Repeal 40B

Boston.com has a great map of Massachusetts showing the percent of “affordable housing”  for all 351 MA cities and towns.  You can take a look here and click on any town or scroll down through the complete listing:

SNAPSHOT: SUBSIDIZED 40B HOUSING IN MASSACHUSETTS, 2010

There is also a one-question poll which asks the question: Should the government encourage economic diversity in communities through affordable housing laws like 40b? And your possible answers are Yes / No / No opinion/other   I have a problem with the question because I DO believe the government should encourage affordable housing.  I don’t think affordable housing and economic diversity are exactly the same thing.  The two concepts come with different problems and opportunities.  I personally KNOW that 40B does not encourage economic diversity, nor does it encourage affordable housing.

If you respond to that question you will see something below that which says

Discuss: Should government encourage economic diversity in communities through affordable housing laws like 40b?

If you read through the comments, you will find mine, some of which I include here below with modifications and additions:

40B is a disaster for cities and towns. The question posed is itself a problem.  I firmly believe that the government can help improve the overall economic health of its citizens by encouraging the production and maintenance of “affordable housing.”  Unfortunately that is not what 40B does.  MA Inspector General Sullivan has completed many studies of 40B projects, calling the law the greatest source of corruption in the Commonwealth and a “pigfest” for developers.  (It’s all up there on the web.)

The MA South Shore is 38% wetlands.  It was settled in the 1600’s.  Over the last 400 years, the good land has been built on.  Our strange road systems where you have to go North on Route 3 up to 128 then down 24 to go what should be a straight shot West is due to wetlands, rivers, and stretches of unusable land.  In Norwell we had an area on Route 53 that had 30 families renting trailers and small cottages.  Very affordable.  But a horrible local developer and his builder buddy (Murphy and Sullivan are the names) bought the land, threw the tenants out on the street in a New England February, cleared the land and built LUXURY CONDOS… all under 40B.  The town fought it in court, but the land courts and appeals courts are all under the illusion they are promoting “affordable housing.”  Karma is such that none of the luxury condos have sold in 2 years.  Who wants to live in a condo in a swamp when you can buy a house in the same town for less?  These luxury condos are still for sale, look it up.  The developer and the builder have moved a few units back and forth between themselves, but nobody is living there.  Just so you get the idea:

40B enables developers to bypass zoning bylaws.  Those bylaws are there for a reason.  Norwell, for example, has town water, but the land is very wet and every home that is built at this point generates further local flooding and requires mounded septic systems.  40B enables a developer to build dense housing on wet land, raising the water table and flooding property for a half mile circle or more around it.

Town Zoning Boards have learned that they cannot “reject” 40B proposals because the housing courts overrule the towns and approve the projects.  So Zoning Boards “approve” the 40Bs with enough conditions to protect the town.  Those conditions would make construction impossible or unprofitable, so back to court we all go.  40B results in local neighborhoods spending tens of thousands of dollars on lawyers and engineers to demonstrate to the housing court that these dense developments are inappropriate.  And still they get approved.  Look at the MA South Shore.  For the most part we have low levels of “affordable housing.”  Those are the reasons why.  There is no more buildable land.  Certainly not large tracks of it to build 40 to 100 units of dense housing.

Norwell has an Affordable Housing Committee.  The best we can do is find small, individual lots and build one or two affordable units at a time.  Even that is dependent upon when such properties become available.  There is no public transportation in Norwell.  There are very few jobs.  There is a lot of water and flooding.  And we’re fighting 40B for our survival with lawsuits brought by neighbors and the town.  This is a nightmare none of us expected.  The state government is killing us.

Did I mention traffic?  Norwell is a rural town.  Because of the wetlands, we have narrow, winding, twisting roads with dense vegetation often right up to the road.  The line of sight on these roads is ridiculously small because the road curves away from you so often.  The town does not have a drainage system, so they have open trenches alongside many of the roads.  That means no place to pull off.  No shoulders on the road.  If you are forced off the road or you skid off the road you land in the drainage ditch or you hit a stone wall, a tree, or a telephone pole.

