Tarnished Sterling

Disclaimer: I’m not asserting much in the way of original thought in this post, rather summarizing some of the better arguments I have encountered in the recent wake of the tawdry episode of Donald Sterling. Surely some of my few readers have not been exposed to anything other than the mainstream script: crusty NBA team owner spews racist barrage at his girlfriend, and gets banned for life for his crime of hate speech.

Yes, Sterling is a bigot and a racist to boot. And it’s jarring to grasp the concept that his claim to fame in recent years has been as proprietor of a basketball team which, like any other that hopes to be competitive talent-wise, is comprised predominantly of black players. Understandably, the stars on his payroll reacted negatively to the words he spoke privately but were leaked to the public.

But, why is the outrage not arising until 2014? And why is the public destruction of the man predicated on words, and not on the truly deplorable actions Sterling has engaged in for decades, earning the well-deserved appellation of “slum lord”? Have we forgotten the nursery rhyme of our childhood, “Sticks and stones will break my bones, But words will never harm me”? (BTW, according to Wikipedia, that rhyme is attributed to a black Methodist church publication.) It is because, in the so-called modern age, deeds matter less than words.

For that matter, how about the deeds perpetrated by some of the NBA “role models” whose transgressions received far less, and in some cases no, punishment? Let Ben Shapiro remind you of some of the most glaring examples.

Indeed, how about today’s dissolving of any distinction between remarks uttered privately (and intended to remain so) and those issued publicly? In an age where most everyone carries a device capable of recording private conversations—i.e., a phone—one no longer has the presumption of keeping his or her utterances confined to the person to whom they were spoken. (Never mind what the NSA may have stockpiled on you, me, and every other person who speaks or writes!)

So what’s the next frontier for the speech police? It’s a given that the owner of the Orlando team will need some Magic to avoid the blackball, based on his support of an institution (traditional marriage, for centuries a sacrament but now a civil entitlement!) that is out of step with the times, or is it “The Times“?

Yes, the NBA is a privately run league, and it has the prerogative of accepting or banishing individuals without interference from others. But, speaking of interference, along comes corruptocrat politician, and former NBA player, Kevin Johnson. Mr. Johnson, current Mayor of the People’s Republic of Sacramento, inadvertently let his slip show, revealing the motive shared by not a few of ilk when he intoned that “sports provides a place for fundamental change for how our country should think and act.”


I have no doubt that Mr. Johnson and his crowd believe that to be literally true. They also possess the power to enforce those standards by fiat. And if that happens, get ready to be slam dunked.


Also see incisive commentaries by Steve Deace and Thomas Fleming, among others.


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Dancing with the devil

I don’t mean to identify in the title with the profane and hateful screed some might call “music,” rather to reflect on the hand-wringing that has been occurring in my business over the last week or so. I refer to the crap sandwich that sailed through Congress just in the nick of time to kick down the road the can known as the sustainable growth rate (SGR) cuts in Medicare payments to physicians.

Warning: for those not in the medical services industry, there’s lots of inside baseball involved. I’ll try not to get too bogged down in the details; rather, I’ll try to interpret this mess for lay people.

Back in 1997, the magicians in DC pulled a rabbit out of their hat with the Balanced Budget Act. One of the tricks up their sleeve was the way they made the numbers work out with respect to physician reimbursement under Medicare. If too much is paid out one year, the rate for the next year is supposed to be cut by a similar amount. (Otherwise the budget wouldn’t balance in the out years.) Except that every year, the doctors’ lobby has successfully convinced the Congress critters to okay a postponement of the cut. It’s literally known in the business as the “doc fix.” They, figuratively, roll the snowball down the hill, and the amount in question keeps getting bigger and bigger. So now, in 2014, without either a permanent solution or another doc fix, Medicare payments to physicians would have been slashed 24% on April Fool’s day. (How apropos.)

Of course, “Congress” and “permanent solution” do not belong in the same sentence. Though some alternatives were floated, none of them stood, um, a snowball’s chance in hell given the dysfunctional nature of our current legislative branch. Thus, another doc fix was drafted. And, somewhere along the line, lobbyists (who have not yet come forward to claim responsibility) managed to add various ornaments to the bill, causing it to resemble a mistimed Christmas tree. It got the rush treatment due to the tight deadline. And, not surprisingly, it has come to be like another one of Forrest Gump’s box of chocolates. At least one provision, for additional mandates around imaging systems, was never reported on until after the bill passed.

