. . . because much of the content relates both to Washington, D.C., and "outside the beltway" -- the heartland, specifically Iowa -- and because after going from Iowa to Washington via Texas and California I subsequently returned, From DC 2 Iowa.
A series of national disasters, legislative and otherwise, but all with ties to Washington, have caused me to realize that there's more than oil creating America's troubled waters.
On March 31 of this year the President went to Andrews Air Force Base to announce:
[A]s we transition to cleaner energy sources, we’ve still got to make some tough decisions about opening new offshore areas for oil and gas development in ways that protect communities and protect coastlines. . . .
[T]he bottom line is this: Given our energy needs, in order to sustain economic growth and produce jobs, and keep our businesses competitive, we are going to need to harness traditional sources of fuel even as we ramp up production of new sources of renewable, homegrown energy.
So today we’re announcing the expansion of offshore oil and gas exploration, but in ways that balance the need to harness domestic energy resources and the need to protect America’s natural resources. Under the leadership of Secretary Salazar, we’ll employ new technologies that reduce the impact of oil exploration. We’ll protect areas that are vital to tourism, the environment, and our national security. And we’ll be guided not by political ideology, but by scientific evidence.
So, oil industry executives, Republican "drill-baby-drill" cheerleaders, oil-funded Democrats -- oh, and you, Mr. President -- how's that scientific protection of tourism and the environment working out for you? Because it's not working worth a damn for the rest of us. We haven't seen much of BP's $5.6 billion in first quarter profits (an annual rate over $22 billion) trickling down to us so far, any more than we did from those of our dollars you gave to Wall Street. And it looks like this "we" to which you refer, you and BP, are on the verge of wiping out a significant portion of the economy of at least three southern states.
The disaster was predictable -- even if no one predicted it would come as soon as a month after the President's repetition of BP's reassuring words regarding its commitment to "reduce the impact of oil exploration" and protection of "areas that are vital to tourism [and] the environment . . .."
Why predictable? Consider the record:
The 2005 explosion at a refinery in Texas City, Tex., killed 15 workers and injured hundreds more. The Occupational Safety and Health Administration fined BP a record $87 million for neglecting to correct safety violations.
Only a year later, a leaky BP oil pipeline in Alaska forced the shutdown of one of the nation’s biggest oil fields. BP was fined $20 million in criminal penalties after prosecutors said the company had neglected corroding pipelines. . . .
Last year, when the federal Minerals Management Service proposed a rule that would have required companies to have their safety and environmental management programs audited once every three years, BP and other companies objected. The agency is also investigating charges by a whistle-blower that the company discarded important records from its Atlantis Gulf platform.
It's just another example of the consequences of the partnership and interlocking ties between corporate capitalism and Congress, known as a "corporatist" form of government (or that, in another time and place, were known as Italian fascism). Because, even if you happen to be a fan of fascism (which I am not), in its American incarnation the allocation of power and control is grossly out of balance in terms of the disproportionate influence of the capitalists on what ultimately emerges as "government policy." And while the Republicans are thought by some to be the party of big business, that is only because the Democrats were initially somewhat slow and clumsy in figuring out that "business is our friend." After all, the "self-regulation" of offshore drilling began under President Clinton and his pro-business Democratic Leadership Council -- including the regulation of those causes of disasters that are not "acts of God," or failures of technology, but rather the failures of top management.
"We are not supportive of the extensive, prescriptive regulations as proposed in this rule," wrote Richard Morrison, BP's vice president for Gulf of Mexico production. "We believe industry's current safety and environmental statistics demonstrate that the voluntary programs implemented since the adoption of [voluntary standards] have been and continue to be very successful." . . .
But when it proposed the rules, MMS said most accidents and spills can be traced to human error or organizational failures and said companies need to ensure safe and environmentally sound operating practices (Greenwire, June 16, 2009).
MMS regulations historically have focused on proper equipment operation, but the agency said at the time that equipment failure is rarely the primary cause of incidents.
An MMS review last year found 41 deaths and 302 injuries out of 1,443 oil-rig accidents from 2001 to 2007. The agency's analysis found a lack of communication between the operator and contractors, a lack of written procedures, a failure to enforce existing procedures and other problems.