Just as a point of information, the above accident – one of many at that very spot – is on Forest Street in Norwell.  As I type this there are two, count them…2, telephone poles on this one mile long street that are now double poles because Verizon knows how often they are hit.  And, by the way, that car crashed about 20 feet from where a road into a new 40B project is proposed.  Want to see this same piece of road after a rainstorm (the broken telephone pole is just off to the left):

That house has been bought by the developer proposing the 40B project.  It is scheduled to be torn down to put in a road to access the project.  Get the idea?  Water is a problem.  Traffic is a problem.  It will only get worse.   This is 40B in Norwell, Massachusetts.  Well meaning, but a nightmare for cities and towns on the South Shore.  And a nightmare for other MA cities and towns, too, just a slightly different nightmare.

I’ve been trying to get Governor Deval Patrick to recognize the problems caused by 40B since BEFORE he was elected.  I explained the problem to him at campaign rallies before his election.  I’ve mentioned it to him since then.  He doesn’t want to hear it.  The only person on Beacon Hill who is fighting for the South Shore against 40B is the Republican state senator Robert Hedlund.  That’s Senator Hedlund and Governor Patrick in the photo above at a speech the governor gave in Hull back in the summer of 2008.  I wore my green 2006 Deval Patrick campaign tshirt so he’d know I was a supporter.  (Dear Ghod, it’s a horrible photo, but there it is.)  None of the three candidates for governor in 2010 will say anything about 40B.  Officially they are all FOR it.  It is a complex subject and nobody wants to be caught with a sound bite that might be against “affordable housing.”  It’s a complicated subject.

This fall, let’s REPEAL 40B.  Encourage your state level politicians to pass some better legislation.  Stop this “pigfest” for developers.  Last year proponents of repealing 40B needed around 65,000 signatures to put it on the ballot statewide.  They gathered around 85,000.  The state threw out about half of those signatures, so the petition was not on the ballot last year.  This year another grassroots effort has gone forward to repeal this miscarriage of justice and hopefully it will be on the ballot statewide this fall.

We need to replace 40B legislation with something that works.  We need affordable housing in Massachusetts.  40B is not the way to do it.

Note:  Repeal 40B signature collection ended Wednesday June 23rd and by all reports, we are well over the 11,099 needed to put 40B repeal on the November ballot.

A tweet from @dougknowles76 – also of Norwell, MA – provides some corrections to the original July, 2008 slide presentation.  The West End Way 40B was originally proposed as 40 units; Silver Brook finished at 30 units, with 8 classified as affordable.  I will assume he is correct.  The original slide presentation is located as a Slideshare upload: Experiencing 40B in Norwell, MA http://bit.ly/atKRQQ Presentation to MA Housing & Community Development Agency in Boston, July, 2008.

Pulled Pork

In general I’m from the school that says dinner should take maybe half an hour to prepare. If that offends you terribly, you are not going to be happy eating in my house. But we can go out for Chinese sometime. I’m not insulted, really. In any event, I look for ways to do quickly and painlessly things that would otherwise be waaaay beyond my span of attention. (Which is to say I set off the smoke alarm a lot.)

If you’re still with me, this is something nice I discovered today and would like to share. Pulled pork, heaven bless it, takes hours of slow roasting or smoking. Having just written the previous sentence I googled pulled pork recipes and discovered that people are way ahead of me here, using crockpots and such.  But to continue my story…. rather than run the oven on a warm day, I decided I would try essentially steaming the heck out of the pork. Dubious idea, since I wasn’t sure this wouldn’t have some unintended dreadful consequences for the flavor. However, it didn’t.

Once in a while I’ll buy a whole pork loin around 15 pounds or so and cut it into 3 pieces: one for now, and 2 to freeze for later. Which means I have a frozen 5 pound hunk of potential pulled pork in the freezer most of the time. Problem is it’s a frozen 5 pound block. So I got out my trusty steamer thing:

And put in some water and the frozen block suspended on an insert.  That was early afternoon, let’s say maybe 2 pm.  Around 7 pm when hubby announced he really would like some food, I decided the pork was done and in a very few minutes, so was dinner.  I took the pork out of the steamer and it was starting to fall apart as I removed it, so the timing was just fine to turn a solid block into pullable meat. Took two forks and easily pulled the meat apart.  Made us two sandwiches with some lovely bread, super barbeque sauce, and cold 4 bean salad.  Not bad if I do say so myself.  Here’s what was left of the plate of pulled pork when I was done making the sandwiches:

Not knowing how this was going to turn out, I didn’t take pictures along the way, although in retrospect it would have been amusing to show you the original frozen object and then the later pile of pulled pork before I dug into it to make sandwiches, but who knew?

