Comments on life, science, business, philosophy, and religion from my personal public health viewpoint
Thursday, November 27, 2008
OK, seriously, WHY didn't we see it coming?
My comment in response to Paul Krugman's NY Times column today, "Lest We Forget".
========================================
Your question is superb - How did those at the top not see this coming, or take it seriously, despite many stifled voices below pointing at it in alarm?
Yes, if financial things broke on this shoal, fix the financial things.
But, at the same time, this shoal has got to go, or it will just demolish the repair effort in a never-ending cycle of "How did that happen? Fix and forget."
This exact problem is well known and well documented by everyone, across industries, government agencies, auto companies, universities, etc. This process is ALSO broken, and needs to be addressed, by as many billion dollars as spent repairing the damage it caused.
Social decision making processes are no more abstract than financial markets, but get no respect, being in a higher leverage, further upstream, less visible place in the chain of events.
High-reliability human systems have been studied extensively, from Chernobyl to The Bay of Pigs to Challenger to aircraft cockpit teams to hospital surgical teams to the US Army Leadership Field Manual. The answer always comes down to the same thing -- dissenting views need to be heard, and dissenters need what Harvard Professor Amy Edmondson calls "Psychological Safety" or they will wilt and become ineffective. This is how humans always behave and unless steps are taken it always breaks along this fault line.
The right question then should be, who is going to take charge of seeing that those steps are taken and that level of social literacy achieved?
I can't emphasize enough how much more important this is than more math and science, in the absence of this. As T.S. Eliot said, we repeatedly get burned "dreaming of systems so perfect that no one will need to be good, but the man that is will shadow the man that pretends to be."
Much of my weblog is about what we really need to do to avoid such errors in judgment. I can only hope the right person wakes up and reads it and the links to sources such as MIT's papers or John Sterman's work on how poorly we can see systems that involve feedback.
"Why we have so much trouble seeing" (and what to do about it.)
http://newbricks.blogspot.com...
(photo by myself - "Fixed at last!" )
Tuesday, November 25, 2008
Medical Tourism - Insurers accept, (Time)
Medical Tourism
By Kate Pickert
Time (magazine)
Earlier this month, the insurance company WellPoint announced a program that will allow employees of a Wisconsin printing
company to get coverage for non-emergency surgeries in India. It's a first for
WellPoint, but puts the insurer in good company.
Over the past
few years, U.S. insurance companies — dismayed at losing income
from uninsured Americans who get cheap surergies abroad or clients who choose to
pay out of pocket for discount foreign surgeries rather than expensive
in-network co-pays — have announced plans to include foreign medical
procedures among those covered by health plans.
It's no wonder. The medical tourism industry has experienced massive growth over the past decade. Experts in the
field say as many as 150,000 U.S. citizens underwent medical treatment abroad in
2006 — the majority in Asia and Latin America. That number grew to an estimated
750,000 in 2007 and could reach as high as 6 million by 2010. .... (See TIME's A-Z Health Guide.)
... But surgery abroad is a fairly modern phenomenon. .... (A large percentage of today's medical tourism is for dental work, as much as 40% by some estimates.)
...Thailand is now a destination spot for all types of plastic
surgery as well as a host of routine medical procedures. Bumrungrad
International Hospital in Bangkok is probably Thailand's best-known
mecca for medical tourists, boasting patients from "over 190 countries" and an
"International Patient Center" with interpreters and an airline ticket counter.
In recent years, companies all over the U.S. have sprung up to guide
Americans through the insurance and logistical hurdles of surgery abroad,...
For those who wrinkle their noses at the thought of going under the knife in a foreign, let alone still-developing, country, the American Medical Association introduced a set of guidelines in June for medical tourism.
The AMA advocates that insurance companies, employers and others involved in the medical tourism field provide proper follow-up care, tell patients of their rights and legal recourse, use only accredited facilities, and inform patients of "the potential risks of combining surgical procedures with long flights and vacation activities," among other recommendations.
Joint Commission International, a non-profit that certifies the safety and record of hospitals, has accredited some 200 foreign medical facilities, many in Spain, Brazil, Saudi Arabia, Turkey and the United Arab Emirates.
Sunday, November 23, 2008
Domestic Violence at Home and Abroad
Nicholas Kristof on Pakistan:
One new cabinet member, Israr Ullah Zehri, defended the torture-murder of five women and girls who were buried alive (three girls wanted to choose their own husbands, and two women tried to protect them). “These are centuries-old traditions, and I will continue to defend them,” Mr. Zehri said of the practice of burying independent-minded girls alive.November 23, 2008
New York Times
Despite Army’s Assurances, Violence at Home
On Christmas Day two years ago, Sgt. Carlos Renteria, recently back from his first tour in Iraq, got drunk and, during an argument, began to choke his wife, Adriana. He body-slammed her. He threw her onto the couch, grabbed a cushion and smothered her, again and again — until, finally, he stopped, she told the police in San Angelo, Tex.
He was arrested and charged with assault, and she went to the hospital for her injuries, which included bruises and a severely swollen knee. It was his second domestic violence arrest. Assured by an Army officer that the military would pursue the case, the Texas prosecutor bowed out.
Yet Sergeant Renteria has faced no consequences. Instead, since his arrest, he has been redeployed to Iraq and promoted to staff sergeant.
“I was told it would be taken care of, in more than one instance, by the Army,” said Ms. Renteria, 30, referring to the assault charges. “That they would help me. And I believed them.”
