“sic transit gloria mundi”

I am mindful that everything is transitory. As Heraclitus said: “No man steps in the same stream twice for the stream is not the same, and neither is the man.”

Since I moved back to California I’ve been working together with some really fantastic people to recreate a delivery system for disaster services for the San Gabriel and Pomona Valleys. Granted, the work was getting done before, and it’s not like we tested our model against the coming major earthquake, but it was our model and there was some pride in our handiwork. That’s going to be transformed now by decisions above our paygrade, and that hurts; but it puts me in mind of the reality that everything changes.

In North Carolina I had the opportunity to participate in forging a 27-county Western Carolinas Region from the 16 counties of Western North Carolina and the 11 counties of Upstate South Carolina. That involved a certain amount of angst among those who had to exchange their time-honored ways of doing things in the face of new realities – although we were always sensitive to the impacts of the changes on folks. As I write this, that Region has been dissolved and the counties reapportioned into a Western North Carolina Region and a South Carolina Region.

Before going to North Carolina, the Pomona Chapter was subsumed into the San Gabriel Pomona Valley Chapter which was subsumed into the Los Angeles Region while I was gone.

The HMO I worked for after college was subsumed into United Healthcare.

Every ship I served in while in the Navy has been decommissioned.

Is there a point to it all then? I believe that there is. I believe that the choices we make, and whether or not we act on them and how are probably our only real legacy. Who knows how long that will last? How far and for how long will the ripples spread?

I did what I did with what I hope were good intentions. I have felt satisfaction in doing things well enough to accomplish their purpose, but I don’t think it’s been about me. I try not to make it about me.

Still, seeing that “wrecking ball” coming again… it hurts.

Happy Birthday, Max!

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A 10th Blogiversary

Ten years ago today I posted for the first time on Always Question. The timing was more than a little odd, if I’d stopped to think about it., but I didn’t.
I do enjoy writing for the blog, but rarely make time for it anymore. I’m more pessimistic than I used to be, and that takes a lot of the fun out of it; but writing helps me organize my thoughts, look at things from a slightly different perspective.
I follow several people on FB, but that isn’t the same as visiting and commenting on their blogs, and I certainly don’t write the same way on FB. How is it then that I post an almanac every morning on FB without fail, and very seldom post here? Is it avoidance of thinking about things?
Happily there are seldom any more Navy Corpsmen (or Marines, for that matter) being killed. There was no easy way to capture and recognize the folks who were wounded however seriously, but recognizing those killed was important to me.
I don’t check the Defense POW/MIA site as often as I used to lately because recovery efforts seem to have fallen off in recent years, but also because it’s slipped from my consciousness.
I need to reengage, to get back into the practice of examining and analyzing and questioning – always questioning. There is plenty to question.
For today: “May no fears affect you.
May no illnesses afflict you.
May no dangers come your way.
May you enjoy good health and long life.”

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I Missed California Politics

I didn’t realize how much I had missed California politics until recently. It’s very different here from North Carolina; still a pretty horrible way to choose our representatives, but more entertaining somehow. Neel Kashkari is a case in point.

The first time I saw his ad on television I thought it had to be a gag. Here’s this cross between Mr. Clean and Paul Bunyan splitting firewood with an ax, and going on about how he knows how money works. I’m thinking, “does he know that Lincoln was The Railsplitter and not the kindling maker?” I mean, I suppose it’s nice that he’s endorsed by Romney, and W, and Issa, and Pete Wilson, but a cursory glance at his biography tells me that he probably doesn’t know the first think about earning a living wage by his own sweat.

Looking at the pool of candidates for governor, I see that his Republican rival, Tim Donnelly, former head of the California Minutemen and a Tea Party candidate, is expected to beat him at the polls Tuesday, and that’s a shame; I think you could sell tickets to a debate between Jerry Brown and Kashkari.

 

 

 

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Donald Who?

I am reminded once again of how topsy-turvy our priorities can be.