So here’s the inside of the steamer at the end of this exercise.

Yes, a bit of the fat came off, which is ok.  The meat stayed moist and there was enough fat left to keep it juicy and tasty.  The cleanup was very easy, which was good, considering that if I had roasted the meat, the pan would have had hard baked junk to clean.  My conclusion is I will try this again.  You might want to give it a shot.  Simple, easy, yummy.  Only advice is to not let the water completely evaporate.  Although, since it was on a gas stove over a low heat, the worst thing that might have happened is that the junk would have hardened on the steamer and it would have turned into a roaster or a smoker and that would set off the aforementioned smoke alarm.  But I did remember, from time to time, to add a bit of water, so all’s well.

In theory one wants a rub on pulled pork, but I wasn’t convinced moist cooking and rubs go together.  Next time I’m going to try that.  Maybe something with a little smoked paprika in it.

As to barbeque sauce, best to keep around both the vinegar type and the sweet type, but that’s a topic for another day.  My humble opinion is that Nashville is the world barbeque capital, and I measure everything against Jack’s Bar-B-Que.   But since they smoke their meat for 18 hours and pay much more attention to it than I ever could, I’m happy with my shortcut.  You could do much worse than to order barbeque sauce from Jack’s, by the way.  (Now that I think about it, you can’t do any better.) Cheers.

Human Nerves are Quirky

Science News, which has been the most valuable magazine subscription I have ever known, recently published an article about pain and teeth.  The article describes how it is difficult to tell exactly which tooth is hurting.  In fact it’s hard to tell, sometimes, whether the pain is from an upper tooth or a lower tooth.  That says something fascinating about the human brain and how our nerves work.  The article is here. It’s called “Why a rotten tooth is hard to find.”  It would appear that the confusion might arise when the pain signal comes into that ganglion of nerves that brings upper and lower teeth nerves together.  Perhaps like the old telephone crossover signals.

I’ve had more than my share of fillings, root canals and caps over the years, and I agree that the dentist has to tap or put ice on a tooth to be sure you’ve identified the real problem.

More interesting than teeth was something that happened to me a few years ago.  I knew I was developing carpal tunnel syndrome and, being right handed, it appeared first in my right hand/arm.  I did the usual braces, pain killers and ergonomic efforts, but the pain became part of my left hand/arm also.  It finally hit the point where I couldn’t sleep well and was in constant pain.  The surgeon that was highly recommended to me was a plastic surgeon who specialized in hands.  When I had the nerve evaluation done by a nerve specialist, I was told that my left hand/arm actually transmitted nerve signals less well than my right.  I could not imagine what would cause that difference.  Being right handed, I favored my right hand.  So maybe the left hand/arm just naturally had lower transmission speeds, but the doctors doing the evaluation and the surgery would have known that and nobody suggested that might be the case.  So it occurred to me that the lower nerve transmission speed to/from the left hand might somehow be sympathetic with the nerve problems in the right hand/arm.

The surgeon asked which hand I wanted operated on first, since we assumed I would need to have both done.  Being right handed I asked him to do the right hand first.  When the right hand had its carpal tunnel surgery, the left hand/arm stopped hurting.  Go figure.  The difference was so dramatic that I assumed there was some sympathetic nerve pathway thing going on in the brain, but I’ve never read anything to that effect either before or since.  This article about differentiating tooth pain is the closest I’ve found to addressing that experience.

If you know of any other articles or studies relating to pain location identification, I’d be interested to hear about them.  The workings of the human mind and body are fascinating.

There is no dialog with Fox News

I made the mistake of reading and then commenting on a WSJ piece about healthcare entitled The Health-Care Wars Are Only Beginning by Fred Barnes.  Mr. Barnes is a conservative of the deepest hue, so any comment that does not agree with him is likely to draw rounds of flak from his supporters.  And, yes, I knew that, but started typing anyway.  If not me, who?  If not now, when?  Yeah, yeah… so my initial comments were:

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(1) Only the jerks from Faux News call it “ObamaCare”. These are the same folks who brought you “HillaryCare”. You can tell how willing they are to engage in intelligent discussion.

(2) There is some truth to this opinion, unfortunately. Conservatives will battle healthcare reform as long as the insurance companies and healthcare related companies continue to put millions of dollars into lobbying and campaign contributions.