Ms. Renteria’s story illustrates the serious gaps in the way the Army handles domestic violence cases and the way it treats victims, despite promises to take such crimes more seriously.
More than five years ago, after a series of wife-killings by soldiers, a Pentagon task force investigation concluded that the military was doing a better job of shielding service members from punishment than protecting their wives from harm. The Department of Defense began to make noticeable improvements, including expanding protections and services for victims. But problems clearly remain.
The Army’s handling of such cases is especially important in a time of war, when the number of soldiers suffering from post-traumatic stress disorder escalates. Studies show a link between the disorder and increased violence in the home.
The Army says that the measures it has taken have been effective in curbing domestic violence. But advocates of victims of domestic violence say that among combat troops the violence has spiked in the past two years and that women are often disinclined to report violence for fear of angering their partners and hurting their careers.
These advocates point to the gruesome murders of three female soldiers based at Fort Bragg in North Carolina within the last four months. One woman’s body was dismembered and dumped in the woods. Another woman, seven months pregnant, was found dead in a motel bathtub. The third was stabbed to death.
In each case, the victim’s boyfriend or husband, a soldier or marine, has been charged in the killing. All three suspects were deployed in Iraq at some point.
The recent killings, which echo a series of wife-killings by soldiers at the fort in 2002, have captured the attention of the Pentagon again. During a visit last month to Fort Bragg, Defense Secretary Robert M. Gates said he was “very concerned” about the stress on combat troops. “We obviously want to stop all kinds of violence among our soldiers and families,” he said.
Yet an examination of Ms. Renteria’s case shows she had sought help from an array of people for behavior by her husband that the Army could trace to 2004.
“She has really tried to pursue this to make sure he gets the appropriate intervention,” said Jacquelyn Campbell, a professor at Johns Hopkins University School of Nursing and a member of the Pentagon’s task force on domestic violence, who was told about the case by The Times. “We had hoped with the military’s new awareness of the issues of domestic violence in the military, and with its new policies and procedures around addressing it, that this kind of thing wouldn’t be happening still.”
Sergeant Renteria was ordered to take anger management classes on base. He attended one class. “ ‘I can’t be touched, can’t you see?’ ” Ms. Renteria said her husband told her. “ ‘They aren’t going to do anything to me.’ ”
Thursday, November 20, 2008
Thoughts on multi-level life
So, this is a familiar concept. Corporations are made up of divisions which are made up of departments which may be made up of teams which are made up of people ... which are made up of cells.
So are corporations alive, then? Probably, but "life" has a nuanced meaning. Corporations certainly satisfy all the descriptions of life in Biology 101 -- they consume energy, adapt to their environments (perhaps poorly), can reproduce, and are ultimately made up of cells. They are capable of dying and growing. They are also capable of merging of course, something humans don't do, but slime molds do.
So what? Is this just fancy definitions?
So what is that the different levels of "one" living thing, modeling the same way Ken Wilbur does, are inter-related and yet, locally, appear to have a significant independence from each other. They certainly operate in different worlds, with different "operations".
The world seen by the US President is different from that seen by a CEO is different from that seen by a worker on the factory floor is different from that seen by a cell. They care about different things, worry about different things, almost completely disjoint so long as everything remains healthy.
It's when things get not healthy that the inter-actions become vivid.
For humans, we do seem to have, looking downward, an animal level with a life of its own, that goes on pretty much independently of "us" and only occasionally appears to exert 'animal urges' on us. ("appears" is a key word here, as they affect us 100% of the time, but we don't see it.)
There is much written about people "getting in touch with" their own bodies. This seems to make sense to people without further explanation or theology. There are techniques, from Yoga to biofeedback to dance to Transcendental Meditation to make that process work faster or better.
Similarly, looking upwards, we belong to a whole nested hierarchy of higher-level living things, from potentially a family to a tribe or neighborhood or culture or country or corporation, or many of those all at the same time.
We can only speculate about how high the pyramid of Life goes. Just as communication and peace with our lower selves seems necessary for peace and health, communication and peace with our upper selves seems necessary for peace and health.
Not too surprisingly by this model, talking upwards ("to God") is about as perplexing and difficult as talking downwards ("to our body as a whole, or to our cells").
For one thing, we are used to thinking about "objects" and "events", but to our cells, if experienced at all, these are "contexts", not objects within the cell's context or events it could possibly have a name for. Cells do not fret about their children getting into Harvard or their 401k's.
Similar, the things even CEO's spend their days worrying about -- mergers, long-term strategy and product placement, etc -- mean very little to individual humans, except as contexts.
So, even more so with God, or whatever one calls all of the levels, going upwards above us, to whatever limit or infinity they rise to. As the levels get higher, the timescales get longer, and the geographic scales get larger. Fish in the open ocean don't notice the tide, it's too big to notice,
and takes too long. Our cells probably don't care much about "next year". Surviving the next few milliseconds is their focus.
So, can we generalize here? Is there anything we can say about communicating up or down the chain of life, aside from that it's hard, and the higher you go, the slower and larger the events of interest become?
It's a good question. I suspect that as one moves up the scale, the math and biophysics shifts from obession with contents, as with isolated billiard balls, to obsession with context and relationships. This happens in both General Relativity and Quantum Mechanics, looking very far up and very far down.
That said, the Search For Extraterrestrial Life is probably looking in the wrong place, looking for rapid changes in contents, (electromagnetic wavaes) for messages, when it might be looking for changes in the contexts, such as a broadcast of "grace" or "healing".
