I read a quote by an international leader whose name I've long forgotten. He called America the "great anti-culture." As I sat on the train yesterday, I thought about his statement while forced to listen to a woman detail the experience of her friend the stripper at a club the last night. The woman was crude and her language made me squirm almost as much as the stripper had during the described lap dance.
I felt imposed upon. I was forced to listen to this. And then I thought about the many nations we have invaded with our anti-culture and forced to listen to our crude tails of irresponsible sex and wanton greed. We've invaded their homes without pausing to ask permission...attacked at the youngest element to ensure "brand loyalty" and "maximum impressionability." We replaced their music with our technological noise; their dancing with our rampant sexuality; their community with our "mass communication"; their identity with our peer pressure. We blast our television and its advertising on every airwave. The Internet is riddled with our insistence that the whole world buy more and more and more of our experience. And the part of us we push on other cultures? It's not the kind America, the good America, the family-values America. We push our worst America - full of irresponsibility, risky behavior, lawlessness, and base language.
We're wrong. Just as wrong as that woman was to force her night on the rest of us. We didn't begrudge her or judge her friend - we just wanted the freedom NOT to relive an event we'd never chosen.
I am often amazed by the bigotry practiced by the so-called "ideal" set in society. I was recently in a situation full of upscale and admired adults where I was the only religious person in the group. I was ridiculed, mocked, and derided at least daily. They were "disgusted" by my bigotry - though it wasn't me who judged any of them. They pressured and fixed "mixed" drinks to trick me into drinking alcohol I didn't want to take. They told me I'd never find happiness if I chose my path. They pointed to the media - that HBO has prostitutes having sex in prime time and pornography is seen as something fun to do at a dinner party and they claimed this is what America is - and so I was just old-fashioned and ridiculous. In time, I started to cave and once they had "won", the whole group was gone. They weren't trying to help me acclimate - just validate themselves. They created a moral and ethical crisis in my life for very little more than their own ego. I was mocked as much for becoming like them as I had been for remaining distinct. In the end, I put myself back together (It's interesting to note that while this group remained awful, my church group showed up and said little more than "whoever you choose to be we want you to be happy with it" while they helped me) and learned a valuable lesson....anyone selling something is just trying to help themselves.
There's a parallel here with the way the U.S. functions in the world. We take our ideas to every corner of the world and convince the rest of the world "if they want to be rich and happy like the U.S." then they have to buy every bit of propaganda and product we force into their world. And many, many, many people fall into the same trap that caught me. In the end, they have loads of product they never asked to own and very little of the promised freedom and happiness we pretended came in the package.
An excellent example of this came in the 1970s when Nestle sent boxes of infant formula to 3rd world nations. Their advertising campaign claimed that the U.S. had stopped breastfeeding and was using formula and their babies weren't dying. Nestle neglected to mention that we also had vaccinations and safe water in the U.S. Millions of women stopped breastfeeding and used the free product. Then the bill came...and millions of children suffered the consequence of Nestles push to "Americanize" infant feeding. I went to one of these countries a few years ago. And I heard the propaganda repeated back to me when I met women who refused to breastfeed their infants and preferred to mix 1/2-strength formula and watch their babies grow ill - because "this is how American women feed their babies. Given that breastfeeding rates are now back above 50% in the U.S., the propaganda is false - but permeating. Our desire to sell our culture and our product has cost thousands, if not millions, of lives in the developing world.
This is the way we practice imperialism in the world - taking over product by product and many people resent our approach. They should. We're wrong. The rest of the world has reason to hate us. I may not always agree with the method of protest, but I can't fault the reasoning. It is simply wrong to force ideals on other people, especially on children, for the simple purpose of "improving quartile gains."
Many people insist that Big Business will take responsibility for itself and should be left to practice anywhere, anyway. When we look around and see the environmental and financial damage that the greed of business has created recently, I would imagine people would begin to grow uncomfortable with the idea of free reign, irresponsible business. And then I would hope that the people could see that even the Middle East has a point - America should mind its own business.
August 24, 2007
August 13, 2007
If it's in the NY Times....
Today's letter to my representatives (with the NYT editorial at the end):
America can do better! We are a nation for the people and yet we're letting the people down by preferring the big business of insurance over the health of our own population.