Donald Stirling or Sterling who apparently owns a local basketball team allegedly made some racist remarks on a tape made by his ex-girlfriend. As terrible as that is, I don’t care.

Okay, I do care because it saddens me that people harbor all of this bigotry in their hearts, but this guy is just a landlord who owns a sports team; he’s not even a bigot who owns a chain of fast-food chicken outlets. I can’t stop going to games or watching them on television because I never started. Send him wherever they sent Mel Gibson and be done with it.

There are real things going on in the real world that really matter, and the news is covering this guy instead of that! It’s maddening!

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I have questions about raising the minimum wage.

I’ve probably said this before – the last time we went through this – but feel that it needs to be said: there’s a reason that economists qualify their opinions with “ceteris paribus.” It means a lot of their opinions are pretty much guesswork because it’s virtually impossible to change just one thing.

The President feels that raising the minimum wage will be just the thing to raise up low-income wage earners; and that’s factually correct. It will raise the wages of those currently earning the minimum wage, and of everyone earning less than the proposed minimum wage, and of everyone whose wages are calculated on the basis of the minimum wage. We used to call that inflationary, but now it passes for social engineering.

I don’t know how much the maintenance guy and groundskeepers in my apartment complex are paid, but I’m pretty sure they’re going to be getting a raise pretty soon. The owners/investors might be willing to eat that additional expense for me – I’d appreciate that – but it’s much more likely that my rent’s about to go up, and I’m on a fixed income and I don’t see the Tea Party voting a raise for me anytime soon.

My sense is that most low-wage jobs aren’t with Fortune 500 companies. I think they’re with small-business operators with very slim profit margins, and they’re going to have to raise their prices to stay afloat. It they can’t do that, I think they’re going to have to sell out which will lead to more consolidation and job losses, but that will probably take a little while to sink in and that should work out pretty well for the Democrats in the 2014 elections. My lease is up for renewal before that.

 

 

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Random Thoughts on the Shootings at the Navy Yard

I’m sorry, but I really want to write about some other stuff and I can’t until I purge my mind so here are three thoughts on these shootings.

I don’t see this as an appropriate basis for a push for gun control. Aaron Alexis took a shotgun to the Navy Yard. He got the handgun when he shot and disarmed a peace officer at the scene.

His access to the Navy Yard is a very real issue that should be addressed. Here’s a young man who was within moments of an other than honorable discharge, but because he took the early (honorable)discharge his clearance was never revoked? HP or whomever accepted his former clearance two and a half years after his discharge? In my humble opinion, that’s pretty sloppy work. Is the FBI still the lead agency on security clearances?

What is up with the Mayor and the DC cops doing the press conferences, and the FBI being the lead agency for a shooting aboard the Navy Yard? I know that Cote de Pablo is leaving the show and Mark Harman isn’t a real NCIS Special Agent, but WTF!?! Unless it’s because the FBI screwed up on Alexis’ security clearance and then it’s just them cleaning up after themselves. That would make sense.

Final side note: I’ve seen people describe Alexis as a “practicing Buddhist.” I’m not one to judge, and I’m certainly not a model for someone trying to be a practicing Buddhist, but I feel that perhaps a guy who is willing to carry a firearm and take a life to protect his material possessions is to being a practicing Buddhist as I am to being skinny, handsome, and rich.

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Admitting That I’ve Moved

I haven’t said anything about leaving Western North Carolina in May, and moving back to Los Angeles County.  A couple of folks have asked me if I’m dying or something along that line; and, of course, that is my destiny, but that’s not why I moved back.

I miss the work I was doing back there – I think a lot of it was good – and I miss the mountains every single day. I miss people with whom I became close. The fact is that I have family and people and a forty three year history in California, and I feel this is where I ought to be.