The nouns and verbs may be off a bit, but the point is, up or down, they won't use the same nouns and verbs that "we" do.
We need to adjust for that fact, and look in entirely different places for different kinds of "messages".
Saturday, November 15, 2008
A different model of what's wrong
- What's wrong?
- Why doesn't this work?
- Where is it broken?
- Where should we intervene?
- If we intervene there, should we push or pull?
- If we did that, what effect would we expect to see and when?
Might as well, nothing else seems to be working, and the models used by the government seem to change daily. Meanwhile, they argue over what it will take to stop GM going bankrupt, which again depends on what you think is wrong. Different camps point to:
- too many government regulations
- too few government regulations
- health care costs
- unions -who make unreasonable demands
- management - which makes unreasonable demands
- consumers - who make unreasonable demands
- "the economy"
- Housing and mortgage defaults
- Nuclear above-ground testing
- Ozone
- Godzilla
- Unfair competition from larger companies
- Unfair competition from smaller companies
- Hedge funds and banks
- tree-huggers
- commies and socialists
- liberals or conservatives
- lawyers
- dentists
- side-effects of anti-depression meds
- Not enough team collaboration and consultation
- Too much team collaboration and consultation
- Too much decentralization
- Too little decentralization
- Alien invasions, UFO's, and demon possession
- breakdown in the moral fiber of our nation
- God's punishment for [ pick your sin and sinner ]
You don't have to "buy" this - just consider it as yet one more possible model, and see where it leads. In particular, see if it leads to an idea we haven't tried yet that seems affordable and that won't interfere with other initiatives underway.
So, my new model of the day looks at the nature of Life - which is clearly and unambiguously organized in a kind of hierarchical and overlapping fashion. Cells are alive, but cells form multicellular thingies that are themselves alive in a whole different way, such as cats and dogs and people and you.
Individual instances of any type of thing collectively form "a species", which itself has many properties of living things, including being the abstract object that really evolves over time. (Individuals don't evolve, at least very much in terms of DNA arrangement, once they are born.)
There is a running argument in biology as to whether genes evolve, and animals are a side effect, or animals evolve, and genes are a side effect, or species evolve, and both genes and individual animals are side-effects.
In my model, they are all evolving, in inter-related but partly independent fashions.
The key feature of this particular multi-level model of life is that each level of Life has its own, largely independent, existence and rules of life and Life. Each level can forget, most of the time (but not all the time) that the other levels exist at all.
You can forget that your body is made of cells, unless your behavior, such as consuming some chemical, affects how the cells work, and then suddenly it matters and un-becomes invisible.
Similarly, management of a company, say GM, or of a country, say the US, lives in its own world with its own rules, and can easily forget that the cell-equivalent (workers / citizens / "consumers") matter -- until some behavior suddenly damages them (or bankrupts them) and they become un-invisible to "the economy".
These actors,however, are all still "people". Just as there are living structures smaller than "people" (such as cells), there seem to be (by this model) living structures that are larger than people, namely corporations and nations.
Smaller, in this sense, means things that make up something, and larger means, things made up of something.
But, our bodies are not "just" a pile of chemicals, or ten trillion cells - they have unique features that only make sense at a person level - such as going to the dentist. Much of "our" lives we spend dealing with issues "mortgage refinancing" that simply have no equivalent at the cellular or atomic level. If we could talk to our cells, it would be a very short and frustrating conversation, pretty much what one gets when management and labor sit down together.
So, let's assume for the moment that Corporations (with a capital C) are themselves life-forms that are dimly aware of their environment, dimly aware of the people who make them up, and yet exist independently (mostly) doing their own things that are similarly unintelligible to us.
We have, in other words, created a new level of multicellular life, called Corporations, which have their own life of struggling with each other, their own rules, and their own economy that is often entirely decoupled from the economy individual humans live in.
What has changed, in a baffling way to these corporations then, is that the health of "the consumer" has suddenly changed. Before this level was a reliable source of income or labor and as invisible as illegal immigrants to our food-processing company stockholders, and now, suddenly, the problems of individual humans have intersected the problems of the corporate world.
The US government is struggling to fix the problems of corporate life forms, because, at their scale, these are the only ones that matter or are even visible. Corporate life forms are trying to stay afloat by laying off 20% or more of their workers, because that always used to work, but it doesn't any more, not once EVERYONE is doing the same thing at once.
Intersecting all this is the confusion and confounding of "management" of a company and the company or industry itself. If there is no such thing as a corporate life form, other than an extension and echo of the top manager, then the company and the leader are the same thing.
However, most of our corporations and industries exist and continue to function even though the top management may be dysfunctional or absent entirely, or entirely engaged in internal power struggles. The plane continues, for a while to fly, even though the crew is having a huge fistfight.
So one thing we need to distinguish, when possible, is the survival of the current pilot and crew, versus the survival of the airplane. In many cases, the two seem to have diverged, and the crew is more interested in stripping the plane and bailing out than in saving the plane.
But the question here is where "the problem" is. Where is this whole multi-level system of cells, humans, corporations, and government breaking down?
This gets to the crux of the matter. Is it the humans at the top who are blind to any world except their own, a fact that is obvious from below but invisible from up there? Or is it that the higher life form, the corporation or nation, is insufficiently well formed to understand how important its constituent people are to its own existence?