(3) What we need is either access to Medicare for everyone or a simple universal, single-payer system. This country cannot return to its former position of strength and economic power with a poorly educated, unhealthy population. It’s a rising tide that lifts all boats, moneybags. Didn’t you learn anything from Henry Ford?

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Yes, item (1) was a tad intemperate.  Item (2) is obvious to me.   And item (3) is my opinion laced with a couple cultural references (and some name calling) I hope we all share.  Conservatives do bring out the worst in me.  In all fairness that was in response to the outrageous nature of the original article.

Mr. Barnes article was published on March 18, 2010.  When I logged in this morning I found a number of responses to what I’d written and a total of 539 comments as of 9:30 am on March 19, 2010.  That says something about the intensity of emotion around the topic.

Most of the comments I could dismiss as coming from sad Kool Aid drinkers.  Then I came across one from conservative Gerald Meazell which inspired me to respond:

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Wow, Mary, please explain to me how this country got to its “former” position of strength and economic power without government run health care. The fact is that this economy produces best when it is left alone. Henry Ford is a good example. He didn’t invent the automobile, he discovered a way to build them more cheaply. Now, if ol’ Henry had been working for the government and not allowed to profit from his work building cars, would he have cared to invent the assembly line? What would be his incentive? Government intervention in health care and its accompanying third-party payer distortions are what have brought the health care business to the state it’s in today. The solution simply is NOT more government, but less.

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Since I was asked, however retorically, to respond, I did.  People like that make me feel like Dennis Miller.  Actually I’m a big fan of Dennis Miller, or was until he became still another conservative mouthpiece.  But I enjoy Miller’s humor and consider listening to him an exercise much like a crossword puzzle.  (How many references do I get? Never all of them.)  My point here being that we share a culture.  Unfortunately it is a big, complex culture and references to some obscure component thereof will not and cannot be understood by everyone.  This leads to misunderstandings.  Kind of makes you nostalgic for the 1700’s or 1800’s where, presumably, English speaking peoples had more universally accessible cultural references.  What I think is common knowledge may not be.  So this was my response:

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There is no point responding to most of the comments above since there is no possible dialog with true believers. With respect to your comment, possibly a little reading of history and economics would help you. Europe was the world power up until World War II. There are a number of geographic reasons for this. After the Industrial Revolution we see power shifting to countries who actually make things. The US became increasingly good at making things. We built superior educational facilities for our children. We had great natural resources. World War II and its aftermath gave us incentives to activate production on all burners, so to speak. Our federal and state governments nurtured productivity and growth. Meanwhile Europe was becoming, as everyone would agree, somewhat more socialistic, if by “socialist” you mean concerned about the living conditions for everyone, not just the wealthy. As time went by in the US, some very smart people learned how to game the system really well. They developed risky financial instruments and they outsourced production jobs out of the US. Both of those activities have ultimately resulted in our current situation which consists of bad economic conditions and chronic unemployment due to jobs that aren’t coming back.

I did not say that Henry Ford invented the automobile. Please consider the history of the thing. Henry Ford developed assembly line techniques to improve production and he was admirably clever in saving money. He did, after all, make his suppliers deliver engines in wooden boxes to his specifications which were then broken down and used to make floorboards. He was brilliant and the sort of capitalist we can all admire. He also recognized that if he paid his workers well, they could buy cars and the cycle would spiral upwards. Ford paid his people extremely well for the time. Look it up. My point in mentioning Ford, which seems to have been lost on so many people, is that a rising tide really does float all boats. Economies tend to spiral up or down as conditions reinforce each other. Guess which way we’re going now? What do you think is driving our economy today?

Keep swallowing the conservative line and your children will be lucky to be dirt farmers in the ruins of the suburbs of Levittown. Have you been exposed to an economist named Hyman Minsky? Do you see why the recent economic explosion was called a “Minsky Moment”? Please, look it up. The conservative line expressed by so many is blind to the fact that we are less and less productive in this country. In recent years we substituted rising debt for the give and take of a productive economy. I’ve gone on long enough here. I hope you see where I’m coming from. Healthcare is just one factor which is making us uncompetitive today. Our superexpensive healthcare system is similar to the housing bubble. It can’t last. As a country our competitors all have universal healthcare. We pay a heavy price as a country, all 308 million of us, to make a few people wealthy via our healthcare system.