I miss the Western Carolinas Region of the American Red Cross. It is already such an achievement by and for some really incredible people who were completely unknown to me less than four years ago. I’ll miss hurricanes and tornadoes and storms (I’m a disaster services volunteer), but the simple structure of this thing is a piece of art. Volunteers going out in the day or night to assist people who’ve experienced the worst is what we do, but they’ve spanned cultures and ideologies and boundaries of all sorts and they’ve made it work over and over and over again. Awesome.

I miss Brother Wolf Animal Rescue and the opportunity to work with some beautiful animals and the dedicated people committed to finding homes for all of those beautiful animals. I could go on and on, but I should stop. It hurts my heart when I read of a dog (or cat) in need of a transport, and I’m not there anymore.

I’m back at work with the LA Region of the Red Cross, mostly with the San Gabriel Pomona Valley offices, working with Disaster Action Teams and training Disaster Responders. I feel like I’m making a difference. It is enough for now.

One is not born into the world to do everything but to do something.   –   Henry David Thoreau

 

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Thoughts on Health Economics

I’ve been reading some of the comments coming out AARP’s Medicare Forum, and they got me thinking.

I wrote my thesis on improving an estimated average cost function for acute care, and I learned a couple of things: it probably can’t be done, and never get two economists on a thesis committee.

Here’s one thing: say I buy a state-of-the-art camera and memory card for $100. What’s the cost of a picture? It depends almost entirely on how many pictures I take with that camera and memory card over its lifetime, not to mention the cost of the photographer. If I only take one picture before I drop it into the canyon, that picture cost me $100 (and it’s on the card at the bottom of the canyon).

What if a much, much better camera comes out while the old camera is still functional, and no one wants a picture taken with the old camera anymore? Do I get the new camera? The photographer across the street is getting a new camera.

I won’t get into the need for a building to house the camera or the need to co-locate it with the subjects or disposal of its hazardous waste by-products or its life-saving implications.

Let’s talk about outcome measures. Want to compare mortality rates? A lot of people do.
If that’s important to you then you probably won’t want an emergency department or to partner with a nursing home, because emergency departments bring ambulances and uninsured people who lack preventive services. Can you guess why you don’t want to partner with a nursing home?

I did an internship in the Quality Management Department of a small community hospital where the Director tasked me with developing outcome measures so that the hospital administration could compare the morbidity rates of the medical staff against state, regional, and national outcomes. I actually told her that I was pretty sure that a few people might not want her to have that; and, after I was done, some of the doctors bought the hospital, and terminated my internship and most of her department. Just saying…

Still, we ought to be able to figure out what an average discharge costs a hospital (or doctor or other provider) in terms of resources, yes? Perhaps. I worked for a doctor who was pretty cutting edge in technology and mastered laparoscopic surgery. She certainly saved her patients at least a few days in hospital, and insurance companies the cost of those days; but she was only paid a fraction of what she’d have received if she’s just cut the patient and it took her substantially longer to perform each procedure through a “keyhole.” How does that make sense?

Then there’s the whole insurance thing. I don’t have an axe to grind with insurance companies, but they don’t deliver health care. I get that they take premiums and invest them and make money with them, and that paying for my health care is a tsuris.
They come in with data on what their average payout is to my hospital for a tonsillectomy, and they offer me like 90% of that and stop nit-picking every single detail of every bill and pay me within a month of discharge. Maybe I can make it up in the business office.
The next thing I know all of the insurances companies have made me (coincidentally, I’m sure) the exact same offer. FYI, most hospitals operate with a profit-margin of less than 5%.

We used to kid one another (they probably still do) about “billed charges” and “cash patients;” but the reality was that the people who could pay us were going to pay us what they wanted to, and the people who couldn’t wouldn’t. Hospitals know what their costs-per-discharge are, and aspirin don’t cost $25 apiece, but the object of the exercise is to try to balance expenses with income; i.e. keeping the doors open. I’m not going to say that there are no bad apples in the healthcare delivery system, but I haven’t met very many people who weren’t at least committed to – if not passionate about – quality care.

