Tue, 25 Jul 2017
Trump and the BSA National Jamboree
I was a Boy Scout when I was a kid. I'm currently an adult leader with a Boy Scout troop. I think the ideals and the potential of the Scouting program are good. The short version of Scouting is that we strive to develop kids' citizenship (in the USA, but also in their community and the world), character, and fitness (both physical and emotional). We use a number of tools to accomplish those goals, but the one that most differentiates Scouting from other similar organizations, in my opinion, is what BSA (the Boy Scouts of America) calls "the outdoor program", i.e. all the stuff we do outdoors, including camping, fishing, hiking, and a whole host of other activities.
BSA is not perfect; there are policies they have that I think should be changed, and bad adult leadership in a troop can give the troop's kids a bad experience. But I believe that the core goals and methods of the organization are good, which is part of the reason I am a scout leader. I want to make sure that the kids in my troop have the opportunities to get as much out of the program as possible and have good experiences while doing it.
As part of BSA's focus on citizenship, the President of the United States is considered to be the honorary president of the BSA (though there's a separate actual president who actually runs the national board). Consequently, the US President is always invited to speak at the BSA National Jamboree, an every-four-year camping event that hosts troops from all across the US (and plenty from other nation's Scouting programs, too). Nineteen National Jamborees have been held (including the one currently underway), under twelve different sitting US Presidents (including Trump). Eight of those presidents have spoken in person at a National Jamboree during their term. (Neither Nixon nor Carter spoke at a National Jamboree while they were President. Reagan was scheduled to speak, but was unable to make it for health reasons, so Nancy Reagan spoke in his place. Obama recorded a video that was played at the Jamboree.) The BSA's Bryan on Scouting blog has a history of presidential visits to National Jamborees through Obama.
So whether you like Trump or not, it was reasonable (in my opinion) for him to be invited to speak at this year's National Jamboree, on the basis of Jamboree tradition and in the spirit of developing citizenship in young Scouts.
That said, Trump took a disappointingly political tack with his speech, seeming to treat it as a campaign rally. Officially, the Boy Scouts of America is a non-partisan organization. Everyone should be able to benefit from the skills, knowledge, and experiences available through Scouting, regardless of political viewpoints, so no one should feel excluded because of their viewpoints. Past presidents have focused on non-partisan topics, emphasizing things like community service and being a good citizen, in their Jamboree speeches. Trump had a fair amount in that vein, but he kept dropping in things like his usual digs at the media or complaining that he hasn't been shown enough "loyalty". There was actually a lot of good stuff in his speech, but it seemed like he couldn't avoid making every few paragraphs about himself, in a partisan, exclusionary manner. (Plenty of past presidents used their speaking opportunity to highlight things they saw as personal accomplishments, but they all presented those things as examples of citizenship or service in line with the ideals of Scouting.) He also managed to use language that most Scout leaders would at least frown on, were it uttered by one of their troop members at an event, and referenced apparently risque activities in a fairly approving manner.
I was also disappointed at the members of the audience who went along with Trump's partisan digressions, booing Clinton and Obama while cheering things like the GOP-supported, Democrat-opposed effort to repeal the Affordable Care Act. I'm not actually surprised that Trump treated his speech like a campaign event. It still saddens me, but it's entirely in keeping with his demonstrated character up to now. I had hoped, however, that Scout leaders would understand that sort of partisanship is inappropriate at a Scouting event. It is, of course, hard to tell just how many people were participating, but it was enough that the TV cameras could pick them up.
But despite all that, the instances of angry, divisive speech from President Trump to the Jamboree crowd do not represent Scouting as a whole. I'm sure there were some people in the audience who would be happy chanting "Lock Her Up" at a genuine Trump rally, just as I'm sure that there were among those 40,000 people some who have marched in anti-Trump protests. I think, however, that most scout leaders care primarily about encouraging their kids to be better people without having to pick a political team and without having to shut out anyone on the opposite side.
If you have qualms about Scouting, go visit some troops in your area and see how they work. The scouting program is big and it provides a lot of resources for individual troops, but what defines each one is really the adults and kids in that specific troop. Each troop has its own character. Some are bad environments for youth development, which makes me sad. Some are good environments that maybe just aren't the right fit for your particular child. But most troops are friendly and welcoming, and in most places there should be at least one where your child will feel comfortable and engaged and where there are people who will help your child develop into a healthy citizen of upstanding character.