In other words, assuming that most of what we see at a national level is a struggle of corporations and Corporate life forms, do they grasp that trying to survive at 'the expense of" their own cells is a losing strategy?
There is a lot of evidence that this fact is not evident. Congress is obsessed with trying to bail out or save the Corporate life forms, at the expense of the individual composite cells (ie, us.)
It is not surprising that humans at the top of such corporations or government become blind to the realities of cellular-level life. This is no longer where they operate.
If corporations are an independent living species, then the problem we face is that this level entity is too stupid to realize what it depends on.
And the solution that suggests is to make corporations more, not less, capable -- if that can be done in such a way that they don't destroy the entire planet that they also rely on in the process.
In other words, imagine that Corporations are "mostly alive", and "dimly aware" of what depends on what, and what part of individual humans and the earth's ecosphere they rely on to survive, which used to be invisible before there were so many Corporations sucking so much out of us and the planet.
Then, an intervention point, in that model, if we could find it, would be to make the Corporation brighter at perceiving long-range, long-term consequences of decisions IT makes, where the humans in it are mostly just there for show, acting as if they are making the decisions, kind of the way humans think they are making decisions that their bodies and brains made minutes earlier, as MRI studies now show.
This gets to the core question of how emergent, synthetic, multi-level life forms perceive the world, and learn about it, including what is connected to what.
Surely the basic laws of cybernetics apply to such learning. Things that have immediate consequences are easier to learn. Things with distant or delayed consequences take longer to learn.
The model says we're struggling with the wrong thing, trying to figure out WHO should be the humans at "the top" of meta-organisms that don't really rely on "the top" for leadership or guidance any more. The thinly veiled secret of those at the top is that they are also clueless and not in control of what's going on, despite their massive marketing effort to persuade everyone that they are just crucial and should be paid massive sums for their invaluable contributions.
We should take some time, remove the individual humans from the equation, and look at how the overall system is organized, and self-organizing to perceive the world around it and to improve its own ability to perceive and act and make alliances and adapt. Such seeing has to extend downward to humans and cells and plants and the ecosystem, as well as upwards to nations and planetary composite life forms that Corporations are themselves cells within.
This seems abstract, but it may be very real. It is certainly outside the normal box!
A few points in closing.
One is the key assumption that collections of things do not just have 'emergent properties", but that the emergent properties themselves take on a persistent, self-perpetuating "life of their own" that no longer depends directly on the collection of things that initially made it. Life has, in some sense, like an electromagnetic wave, been radiated outwards and no longer depends on the existence of the broadcast antenna. In fact, the corporate entity may turn on its founding fathers and expel them and go off its own direction, and often does.
The huge mental barrier to this concept is the idea we have of "life" being a property of collections of cells that are touching in a more or less fixed arrangement, although even that breaks down if one includes blood and white blood cells, etc.
To "see" or visualize the type of "life" I'm talking about, you may need to just follow the feedback loops and see what aspects of things are self-regulating, self-perpetuation, self-repairing, self-defending, DESPITE the efforts to go a different way by the employees ,management, stockholders, regulators, etc.
It is, ultimately, not DNA or proteins or genes, but the existence of these abstract "feedback control loops" that seem to be the universal property that defines something that behaves as if it were "alive". If we look at it from that point of view, this includes all biological life, but now includes as well ecosystems, the planet, corporations, major religions, etc. as living things.
This would also suggest that the key aspects of information transfer, the web and Google, for example, are at the core of the thinking neurons of this meta-being that has taken shape, or is taking shape around us even now.
That in turn suggests that the place to look for successful new product innovations for Google or Web-3 systems is beyond collaboration into synthesis of smaller-scale living units, something akin to "teams" but way beyond them, as well as synthesis of dyads of people that have a life beyond that of each of the two separately.
What structure, system, framework, boost, database, service, etc. would catalyze the emergence of such multi-human life forms, detect them, make a space that nourishes them and makes them bright enough to surround us safely instead of destructively?
That may be the question some people should be asking. That may be the gap. It's not just a question of groupware and collaboration and working-together, or of fixing 'broken" relationships or marriages. It's a question of what the positive side is, what levels of emergent life we can make with and out of our interactions with each other.
What kind of network service would detect and facilitate the closure and stability of such closed, feedback loops between individual agents -- the substrate of Life itself?
NOW you're talking "market share" and pent-up demand.
Wade
Wednesday, November 12, 2008
What about GM?
references:
Becoming Lean , Jeffrey Liker, page 62-63
http://books.google.com...
Stop Rising Healthcare Costs Using Toyota Lean Production Methods
By Robert Chalice (page 53)
http://books.google.com...
There may be no reason to lose the jobs, plants, or contracts.
Actually, what changed was not just management, but the whole underlying philosophy on which the plant was managed, which is the crucial change.
Chalice cites these factors as the new "five core values: teamwork, equity, involvement, mutual trust and respect, and safety."
In short, workers were treated as first class partners in the plant, not as some kind of "asset" to be "managed" and "controlled." They were listened to. They were respected.
Yes, that does make all the difference, in automobiles, as Liker points out, or in hospitals, as Chalice points out, supported by the Keystone study of John's Hopkins Dr. Peter Pronovost in Michigan, showing that when nurses were actually listened to by doctors, patients were significantly better off and had better outcomes.
Gasp. I took Dr. Pronovost's class in Patient Safety last year, and, yes, it really is that "simple." Culture drives safety and productivity. Culture drives the bottom line, not technology.