Two other provisions, which were talked about in the trade press, amount to a yummy caramel and one of those coconut-filled ones that a person either loves or hates. The first delays enforcement of the hated two-midnight rule that CMS imposed upon hospitals last year, under the aegis of Obamacare. What—you don’t know about the two-midnight rule? Read here what kind of havoc it is going to wreak on seniors across the country, even before it’s enforced. The other delays, by at least a year, the deadline for healthcare organizations to bill using the new (relatively speaking; it has been out there since 1992!) diagnosis code set known as ICD-10. Because many existing billing systems were hard-coded for the previous version, ICD-9, lots of health IT folks have been in a mad dash to meet the October 1 deadline. It has been likened to healthcare’s version of Y2K.

Nobody, yet, really knows who snuck the ICD-10 adoption delay into H.R. 4302. But it is now law, and the CMS chief who promised health IT leaders in February that there would be no more delays—I hopes she likes eating crow.

To me, by far the bigger issue is that my industry now toils at the whim of the likes of John Boehner, Nancy Pelosi, Harry Reid, and Mitch McConnell, along with their cronies. We signed that deal with the devil many decades ago, when we allowed our “leaders” to insert government into the health insurance business; it started with Medicare and Medicaid, and the slope has been getting more slippery ever since. This is a dance many of us don’t like, but without radical alternatives, we have little choice but to snuggle up to our diabolical partner.

I am doing some research into the dissident outfit out in the heartland, the Surgery Center of Oklahoma. Seems like a promising model, if only we can extract our Medicare population from the grips of Congress, the CMS, and their whims. I’m tired of dancing….

(As always, posts on this blog reflect my views alone, and not those of my employer.)

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On racism

While I spent my pre-adolescent years in the 60s, I recall little of the civil rights struggles of that decade, other than staring in wonderment at the TV as Huntley and Brinkley showed us footage of Watts and Detroit burning. So I admit I can’t speak with ultimate authenticity about the emotions from that time—though I can reflect on what is happening in this time. We hear the trope that it’s not possible for minorities to be racist, as they were the ones oppressed in the first place. If the tables are being turned, that just makes things “fair.”

What a pile.

Human beings, by virtue of being endowed by their Creator with certain inalienable rights (remember that insignificant piece of parchment called the Declaration of Independence?), are protected from being harmed by acts of force (bodily and otherwise) exerted by others. The Constitution (remember that one?) lays out the limits on how the national government may, and may not, assure that basic liberty. These documents make no intrinsic distinction on skin color. Yes, slavery was a gross moral injustice, and the Framers were sadly unable to eradicate it in their day. But it did eventually meet its demise, and so did the government-sanctioned restrictions on civil liberties that sprouted in its aftermath. Yet, some few out there seem to believe that two wrongs do make a right. Witness the gruesome spectacle that played out in Detroit this past week. An unfortunate black youth darted into the oncoming path of a white motorist who could not stop in time, causing an injury to the child. As any morally upstanding citizen might be expected to do, the driver stopped, exited his vehicle, and came to tend to the youngster. He was rewarded for this behavior by getting brutally beaten by a dozen street thugs. One witness candidly told the Detroit Free Press, “He got his.”

What have we come to?

Disclaimer here. Granting that Atlas Shrugged is a 20th century masterpiece that in many respects is sadly prophetic, there’s a lot I find disagreeable with the outlook of Ayn Rand. But not when it comes to racism. Here are a couple of Rand quotes that apply, courtesy The Ayn Rand Lexicon.

Today, racism is regarded as a crime if practiced by a majority—but as an inalienable right if practiced by a minority. The notion that one’s culture is superior to all others solely because it represents the traditions of one’s ancestors, is regarded as chauvinism if claimed by a majority—but as “ethnic” pride if claimed by a minority.

Racism is the lowest, most crudely primitive form of collectivism. It is the notion of ascribing moral, social or political significance to a man’s genetic lineage—the notion that a man’s intellectual and characterological traits are produced and transmitted by his internal body chemistry. Which means, in practice, that a man is to be judged, not by his own character and actions, but by the characters and actions of a collective of ancestors.

The gang who bashed Steve Utash’s head in judged him based on their perception of “a collective of ancestors.” This is what happens when the laws of nature and nature’s God—on which our society and culture were once based—are supplanted by a victim mentality that justifies the violent restriction of another’s basic human rights.

It wasn’t right when one tribe oppressed another two centuries ago. It isn’t right today. Will those in power affirm their oath to uphold the Constitution of the United States? Oops, didn’t think so.