The solution actually is “big government” to dampen risk and provide economic stability, with an ongoing dialog about our values and our future.

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There really is something about addressing conservatives that brings out the worst in me.  Sorry.  I’m also a big fan of Henry Ford.  I could be wrong about him, but he strikes me as a very sharp businessperson, successful capitalist, and a man who understood that improving the life of his employees would improve his life, too.  THAT is a capitalistic way of thinking which I can support.  On the other hand, the people at the top of the financial and healthcare insurance pyramids add nothing of value to our country.  They absorb wealth from our economy and drain it from the rest of the working class.  Ultimately this will hurt not only our country but their own positions.

We all, I believe, want to live in a country where shared values include the best possible education for our children, steady advances in science which result in new businesses, and a healthy life for everyone while they pursue their view of “happiness.”  Am I wrong here?  I’d love to hear your view.

“Thinking is the hardest work there is, which is probably the reason why so few engage in it.” — Henry Ford

What I Learned from Mom’s Hip Replacement

Being involved on the business side of the medical device industry in recent years, I have taken a keen interest in all things healthcare related. I also have a mother who is over 65 by a good deal and has dealt with Medicare and Medicare Advantage programs (in Florida) for some years now. I have had the dubious distinction of sorting through the hundreds of Medicare Advantage programs out there to find some that are appropriate for her and then guide her to reasonable choice. (Thank heaven the government has a website to help with that. I cannot imagine most folks on Medicare coping with that project, but that’s another post entirely.  You can start here if you’re researching the matter yourself:  http://www.medicare.gov/Choices/Overview.asp )

Before the Surgery

My mother complained of a painful right hip for a couple years. Her primary physician finally said mom was a candidate for a hip replacement and she would recommend the operation whenever  mom would like to have it done.  This is a very common operation these days and a good, experienced surgeon will normally yield good results.  Recovery progresses fairly quickly, you can walk again within a couple days, and the patient is back to mostly normal (pain free) in 3 to 4 months.

A separate request had to be made to my mother’s primary doctor to obtain a recommendation on a surgeon, which I thought was odd.  I would have expected her primary care physician to help guide her to a surgeon, but I guess not.  We were given 5 surgeon names, 3 of which, upon investigation, were participating in her insurance plan. Of the 3, we requested that the primary care physician’s office recommend one of the three. We asked around (in the over 55 community in which she lives) about hip replacement surgeons and got additional recommendations, eventually all converging on a particular nearby surgeon.  Surgery was scheduled at Blake Medical Center in Bradenton.

Surgery, the Hospital, and Rehab

Surgery was scheduled and then moved to an earlier date as one became available. She was in surgery maybe 3 hours, then in the hospital for 4 days, then transferred to a physical therapy rehab facility a short distance away that was highly recommended.

I arrived in Florida the day she entered rehab and my sister flew out the next day. We were initially told she’d be in rehab for maybe 10 days. She was in rehab for 15 days. It was clear to me that it would have been longer if I hadn’t kept asking questions about her progress and their expectations.

The rehab facility did physical therapy for patients 5 days out of 7.  Why it was not 7 days out of 7 I don’t know.  Their website claims 7 days out of 7.  I never received an answer.  I was at the rehab facility several hours a day, every day,  bringing what my mother considered “real” coffee, walking around with her, giving her outdoor wheelchair rides, monitoring her medications, and so on.

Her first roommate (two people in every room) was a nearly deaf lady who would turn her TV on so loud that you could hear it from the nurses station down the hall.  It took several days to have my mother transferred to a different room.  Moving was dependent upon somebody else leaving the facility.  There were 55 beds and all were full, pretty much all the time from what I could learn.  Did I mention the food was surprisingly good?!

The staff was wonderful. Everyone we met was helpful, kind, and gave 110% to every task. That was encouraging. I did ask about the medications being supplied in the morning, during the day, and in the evening. Some meds were things we had agreed with her primary care physician that she no longer needed. It was disturbing to see them pop up again. It turns out that older people are seen by several doctors (primary, surgeons, specialists) who do not talk to each other. Each prescribes meds. Sometimes without looking at what has been prescribed by someone else. (My mother-in-law had been prescribed near lethal levels of one med by several physicians before her two sons figured out what was going on with her.)

