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Lily Tomlin, State of the Union January 28, 2010

Posted by jfistere in Entertainment, News, Politics, business.
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When I first started this blog, I had some things I wanted to talk about, and I had hoped there would be continued discussion.  Although there have a been a few comments, I was disappointed by how few there were.  So I sort of lost the motivation to keep posting.  Also, I had felt that I needed to say something “significant” each time and that led to a form of writer’s block.  I think I’ve dealt with both of those issues, and now I”ll just write whatever I want, significant or not, and regardless of the response or lack of response.

Lily Tomlin

Last night Teresa and I went to see “An Evening of Classic Lily Tomlin” at the newly restored/renovated Balboa Theater.  It was a fun show, and opened with a series of film clips to remind us all of the wonderful characters she has portrayed over the past 30 years.  For me there was a striking contrast between her new material and the reprises of some of her classic characters.  Her opening monologue was over the top funny and witty, dealing with current issues, including the collapse of the San Diego Chargers football team.  On the other hand, her characters seemed a little dated.  The main exception was Ernestine, the telephone operator, who is now employed at a medical insurance company, and provided Ernestine with the opportunity to deny coverage with glee and wonderful one-liners.  I wish I could remember some for you.

State of the Union

Obama’s speech was wonderfully delivered as usual.  I found many of the specific proposals to be merely interesting tweaks to existing policies, and some recommendations for new legislation rather symbolic and not that significant. The most important thing he said is that we have to learn how to work together, and that Congress should place the needs of the country over petty politics.  He announced that he would begin to hold regular meeting with leaders of both parties, a proposal which was completely ignored by the Republican response.  In fact, Virginia Governor Bob McDonnell criticized him for not offering to meet with Republicans, which in fact he had done in the speech.  McDonnell’s speech seemed written without regard to Obama’s, as though they had not made a draft available to him, which is the normal practice.

The idea of providing more money to small banks to make loans to small businesses seems like a futile gesture to me.  As I understand it, banks have plenty of money to loan, but they are being particularly cautious about to whom they lend.  After all, risky loans were part of the cause of the original problem.  As one small business owner put it on KPBS radio, take that $30 billion and provide more stimulus, so that business activity increases and small businesses become more creditworthy.

Regarding health care, I still have hope.  The specific features of the program are less important to me than the inclusion of the uninsured.  Let’s get them covered now.  The Republicans mentioned several items that they feel should be included in the bill, and I don’t see why the Democrats don’t throw those in.  For example, tort reform and allowing the purchase of policies across state lines.  If that will increase possibility of getting a bill passed, go for it.

Congress has been in a political gridlock for years, and it will take statesmanship at every level to make progress.  The most striking evidence of that was the way the Republicans sat in stony silence in response to many of the ideas that are basic common sense.  I would like to see a tabulation of the Republican “sitting” vs. Republicans “standing” issues, and the same for the Democrats.

I am hopeful that a better attitude in Washington will evolve and allow some progress.

Reaching for the Moon October 9, 2009

Posted by jfistere in Ethics, Humanitarianism, News, Politics, Science, Taxes.
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It was an interesting day today.  The NASA project “LCROSS” may have been a technical success, but it was visual disappointment to the thousands of people directing their telescopes towards the moon or watching NASA TV at 4:30 AM this morning.  Visually, the TV viewers were shown one yellow pixel, and those with telescopes saw nothing.  It will take days, weeks, and months to tease out what can be learned from the spectroscopic, infra-red, and other data recorded.  A big issue is whether there is enough water from which to make fuel for further space travel.  We won’t be getting that answer for a while.

“In other news…”
The Nobel Peace Prize was awarded to Barack Obama today, which produced predictable reactions from Obama fans and foes.  I happen to be an Obama fan.

Before the critics get too carried away, I would recommend that they watch the presentation of the award by the Committee’s Chairman Thorbjorn Jagland, at http://nobelprize.org/mediaplayer/index.php?id=1173, and an 8-minute interview with Geir Lundestad, Secretary of the Nobel Committee, at http://nobelprize.org/mediaplayer/index.php?id=1174.   If watching videos is not your thing, check out the following “speed read”: http://nobelprize.org/nobel_prizes/peace/laureates/2009/speedread.html.

The point is that the committee felt that Obama’s concrete achievement has been to create a new climate in international politics, emphasizing multilateral diplomacy and negotiation, democracy, human rights, a world free from nuclear weapons, and climatic challenges.