Tue, 10 Dec 2013
Dottie Gold-Humphreys, October 1999 - 9 December 2013
Less than five months after getting married and moving into an apartment together, my wife, Becca, and I got a pair of cats. They'd been with a friend of ours for about ten years, longer even than she'd known her husband. She and her husband loved them dearly despite their cat allergies, but their two-year-old was turning out to be allergic and was terrorizing the cats (as only a two-year-old can do) to boot, so they were reluctantly looking for a new home for the cats. Thus it was that on January 31st, 2009, Becca and I took Nico and Dottie to our apartment to live with us.
Once the cats got used to the apartment, they settled into distinct roles. Nico was used to getting his way with everything and tended to crowd Dottie out when there was something he wanted. We were always worried about her getting enough food because even though we gave them separate bowls she usually wouldn't eat until he'd finished. Nico would often eat so quickly that he'd immediately regurgitate some of his food, which Dottie would promptly eat. It was a little gross, but we felt oddly comforted by it, because we knew Dottie was actually eating something. (We had Nico on a diet because he was 20 pounds when he should have been about 15. Dottie always seemed a little scrawny at her 7 pounds.)
Nico was always the cat that would greet newcomers to the house and aggressively demand attention, but Dottie was Becca's special baby. Dottie always seemed prim and dainty, especially when compared to the more boisterous Nico.
Becca delights in nicknames for people, cats, cars, and probably other entities too. Nico and Dottie were no exception and went through a plethora of names, including Small Cat, Muffin, Princess, and Sneezy for Dottie. "Princess Baby" was probably the most long-lived nickname for her (as was "Fatty" for Nico).
In February 2011, Nico developed kidney cancer and that April we made the difficult decision that it was time to let him go. Dottie mourned Nico for a time--at least it seemed that way. She was even more withdrawn than usual and I think she missed his presence in some sense or other. Eventually, though, she blossomed in a way that she had never done around him. She became more confident around the house; she hid under things a lot less; and she was a lot more comfortable around other people. For all that we loved Nico, I think Dottie was a lot happier by herself.
Both Dottie and Nico had had renal problems for pretty much their entire lives. When we got them, we continued their diet of kidney-friendly food (high in calories, low in protein) and we had bloodwork run on them periodically to make sure they were doing okay. The bloodwork measured levels of substances that the kidneys should be removing from the blood. For both cats, those levels were always higher than what a cat should normally have, but they never worsened into areas that would be problematic.
Until a couple of months ago. I forget now what particular symptom prompted the vet visit, but while we were there they ran her bloodwork and her creatinine levels had spiked, indicating a decrease in kidney function. At the vet's recommendation, we started administering subcutaneous fluids to help flush out her system and compensate for the lost kidney capacity. We had done this with Nico, and he had been easy to handle. He seemed to enjoy the attention, even though we were sticking him with needles on a regular basis. (One vet tech told us that he was the only cat she'd seen who didn't react at all when she took his temperature rectally.) Dottie was a lot less happy about the fluids. Although she eventually became more accustomed to them, she never liked the process and it took both of us to hold her while we were administering them.
The fluids plus a few pills to also supplement her kidney function held her for a month or so and seemed sustainable; we'd be doing them for the rest of her life, but it seemed likely that they'd be able to sustain her for some time to come while preserving her quality of life.
In November we moved into a new house. I was worried that Dottie would be disoriented by the change and would be unhappy with the new house, especially since there were stairs and she was starting to look a little arthritic in her back legs. She took to the house surprisingly well, however. She seemed happy to go up and down the stairs and explore everything in the place. Unfortunately, we discovered fleas several days after moving in. Most of the house has hardwood floors, but we fogged the entire place (spending several hours with Dottie in the old apartment) and put flea powder down on the carpets. We kept Dottie in our bedroom while the flea powder was down.
After about a week at the new house (and about three weeks ago), Dottie stopped eating. She'd gone through phases of not eating in the past and we had an appetite stimulant on hand for times when it went on for more than a couple of days. Correspondingly, after a couple of days, we gave one to her. It didn't appear to have any effect. We thought she might not have gotten it (sometimes she managed to make us think she took her pills but would spit them out later), so we waited three days (the minimum dose window) and gave her another. When that one also had no effect, we started syringe-feeding her and we took her to the vet as soon as we could. The vet found that she was very anemic--another side effect of the kidney dysfunction--and prescribed an injection that would fill in for the red-blood-cell-creation function of the kidneys.