My mom is becoming a bit forgetful, not Alzheimer’s but forgetful.  Doctors and therapists should not assume that telling older people something is adequate. Things need to be written down and should be transmitted to family members. Even if the older person does not appear to have dementia, it seems to be a natural issue as people age. It is very clear to me that both in hospitals and in rehab facilities, people needs advocates watching out for them when they are not completely able to manage their own care. This appears to be true for everyone, regardless of their age.

Upon entering rehab, we were told that my mother was now under the care of one of the two physicians associated with the rehab facility.  She was there 15 days.  She NEVER saw a doctor of any size, shape or color while she was there.  Her second roommate had been there for a month and she said a woman doctor had popped her head into the room once during that time and asked her “How are you doing today?” and then left.  Without being overly cynical we all assumed that both doctors were charging everyone in the facility (55 patients) on a regular basis for “visits.”  Let’s see, 55 people a day times let’s call it $100 a visit would come to $5,500 a day that Medicare is paying this place for absolutely nothing.  Let’s assume that these two doctors are on call.  Maybe they do get called to deal with a patient once or twice a day, maybe.  Still, $5,500 a day is pretty good.  Times 7 days a week that’s, let’s see, $38,500 a week.  Not bad for being on call and walking through the building maybe twice a week. The nurses and staff do all the work and are very good. I thought the references to patients being under the care of these doctors was pretty clearly fraudulent.

Conclusions

(1) Ask questions. What is being done? Why? When and where will it be done? How long will it take? What are the expectations? When does the patient transition from one stage to another and what are the criteria for transitions?

(2) Watch medications. Who prescribed what? Was the surgeon aware of the person’s previous medications? Does anything conflict with anything else? Are any of the medications to be given on an “as needed” vs. “regular” basis? What are the meds and what is each being given for?  Assuming some of the meds are sent home with the patient, find out again what needs to be given and when.  Then make an appointment with the person’s primary care physician to review.

(3) Watch what you are being billed for. Since most bills will be transmitted directly to Medicare or to the Medicare Advantage health insurance program, this is not always something you see.  I remember when my father died, the doctors charged for several visits “to him” after he had already died. (That was also at Blake Medical Center in Bradenton, FL.) These people have no shame. They simply game the system for their own benefit.  If that explanation seems harsh, the only other explanation is that they are too disorganized to bill correctly, but somehow the errors are always in their favor.  You pick.

That’s what I learned.  I hope it helps you.

And today (3-17- 2010) I learned something else

Martha Coakley, the Massachusetts Attorney General, published a preliminary report titled Investigation of Health Care Cost Trends and Cost Drivers dated January 29, 2010.  I highly recommend you read it.  All 21 pages.  Don’t worry, there are some large graphs!  It will either enlighten you or confirm whatever cynical views you may have about our healthcare system.  The conclusion is that in our free market system, healthcare providers charge what the market will bear.  And that drives up costs. Let’s put it this way: you can pay 280% more for the exact same market basket of healthcare services, depending on where you go in the state of MA.  And we have some pretty fancy, well known medical institutions here.  Mind you, I am not condemning them for this, because I believe those that charge more are also doing more in the community that they are not being paid for.  But the overall report helps explain how broken the system currently is.  I hope you can read this below.  It shows the variation in price for the same services is, broadly, 100% from lowest to highest paid, with the exception of one heck of an outlier which is 280% of the lowest paid.  Still, a 100% difference is a heck of a market premium for healthcare.

Pages 19 and 20 have conclusions, including the following:

Our preliminary findings show that the current system of health care payment is not value-based – that is, wide disparities in payment levels are not explained by differences in quality or complexity of the health care services provided. These findings have powerful implications for ongoing policy discussions about ways to contain health care costs, reform payment methodologies, and control health insurance premiums without sacrificing quality or access in Massachusetts. The Office of the Attorney General looks forward to completing its investigation and to presenting a fuller exposition of its findings through the DHCFP cost containment hearings.

Although our investigation continues, it is clear that prices paid for health care services reflect market leverage. As a greater portion of the commercial health care dollar shifts, for reasons other than quality or complexity, to those systems with higher payment rates and leverage, costs to the overall system will increase and hospitals with lower payment rates and leverage will continue to be disadvantaged. If left unchecked, there is a risk that these systemic disparities will, over time, create a provider marketplace dominated by very expensive “haves” as the lower and more moderately priced “have nots” are forced to close or consolidate with higher paid systems.