He is the world’s leading spokesman for the values expressed in Alfred Nobel’s will, which for the Peace Prize, are:
1. Fraternity between nations
2. Reduction in standing armies  (i.e. freedom from nuclear weapons)
3. Holding of peace congresses   (i.e. multilateral negotiations)

President Obama recognized that the Prize was also meant be an affirmation of common values and to create momentum towards these goals, and he accepted it as a call to action by all nations.   http://www.youtube.com/watch?v=p7bHkH779qg

So let us be glad that the award was made as a step towards a better world, and let all people of good will see his award in that light and make some progress.

Obama’s Plan and the Republican Response September 9, 2009

Posted by jfistere in Ethics, Humanitarianism, Medicine, News, Politics, Taxes, business.
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Well, we’ve finally heard the speech and it was as well delivered as any of  his speeches, I would say. He made dramatic appeals to our moral sense as individuals, and to the traditions of our nation over the years.  He invoked the memory of  Teddy Kennedy, and read from a letter delivered after his death.

Obama stated three main goals:  1) Increase security and stability of existing of existing plans,  2) Provide insurance for those who don’t have it, and 3) Slow the growth of health care costs.

Reduced to bare essentials, here are the main points of his proposed plan:

1. Those with existing coverage will not have to change plans.  However, insurance companies will have to make specified improvements.  It is not clear whether employers will have the option to change to other plans.

2. Exclusions for pre-existing conditions will not be allowed.  There will be no reduction in coverage or failure to renew because of health problems.

3. Insurance will be portable.

4. Preventive care will be covered.

5. If you don’t have health care insurance now you will be able to buy a policy from a new “insurance exchange” as if you were in a very large insurance group.  A “public option” will be one of the choices available.  This will force private insurers to behave better.  The insurance exchange will become operational in four years.

6. To  spread the cost equitably, everybody, including the young and the healthy, will be required to buy insurance.  There will be a hardship waiver for individuals, and 95% of small businesses will not be required to offer insurance.

7. The public option will be paid for by insurance premiums, and not require an infusion of money.  There will be no impact on the deficit.

8. There are many details to be worked out, and there is some flexibility in those details.

9. He is directing his Secretary of Health and Human Services to move forward to test tort reform proposals in several states.

10. He will appoint an independent commission to identify waste and fraud that can be eliminated.

Other stated points

Providing insurance for all is a moral issue, and now is the time to do it.  We are the only advanced democracy on Earth that does not provide it.

The plan will cost $900 billion over ten years, and will be paid for by reducing wasteful spending, and reducing the cost of health care.

Health care, amounting to one-sixth of our economy, is too large to rebuild from scratch.  For that and other reasons, a single-payer system is not being proposed, nor is our employer-based system being abandoned.

There is not enough competition among insurance companies, and as a result, they behave badly in order to increase profits.  The public option will provide increased competition.  He noted that public and private universities compete successfully with each other.

He appealed to the legislators to set aside politically motivated false statements and work together to achieve the overall goal.

[What follows below is a correction to this post, which originally summarized the wrong speech.    JF 9/11/2009]

Louisiana Congressman Charles Boustany delivered the Republican  response:

1. Republicans are ready to work towards affordable common-sense bipartisan reforms.

2. Government run health care will make health care more expensive.

3. He pointed out what he considered deficiencies in the existing Democratic health care reform bills: New bureaucracies, higher costs, increased national debt, and cuts to Medicare.

His pointed out four areas where he saw agreement:

4. All individuals should have access to health care insurance, regardless of preexisting conditions.

5. Individuals and small business can pool buying power to procure lower cost insurance.

6. We should provide assistance to those who still cannot afford to see a doctor.

7. Insurers to offer incentives for preventive care.

He expressed support for the following other ideas:

8. Tort reform [Although Obama also took steps towards tort reform.]

9. Allowing the sale of insurance across state lines to increase competition and lower costs.

Health Care Reform – My View September 7, 2009

Posted by jfistere in Ethics, Medicine, News, Politics, Science, Taxes.
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We’ve recently been having discussions with a variety of people and reading and listening to a number of public statements on health care.  I have read the four-page table of contents and parts of the 1018 page  Dingle House bill as it existed about a week ago.  It is heavy going but interesting.  It has three Divisions: Affordable Health Care Choices, Medicare and Medicaid Improvements, Public Health and Workforce Development.  It does not reflect the ideas presented below.

I have reached some conclusions that make sense to me.  I am a registered Republican but for some time I have felt disconnected from what the party has become.  What follows below is apolitical.