Story of the week: A friend told me today that her 87 year old grandmother fell and broke a bone as well as detached her retina. Because she has reached her "payout limit" for the year, the doctors were not able to admit her to the hospital for observation and treatment. She underwent 2 painful operations as an outpatient and was only given outpatient pain medications and minimal monitoring (only her family who are not trained medical practitioners).
Our nation owes this woman more than a risky procedure and being tossed on the street to care for herself. Our entire charter claims that we, the people, are self-governed. Not CEOs. Not healthcare analysts. I'm sure her doctors wanted to do more - but they are now under the constraints of our organizations. It's sad. It's wrong. There's no other argument.
If other nations can do this, so can we. If the businessman who have figured out business ventures in hundreds of countries without violating tax or trade laws would help us in figuring out healthcare, we'd be the best system in the industrialized world, not the worst.
_________________________________________________________
08/12/07 NY Times Editorial
Editorial World's Best Medical Care?
Published: August 12, 2007
Many Americans are under the delusion that we have "the best health care system in the world," as President Bush sees it, or provide the "best medical care in the world," as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.
Michael Moore struck a nerve in his new documentary, "Sicko," when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.
Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations - Australia, Canada, Germany, New Zealand and the United Kingdom - on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.
Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.
Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.
Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.
Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.
Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the "right care" for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.
Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.
Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation's health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.
That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.
Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.
Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.
*
With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has "the best health care system in the world" and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world's most powerful economy should be able to provide a health care system that really is the best.
America can do better! We are a nation for the people and yet we're letting the people down by preferring the big business of insurance over the health of our own population.
Story of the week: A friend told me today that her 87 year old grandmother fell and broke a bone as well as detached her retina. Because she has reached her "payout limit" for the year, the doctors were not able to admit her to the hospital for observation and treatment. She underwent 2 painful operations as an outpatient and was only given outpatient pain medications and minimal monitoring (only her family who are not trained medical practitioners).
Our nation owes this woman more than a risky procedure and being tossed on the street to care for herself. Our entire charter claims that we, the people, are self-governed. Not CEOs. Not healthcare analysts. I'm sure her doctors wanted to do more - but they are now under the constraints of our organizations. It's sad. It's wrong. There's no other argument.
If other nations can do this, so can we. If the businessman who have figured out business ventures in hundreds of countries without violating tax or trade laws would help us in figuring out healthcare, we'd be the best system in the industrialized world, not the worst.
_________________________________________________________
08/12/07 NY Times Editorial
Editorial World's Best Medical Care?
Published: August 12, 2007
Many Americans are under the delusion that we have "the best health care system in the world," as President Bush sees it, or provide the "best medical care in the world," as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.
Michael Moore struck a nerve in his new documentary, "Sicko," when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.
Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations - Australia, Canada, Germany, New Zealand and the United Kingdom - on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.
Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.
Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.
Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.
Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.
Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the "right care" for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.
Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.
Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation's health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.
That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.
Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.
Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.
*
With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has "the best health care system in the world" and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world's most powerful economy should be able to provide a health care system that really is the best.
August 8, 2007
Today's Quote
Robert Jackson
"The price of freedom of religion, or of speech, or of the press, is that we must put up with a good deal of rubbish."
Now if people would just get together in communities to discuss what they hear...give their brains a chance to process...we'd have democracy again....
"The price of freedom of religion, or of speech, or of the press, is that we must put up with a good deal of rubbish."
Now if people would just get together in communities to discuss what they hear...give their brains a chance to process...we'd have democracy again....
August 7, 2007
A Great Quote
"We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the foundation of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made and his senses are being developed. To him we cannot answer "Tomorrow". His name is "Today"."
Gabriela Mistral, 1948
And that's what I call fabulous....today's children have lost so much of what was wonderful. Parents are frequently not committed enough to what's best for them. Multiple avenues of child research say that intact families are a necessity for healthy children...what about healthcare?....a good political system....financial integrity....sufficient discipline to pay attention and achieve in school....when do we start to care for the children?
Gabriela Mistral, 1948
And that's what I call fabulous....today's children have lost so much of what was wonderful. Parents are frequently not committed enough to what's best for them. Multiple avenues of child research say that intact families are a necessity for healthy children...what about healthcare?....a good political system....financial integrity....sufficient discipline to pay attention and achieve in school....when do we start to care for the children?
Subscribe to:
Posts (Atom)