add one important rule that should be first:
- Early!
That is, start early, set deadlines early, make the deadlines earlier than necessary. “Early” gives you the ability to recover from setbacks, the ability to expand your initial scope, and—at the end—time to revise and improve your final report. If the final research report is due in 6 months, by all means start today and schedule work on it heavily for the next two weeks. The earlier the better.
Tom Gilb emphasizes this important point in his excellent book Principles of Software Engineering Management, a book that I highly recommend to anyone working in software development. (The book is a mother lode of great advice and insights—for example, establishing metrics to measure project progress and success, and then checking those metrics against existing best practices. If you do that, you may discover that your goal is well beyond the current “best” in the industry, which means you’re taking on advancing the state of the art. Sure you want to do that?) Gilb’s other books are also worth a look.
Being happy at work
Good post from Lifehack.org:
Everyone wants to be happy at work. Nearly everyone also wants to feel fulfilled by what they do. The Baby Boomer generation thought they could achieve both of these by hard work, long hours, and (hopefully) hard cash. Many people today are not so sure they were right.
Their conventional approach at least had the merit of being clearly understandable and easily translated into action. It also proved to have serious drawbacks in terms of delivering either happiness or fulfillment; often providing stress and anxiety in their place as people launched themselves into a frenzy of competitive striving where losers inevitably outnumbered winners.
I don’t believe that there are any sure-fire recipes for obtaining happiness. It’s too personal a concept. Too much of it relies on chance elements like genetic make-up, early family circumstances, and social background. The best that anyone can do, in my opinion, is make sure that they don’t choose a path that is more likely to squash opportunities for happiness that create them—which is what my generation, the Baby Boomers, has done on a massive scale.
So here’s my alternative approach. It has less to do with grim effort and following a set of rules and much more to do with creating the circumstances in which happiness and fulfillment can arise by themselves. And, since it neither prescribes what happiness is, nor assumes that what makes me happy will do the same for you, it at least has the merit of being applicable to almost anyone’s circumstances.
The approach is based on providing guidelines for answering the four commonest questions that people ask:
How to give instructions
Covey actually discusses this in his book The 7 Habits of Highly Successful People, under the heading of “effective delegation.” (Also, see this study outline for book (PDF file).) But here’s a quick list of steps:
In his book Follow the Yellow Brick Road: Learning to Give, Take, and Use Instructions, Richard Saul Wurman outlines a simple set of conditions that a good set of instructions must meet (no matter how complex the desired outcome is). In order to be effective, a good set of instructions must provide information about six things:
- Mission: What do the instructions show me how to do?
- Destination: What will I see, hear, experience when I’ve followed the instructions?
- Procedure: What are the exact steps I need to follow to reach the destination and accomplish the mission? What tools and equipments will I need? What special information do I need to finish?
- Time: How long will it take me to finish? (Other measures might be appropriate, like “how much money will I have to spend?” or “how far will I have to drive?”)
- Anticipation: What difficulties should I expect to encounter on the way? How should I prepare for the project?; and
- Failure: What will happen if I screw up? What does failure look like?
“Failure” and “Anticipation” are the most overlooked among these — which is what makes the assembly instructions with a lot of “assembly required” furniture so frustrating. We are rarely told when a piece should slide easily into place, or when it needs to be forced (anticipation) or that if a door is put on upside-down it won’t close properly (failure).
How to save $100 a week
As soon as I saw that title, I thought: “Simple. Save $15 per day.” But in fact the tips provided below are slightly more helpful. (UPDATE: Also, look at these 106 money-saving tips.)
1. Bag your lunch and bring it to work.
This is a goldmine so to speak. Personally, I spend about $7-20 a day on lunch while I’m at work depending on what I feel like eating, the fact that I work in downtown Manhattan doesn’t help. Let’s make the average to $10.
I could save a bundle if I were to make a sandwich for about $2-3 from home and bring it to work (buying coldcuts at the local grocery store), along with a $1 soda thats about $3-4 spent on lunch everyday as opposed to an average of 10$.
[Also, when you make the lunch, make and pack the lunch for 3 or 4 days. Then most mornings you have a free ride—just grab the bag and go. This may involve making the sandwiches without mayonnaise or mustard, for example, putting those into little plastic containers to be applied at lunchtime (to keep the sandwich from getting soggy). – LG]
Savings: $36 per week.