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I don’t understand…

This post on the Atlantic web site by Olga Khazan is insightful, though perhaps not the way she planned it.

Olga’s surely a liberal. But even the blind squirrel finds the occasional acorn. Her lede is that most uninsured folks don’t understand the Affordable Care Act. Her conclusion, based on such a stunning observation, is that we should work ever harder to convince them how supercalifragilisticexpialidocious it is.

I’d suggest approaching the issue from a different angle. Let’s suppose for a moment that the clearer and less ambiguous a law is, all else being equal, the more likely it is to be effective once enacted. In other words, those affected by it have a better idea of the benefits and risks it presents to them, they can make more reliable decisions on how to act, and the collective acts of the populace are more accurately predictable—allowing the framers of the law to tell ahead of time whether it will achieve its intended outcomes.

The ACA clearly fails this test. As one who spent numerous weeks in many of my MHA courses facing assignments focusing on one or another of its endless provisions, I can attest that leafing through it (assuming you can hold it in your hands) is akin to opening Forrest Gump’s box of chocolates. Progressives dumped a boatload of old favorites into the bill, took a single-state experiment (that, on further review, is a blazing failure) and took it national, added a generous dollop of “The Secretary shall“s, and larded it with goodies like the Cornhusker Kickback and the Louisiana Purchase to get it through the Senate. No wonder people can’t understand it!

My take, in general, is that an act of such complexity stands a good chance of being a bad law. That is a generality, ignoring right vs. left or other distinctions. But I believe it to have plenty of validity. It is distressing, by the way, that acts of Congress are becoming increasingly obtuse over time, regardless of who’s minding the House, the Senate, or the White House. We’re better off with slimmer, simpler statutes that are easily understandable by those of us who aren’t policy wonks in our specialty field (or lawyers…).

To paraphrase a remark I saw on Facebook today, where the object of comparison was not the ACA but the case being brought by Hobby Lobby to the Supreme Court on behalf of religious liberty, if you know who got kicked off DWTS but have no clue about Obamacare, you deserve the continued removal of your rights.

Now that’s clear and concise.

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Family pet visitation: 20 years later

I am inspired to post the below on reading in the December American Journal of Nursing today, and encountering on my Facebook news feed, a fascinating article about family pet visitation. I commend the article for your review. Without further ado, here is an exemplar I submitted to the American Association of Critical-Care Nurses approximately twenty years ago, recounting a real-life experience that I will never forget. As far as I know, it was never published. Enjoy!