If you want things to work, you have to learn about human beings, and culture, and work within the constraints that puts on you. Humans are not machines and work way better than machines if allowed to (McGreggor's Theory Y), or way worse than machines if forced to (Theory X).
It's the job of the stockholders and stakeholders to realize that, and put management in place that will support the work force instead of trying to exploit it.
Period.
Sunday, November 09, 2008
Domestic violence against men
http://menshealth.about.com/od/relationships/a/Battered_Men.htm
http://www.batteredmen.com/
http://home.comcast.net/~philip.cook/
http://en.wikipedia.org/wiki/Domestic_violence
http://domesticviolenceresourcesformen.blogspot.com/
http://www.eurekalert.org/pub_releases/2008-05/ghcc-med051508.php
http://menweb.org/battered/batsacks2way.htm
http://www.gmdvp.org/gmdvp/index.htm
http://www.dahmw.info/resources.html
http://www.dvmen.org/
http://news.mensactivism.org/files/research_flyer.pdf
http://www.youtube.com/watch?v=YvGicpwAl-0
http://leehopkins.net/2008/09/22/domestic-violence-against-men-i-never-knew/
http://www.themenscenter.com/National/national01.htm
http://www.batteredmen.com/gjdvdata.htm
http://www.law.fsu.edu/Journals/lawreview/downloads/304/kelly.pdf
=================================================
American Medical Association - JAMA special issue on violence
http://www.dv911.com/articleabusedmen.htm
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African American:
http://www.dvinstitute.org/index.htm
=========================================
GBLT Domestic Violence in specific (many excellent links)
http://www.aardvarc.org/dv/gay.shtml
============================================
comment on Obama and Intellectualism
While I admire those who command many facts and can stand complexity and ambiguity, what I hope for Obama is that he has the wisdom and humility or insight that other people know things too, and see true and important things that he doesn’t.
The greatness we need is someone who can rally us to pitch in and who will listen to our voice and wisdom and insight, not just his own voice and small group of males with a false consensus.
I read with alarm that his aides are trying to pick the few most important issues to start on. I’d suggest the single most important issue is that, with 200 holes in the bottom of the boat, fixing the “most important 3″ while everyone else watches will not be the winning strategy.
We need someone who can decentralize power and get 200 different centers of action working on all 200 problems at once. Any one of them can sink us. There is no “most important problem” any more, aside from the meta-problem of how to get more people independently working to help, and welcoming their help.
And he just might do that.Saturday, November 08, 2008
Medicaid, poor, hospitals take hit
November 8, 2008
New U.S. Rule Pares Outpatient Medicaid Services
WASHINGTON — In the first of an expected avalanche of post-election regulations, the Bush administration on Friday narrowed the scope of services that can be provided to poor people under Medicaid’s outpatient hospital benefit.
Public hospitals and state officials immediately protested the action, saying it would reduce Medicaid payments to many hospitals at a time of growing need.
[...]
In a notice published Friday in the Federal Register, the Bush administration said it had to clarify the definition of outpatient hospital services because the current ambiguity had allowed states to claim excessive payments.
“This rule represents a new initiative to preserve the fiscal integrity of the Medicaid program,” the notice said.
But John W. Bluford III, the president of Truman Medical Centers in Kansas City, Mo., said: “This is a disaster for safety-net institutions like ours. The change in the outpatient rule will mean a $5 million hit to us. Medicaid accounts for about 55 percent of our business.”
Alan D. Aviles, the president of the New York City Health and Hospitals Corporation, the largest municipal health care system in the country, said: “The new rule forces us to consider reducing some outpatient services like dental and vision care. State and local government cannot pick up these costs. If anything, we expect to see additional cuts at the state level.”
Carol H. Steckel, the commissioner of the Alabama Medicaid Agency, said the rule would reduce federal payments for outpatient services at two large children’s hospitals, in Birmingham and Mobile.
Richard J. Pollack, the executive vice president of the American Hospital Association, said these concerns were valid.
“The new regulation,” Mr. Pollack said, “will jeopardize important community-based services, including screening, diagnostic and dental services for children, as well as lab and ambulance services.”
Herb B. Kuhn, the deputy administrator of the Centers for Medicare and Medicaid Services, defended the rule.
“We are not trying to deny services,” Mr. Kuhn said. “We want to pay for them more accurately and appropriately. Payments for some services were way higher than they should be.”
The rule narrows the definition of outpatient hospital services to exclude those that could be provided and covered outside a hospital.
Medicaid, financed jointly by the federal government and the states, provides health insurance to more than 50 million low-income people. Services can often be billed at a higher rate if they are performed in the outpatient department of a hospital rather than in a doctor’s office or a free-standing clinic. Hospitals generally have higher overhead costs....
“More and more people are coming onto Medicaid,” she said. “People are losing their jobs and running out of unemployment benefits. Some employers can no longer afford to provide health insurance to their workers.”
In the last 18 months, Congress has imposed moratoriums on six other rules that would have cut Medicaid payments. But the administration says Congress did not block the rule issued on Friday.
Larry S. Gage, the president of the National Association of Public Hospitals, said, “We will urge Congress to extend the moratorium to this rule, and we will ask the Obama administration to withdraw it.”