"The MMS believes that if OCS [outer continental shelf] oil and gas operations are better planned and organized, then the likelihood of injury to workers and the risk of environmental pollution will be further reduced," the proposed rule said.
The voluntary approach was adopted in 1994 during the Clinton administration.
. Moreover, "The [Department of the Interior] inspector general said that these relationships have cost taxpayers $4.4 million in lapsed collection fees, but due to the sloppy administration at MMS, the real cost may go undiscovered. In a separate report, the Government Accountability Office (GAO) found that MMS is plagued by inefficiency in collecting royalties, and that there is no way to backtrack and figure out how much has actually been lost. Currently, oil companies submit their own data and MMS simply takes them at their word, rather than independently confirming that the numbers are correct — what the inspector general has referred to in a letter to Secretary Dirk Kempthorne as a “Band-Aid approach to holding together one of the federal government's largest revenue producing operations.” A separate GAO report found that the United States is not collecting fair market price for royalties on public resources — which may be seriously limiting the amount of money taken in by MMS, and hence, the taxpayers." "Broken Government," Center for Public Integrity.
Apparently no one knows precisely how much oil is now flowing into the Gulf of Mexico. Originally estimated at 1000 barrels a day, then 5000, some are now saying 25,000.
How can we put this daily flow into an understandable perspective? Try this: Have you ever held a can of oil while it slowly drained into your car? Let's split the 5000-to-25,000 barrels a day into a conservative 10,000 barrels a day, OK? A barrel contains 42 gallons. A gallon contains four quarts of oil. So 10,000 barrels is 1,680,000 quarts of oil. There are 86,400 seconds in 24 hours of 60 minutes each. Let's say it takes 10 seconds to drain a quart of oil; that would mean one person, working continuously, with no breaks, 24 hours a day, could drain 8,640 quarts a day. At that rate, it would take 195 people on a large boat, filled with quarts of oil, working round the clock, each emptying a quart of oil into the Gulf every 10 seconds, to equal the 1,680,000 quarts of oil BP is dumping into the Gulf every day.
So the 11 lives lost on the offshore drilling rig explosion and fire very likely could have been avoided if government had not given in to the notion of "self-regulation." The impact on the coastal economy and environment and wild life could have been prevented. The economic cost of the clean up would have been saved. And hopefully someone will follow up by reviewing the accounting after this all is over to see if the President's reassurance that BP is going to pay for it all -- including the taxpayers' share of the massive government expenses on BP's behalf -- ever happens.
Coal
Meanwhile, an almost idential story played out in a West Virginia coal mine less than a month earlier.
[T]he explosion of the Upper Big Branch mine two weeks ago, a disaster that killed 29 miners, rattled West Virginia and, once again, raised questions about Massey’s safety practices . . . with federal investigators saying they suspect that a buildup of methane and coal dust led to the explosion . . ..
Four years ago, in another southern West Virginia coal mine owned by a Massey subsidiary, a preventable fire broke out two miles below the surface. A faulty conveyor belt that should have been better maintained ignited some coal spillage that should not have been allowed to accumulate, federal investigators found in a report compiled after the incident.
One of the miners hurriedly tried to connect a fire hose to a nearby water valve, but this was futile; the threads of the coupling and the outlet were not compatible. The miner then tried to open the valve — just to get water on the fire — but the line was dry. And things only got worse.
The miner belonged to a crew working in Massey’s Aracoma Alma mine. In a memorandum issued three months before this fire and widely disseminated in 2006, Mr. Blankenship, the company’s chief executive, ordered subordinates to run coal and ignore everything else.
Here is a company that had been written up literally dozens of times for safety violations, and did little if anything to remedy its miners' working conditions. The regulatory agency had the power to shut down such mines, but refused to do so.
A systemic problem
Chris Mathews has a feature he calls "Tell me something I don't know," on his MSNBC program "Hardball." My guess is that if you're a regular reader of this blog you already know what I'm about to tell you. But it bears repeating from time to time anyway.
We've recently seen the consequences -- in human life and the environment -- from the disproportionate allocation to corporations of the business-government partnership of power. These examples happened to involve corporations in the oil and coal industries. But the problems they illustrate are systemic.
