A New Dimension To Health Care

Primary care is where [as the word primary says] health care begins and hopefully ends for a great many folks, because the problem either was addressed promptly or was not too serious but did need a ‘band-aid’.

As with most things involving large populations, the first stage –and perhaps most important— is the weeding out stage which enables the succeeding phases to be more efficient and effective by focusing the more trained and experienced doctors to spend ALL their time working on what they were especially trained to do—not just doing the weeding out.

The new, and now rapidly growing, problem is that doctors and community health centers

[which see most people in need of help first before they go to hospitals]

are watching their populations of primary care doctors age and retire and at the same time they are having a VERY hard time rebuilding their essential base of primary care physicians.

There has long been a preference for doctors to go to densely populated areas where they can specialize easily with enough population to feed them with their type of cases.

The problem has gotten worse with the training in med schools focusing student interests in specialization. And, the ability of specialists to attract enough economic support to work, and to live the lives they want, they are led to ignore smaller less populated communities.

There are various ways this problem can be addressed in the smaller less populated areas.

The problem is that there are strict medical rules about what doctors can and can not do.

The consequence is that it is becoming more and more very difficult for local medical facilities to see all the people who “need to ‘see’ a doctor”.

A simple answer is to get more doctors. Unfortunately, that simple answer does not work the way the system operates today. That is not where enough doctors want or can afford to go. And those local communities—with rare exceptions—can not afford enough doctors to cover even their smallish populations.

A less simple, but in most cases, workable solution is to change doctor/assistant ratios. There are lots of new positions in medicine – physician’s assistants [PAs] as well as nurse practitioners [NPs] for example.

What is needed now is a top down and bottom up review of how best to utilize the skills and training that are already available and, in the system, and could be redeployed more efficiently. 

The aim here should be less what can not be done than what can be done. Solutions are always better than NO!

Where previously a local center ‘needed’ four or five doctors, but cannot get or afford 3, if they had 3 PAs and/or 3 NPs –one or two doctors could, most of the time, cover all the needs of that community.

But, frequently those local medical facilities do not have a strong enough voice to change the rules to enable them to provide that service.

Once again, we see ourselves governed by what sounds like rigid ‘union’ rules and sometimes even greed, at the expense of providing health care to their populations. 

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How to Mix and Match Americans?

Data is pouring out everywhere about how tribal America has become in recent years.

Amazing information is appearing about how easy it is to predict voting ‘habits.’ Our sex, age, education, color and other factors reveal how we think about ourselves, our lives and other people’s lives.

 It occurs to me that there just might be some quite simple and inexpensive ways to restore at least some of the American genius for integrating our varied populations again into larger groupings of people who cherish and value the strength and power of our differences.

When most of us are born, we enter a world of siblings and cousins, who, depending on where they live, we come to know as family.

Perhaps we could add to our little worlds a few ‘strangers’ who might be called co-cousins, as collaborative cousins (as distinct from second cousins etc.) who would be selected and assigned randomly—but deliberately geographically accessible and ‘different” —  to every child born.

The very fact that we would find ourselves with co-cousins as additional relatives might stimulate people with curiosity to try to get to know them.

In the process, there could be quite a lot of mixing and matching at an age when children, in general, have not yet learned to beware of strangers or even notice distinct differences.

Anything that stirs the pots of our lives to enable us to know ‘strangers’ better would most likely strengthen our bonds as a nation. A national “pen pal” program connecting youth to their co-cousins in other parts of our nation at a young age, for example, might serve a similar purpose.

Our differences are one of our greatest strengths!

Whales Vs. Humans

Whales and humans have more in common than most folks know or recognize. We are both mammals, even though whales live almost entirely underwater. They breathe air like we do but hold their breath better and longer.

And, the fact that we share a common breathing system means whales are most likely the closest relatives to our land-based forbearers, because some of their ancestors must have been like some of ours.

Perhaps that is why many humans have always been particularly fascinated by whales – Moby Dick being the most famous example.

Now that humans have scoured the seas for hundreds of mindless years finding whales and turning them into lamp lights, those seas are left with very few whales. Many humans, who no longer worry about lamp light, are finally beginning to worry about their disappearing relatives – those cozy, friendly whales.

The remaining whales of all sorts are struggling for survival, coming closer to shore and shallow water, are allegedly becoming entangled with fishing gear, and being struck by unknowing ships simply passing through normal shipping lanes which lack any “BEWARE” signs in whale language.

The voices of many human whale lovers, who have very few reliable facts, are in support of their ancient relatives. Great political pressure is also rising to slow ships and cut back on underwater fishing gear, in a largely hopeless belief that will save a lot of whales. The evidence is NOT there but the political voices keep rising.