Verizon Wireless fights domestic violence
Verizon Wireless Marks Domestic Violence Awareness Month with Community Activities Nationwide [November 6, 2008]
Company Awards Nearly $150,000 to Local Organizations, Honors HopeLine Heroes, and Partners with Sports Teams to Collect Phones Among Other Efforts
BASKING RIDGE, N.J., Nov. 6 /PRNewswire/ -- Verizon Wireless, a recognized corporate leader in domestic violence awareness and prevention, put its technology to work for domestic violence victims during October, highlighting its HopeLine(R) phone recycling program as part of Domestic Violence Awareness Month (DVAM) activities.
Verizon Wireless partnered with sports teams, local governments and universities across the country to sponsor events and hold phone drives to raise awareness of domestic violence and collect no-longer-used wireless phones to benefit survivors. Across the country, the company also presented HopeLine grants totaling nearly $150,000 and honored two HopeLine Heroes for their work on behalf of victims.
Some of Verizon Wireless' efforts during DVAM included:
Partnerships with colleges and universities to raise awareness of domestic violence:
-- Rutgers University in New Jersey introduced UHopeLine, establishing
permanent cell phone recycling points on campus.
-- Best-selling author and empowerment specialist Yasmin Davidds shared her
story of survival with students at several colleges and universities in
the Western United States and discussed domestic violence in the Latino
community.
-- Verizon Wireless continued its sponsorship of the Red Flag college
campus campaign in Virginia to build awareness of the signs of partner
violence.Phone drives at sporting events:
-- Several professional football teams, including the Denver Broncos and
the Buffalo Bills, hosted phone recycling drives at Sunday afternoon
games.
-- Several schools, including the University of Texas -- El Paso and the
University of Wyoming, conducted phone collections during college
football weekends.Presentation of nearly $150,000 in donations made to organizations that support domestic violence prevention programs such as:
-- Five San Francisco Bay Area organizations in the Asian-American
community: Asian Americans for Community Involvement, Asian Women's
Shelter, Chinese Community Health Resource Center, Korean Community
Center of the East Bay and Maitri.
-- Friendship Home in Nebraska that provides 24-hour emergency shelter,
transitional housing and programs for families of domestic violence.
-- Albion Fellows Bacon Center in Indiana to makeover the
organization's playground area, presented as a grant from the
Indiana Pacers Foundation and Verizon Wireless.Sponsorship and participation in many community events to increase awareness of domestic violence, including:
-- The Montgomery County Women's Center 2nd Annual "Walk a Mile
in Her Shoes" event in Texas.
-- The Clothesline Project in Mobile, Ala., and throughout Florida.HopeLine Hero Awards presented to the following individuals for their ongoing efforts to prevent domestic violence and support those scarred by domestic abuse:
-- Florida Governor Charlie Crist.
-- Yolanda B. Jimenez, commissioner of the New York City Mayor's
Office to Combat Domestic Violence.HopeLine is Verizon Wireless' exclusive year-round phone recycling and reuse program that collects no-longer-used wireless phones, batteries and accessories in any condition from any wireless service provider to benefit victims of domestic violence. Proceeds from the HopeLine program are used to provide wireless phones and cash grants to local shelters and non-profit organizations that focus on domestic violence prevention and awareness.
For more information about Verizon Wireless and the HopeLine program, visit www.verizonwireless.com/hopeline.
About Verizon Wireless
Verizon Wireless operates the nation's most reliable wireless voice and data network, serving 70.8 million customers. Headquartered in Basking Ridge, N.J., with 71,000 employees nationwide, Verizon Wireless is a joint venture of Verizon Communications (NYSE: VZ) and Vodafone (NYSE and LSE: VOD). For more information, go to: www.verizonwireless.com. To preview and request broadcast-quality video footage and high-resolution stills of Verizon Wireless operations, log on to the Verizon Wireless Multimedia Library at www.verizonwireless.com/multimedia.
SOURCE Verizon Wireless [ press release ]
In Her Shoes - domestic violence simulation game
Developed by Washington State Coalition Against Domestic Violence, the
game "In Her Shoes" can be purchased at their site.
A revolutionary community education tool, In Her Shoes is designed for learning about domestic violence. Participants move, do, think and experience the lives of battered women. This version is the original simulation which is great for educating a broad range of community and professional groups. Can be facilitated in sessions of one to two hours.
In her Shoes - Economic Justice Edition
In Her Shoes: Economic Justice Edition
A revolutionary community education tool, In Her Shoes is designed for learning about domestic violence. Participants move, do, think and experience the lives of battered women.
The newest version of "In Her Shoes" will increase awareness of the additional struggles battered women face when they are poor. The perspective of the batterer is also represented in the Economic Justice Edition. Most useful for longer training sessions where there are opportunities for group discussion.
From the Daily Toreador (10/31/2007)
Domestic violence month ends with 'In Her Shoes'
By: Elliot Cochran
Posted: 10/31/07
October can be a frighteningly good time of the year for the Lubbock community, but the Texas Tech Feminist Majority Leadership Alliance has worked with students and faculty this month to prevent a fearful issue for the organization: domestic violence.More info:
Tuesday night, the organization closed out the October events with a game, "In Her Shoes" - an interactive experience simulating the role of a victim of domestic violence or her abuser from their perspectives.
Roy Rios, coordinator of community education and development for Women's Protective Services, said the game draws many personalities, lifestyles and behaviors together, offering a broad range of emotions and opportunities for college students living with, or on the brink of, domestic violence.
"The game tries to make the experiences lifelike, it really tries to portray a diverse group; it's everywhere," he said. "This issue is hitting home for a lot of people because (college) is where it begins, it sets you on your path to make tough decisions."