After about a week on the injection, Dottie started recovering. She started becoming more energetic and she started eating again. We were administering a lot of treatments at that point, but it seemed likely that once she recovered more we could stop some of them and go back to just the handful of maintenance treatments.
In the last couple of days, though, her appetite dropped off again. We attributed this to one of the supplemental (and bad-tasting) drugs we were giving her, so we decided to just stop that one. It was for nausea relief and she was already on a couple other things with the same effects. Sunday night she seemed to be wheezing a bit but was otherwise about the same as she had been, so we just figured we'd mention the wheezing when we took in for her scheduled vet visit on Wednesday.
On Monday morning Becca and I woke up, showered, got dressed, gave Dottie her pills, syringe-fed her a bit, wished her goodbye, and went to work. When we came home that evening, she was dead.
Our vet is of the opinion that, given everything that we know, she probably went peacefully. That gives a little consolation, as does the fact that we'd been deliberately spending time with her--carrying her out to the couch to sit with us as we ate, talked, and watched TV--but we never really said goodbye, because we really didn't expect this so soon. We thought the treatments we were giving her would hold her for at least a few weeks, by which point we'd be able to tell whether she'd be able to recover from the most immediately-threatening symptoms like the anemia. We figured we'd be in store for a difficult decision about what would be best for her at that point, but we really expected her to live until then.
So this is the best I can do for now: Goodbye, Dottie. You were our princess baby and you were a special and unique cat. We will miss you and you will remain special to us for the rest of our lives.
Mon, 25 Jan 2010
Car Engine Advice Sought
I've been having intermittent problems with my car that have now stumped two mechanics, so I'm turning to the Internet for advice. I have a 1996 Jeep Grand Cherokee, with Selec-Track four-wheel-drive and a 6 cylinder engine.
The problem I'm having is that the engine will sometimes just stall (the motive power goes away and the engine RPMs drop to zero). It only seems to happen right after starting the car (so the engine hasn't warmed up yet), and it's much more common in wet weather (rain, snow, heavy fog). Often times, I can feel the engine losing power and can prevent a stall by stepping on the gas pedal. If the engine actually stalls, I have to wait at least a minute to restart it; if I try restarting it immediately, I hear the chug-chug-chug of the starter, but the engine won't start running.
I've had a few times when the stalling seemed to hit as I was braking, just as the automatic transmission was downshifting from second to first gear. I've had the car sall at times apparently unrelated to shifting, though.
This morning, it was particularly bad. I barely got out of the parking lot at home (after several stop/wait/restart cycles) before the engine stopped being useful--it would only run for 30-45 seconds before stalling, and I couldn't prevent the stall. I had the car towed to a mechanic, but by the time they took a look at it, the engine started and ran normally. They couldn't find anything wrong with the engine, and there were no codes from the onboard diagnostics.
The coolant system has a slow leak (my regular mechanic tracked it to the water pump, I think), but I've had that for over a year now and I doubt it's related. In the time since the problem first manifested, I've had a system tune-up (including replacing the spark plug wiring, apparently a common contributor to problems such as these), had the oil changed, had the transmission fluid changed, and had a (presumably unrelated) badly-leaking coolant hose replaced.
Any suggestions on what to look for to fix this will be gladly accepted. I'll be cross-posting this to several social media sites; responses there are fine, or just send an email to firstname.lastname@example.org
Update 2010-01-02: I've gotten a number of suggestions for problem areas that could be causing this problem. The most-suggested item was the fuel filter, which I haven't replaced since I got the car five years ago, so I'm taking care of that to start with. I'll see how well the car behaves with a new filter. Other suggestions have included the idle valve, O2 sensor, or fuel pump. If replacing the fuel filter doesn't work, I'll check out some of the other possibilities.
Wed, 02 Dec 2009
I've been contributing to Kiva for a number of months now, and am sufficiently appreciative of them to want to tell others about them. The short version is that Kiva is a distributed, peer-to-peer microlending non-profit with the goal of alleviating global poverty.
Microfinance is the practice of providing financial services to people in low-income parts of the world who are not generally considered profitable-enough customers to warrant service from traditional banking institutions.