The Need
The fundamental point is that everyone needs to be covered by some form of medical insurance.  It is a moral issue.  When it comes to illegal aliens there is some wiggle room, but since they already get medical care in emergency rooms, we might as well include them too, at a lower cost.

Some say that we don’t need medical reform because anyone can get emergency room care.  However, emergency rooms are not a substitute for appropriate medical care. In the first place they are too expensive for many of services they provide.  Doctors’ offices and urgent care clinics are the most appropriate and economical place for much of what goes on in emergency rooms.  Secondly, preventive medical care is what people need, and nobody goes to the ER to deal with obesity or high blood pressure until it is too late.  The nation’s medical costs will be reduced if we develop more universal preventive care practices.  And we will feel better.

I have heard that the death rate for children under one year in Europe is 4 per thousand while in the US it is 6.3 per thousand.  Although there are differences in the standards of measurement, it says something about the quality of our health care.  We can do better, and part of the solution is better preventive medicine.

The Public Option
I believe we can and should expand Medicare as the “public option”.  For the most part, people on Medicare are satisfied with the service they receive.  The fact that Medicare is “running out of money” is due to a number of causes including the aging of the population, fraud, and the high cost of medical care in general.   We absolutely need to fix the fraud problem.  The aging of the population is an actuarial fact that we just have to accept.  The high of medical care is discussed below. It looks like the “pay as you go” approach will not work for Medicare and so we will have to accept substantial support from the government (your taxes) as is done in other countries. Our schools don’t pay for themselves, and neither do our libraries.

Consider the United States Post Office.  It provides excellent service.  The fact that you can use a competing service at lower cost in some cases may be that they can at least theoretically tailor their service to minimize their costs, while only the Post Office is legally required to provide economical service to everyone no matter where they may live.

In effect, the US Post Office is the “public option” for mail delivery, with UPS, Fedex, etc., playing the role of independent providers.  The analogy soon breaks down, but it does provide a starting point for discussion.  The point is that they are an example of public and private service providers that successfully co-exist and compete with each other.

We would need to charge a reasonable price for the “Public Option”, which will allow private insurers to compete. They may not make money at the same level as they do now, and that’s why they are lobbying so intensively, and apparently, successfully so far.

We would need to subsidize those who cannot afford it.  Of course this is a tricky issue, and one which will need fine tuning along the way.

Another tricky issue is how to handle people in marginal categories such as illegal aliens, people who have not yet gotten green cards, those who have, and so forth.  I think that is a matter, while extremely controversial, can be worked out and must be worked out.  It cannot be allowed to divert us from the overall goal.

Insurance providers should be required to accept clients with preexisting conditions, and should be prevented from dropping patients with poor medical histories.  Portability would be a feature of all future insurance coverage.

There are many details to be worked out, and that is, in part, why the proposed bills have so many pages.  We have to rely on our legislators and their staffs to get it right, or at least close to the mark.

The Cost of Medical Care
The high cost of medicine, is to a certain extent, a separate issue.  Two reasons for the high cost seem to be 1) Our current fee-for-services approach to medicine, and 2) The lack of tort reform.

The fee-for-services approach, which pays a doctor for each test or procedure performed, provides an incentive to provide services that might be only marginally necessary, especially when justified on the basis of defensive medicine as a result of lack of tort reform, as a result of which some settlements are unreasonably large.

The Mayo and Cleveland Clinics operate at low cost and provide excellent medical care and service.  They operate as multi-specialty clinics and the doctors are on salary.  That doesn’t mean they are not well-paid.  They are rewarded for the quality of the care and service they provide, and not the number of procedures they perform.  Can we extend that model?  I think we have to. Not every multi-specialty clinic would have to be a center of excellence as the Mayo and Cleveland are, but the others could provide excellent care with the doctors appropriately rewarded, which should mean well-paid.

Tort reform would require bucking the lawyers’ lobby, and Congress is dominated by lawyers.  I don’t have a high expectation of solving that problem anytime soon, but reform is needed.

The high cost of medicine cannot be allowed to divert us from the goal of acceptable health care for all. High medical costs are a problem that requires a solution, but we can’t do everything at once.

I am not qualified to comment on the effect of medical care reform on our national budget and deficit.  We can probably agree that we have spent much more than the cost of medical reform on activities that have returned significantly less value. Regardless of the cost, it is something that must be done.

The Need for Leadership
Achieving the goal will take the kind of Presidential leadership we have not seen in many years.  At a minimum, Barack Obama will have to bring his own party into line, and hopefully convince many others that it is time to “do the right thing”.  As journalist and commentator Bill Moyers said on Bill Maher’s “Real Time”, it’s a moral issue.  “We need to care about each other.”  If Obama is beholden to insurance companies and/or pharmaceutical companies, he will have to cut himself loose and take the political consequences.  It could cost him a second term, but it might instead make his place in history.