Students picked through six color-coordinated cards, each containing details of the characters' personal and private lives. Once the selections were made, the stories unfolded to reveal the trials and tribulations caused by the students' decisions in various situations.
Students were engulfed in the lives of the characters struggling with drug addiction, alcoholism and poverty throughout the lives of the teenage to early-20s characters.
Rios said the dialogue and thought processes seemed realistic to the students, because the stories are real-life cases taken from women in the Washington D.C. area.
Christina Rhode, a junior anthropology and sociology major from Corpus Christi and president of the Tech Feminist Majority Leadership Alliance, participated in the game. She said the problems with domestic violence come from the misconception that the problems are not important in society.
"So many people don't like to think that something like this is so prevalent," she said, "because then they might feel like they should do something about it, or because they just don't want to deal with that reality. The first step to fixing such a large problem like domestic violence is to make people acknowledge that it is a problem, and then they will want to do something about it."
[...]
© Copyright 2008 Daily Toreador
Presbyterian News Service
TUCSON — Quietly, in pairs — some holding one or more dolls — the 30 or so women begin moving about the small meeting room. They pause at a chair labeled “clergy,” pick up a color-coded card and read it, then move on to another chair and read another card. Before long, as the women move from chair to chair, the quiet conversations become more animated and are frequently punctuated by angry outbursts. And by the end of the one-hour simulation game, “In Her Shoes,” most of the participants are ranting in frustration. | ||||||
Welcome to the world of battered women — victims of domestic violence — and the bewildering maze they must navigate to access the resources they need in order to survive. And in the game, as in real life, some don’t survive. One of the “stations” in the simulation is labeled “Funeral Home” — a clear signal that the player has died as a result of the choices she has made. Developed in Washington State, “In Her Shoes” has become an extremely effective tool for educating pastors, social workers, police, government officials and those interested in combating domestic violence about the gauntlet faced by women seeking to escape abusive relationships. The simulation was brought to the Presbyterian Health, Education and Welfare Association (PHEWA)’s biennial social justice and ministries conference Jan. 13–16 here by the Presbyterians Against Domestic Violence Network (PADVN). It is also endorsed by the Office of Women’s Advocacy in Louisville, which for the first time partnered with PHEWA on the conference. “People aren’t going to believe it unless and until they walk down the road,” says Tyra Lindquist of the Washington State Coalition Against Domestic Violence, which helped develop “In Her Shoes” six years ago. “This simulation is really good because people like experiential things. The stories in this simulation are compelling and people quickly get immersed in them.” | ||||||
There are 17 “stations” in the simulation — including such topics as “court,” “mental health,” “child protective services,” “housing,” “medical,” “shelter,” “job” and “support group.” Each pair of participants picks a real-life scenario and visits the 17 stations. At each station choices are offered, which, of course, impact the range of choices available at subsequent stations. | ||||||
“Ideally, this game would be played over the entire hotel, including some impossible-to-find nooks and crannies,” says the Rev. Bonnie Ortho, an upstate New York pastor who is PADVN co-moderator along with Sandy Thompson-Royer. “That way, participants would get totally lost even trying to find some of the stations, which is the way it is for women in the real world.” Also like real life, a few participants conclude the simulation by successfully escaping the violence. Most do not. And some die, their choices leading them inexorably to the station labeled “Funeral Home.” Asked how they felt at the end of the simulation, participants variously said: “tired,” “helpless,” “ashamed,” “voiceless,” “powerless,” “frustrated,” “gullible,” “guilty,” “confused” and “angry.” One participant asked wearily, “Is there no end to it?” Another agreed, saying, “I felt like I was going around and around in circles.” That’s precisely the reason why domestic violence is so prevalent and why “In Her Shoes” is such an effective teaching and training tool, Ortho says. “In the simulation there are some choices you want to make but can’t,” she says. “The simulation gets people in different professional fields to think about how, despite people’s best intentions, systems break down.” Helping domestic violence–related professionals understand the complexity for victims of abuse of trying to deal with multiple systems is critical to helping women (and some men) out of the cycle of domestic violence. “Blaming and judging are the worst,” says the Rev. Kevin Frederick, a pastor in Black Mountain, NC, and PADVN member. “Statistics show that, for a variety of reasons, it takes an average of seven incidents of domestic violence for a woman to figure a way out. That’s simply intolerable. We have to do better.” Workshop participants were introduced to a new PC(USA) resource on domestic violence, “Anguished Hearts,” which addresses domestic violence as a faith issue. The seven-session study — designed for church school classes, study and youth groups, and retreats — builds on the 2001 General Assembly’s policy statement “Turn Mourning Into Dancing!” It is available for $8 from Presbyterian Distribution Service — order by phone , 800-524-2612, or on the Web at www.pcusa.org/family/resources.htm. Ortho says PAVN is offering training that includes use of “In Her Shoes” to synods and presbyteries. For more information, visit the PADVN Web site at www.pcusa.org/phewa/padvn. | ||||||
Verizon Wireless funds programs against domestic violence
Distrust between groups can be broken in 2 hours
Tolerance Over Race Can Spread, Studies Find
This was supposed to be the election when hidden racism would rear its head. ...
But lost in all that anguished commentary, experts say, was an important recent finding from the study of prejudice: that mutual trust between members of different races can catch on just as quickly, and spread just as fast, as suspicion.