The present health care marketplace does not allow employers and consumers to make value-based purchasing decisions. Our findings show the system lacks transparency in both price and quality information, which is critical for employers and consumers to be prudent purchasers.

These market dynamics and distortions must be addressed in any successful cost containment strategy. Payment reform, such as the global payment methodology recommended by the Special Commission on the Health Care Payment System, may result in system benefits such as better integration of care. But, a shift to global payments may not control costs, and may result in unintended consequences if it fails to address the dynamics and distortions of the current marketplace.

We need universal healthcare.  And we aren’t likely to get it in the near future, no matter what Congress does.

Would you crash an airplane or vote your stock proxy?

A programmer named Joseph Andrew Stack crashed his Piper plane today into an office building in Austin, Texas.  Prior to that he reportedly set his house on fire and posted a suicide statement on his own website.  His website has been taken down, but the letter can still be read on NPR and Huffington Post websites.

This is very sad. From the headline (Austin Plane Crash Pilot’s Apparent Suicide Note), I expected the ramblings of a crazy person, one I would not  –  most likely –  relate to.  Instead, what I read reflects the experience of a generation of tech workers.  This was one member of the former American middle class who found himself squeezed out while the management of so many companies was giving itself multimillion dollar salaries and bonuses.  This fortunately was not my story, but I recognize exactly the IRS ruling he references because I knew people who complained bitterly about it at the time.  Every sitting congressperson should read that letter and consider the desperation driving this man to do what he did.  Joseph Stack may not have been the strongest person among us, but his experience reflects the middle class’s feeling that they have been cheated out of everything they thought they were promised for their hard work. This is surely something for all of us to think about.

That was pretty much what I posted on the NPR website immediately after reading the letter.   Upon later consideration, it is especially sad that this man retaliated against a random (albeit local) IRS office.  The people working there are just everyday grunts, like the rest of us. However much they may have implemented this man’s torture, they did not cause it.   The problem lies with the unholy alliance between American politics and capitalism.  Our system is broken, guys.  Our system drove this person to madness.  Politicians and fat cats benefited from that specific legislation that unfavorably impacted “independent consultants” and they have much to answer for.  They were nowhere near where this poor man crashed his airplane in frustration.

As emotional as we become in this country, few of us would crash an airplane to register our frustration.  I can’t help but remember the assassinations of JFK, RFK, MLK Jr. and the attempted assassinations of Ronald Reagan and Gerald Ford.  This is no way to solve a problem.  Death and destruction can never make things better.  They can only register our discontent.  Ultimately, don’t you think we can elect officials and vote for Boards of Directors who will perform their functions with honesty and integrity?  I personally vote against every single company employee who is currently or aspires to be on their company’s Board of Directors.  I urge you to do the same.

My point in that last paragraph, in case it is misunderstood, is that those who manage companies are paid to manage them, not to plunder and control the distribution of profits to their own advantage.  Peter Drucker in his last book pointed out that the natural lifespan of a corporation is usually about 25 years…. that being the length of time the original founder builds and runs the company.  After that, the going concern is taken over by “managers” who put their own interests ahead of the corporation’s future.  I saw it up close at DEC, Prime, and Wang.  You’ve seen it, too.  Unless new legislation is passed, corporations which are controlled by their plundering CEOs will be able to blatantly pay for political ads favoring those politicians who vote as they are told.  This is not a good road for us to travel as a country.

MSNBC’s Today Show carried a detailed article posted Friday, February 19, 2010 with links to related material.  I haven’t changed my mind about the underlying cause of this tragedy.  The French Revolution, after all, was the result of a thwarted middle class.  This sort of action is a serious message.

Tinnitus

My Story

Many years ago I was sick with what I thought was a bad cold.  After a couple days it seemed like more than a cold, in fact it felt like what I imagined pneumonia would feel like due to a heaviness in my lungs.  The cause was a classic sick building situation.  I was driven to a friend’s doctor, told him I thought I had pneumonia, he took an x-ray and said I was fine.  Two weeks later the doctor’s office phoned and said they looked at the x-ray again (must have been a slow day) and decided I had viral pneumonia.  There is no known cure for viral pneumonia.  Eventually I got over it and life goes on.