Microlending (or microcredit) is a subset of microfinance that provides loans to low-income people, typically entrepreneurs in low-income area of the world, who do not have access to loans from traditional banking sources. Sometimes there simply are no banks in the area, but more typically the entrepreneurs don't make enough money to qualify for loans, don't have sufficient collateral, or don't have a sufficient credit history. Modern microlending started in the 1970s with the Bangladesh-based Grameen Bank.
The advantages of microlending over traditional aid programs are in its benefits to developing economies: it encourages growth of local businesses, puts more money into local economies, encourages local employment opportunities, and gives entrepreneurs a foothold to establish their businesses and a credit record. In some areas, it provides an alternative to tribal moneylenders, who charge high interest rates and respond to repayment failures with physical violence. In short, traditional aid addresses people's basic needs: food, shelter, clothing, education, sustainable agriculture; while microlending works on the next step of growing local economies.
Kiva was created as the first distributed, peer-to-peer microlending organization in the world. It's peer-to-peer because all Kiva does is list loan applicants on their website; it's up to the users of the website to supply the money to fund the loans. As the loans are repaid, those repayments go to the people who supplied the money. Kiva is distributed because the funding for any given loan is made up of contributions from many different Kiva users. (And as the loan is repaid, each contributor is repaid according to his or her portion of the overall loan.)
The actual process is a little more involved. Kiva doesn't make loans directly. Instead, they partner with microfinance institutions (MFIs) in other countries. The MFIs accept loan applications, evaluate the applicants, disburse loans, and collect payments. During this process, the MFIs tell Kiva about the loans in batches, Kiva lists the loans, collects the contributions from Kiva users, and sends the money to the MFIs. When the MFIs collect money, they send the payments (again, in batches) to Kiva, which distributes the payments to the loan contributors. The MFIs often fund the loans before telling Kiva about them (to avoid the delays in the funding process and get the money to the applicant quickly), and then backfill the accounting once the loan is actually funded. In some cases, a loan will expire on Kiva without being fully funded; when that happens, any contributors will have their contributions refunded, and if the MFI already disbursed the loan, they will have to find another source of funding for it.
When payments are received on a loan, the money is made available to contributors as "Kiva Credits". If you have Kiva credits, you can apply them to a different loan, donate them to Kiva itself, or transfer them into a PayPal account.
Because most loans are made in developing areas of the world, if someone defaults on their loan, there is often no workable legal recourse for requiring repayment and the people who contributed to the loan are not repaid. The MFIs do research on the applicants before granting loans, and do a generally good job of selecting people who will repay their loans. Kiva has an overall default rate of about 2%. (For comparison, in 2004, the federal Small Business Administration, which makes loans to small businesses in the US, had a 2.4% default rate, which has hit 11.9% with the recession.)
This does mean that any loan made through Kiva carries the risk of losing the money contributed.
Kiva does not collect any interest on its loans. Consequently, Kiva users will only get back exactly what they put into the loan in the first place, unless the loan defaults. This means that anyone contributing to Kiva loans over a long term can expect to lose some money to defaults. Because Kiva is operated as a non-profit organization with the goal of alleviating poverty, they don't feel it is appropriate to add interest payments to the loans they fund.
The MFIs that Kiva partners with do charge interest, however. The interest that they charge pays for their staff and administration costs. Typically, they charge a small percentage of the loan in interest, plus a flat fee to cover the effort necessary for any loan, regardless of its size. This includes things like interviewing applicants and researching their financial history and dependability. Because the loan amounts are small, that fee often adds a noticeable percentage to the loan, leading to interest rates that seem surprisingly high. The average interest rate on Kiva is about 35%, but I've seen rates as high as 50%.
The MFI interest rates are another reason that Kiva doesn't charge interest themselves; they don't want to add any more to the borrower's repayment load.
For each of its partners, Kiva shows both the average interest rate for that MFI and the median interest rate for other MFIs in the same region. People worried about the high rates are encouraged to check up on the MFI before committing to a loan.
Since Kiva doesn't collect interest and they apply all of a contributor's money to the loans themselves, they rely on donations to keep running. After you contribute to a loan, they ask for a donation and suggest an amount equal to 15% of your loan contribution. You have the option of choosing a different percentage (including 0%) or specifying a particular dollar amount. You can also give the repayments on your loans to Kiva as a donation, either manually (by donating your Kiva credits) or automatically (by specifying that all repayments should be automatically donated).