“I know you probably won’t approve of it, but I would like to ask one favor of you. . . . ”
R.R.’s wife came to me with these words about midway through my twelve-hour shift in the cardiac ICU. And at this point, I was ready to grant her just about any favor.
R.R., who had undergone coronary artery bypass surgery only a month before, seemed very close to death. After returning home from his surgery, his mitral valve decided to go on strike and R.R., in his seventies but otherwise in good health, went into severe heart failure.
For ten days we had worked to get him off the ventilator and normalize his cardiac output, but we had been unsuccessful. The previous day, his attending physician discontinued all his medications, ordered comfort measures only, and set up a meeting with the hospital’s ethicist and attorneys to discuss disconnecting the ventilator.
On this day, while mentally preparing myself to assist in terminal weaning, I noticed that R.R. appeared slightly more alert, and that his vital signs were fairly stable even without being pumped full of inotropes and diuretics. Even so, I knew his prognosis, and my goal for the day was to provide whatever solace I could to him and his family.
Although I had only worked in the ICU setting for five months, I was feeling more comfortable about my critical care skills. Before taking this position, which allowed me to “flex” between the cardiac ICU and stepdown units, I had worked on a medical-surgical intermediate care unit for more than two years. Clients’ acuities were high, and so was the nurse’s workload–but it was a wonderful place to learn nursing. Even though I had been an orderly and nursing assistant in hospitals for six years before graduating from nursing school (not to mention a nursing home orderly for too many years before), that was important to me. So on this day in late March, I was getting better at keeping the high technology, tubes, and wires from overshadowing what my clients and their families really needed.
“We have Benji out in the car. I wondered if you could let us bring him in to see Dad one last time.”
At once I realized not only that it could be done, but that it had to be done. The hospital had recently implemented a pet visitation policy, despite some initial objections from infectious disease doctors and others. And I was aware that if there was ever a right time for a pet visit, this was it.
Of course, the policy had to be followed to the letter. But I had no idea what kinds of hoops I would have to jump through to make Benji’s visit happen. I had to obtain a veterinarian’s OK, a clean bill of health for the dog. And though R.R.’s wife had vaccination papers with her, I needed to phone the vet and confirm that Benji was disease-free.
I called security, to let them know there would be an animal entering the lobby, and to have them reserve us a service elevator. And when the patient representative got wind of what was happening, he questioned me to make sure that a visit was appropriate–fortunately, with all private rooms on the unit, there would be no roommate to object.
With all the arrangements I was making, I felt more like a politician’s press secretary than a nurse. But I had a suspicion that this work would not be in vain.
Almost three hours after R.R.’s wife approached me with her request, I met her and Benji in the lobby. I examined the overweight but otherwise healthy-looking Cairn Terrier for fleas, wrapped him in a sheet, and escorted him to the ICU.
As soon as we entered the room, I sensed that something therapeutic was happening. R.R. instantly recognized the twenty-pound dust mop on his lap, and vice versa. Benji’s only problem was that the endotracheal tube hindered easy access to his master’s face; and it scared him when the extra abdominal pressure caused R.R. to cough, and the ventilator responded by alarming in disapproval.
The visit itself was a total, unqualified success, and what followed was even more remarkable. Pleasantly surprised at R.R.’s mental status half an hour after Benji’s visit, the pulmonologist decided to try weaning him once more, this time without cardiac drugs. And, incredibly enough, we succeeded; he was extubated less than 48 hours later. His DNR status was reviewed, medications were resumed, and within a few days he was transferred to a general floor. And most significantly, R.R. was able to return home and reunite with Benji and the rest of his family.
Of course, skeptics will say that pet visitation, and my role in facilitating it, had nothing to do with this man’s recovery. While that is possible, I do not believe it. The literature is starting to show examples of the therapeutic benefits of pet therapy, and I am convinced that it played a role in R.R.’s healing process. Even if he had not survived, a visit from his beloved dog would have helped to brighten his last days and raise his family’s spirits.
This incident has earned me a certain amount of notoriety, especially after we re-enacted it for a feature story on a local television station’s evening news. And it seems that if any of my colleagues in the Heart Center has a question about pet therapy or visitation, they come to me first as a resource person. But the most important feeling I retain from this experience is that I helped make a difference, that I went the extra mile, and that perhaps as a result, Benji is perched on R.R.’s lap right now as I remember them from not so long ago. And as for my own dogs at home, I hope that, if I am ever critically ill, my nurses will allow Bentley, Gertie, Bucky, Ali, Stormy, and Demi to visit me as well.

The only postscript I’ll add is that the above-named canine family members, of course, have all crossed the rainbow bridge since 1994. So I’ll just mentally substitute for them Jinx, Zora, and Visa.

Posted in Dogs

Bleeding edge

I knew I couldn’t hold out for long. Having some time available this evening, I went ahead and updated the laptop to Windows 8.1. Up to now I have spent as little time as possible in the Metro/Modern UI. Will see if 8.1 improves my experience any. The jury is out. Really annoying big black and orange boxes commanding me to use gestures even though I do not have a touchscreen, obscuring large swaths of the screen. I think I was able to banish them, at least for the moment. Several important browser add-ons show as incompatible with IE 11, especially Evernote. Looks like it’s back to Firefox for me. Also a Citrix file called pnamain.exe does not seem to like 8.1. Getting on to HPM and Epic from Citrix may be a challenge.

Desktop will have to wait. It is almost five years old and came from Dell with Vista on it. It is definitely time to do a clean install. In any event, I can’t get to the Windows Store since a month or two back when I got a bad infection with Sirefef. I was fortunately able to clean the Trojan off the machine, but ever since then, the Store and all of its apps fail to communicate through Windows Firewall. I have not been able to figure out how to fix that. No other way, it seems, to download Windows 8.1. (Not to mention the Weather app being frozen in time….)

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Back to the blog

Well, it’s official. At least the grades are posted. I have completed my Master of Health Administration program, and sometime early next year will get the diploma to go with it. Lots and lots of work writing papers and participating in group projects. Due in part to my Type A nature, I would agree with the university’s estimate at the outset of an average of 15-20 hours per week dedicated to course work.

Now that it is done, I pledge to be more regular here and on the Twitter feed; while I perhaps could have kept them up in some limited fashion, the last two years have been all about simplifying what I could. Simple is still good, but I feel like I can unleash my voice a little more now. (Readers can judge whether that’s a good thing….)

There’s plenty of grist for the mill these days. The health insurance exchanges are proving to be a major dud, and there is no shortage of worry in my business. Buckle up with me for the challenging ride!

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