2. Institute a ‘tax’ on your household.
We all hate taxes. No, let me rephrase that, despise taxes. However this is a little different. What about getting you and each person living in your house to put $2 a day in a savings jar? You can then use this money towards anything. Clothes, food, movies, a long needed vacation, a car, anything basically, be as inventive as possible!
Savings: ~$20 per week (based on 2 family members).
3. Change adds up quickly, don’t let it disappear under your couch.
You’re at your local StarBucks and you order a cappuccino for $3.42. You get an ugly $0.58 cents back. I used to forget about this change, lose it, or stuff it down my pants pocket for it never to be seen again.
A week ago I started saving all my change, I mean every single penny and dime. Then at the end of the week I went to a coinstar machine at my local grocery mart. How much did I save? $9.87. I was shocked really, I didn’t know it added up so quick. I was well on my way to an easy extra $100 a week.
Savings: $5-10 per week.
Cool idea: the one-sentence journal
August 1 marked the first anniversary of my One-Sentence Journal.
For a long time, I’d been alarmed by how little I remembered about my own past. In particular, because one of my resolutions is to “Appreciate this time of life,” I felt the impulse to keep a record of the pattern of our days (not to mention the funny things my children said) so I’d remember this time of life later.
The idea of keeping a proper journal was far too daunting, so I decided instead to keep a “one-sentence journal.”
Each night, I write one sentence (well, actually, usually it’s three or four sentences, but by calling it a “one sentence journal” I keep my expectations realistic) about what happened that day to me, the Big Man, and the girls.
Right now, I can’t imagine forgetting the time when the Little Girl said politely, “Can I have some more pajamas on my pasta?” when she meant “parmesan,” but I will, I will.
And I’ll forget what it was like to have a child who still sleeps in a crib, or one who is reading Elizabeth Enright’s The Saturdays for the first time. I’ll forget the huge amount of meat that the Big Man once grilled in a single evening.
My hope is that, years from now, when I’m trying to remember what life was like at this point, I can look back at my one-sentence journal.
Of course, I’ve missed a lot of days. Although I’ve been trying to keep it up for a year, it still hasn’t quite solidified into a habit. I’ve let ten days go by, without thinking about the journal once. But still, I’ve managed to get a lot of memories down on paper.
When I get back from vacation, I’m going to use my beloved Lulu.com to print out three “books” of the journal’s first year – one for the Big Man and me, one for each of the girls.
My path-breaking happiness formula holds that to be happy, you must think about feeling good, feeling bad, and feeling right, in an atmosphere of growth.
Keeping this journal is a project that adds to my happiness in all of these ways: it helps keep happy memories vivid (because I’m much more inclined to write about happy events than unhappy events); it gives me a reason to thinking lovingly about my family; it’s manageable, so it doesn’t make me feel burdened; it makes me feel like a good mother who is passing happy memories along to my children; and it gives me a feeling of accomplishment and progress.
Excellent idea for cherry tomatoes
I went a little overboard with the tomatoes at the farmers’ market on Tuesday morning. I already had a few nice yellow ones from a market visit over the weekend and then ended up buying several heirlooms as well as an overflowing pint of black cherry tomatoes. When I came home tonight, I noticed that the black cherry tomatoes were starting to get just slightly wrinkled and needed to be used as soon as possible.
I picked them over, tossing out the couple that were too far gone and poured the rest into a glass baking dish. I gave them a little drizzle of olive oil, along with a sprinkling of salt and pepper and popped them into the oven at 450 degrees for about 15 minutes. When I took them out, they had softened and created a gorgeous juice. I ate them over a scoop of quinoa (they’d also be great tossed with pasta), topped with a nice handful of crumbled feta cheese. These little guys started out pretty sweet, but the addition of roasting made them even sweeter. This is a great way to handle grape and cherry tomatoes in the winter when they aren’t in their prime the way they are now.
You know what to do: add a little sprinkle of crushed red pepper along with the olive oil. Right?
UPDATE: And, it occurs to me, a sprinkle of minced garlic would not go amiss. Maybe also some minced sweet onion? Basil?
Later On 