Kiva is a 501(c)3 nonprofit, so all donations are tax-deductible, although loans are not. (As mentioned above, loans are not even guaranteed to maintain value.)
I feel it would be unfair to talk about Kiva without acknowledging that some people have criticisms of the microlending process.
The most common criticism about microlending in general is the high interest rates. Kiva does as well as it can in this area, recognizing that MFIs need to charge enough to fund their activities, but also being as transparent as possible about what is being charged. Kiva also periodically reviews their partners' claims and practices. (They have closed relations with at least one partner because of fraud--not interest related, in this case; the partner was claiming much higher amounts on its loans than it was actually disbursing.)
Conversely, some people argue that Kiva should themselves be charging interest. I can't find the article now, but I read a piece a while back that argued that when microfinance funding organizations like Kiva pay interest, contributors change from a "charity" mindset to an "investment" mindset and end up putting more money into system. Personally, I think that the charity mindset is a better fit here. If the goal is to alleviate poverty, then helping people establish businesses with as few impediments (including additional interest) as possible is a better approach than one that is beholden to the best return on investments.
There are also claims that microlending doesn't help all that much. There was an article in the Boston Globe a few months ago titled "Small change: Billions of dollars and a Nobel Prize later, it looks like ‘microlending’ doesn’t actually do much to fight poverty". Despite the inflammatory subtitle, the article is reasonably balanced. It refers to two unpublished papers about studies that concluded that microlending is not as effective as many people think. For one thing, I'd want to wait until the papers are published; peer review is likely to shake out any methodological problems in the studies. But the article points out that the studies found that microlending did make a difference for a lot of businesses and helped them either establish themselves or grow. It's not a panacea--if for no other reason than that the eligibility requirements for "who can take out a loan and be counted on to repay it if there's little government enforcement to rely on" mean that only a small part of the population will be considered in the first place--but it is a step in the direction of helping establish functioning local economies in poor regions. The article provides a number of pro-microfinance perspectives, most of which boil down to, "The studies show that microlending isn't magic, but it's a useful tool--as long as you understand that it isn't magic."
Kiva in particular was the target of some criticism recently when they began offering loans to entrepreneurs in the US. Many people felt that people in the US are either well-served by the standard banking system or have access to many government programs and would not get much additional benefit from a microloan. I tend to regard this as a place where it's best to give people the ability to make their own decisions. Kiva felt that there was benefit to offering loans in the US, and those who agree with them can now participate in those loans. Those who disagree have no obligation to fund US loans, and there are plenty of available loans in poorer countries. (There was a time when Kiva funded every loan it offered and sometimes ran out of new loans to fund. These days, there's more demand, and loans do periodically expire unfunded.)
I think that Kiva provides an important service to developing areas of the world, and I put a portion of my charitable giving into the site each month. Personally, I don't plan to take money out of it; what I put in goes either towards funding more loans or donations to keep Kiva running. Other people have different financial approaches, of course.
Kiva also isn't the only place I donate. In addition to local giving, I also contribute to more traditional aid organizations, because microlending is only effective if people are already healthy, educated, and empowered. For giving along more traditional lines, I recommend Heifer International, which mostly focuses on sustainable agriculture in developing regions.
Kiva was the first peer-to-peer microlending website, but many others have followed in its footsteps, and some of its competitors take different approaches to microlending. If you don't like Kiva, there might be another organization that's a better fit for you.
- The Microfinance Gateway is a large database of microfinance organizations, including aggregators like Kiva. It contains links to many more organizations than I'm going to link to here.
- United Prosperity doesn't directly give contributed money to borrowers; it uses that money as collateral for traditional bank loans. They feel that this approach is better at integrating people into the traditional banking system.
- The Rotarian Action Group for Microcredit works to assist Rotary groups with setting up their own microlending operations.
- MicroPlace collects interest on its microloans, so contributors earn a return on their contributions.
- Prosper is a more general peer-to-peer lending broker. Contributors can use it either as a general investment fund or a broker for choosing individual loans to fund. Anyone with a decent credit score can request a loan, which is bid on by lenders.