I would be pleased if you would add your comments to the discussion.

Health Care Reform – Message to Congress August 28, 2009

Posted by jfistere in Medicine, Politics, Taxes.
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This is an email (with revisions since) that I sent to our two CA Senators and our Representative:

I urge you to take an active role in the reform of our health care system.  The cost is excessive, our care is not the best, and we need to cover all people.

COVERAGE

I want it to allow people to keep the plans they have or to sign up for a public option.  I want the public option to build on the success of Medicare and Medicaid.

I want the insurance companies to be more effectively regulated, so that plans are portable, people cannot be excluded for pre-existing conditions, or their claims rejected for minor technicalities, or dropped because of health problems.

I want the plan to cover all citizens, with a limit on out-of-pocket contributions, perhaps based on income level.  Essential medical services should be available to undocumented aliens at costs that are lower than emergency room visits.

COSTS

There is no question that expanding medical coverage will be costly.  But perhaps only in the short run.

I am in favor of encouraging multi-specialty clinics with doctors on salary.  The Mayo and Cleveland Clinics operate this way, and are renowned for excellent care.  The Fee-for-Services approach is an irresistible temptation for many doctors to order procedures that are only marginally justifiable.

The plan should provide for limits on malpractice insurance awards and premiums in such a way as to limit excessive defensive medical practices.

I realize that reform will be costly in the short term, but as cost controls and more efficient methods are developed over the years, we should be able to bring costs in line with other countries.

QUALITY

Health care reform should include provisions to monitor and make public the quality of health care based on results.  This should apply to facilities and physicians.

Incentives for preventive medicine should be a part of the plan.  This will both reduce the cost of health care and improve the quality of people’s lives.

LEGISLATIVE RESPONSIBILITY

I urge you to resist the poisonous partisanship that seems to be destroying Congress’ ability to legislate effectively.  Barack Obama is doing his best to lead Congress towards constructive practices and legislation, and I hope you will support him in that.  It will be a tragedy if health reform is further delayed.   This is our main chance.

Insurance and pharmaceutical companies seem to be leading the resistance to effective health care reform.  I urge you to resist the pressures to delay reform.

Travels, Old Town, and Medical Care Reform July 23, 2009

Posted by jfistere in Education, Medicine, Politics, Taxes, business.
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It’s been a while since I last posted, and that was not my plan. This will be sort of a catch-up message, and then maybe I’ll get back on a more frequent schedule.  Our big recent event was the trip to Italy of forty members and twenty friends of the San Diego Festival Chorus.  Among the cities we visited were Venice, Florence, Lucca, Palestrina, and Rome, where we performed a Mass at St. Peter’s in the Vatican.  Our final concert was in Amaseno, the home town of our Musical Director, Maestro Anthony Mostardo.  We were welcomed by the mayor and it seemed like the whole town turned out for the concert.  Tony was given the key to the city.  If you would like to read a personal log of the trip with pictures, check Italy 2009.

Old Town San Diego

On Saturdays in July, Teresa and I have been putting on our 1865 period clothing, and handling the “Letter Writing” demonstration table.  In those days, children were trained in Spencerian Script, and used quill or metal pens you dipped in ink.  (The Palmer method was soon to follow.)    In those days a letter cost 3 cents to mail, and rather than use an envelope, the letter itself was folded, origami style, into a rectangle that could be stamped and addressed.  I was happily surprised to see how eagerly children and adults tried their hand at the script, and wrote actual letters.  We had a good time helping people do things the really old fashioned way.

Health Care

Health care reform is one of today’s big issues, and Obama has touted the Cleveland Clinic and the Mayo Clinic as examples of how excellent care can be given at lower cost than more traditional hospitals and educational institutions.  The key seems to be that the doctors are part of multi-specialty medical teams that collaborate on patient treatment.  They are on salary, rather than being independent practitioners that are paid on a fee-for-services basis.  Obviously there is not much incentive to provide unneeded services at the Cleveland and Mayo Clinics.  Also, the medical system is highly computerized at those clinics, which is a big saving.

The current medical reform bill does provide for some experimental pilot programs to incorporate some of these principles.  Let’s hope the bill gets through, and that the pilot programs are astoundingly successful.  It will be quite a challenge to convince U.S. doctors to forgo their independent status and go on salary, or more significantly perhaps, the fee-for-services approach.