In some new studies, psychologists have been able to establish a close relationship between diverse pairs — black and white, Latino and Asian, black and Latino — in a matter of hours. That relationship immediately reduces conscious and unconscious bias in both people, and also significantly reduces prejudice toward the other group in each individual’s close friends.
This extended-contact effect, as it is called, travels like a benign virus through an entire peer group, counteracting subtle or not so subtle mistrust.
“It’s important to remember that implicit biases are out there, absolutely; but I think that that’s only half the story,” said Linda R. Tropp, an associate professor of psychology at the University of Massachusetts. “With broader changes in the society at large, people can also become more willing to reach across racial boundaries, and that goes for both minorities and whites.”
...In studies over the past few years, researchers have demonstrated how quickly trust can build in the right circumstances. To build a close relationship from scratch, psychologists have two strangers come together in four hour-long sessions. In the first, the two share their answers to a list of questions, from the innocuous “Would you like to be famous? In what way?” to the more serious, like “If you could change anything about the way you were raised, what would it be?”
In the second session, the pair competes against other pairs in a variety of timed parlor games. In the third, they talk about a variety of things, including why they are proud to be a member of their ethnic group, whether Latino, Asian, white or black. Finally, they take turns wearing a blindfold, while their partner gives instructions for navigating a maze.
Trivial as they may sound, those exercises create a relationship “that is as close as any relationship the person has,” said Art Aron, a social psychologist at Stony Brook University who developed the program with his wife, Elaine N. Aron.
The new relationship can last months or longer, and it almost immediately lowers a person’s score on a variety of prejudice measures. Moreover, it significantly reduces anxiety during encounters with other members of that second group, as gauged by stress hormone levels in the saliva.
In a series of studies, Art Aron and others have found that, by generating a single cross-group friendship, they can quickly improve relations between cliques that have been pitted against one another in hostile competitions. In a continuing study of some 1,000 new students at Stony Brook, Dr. Aron has found that merely being in the same class where other interracial pairs were interacting can reduce levels of prejudice.
The reason such changes emerge, some psychologists argue, is that people have a selfish urge to expand their own identities through others — to make themselves a part of others’ lives, and vice versa, as lovers, parents, colleagues, friends. Studies find that that is exactly what happens in a relationship: people are not merely aware of their closest friends’ problems but to some extent feel the sting, the humiliation, the injustice.
Psychologists can manipulate this need for self-expansion. In one recent experiment, led by Stephen Wright, a psychologist at Simon Fraser University in British Columbia, researchers had 47 students describe their workloads and activities and made each student feel either overextended or in a rut, based on bogus personality tests. [also see Wright's home page.]
“It’s easy enough to do, because students always feel both overwhelmed and in a rut,” Dr. Wright said. Those led to feel in a rut, he went on, “were more interested than the others in having a friendship with someone with a name that is clearly from a minority group.”
This impulse pushes against any implicit or subconscious bias a person may have....
(copyright 2008 New York Times)
Sunday, November 02, 2008
Review: Honest Signals by Alex Pentland
Pentland's work truly improves the human condition and revolutionizes the way we live and relat to one another ( Award citation, Future of Health Technology Institute, 2008 )
Pentland and his research group: (from http://web.media.mit.edu/~sandy/ )
Professor Alex (“Sandy”) Pentland is a pioneer in organizational engineering, mobile information systems, and computational social science. Sandy's focus is the development of human-centered technology, and the creation of ventures that take this technology into the real world.
He directs the Digital Life Consortium, a group of more than twenty multinational corporations exploring new ways to innovate, and oversees the Next Billion Network, established to support aspiring entrepreneurs in emerging markets, and the EPROM entrepreneurship program in Africa. He is among the most-cited computer scientists in the world, and in 1997 Newsweek magazine named him one of the 100 Americans likely to shape this century.
(video - http://web.media.mit.edu/~sandy/pentland-2007-10-18-web.mov )
Other videos: (BBC, etc. )
http://web.media.mit.edu/~sandy/videos.html
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The book:
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Review from New Scientist (10-28-08)
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His message, in terms of the other concepts
in this weblog (feedback, emergent synthesis,
consultation, theory Y, etc.)
Pentland joins many others in the rising tide of evidence that humans are not nearly as separate, rational, and in control of their own destiny as we have been taught.
He and his research team, using fancy electronics, have tracked a variety of actions and non-verbal behaviors of humans, and discovered that a large fraction of human decisions seem to be made, and in fact visible to these devices, long before the humans themselves are aware of making a decision.
Though pairwise and even more complicated signalling feedback "circuits", humans as a group can process information and make decisions far better than any single group member can, and entirely nonverbally. They, collectively, form a sort of meta-brain (my term.)
This is good news, and the exact type of behavior I was suggesting in many earlier posts where I first published this graphic of humankind's dilemma:
In short - the graphic says that, once our social problems get beyond the ability of our smartest person to track, it only gets worse from there. No amount of education of humans-acting-alone will catch us up. We need to get into the world of synergy, and learn how to be humans-acting-together.
Pentland's research, in my reading, further supports the idea that much of the "emotions" and "bugs" that scientists have disdained as messy and irrational are, in fact, from a collective social brain point of view, very necessary and valuable.
If we attempt to throw out all the emotional and human side of humans and make ourselves "rational", we only handcuff ourselves to the sinking Titanic model of humans as mini-gods.
Further reading in this weblog:
Active strength through emergent synthesis
How many are we?
Houston, we have a problem
Institute of Medicine - Crossing the Quality Chasm and microsystems (small group teamwork)