My Kiva History
If you want, you can look at my lender page on Kiva. So far, I've contributed to 11 loans:
- Ibrahim (last name withheld for privacy) in Lebanon: Owns a sewing factory. Currently 58% repaid on a $3,000 loan.
- Neang Soknoeun in Cambodia: Weaves and sells groceries. Currently 33% repaid on a $700 loan.
- Khosiyat Kuldasheva in Tajikistan: Sells foodstuffs at a local market. Currently 37% repaid on a $3,000 loan.
- Harriet Namugabo's group in Uganda: A 5-person group who are collectively responsible for the loan. The leader sells medicines. Currently 66% repaid on a $875 loan.
- Lilane (last name withheld for privacy) in Lebanon: Owns a clothing store. Currently 24% repaid on a $1,000 loan.
- Emélido Oporta Alvarado in Costa Rica: Raises cattle. Currently 0% repaid on a $1,175 loan. (His payment schedule is one payment every six months. The first one is due next April.)
- Efrain (last name withheld for privacy) in Peru: Grows and sells potatoes and raises cattle. Currently 0% repaid on a $1,200 loan. (He doesn't have a monthly payment schedule; the entirety of the loan is due next March.)
- Felix Alberto Tórrez Machado in Nicaragua: Runs a cybercafe. Currently 13% repaid on a $975 loan.
- Anonymous in Iraq: Runs an auto repair shop. Currently 0% repaid on a $3,000 loan. (First payment is due in January. Kiva also notes that government regulations on foreign loans are murky and they might not be able to receive the money from the borrower's payments. I figured it was good to support a business in Iraq, though, so I accepted the risk.)
- Nuevo Amanecer Group in Bolivia: a 13-person group who would be collectively responsible for the loan, with various jobs. Loan expired before being fully funded and my contribution was refunded.
- Gaibullodjon Sobitov in Tajikistan: Processes and sells dried apricots. Currently 70% raised on a $1,500 loan, with 2 days before the loan expires.
Thu, 12 Feb 2009
Betsy McCaughey on the Obama Stimulus Plan: A Rebuttal
Betsy McCaughy has written an opinion piece for bloomberg.com titled Ruin Your Health With the Obama Stimulus Plan. In it, she characterizes the stimulus package (as passed by the House) as containing sinister language that will allow the government to control and reduce the quality of health care available to the American public. I took a look at the sections of the bill that she has issues with, and I found that her conclusions are gross distortions at best. More or less everything she points to in the bill is focused on providing a healthcare information technology infrastructure to allow doctors and hospitals easy access to patients' complete medical information--nothing more.
(Since I wrote my analysis, the people at FactCheck.org have done their own analysis, which is more in depth than mine. The conclusions are similar--McCaughey is misunderstanding a lot of the bill--although they allow that some parts of the bill don't necessarily forbid her worst-case scenario. (They also note that much of what she worries about has been in place already, under a program created by George W Bush: the bill just turns an executive order into established law.))
She also makes a lot of comparisons to Tom Daschle's book Critical: What We Can Do About the Health-Care Crisis, drawing sinister inferences from the comparisons. I haven't read the book, so I can't judge how right or wrong she is about its contents, but the contents of the actual bill are not what she says they are.
To begin with, she claims that the government will be overseeing what your doctor does and dictating treatments:
One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446).
The actual text of the bill is as follows:
page 441 19 “(b) PURPOSE.--The National Coordinator shall per- 20 form the duties under subsection (c) in a manner con- 21 sistent with the development of a nationwide health infor- 22 mation technology infrastructure that allows for the elec- 23 tronic use and exchange of information and that-- page 442 1 “(1) ensures that each patient's health informa- 2 tion is secure and protected, in accordance with ap- 3 plicable law; 4 “(2) improves health care quality, reduces med- 5 ical errors, reduces health disparities, and advances 6 the delivery of patient-centered medical care; 7 “(3) reduces health care costs resulting from 8 inefficiency, medical errors, inappropriate care, du- 9 plicative care, and incomplete information; 10 “(4) provides appropriate information to help 11 guide medical decisions at the time and place of 12 care; 13 “(5) ensures the inclusion of meaningful public 14 input in such development of such infrastructure; 15 “(6) improves the coordination of care and in- 16 formation among hospitals, laboratories, physician 17 offices, and other entities through an effective infra- 18 structure for the secure and authorized exchange of 19 health care information; 20 “(7) improves public health activities and facili- 21 tates the early identification and rapid response to 22 public health threats and emergencies, including bio- 23 terror events and infectious disease outbreaks; 24 “(8) facilitates health and clinical research and 25 health care quality; page 443 1 “(9) promotes prevention of chronic diseases; 2 “(10) promotes a more effective marketplace, 3 greater competition, greater systems analysis, in- 4 creased consumer choice, and improved outcomes in 5 health care services; and 6 “(11) improves efforts to reduce health dispari- 7 ties.
