Health Care Reform – Message to Congress August 28, 2009
Posted by jfistere in Medicine, Politics, Taxes.Tags: coverage, health care reform, insurance, legislation, Medicaid, Medicare, partisan, preventive medicine, public option, universal health care
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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.Tags: Cleveland Clinic, Italy, Mayo Clinic, medical care, medical insurance reform, Old Town, San Diego Festival Chorus, The Vatican
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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.Tags: FFW, Grameen, Microcredit, Microfinance, MRM, poverty, RAGM, Rotary, Village Banking
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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 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.add a comment
Teresa and I were shopping at Vons and we came across this item in the meat display case:

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.Tags: children, evaluation, incentive, layoffs, merit pay, parents, performance, seniority, students, teachers, tests
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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.Tags: cancer, donations, La Mesa Rotary, Relay for Life, research
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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
Interrogation of Terrorists: What is torture? April 20, 2009
Posted by jfistere in Ethics, Politics.Tags: Abu Zubaydah, al Qaeda, Bybee, Gonzales, interrogation, law, Rizzo, Section 2340A, stress, Taliban, terrorists, torture
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I have been struggling with the issue of harsh interrogation of terrorists for some time, and doing a little reading, and I have come to some conclusions. First of all here are some initial stipulations:
- We are not talking about rounded up terrorism suspects, who may or may not be terrorists. We are talking about known committed leaders, who almost certainly have information that we need.
- We are not talking about what we would like to do, but what we need to do.
- The issue is to differentiate between harsh interrogation methods, which are useful and acceptable, and torture.
There are those who believe harsh interrogation methods should never be used, and for those people, this discussion will have little significance.
The Geneva Convention is an agreement among nations, and al Qaeda and the Taliban are not nations or parties to the treaty. Also, the treaty is intended to apply to nations at war in a more conventional sense. Terrorists do not fall into that category. Therefore the subjects are not “prisoners of war”. So the primary issue is which techniques are permissible under U.S. Law, rather than the Convention.
On August 1, 2002, Jay S. Bybee, Assistant Attorney General in the Office of Legal Counsel, wrote a memo to Alberto R. Gonzales, Counsel to the President. It has been widely criticized, but it bears reading. The question is what sorts of harsh interrogation methods would violate Section 2340A of the United States Code, which prohibits torture. He discusses the issue from the following standpoints:
- US Criminal Law
- The UN Convention Against Torture
- US Civil Case Decisions
- International Decisions
- Constitutionality issues
- Other defenses, or justifications, such as self-defense
Bybee analyzes a variety of sources, including the law itself, dictionary definitions, U.S. and international case law, and our Constitution . The documents support the conclusion that certain methods or acts may be “cruel, inhuman, or degrading”, but not all such acts fall within the definition of torture. He documents the position that “… torture is not the mere infliction of pain or suffering on another, but is instead a step well removed. The victim must experience intense pain or suffering of the kind that is equivalent to the pain that would be associated with serious physical injury so severe that death, organ failure, or permanent damage resulting in significant body function will likely result. If that pain or suffering is psychological, that suffering must … cause long-term mental harm.”
In other words, torture must be extreme cruel, inhuman, or degrading treatment. Anything less falls outside the definition.
Jay Bybee wrote or signed another memo on the same day. In this case he was advising John Rizzo, Acting General Counsel of the CIA on how to proceed in the interrogation of Abu Zubaydah, a high-ranking al Qaeda operative. Specifically, the memo addresses whether any of the methods proposed would violate Section 2340A.
The actions proposed by the CIA were:
- Attention grasp
- Walling
- Facial hold
- Facial slap (insult slap)
- Cramped confinement
- Wall standing
- Stress positions
- Sleep deprivation
- Insects placed in a confinement box (non-biting)
- The waterboard
The memo restates detailed descriptions provided by the CIA for each of procedures. There is no beating, shocking, burning, wounding, threat of death, or similar activity in the list. Methods for assuring the safety of the subject are described. The memo also states that over 10,000 of our own people have gone through SERE (Survival, Evasion, Resistance, Escape) training, which includes all of these techniques, including waterboarding , except #9, the insect. Only two people have dropped out, and none have had any lasting physical or psychological effects. The memo goes on to describe various avenues of investigation that showed that none of these techniques produce lasting effects.
The memo concludes than none of the techniques proposed would violate Section 2340A, which prohibits torture.
So what does all of this mean? It certainly means different things to different people. From what I have observed on television, the “extreme” part of the distinction has been lost by the press. As a compassionate, civilized person, one might automatically be against cruel, inhuman, or degrading treatment of anyone. However, when you consider that not using such methods may result in the death and injury of many others, the decision is not so easy.
Based on what I initially heard about the infamous Bybee memos on television, I was regretting that the statute of limitations had run out on him, and angry that he is now a judge. After actually reading them, I think he gives us a pathway to successful, legal harsh, interrogations.
Perhaps waterboarding deserves special mention. From the very beginning I was never convinced that waterboarding is torture, in spite of the statements of some noted and respected people. Although you “feel” like you are drowning, you “know” you are not, and there is no particular pain, as I understand it, and there are no lasting effects. It seems like an ideal high stress interrogation method to me.
One is tempted to say that because these terrorists know no limits, and obey no rules as we know them, they deserve whatever they get. One might say that people who are willing to blow themselves up, or even worse, convince others to do so, in order to kill as many civilians as possible, deserve no limitations on their treatment. But, as despicable as their actions are in our eyes, we cannot measure our own behavior against theirs.
The bottom line is that we are dealing with highly motivated people determined not to give up the information we need to protect lives. Although we must not use torture, we need to have available every legal interrogation method that will work. I believe Bybee’s memos define those methods.