Significant changes have been proposed ‘hopefully’ to enhance whales’ prospects inevitably will lead to shipping inefficiencies (slower is much more expensive) and fishing obstacles would reduce fishing jobs and raise the cost of fish and lobsters to consumers—not to mention to the effect on the overall fishing communities.

Mindless whale lovers say ‘too bad,’ that such results are the unavoidable consequence of saving our whales.

The communities that are based on fishing could be devastated and their consumers will eat less of a more expensive product, as well as many other people everywhere who buy products from slowed ships will pay more for the higher cost of shipping those products.

To deal with all those problems presents a classic political challenge. Generally you can beat something with nothing.

We have already seen that a nose count of support today for whales vs. humans is likely to be won by whales, therefore we need to out-flank the whale supporters with a political ploy—which is slow down their demand for more tighter regulation AND demand that it be introduced very slowly to provide more time to get more facts and give both fisherman and shippers time to prove the reality that their activities are not the cause of whales’ problems—and at the same time hold off the adverse effects on fishing communities.

This saddening controversy is typical of today’s fractionated world.

The fishing community should embrace a very slow approach to help gather the data which should send the regulators away in disgrace and put the purist whale lovers onto other harmless adventures.

Domestic Terrorism

The mass shootings in El Paso and Dayton are just the most recent evidence that we are slipping into the early stages of a modern revolutionary war.

I will not linger on the dimensions of gun violence, per se – we are long past the moment to deal with all the Second Amendment issues and address this crisis in some sensible way.

I also will not focus on ‘white supremacy’ itself. The vast majority of Americans know that multiculturalism has been and is at the root of our greatest strengths, and has been a key source of our nation’s leadership in the world in inventiveness, competitiveness and togetherness.  We simply cannot weaken our resolve to stay on that course.

Instead, I will focus on a procedural issue which underlies today’s tragedies which can and must be addressed vigorously.

Our legal system is clear: we cannot stop people from having bad ideas. We believe that words and thoughts alone are immune to legal intervention.

However, the internet has enabled people to stir up other people, as has been the recent case with white supremacy.

And, as in the most recent tragedy, perpetrators have often advertised their plans in advance on the internet. The FBI –if they had had enough time –might have been able to intervene in some fashion. But, all they could have done in advance is get in the way, because until the first shot are fired there was not yet a crime committed.

Therefore, we need to look carefully at our laws and regulations about how and what to do in those situations.

It is now clear that the FBI and police everywhere must be better able to intervene in advance and detain such people and have them held and ‘treated’ until experts are reasonably satisfied that they are no longer a threat to society.

It is tempting to think that the internet is the culprit. Its existence sadly has made the problem worse, BUT it also is a place where experts can pick up a lot of useable information in advance of evil action.

All these problems are built on a combination of elements—guns, fear of others and our basic desire for freedom. We have to deal with ALL those issues, including making it more common to intervene in advance.

Voting Rights & Responsibilities

At the very root of democracy is VOTING. Why, therefore, do we tolerate the incredible fact that only about one half of Americans vote regularly?

In addition, Republican politicians at the state and federal levels are actively striving to make it difficult, for many minority groups to exercise this core constitutional right.

It is true that in many places – like most of New York and California — one vote really does not matter because both those States are so overwhelming one sided that, regardless of your side, your vote lacks the import of those cast by voters in more competitive states.

Our Constitution requires an Electoral College to elect our President, which probably does not make sense in the modern world, but as a practical matter can only be eliminated by a Constitutional Amendment – a virtual impossibility in today’s political environment.

Still, if anything like 80 percent of eligible citizens voted, the possibility that a candidate could win the electoral college WITHOUT a majority of the popular vote would likely approach zero.

Therefore, if I were a candidate for President today, I would promise to incentivize every citizen to vote in every federal elections by (a) making election day a federal holiday; and (b) giving every person who casts a ballot a federal tax credit of $100.  

Such a proposal would likely enjoy wide popular support, being both simple and right. It could even spur increased voter turnout in the 2020 election [before taking effect] —which would also increase the likelihood that Congress would achieve that goal in 2021.

That one simple change would side step the obstacles of a Constitutional Amendment, most likely secure a Democratic Presidential victory in 2020, and at the same time RESTORE DEMOCRACY IN AMERICA.

See previous posts at https://fawideas.com

Presidential Election 2020

We already know a lot more right now than we typically know more than a year before a Presidential election.

We know (health aside) that Trump is the Republican candidate. And we probably know who the top four Democrats are likely be: Biden, Harris, Sanders, and Warren.

It’s less certain, but we can wisely surmise that the Democrat ticket will include two of those top four possibilities.

We do not know when and how the Democratic field will shake out, and Trump’s head start on fundraising is a cause for concern. At some point, party leaders will try to stop whoever remains of the long-shot candidates from continuing to syphon off precious campaign funds to a lost cause. We also do not know how far those ‘out of it’ candidates might go to improve their standing. At some point, tossing grenades at the likelier nominees becomes counterproductive, and the imperative of beating Trump must win out.