The whole thing is talking about making patients' medical information available by electronic means to hospitals, doctors, and insurance companies while maintaing the patients' privacy. Clause (4), in particular, refers to doctors being able to have all of the information they need when making decisions. It does not imply anything about the government dictating doctors' decisions to them.
She goes on to talk about hospitals and doctors not being "meaningful users" of the system, and she seems to imply that this will result in doctors abandoning treatments that aren't government-sanctioned:
Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. ... What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment?
Here's what the bill has to say about "meaningful users":
page 511 14 “(o) INCENTIVES FOR ADOPTION AND MEANINGFUL 15 USE OF CERTIFIED EHR TECHNOLOGY.-- 16 “(1) INCENTIVE PAYMENTS.-- 17 “(A) IN GENERAL.--Subject to the suc- 18 ceeding subparagraphs of this paragraph, with 19 respect to covered professional services fur- 20 nished by an eligible professional during a pay- 21 ment year (as defined in subparagraph (E)), if 22 the eligible professional is a meaningful EHR 23 user (as determined under paragraph (2)) for 24 the reporting period with respect to such year, 25 in addition to the amount otherwise paid under page 512 1 this part, there also shall be paid to the eligible 2 professional (or to an employer or facility in the 3 cases described in clause (A) of section 4 1842(b)(6)), from the Federal Supplementary 5 Medical Insurance Trust Fund established 6 under section 1841 an amount equal to 75 per- 7 cent of the Secretary's estimate (based on 8 claims submitted not later than 2 months after 9 the end of the payment year) of the allowed 10 charges under this part for all such covered 11 professional services furnished by the eligible 12 professional during such year. page 540 6 “(3) MEANINGFUL EHR USER.-- 7 “(A) IN GENERAL.--For purposes of para- 8 graph (1), an eligible hospital shall be treated 9 as a meaningful EHR user for a reporting pe- 10 riod for a payment year (or, for purposes of 11 subsection (b)(3)(B)(ix), for a reporting period 12 under such subsection for a fiscal year) if each 13 of the following requirements are met: 14 “(i) MEANINGFUL USE OF CERTIFIED 15 EHR TECHNOLOGY.--The eligible hospital 16 demonstrates to the satisfaction of the Sec- 17 retary, in accordance with subparagraph 18 (C)(i), that during such period the hospital 19 is using certified EHR technology in a 20 meaningful manner. 21 “(ii) INFORMATION EXCHANGE.--The 22 eligible hospital demonstrates to the satis- 23 faction of the Secretary, in accordance 24 with subparagraph (C)(i), that during such 25 period such certified EHR technology is page 541 1 connected in a manner that provides, in 2 accordance with law and standards appli- 3 cable to the exchange of information, for 4 the electronic exchange of health informa- 5 tion to improve the quality of health care, 6 such as promoting care coordination. 7 “(iii) REPORTING ON MEASURES 8 USING EHR.--Subject to subparagraph 9 (B)(ii) and using such certified EHR tech- 10 nology, the eligible hospital submits infor- 11 mation for such period, in a form and 12 manner specified by the Secretary, on such 13 clinical quality measures and such other 14 measures as selected by the Secretary 15 under subparagraph (B)(i).
"Meaningful EHR users" will be given financial incentives to use the electronic system. If a doctor or hospital is not a "meaningful EHR user", that means only that they're not making use of the electronic medical information infrastructure. It has nothing to do with what treatments they offer. Furthermore, non-"meaningful users" don't face penalties; they just don't have the government helping them pay for the upfront cost of implementing the electronic system.
Next, she claims that the bill creates a department to prevent people from using new medical treatments because they're more expensive:
In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make. The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs.