About 6 months later I was aware of a persistent ongoing noise that did not reflect noises in my environment.  A doctor I had seen before recommended seeing a neurologist who did a bunch of tests and gave me the bad news:  viral pneumonia had stripped the myelin sheath off my nerves (some, not all, I presume), leaving me with lifelong tinnitus and some physical strength asymmetries.  Everything else is back to normal. There is, of course, no known cure for this variety of tinnitus. Or for damaged myelin nerve sheaths.

A Possible Solution for Some

Some 10 to 50 million Americans reportedly have tinnitus, depending on who you believe.  Most of it is caused by physical damage to delicate ear structures from work conditions, loud music, explosions (gunfire, airbags going off…) and other loud noises. A single loud noise or loud noise over a period of time may be the instigator.  Inside the cochlea there are tiny hairs that are easily bent out of shape by loud noises.  Thus tinnitus.

Anatomy of the human ear.

There is no known cure for this variety of tinnitus, either.  Maybe.  For those whose tinnitus was caused by noise, I do have a suggestion.  (And I’ve tried a lot of things.)  At one point I investigated a delightful and very skilled Chinese acupuncture specialist who said he MIGHT be able to help, but it would take several treatments, it would hurt, and he could make no guarantees.  In the past I’ve had amazing experience with acupuncture resolving pain and speeding up injury recovery from torn muscles.  I was willing to do anything to regain some quiet.  We tried it.  The needles went into the web between my thumb and index finger, which would appear to have been the LI 4 point in the diagram below. (Not completely sure.  I recall it being more in the web than in the hand itself.)

I have never felt pain like that… unbelievable… tears flowed from my eyes like a faucet.  In the end it didn’t work.  He had been able to cure some people this way, but I now suspect they had a different underlying problem from my situation.  In any event, that’s my main contribution to the discussion of tinnitus. (A solution that didn’t work for me, but might work for you.)

Distant Solutions and Immediate Coping

Science News magazine/online recently (1-25-2010) had an article on how prions might be the proteins that cause the myelin sheath to grow and possibly regrow.  That gave me a bit of new hope that a cure might one day be found for my type of tinnitus sufferer.

http://www.sciencenews.org/view/generic/id/55594/title/Prion_protein_is_not_all_bad

A reader of this humble blog told me that you have to be a Science News subscriber to be able to read the above link.  I apologize to any and all who have been inconvenienced by this.  To briefly summarize the article, ” A new study suggests that the normal form of prion protein helps maintain the insulation that speeds electrical signals along nerve fibers.” Prion proteins are known to cause bad things like mad cow disease and wasting in deer, as well as a similar problem in people.  The article goes on: prions “may direct cells called Schwann cells to wrap around neurons and produce myelin, a type of insulation that aids electrical communication between nerve cells.” While there’s more, the key to me is that it may be possible to regrow that myelin sheath. However, it is July, 2011 as I type this and I haven’t encountered anything about further progress. The study in the article was done at the University of Zurich, although a comment from someone at the Dartmouth Medical School in Hanover, NH leads me to hope that possibly some work in this area could be ongoing in the USA.

It turns out there are many more causes for tinnitus than I imagined.  I came across a blog entry

http://www.toahealthybody.com/what-causes-tinnitus/

that listed 10 causes, and none of them included viral pneumonia.  I wrote a subset of this entry as a comment.  So there you are.  There’s also a William Shatner video on the web where he asks for donations to the American Tinnitus Association.  I did a search for tinnitus on Twitter but was disappointed to see that some comments were meant to draw you to sites selling products I don’t think would do any good.  But, again, my problem may not be your problem.  WebMD has a thorough treatment of the subject starting here,

http://www.webmd.com/a-to-z-guides/ringing-in-the-ears-tinnitus-topic-overview

The only information of value to me in the WebMD article is that I must reluctantly admit when I cut down on coffee, the tinnitus is less bad than on the days when I drink 6 or 8 cups.  (Oh, come on, you know those days…. )

To those of you suffering with tinnitus, my sympathies.  I find it best to keep busy and distracted.  Music helps.

http://www.medpagetoday.com/Neurology/GeneralNeurology/17709

But I think music always helps.  To quote one of my favorite people, Frank Zappa: “ Information is not knowledge. Knowledge is not wisdom. Wisdom is not truth. Truth is not beauty. Beauty is not love. Love is not music. Music is the best.”  (I have that on a t-shirt actually.)  He also said “Jazz is not dead, it just smells funny.”  Gotta love that guy.  Peace.