Still, reasons for hope abound. Trump himself, while perhaps continuing to solidify his support from roughly 40 percent of the country, has yet to show how he might draw support from the other 60 percent next year.

Even the incumbent’s best friend, a strong economy, is failing to lift Trump’s prospects. Now, the economy is showing signs of slowing and trade wars are taking a toll. Financial markets will soon begin to reflect that as well.

It is possible, but highly unlikely, that Trump might pull off one or more foreign policy victories. But, a public weary of the belligerence and braggadocio of Trump’s transparent negotiating style isn’t likely to swallow his exaggerated claims of triumph. No, the North Korean nuclear threat is not “gone.” Iran is closer to a nuclear weapon than ever, with no real reason to turn back. And, while Trump continues to tout the billions of dollars “pouring in” to the American treasury from tariffs wantonly slapped on friend and foe alike, most people – even Trump supporters – know that money is coming from American pockets.

Despite these seeming advantages – and an electorate that seems largely “baked in” for a Trump defeat in 2020 — wherever I go people keep repeating that they fear that Trump will be reelected.

It’s an understandable worry. Trump was such a fringe candidate in 2016 – one part celebrity scold mixed with hucksterism and a healthy dose of racism – no one took him seriously, except those tens of millions who voted for him.

There can be only one thing that would allow that to happen: lack of turn out resulting from lack of belief in prospect for change.

It is important to talk about health care, income inequality, taxes, and more. It’s valuable to have bushels of 10-point plans.

What is still missing is a gut-stirring message of change.

If it were not already taken ‘Let’s Make America Great Again’ would be fine. Many would settle for ‘Let’s Make America, America Again.’

I like ‘A World Safe for All Americans.’ It speaks to the fears of groups seeing their rights diminished by the Trump administration and allies in red states (reproductive freedom, voting, and immigration) and touches on the broader responsibilities America has in the whole world.

Spouses v Husbands And Wives

SPOUSES v HUSBANDS AND WIVES

The word ‘spouse’, according to the dictionary, means either the husband or wife of a married couple.

As modern society finally has grown more accepting of the obvious realities of the natural distribution of sexuality and gender among humans, it’s become clear that our language hasn’t kept up with our understanding.

There are a significant number of people whose gender identities conflict with physical anatomy; similarly, a person’s sexual orientation may differ from “traditional” expectations.

It is certain that it has always been so, and only as modern society ‘grew up’ was it feasible for people to come out and declare themselves, with at least some expectation that society would treat them the way ALL humans are supposed to be properly treated.

And, happily, most people in America today are clearly comfortable with the new landscape, and discrimination, while still quite present, is diminishing.

One of the remaining issues has been nomenclature. In the not-very-distant past, “husbands” were always men and “wives” were always women. The trend toward cohabitation without marriage added the term “partner” to the mix (“life partner” if you enjoy being insufferable), and “spouse” allowed us to skirt the issue altogether.  Now, when same-sex couples marry, they may or may not assign themselves “husband” or “wife” roles, but those are, obviously, decoupled from gender, and may or may not be publicly declared.

 Compounding the matter: some couples eagerly embrace the traditional nomenclature, while others find it a stifling symbol of oppression from which they are desperate to have new choices emerge. Both are valid viewpoints, and most couples, whatever mix of gender and orientation they bring to the table, can readily agree on such things.

The bigger problem is the people around them who insist on applying old terms to new realities, much the way people still “dial” a phone number. I grew up in a world where most people fit neatly into boxes, and the few who didn’t were outcasts.  But in our brave new world, the boxes are of infinite variety, and which one(s) you fit in is for you to decide and declare. We keep hoping for new words and new pronouns, but what we really need is a new understanding; our job is simply to accept people for who they are. If they’ve declared a label for who they are, honor it. If they haven’t, don’t try to give them one, or many.

Today, couples may declare one another “husband” or “wife,” but many choose to not lend credence to what they perceive as gender stereotypes. We’ve easily settled on “spouses” or “partners.” No doubt new words will come along – consider “rom,” a play on romance that is also an acronym for the “rest of me.” It speaks to the essence of a relationship, where “husband” and “wife” speak to either the genders of the relationship or the roles each person assumes within that relationship.

Today, we ask people what gender pronouns they prefer (he/him/his, she/her/hers, they/them/theirs). In the future, all gender references will likely disappear from the language – problematic vestiges of a bygone era. And while grammarians will cringe at the thought of a world in which everyone is a “they”, it will also be a world in which everyone is “us.” That seems worth the tradeoff.

Until that day, perhaps modern language could be clarified and the words husband and wife consigned to the trash bin, and ALL married people would become simply spouses!