Again, the bill:
page 190 7 SEC. 9201. FEDERAL COORDINATING COUNCIL FOR COM- 8 PARATIVE EFFECTIVENESS RESEARCH. 9 (a) ESTABLISHMENT.--There is hereby established a 10 Federal Coordinating Council for Comparative Effective- 11 ness Research (in this section referred to as the “Coun- 12 cil”). 13 (b) PURPOSE; DUTIES.--The Council shall-- 14 (1) assist the offices and agencies of the Fed- 15 eral Government, including the Departments of 16 Health and Human Services, Veterans Affairs, and 17 Defense, and other Federal departments or agencies, 18 to coordinate the conduct or support of comparative 19 effectiveness and related health services research; 20 and 21 (2) advise the President and Congress on-- 22 (A) strategies with respect to the infra- 23 structure needs of comparative effectiveness re- 24 search within the Federal Government; page 191 1 (B) appropriate organizational expendi- 2 tures for comparative effectiveness research by 3 relevant Federal departments and agencies; and 4 (C) opportunities to assure optimum co- 5 ordination of comparative effectiveness and re- 6 lated health services research conducted or sup- 7 ported by relevant Federal departments and 8 agencies, with the goal of reducing duplicative 9 efforts and encouraging coordinated and com- 10 plementary use of resources.
The supposedly sinister Federal Coordinating Council for Comparative Effectiveness Research seems to be more like the Department of Homeland Security for existing federal health care systems. Programs like Medicaid, veteran's benefits, and federal employee health insurance already make estimations on the effectiveness of various treatments, just like every private health insurance company. The new council would share information across the federal programs that already exist.
Following that, she claims that the bill would change the standards for approved Medicare treatments, implying that fewer treatments will be approved:
Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).
Page 464 contains references to implementing things specified under section 3004, which describes the process for adopting and implementing the previously-mentioned technology infrastructure. I can find no mention of Medicare. It seems very much like this claim is completely fabricated.
Every complaint that the author raises, everything that she claims will affect what care doctors are willing to give, seems to only concern the healthcare information technology infrastructure that Obama has been talking about implementing for months. I see no places where the government will be dictating anything to doctors, aside from providing financial incentives (not punishments) to work with the new infrastructure. None of the author's claims about the government cutting off healthcare seem at all founded in fact. At best, she's consistently misreading the text of the bill. I think it more likely that she has other reasons not to want the bill to pass and is distorting the reality of the situation to steer people in the direction she wants them to go.
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Mon, 17 Nov 2008
Take My Stuff!
I'm divesting myself of a lot of computer-related things that are taking up too much space in my apartment. Take a look at my stuff and let me know if there's anything you'd like to take off of my hands. Anything left after a couple of weeks will go to the electronics recycling center.
Tue, 14 Oct 2008
Change of Name
On September 27th, 2008, I got married. As a consequence of my marriage, I gave up my last name and took my wife's, going from Phillip Gregory to Phillip Gold. I've been asked about my decision a lot; this is my explanation.
I feel that the prevaling societal standard--the assumption that the woman must go through all the work to change her name and give up the identity she's had since birth--is unfair and an example of gender inequality. Rather than simply make that assumption, Rebecca and I discussed our names a lot before the wedding, starting with what we each wanted out of our married names, and working from there to a mutual decision.
I wanted us to both have the same name, as symbolic of our marriage. I also didn't want a hyphenated last name, because I feel that those are cumbersome and unwieldy. Rebecca also wanted to have a Jewish last name, to honor her cultural heritage. Finally, I was inclined to have a name that started with "G" so my (and her) initials would stay the same.
Our first thought was that we would find a new name that met all of our criteria and both change to that name. Unfortunately, there are only really two common Jewish surnames that start with "G": Gold and Green (plus all the variations thereof), and we couldn't find a variation on Green that we both liked. We started looking at other Jewish surnames, and I realized that I really did want to keep my initials, if only because I have the username "phil_g" on a lot of sites, not least of which is the email address I've had for over a decade now.
So I offered to just take Rebecca's name because that approach accomplished everything we wanted. She was a little hesitant, feeling that doing so would require more of me than her, but we eventually agreed that it seemed the best approach given our requirements.
Postscript: Some people suggested changing my middle name to my old last name, as some married women do. I opted against that approach, because my middle name is the same as my dad's. I would never want to give my child the same first name as myself, but I like the subtle continuity of shared middle names.