If the American public wants to entrust their health to corporations with a vested interest in not paying for it, that’s their business. I’m old.

If consumer activists want to nickel and dime their doctors, they can do that. Seems short-sighted to me, but it’s their call. If you want your health care from the lowest bidder, go for it.

I spent twenty years getting (and providing) health care in a federally-operated managed care system, and I haven’t run into too many shipmates who were dissatisfied. Plus, I’m pretty satisfied with Medicare. I don’t see the problem with it.

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Thoughts on Journalism

I’ve had quite a bit of time to reflect this week as the media strove mightily to wring the last possible second of screen time out of the Boston Marathon bombing and its sequelae.
It occurred to me that ours is one of the first generations that has been able to instantly access inputs from across the globe, and we obviously have no idea how to manage that.
I have a couple of thoughts.

Merriam Webster defines journalism as the collection and editing of news for presentation. More specifically, they define it as writing characterized by direct presentation of facts or description of events without interpretation. I also checked for a definition of news and found: a report of recent events. Parenthetically, in order to be newsworthy, something should be “interesting enough to the general public to warrant reporting.”

I know the bombing was a big deal, and I was concerned for friends in the area; but, really, what was the news? Obviously some people must have been glued to their screens because the MSM could not shut up about it. I don’t think we needed the hours and hours of “reporters” in front of cameras sharing tweets, rumors, file footage, and speculation.

The absent parents can’t believe their kids did this; I get that. I worked with a woman whose son murdered a woman, and she had a lot of trouble dealing with that. If either of my angels got into trouble, I’d blame their mother straight out.

Since they stopped the race after the blast, there’s no way we needed more than three or four hours of media coverage from the blast to the capture of the second suspect last night to address the actual news. Everything over that was just the media sucking every iota of interest out of what was, at its root, a tragic event that will forever change the lives of the casualties and all who loved them.

I think the coverage has been a disservice to those folks and bad journalism.

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Thoughts on Difference

Among the things I enjoy about working with the animals at Brother Wolf Animal Rescue is their apparent lack of awareness of their differences. The biggest thing is their lack of any guile, but this is pretty high up there.

When I first met Max, my little Boston, he was in a pasture playing with a Rottweiler and a horse, seemingly indifferent – if not oblivious – to their differences. Max is not what I’d call a smart dog, but I’ve observed many interactions on hikes or in play areas when dogs would just all pile up – sometimes with a cat, although cats seem much more aware of their being cats and not dogs. To be sure, there are spats between dogs, generally when it comes to food or water or attention from humans, and they often behave differently on-lead than they do off-lead. Some of the coon hounds have learned to regard smaller mammals as prey, but that’s almost always  been more of an issue with cats than with dogs; and a bark and a sniff usually straightens it out.

I can’t say that I’ve encountered an aggressive dog. When I first moved to Asheville we went to an established Boston Terrier Meet-Up group, and apparently the dogs there felt that their pack was okay as it was. They collectively marginalized not only Max but other new dogs, but they weren’t ugly about it.

Some dogs are more timid, some more boisterous… They may have their individual hopes, dreams, and agendas. I know Max much prefers being with women to being with me, all other things being equal. A lady recently moved in next door, and since Max met her he’s been going to her door instead of ours whenever we get back from an outing.  Not the first time he’s done this.

This week, within hours of the anniversaries of the Texas City Disaster, and the Branch Davidian Fire and Oklahoma City Bombing, and the shootings at Columbine, it looks like a couple of kids blew up the finish line of the Boston Marathon and West, Texas, got blown up by fertilizer. I hear these discussions of whether or not these kids were inserted back in 2001 as a pre-pubescent sleeper cell. I don’t even want to get started on the Senate’s failure to do anything about controlling access to guns, and the hate legislation coming out of Raleigh. I’m trying to develop mindfulness and compassion and equanimity and I keep coming back to a perception that people suck.

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