The main thing is that people who were previously uninsured will have a chance to be insured.  That’s a big step forward.

A Rotary Weekend in Temecula – and Microcredit May 25, 2009

Posted by jfistere in Humanitarianism, Politics, globalization.
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The weekend of May 14 – 17 was the annual Rotary District 5340 Conference, which was held at the Temecula Creek Inn, to wind up the Rotary Year.  The main days were Friday and Saturday, and Teresa and up went up Friday morning to set up and staff a table on Microcredit.  It was only supposed to be up between breakfast and lunch on Saturday, but we got it going before breakfast and kept it there until the middle of the afternoon.

Microcredit - Teresa and John

Microcredit - Teresa and John

Microcredit is an amazingly successful concept to combat extreme poverty all over the world.  Small loans are provided to the poorest of the poor (mostly women) to start small businesses, which allow them to buy food, shelter, and education and even start a saving account.  The loans are a genuine business transaction, with interest rates starting around 18% to handle the high cost of such loans.  The loans are primarily to women, because about 92% of the income will be invested in food, shelter and education, while only 50% to 10% of a man’s income will benefit the family.  The repayment success rate is excellent, typically 95 to 98 percent.  As loans are repaid, the money is used to make more loans.  Donations go to form Village Banks which make the actual loans.

Dr. Muhammad Yunus originated the concept in 1976 in Bangaladesh, where he started Grameen Bank.  In 1998 a World Bank study showed that in Bangaldesh, Grameen Bank’s clients were escaping poverty at the rate of 10,000 per month.  Microcredit loans are not just for underdeveloped countries.  Microcredit loans have been made in San Diego, New York City, and many other such cities.

Locally, our Rotary District supports Microcredit through the Foundation for Women, and through Rotary’s Matching Grants program.  Nationally, there is the Rotarian Action Group for Microcredit.

We received a significant amount of interest at our table, and committee people are following up on information and speaker requests.  If you would like more information, I suggest you contact the Foundation for Women or any Rotarian.

The weekend was not all Microcredit, of course.   We had a variety of workshops on other Rotary subjects, golf on Thursday, a barbecue on Friday night, and a dinner dance on Saturday night.  It was an enjoyable, productive weekend, I would say.

Interesting item at Vons grocery store May 7, 2009

Posted by jfistere in Cooking.
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Teresa and I were shopping at Vons and we came across this item in the meat display case:

Chicken Kiev

Ready in 30 minutes?   I guess so, if you like your Chicken Kiev really rare.   The directions say, “Bake at 400 F for 35 minutes.”

Cheers,
John

Teacher layoffs, performance, and pay April 27, 2009

Posted by jfistere in Education, Ethics, News, Politics, Taxes, business.
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Here’s my letter that appeared in the San Diego Union Tribune today, May 2, 2009.  The original story was about the excellent young teachers that were being laid off on the basis of seniority, which they lacked.  Even “teachers of the year” were being laid off.

Regarding “Schools struggle with method to reduce teaching staffs” (Our Region, April 27):

The policy of laying off our newest teachers first cripples our educational system. Good teachers are being shown the door, and bad teachers are being retained.

It is no mystery to me why teachers’ pay is low. If teachers are unwilling to be judged on performance, why should they be paid as though everyone is a high performer? Arguments against merit pay, such as cronyism, evaluating intangibles, student body differences and supervisory incompetence, are issues that industry handles successfully (despite some recent spectacular failures).

Schools need to reward performance, weed out the incompetent and the burned out, and identify those who would benefit from support and training. Teachers need not, in fact should not, be judged just on student test results. Nor should time in service be ignored. But there are other measures, including student and parent feedback, student success in later grades and direct observation. It is our children who need excellent educations, and this should be our primary concern, rather than the jobs of low-performing teachers, which the system protects.

Until performance evaluations are given greater weight in salary and retention decisions, our schools will not retain the best teachers, or provide the best education for our students.

JOHN FISTERE
El Cajon

The Relay for Life April 22, 2009

Posted by jfistere in Ethics, Humanitarianism, Medicine, Science.
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Once again La Mesa Rotary has a team in the American Cancer Society Relay for Life, to raise money to fight cancer.  We’ll be on the track for 24 hours, starting 9 am this Saturday the 25th of April.  No single person will be on the track the whole time (I don’t think!) but we’ll have someone out there the full 24 hours.

You can make a difference in the fight against cancer.

To check out donations so far, and maybe make your own donation click here.  If you want to see how our La Mesa Rotary team is doing click here.

Thanks in advance for your donation!

John