Consider unsafe workplace deaths and injuries alone:
In recent weeks and months there have been a series of workplace tragedies that have heightened concerns—the coal mine disaster at the Massey Energy Upper Big Branch mine in West Virginia that killed 29 miners, an explosion a few days earlier at the Tesoro Refinery in Washington State that killed six workers, and the explosion at the Kleen Energy Plant in Connecticut in February that also claimed the lives of six workers.
In 2008, 5,214 workers were killed on the job—an average of 14 workers every day—and an estimated 50,000 died from occupational diseases. More than 4.6 million work-related injuries were reported . . ..
Federal OSHA can inspect workplaces on average once every 137 years; the state OSHA plans once every 63 years. The current level of federal and state OSHA inspectors provides one inspector for every 60,723 workers. OSHA penalties are too low to deter violations. The average penalty for a serious violation of the law in FY 2009 was $965 for federal OSHA . . ..
But the adverse impact of our corporatist form of government on our citizens is not limited to their preventable injuries and death.
Healthcare It's the reason that "universal, single-payer health care," the care provided most of the world's people lucky enough to live in progressive, industrialized countries, and provided at significantly less cost than here, could not even make it onto any table in Washington. It's the reason that the "public option" was quickly shoved off the table, fell to the floor, was swept up and thrown in the trash. It's the reason the pharmaceutical companies got a secret closed door meeting at the White House -- and promises they could continue to gouge America's ill. It's the reason "health care" was quickly redefined as "health insurance" -- essentially a subsidy for the health insurance industry. And it's the reason why the lessons Atul Gawande taught us were ignored: how it is that some cities in America have higher quality medicine than others -- at half the cost. Atul Gawande, "Annals of Medicine: The Cost Conundrum; What a Texas town can teach us about health care,"The New Yorker, June 1, 2009.
Financial regulation There are two obvious first steps, whatever else we may do, to bring common sense to Wall Street. One is what we did during the 1930s, and then repealed during the Clinton Administration: the Glass-Steagall Act (Banking Act of 1933). Glass-Steagall Act, Wikipedia ("The Banking Act of 1933 . . . introduced banking reforms, some of which were designed to control speculation. . . . Provisions that prohibit a bank holding company from owning other financial companies were repealed on November 12, 1999, by the Gramm–Leach–Bliley Act."). The other is to break up the biggest, multi-trillion-dollar banks into banks with assets of $100 billion or less. This is not an antitrust issue; there may or may not be antitrust problems associated with the biggest banks (many economists say there are not). This is simply the smartest response to the "too big to fail, taxpayer bailout problem." You don't try to "regulate" to prevent the most obvious risks -- especially when that "regulation" will quickly come under the control of the regulated anyway -- you simply eliminate any possibility of the "too big" problem by making them smaller.
Sadly, like universal, single-payer health care, neither is even on the table, as Congress pretends to fashion regulations of derivatives and other creative casino games, regulations that will be creatively worked around by Wall Street's "masters of the universe" just as quickly as music-loving computer geeks create new ways to share copyrighted music illegally.
National Broadband Plan The FCC, commendably, wants more Americans to have access to broadband Internet connections at faster rates and lower prices. We need to be more competitive with other countries in the world. But once again, it looks like the cable television and telephone company influence in Congress may prevent the one thing that has enabled other countries to provide more of their citizens a faster service at significantly cheaper rates than American companies make available. It's called "open access" and "net neutrality" -- in other words, "competition" -- something heralded in a corporatist state only up to the point where it threatens to move in next door.
Nutrition Two generals who were former chairs of the Joint Chiefs of Staff are now telling us that Americans' obesity has reached not only epidemic proportions, it has become a threat to our national security. John M. Shalikashvili and Hugh Shelton, "The Latest National Security Threat: Obesity,"Washington Post, April 30, 2010 ("Are we becoming a nation too fat to defend ourselves? It seems incredible, but these are the facts: As of 2005, at least 9 million young adults -- 27 percent of all Americans ages 17 to 24 -- were too overweight to serve in the military, according to the Army's analysis of national data. And since then, these high numbers have remained largely unchanged.").
Once again, any remedies must confront the money to be made, and the political ties it creates, from selling sugar-sweetened sodas in schools' vending machines, "sweet-grease-salty-grease" in fast food dispensaries, and pushing tobacco and alcohol addiction on our teenagers.
The Remedies
Why do we call the money corporations give to government officials a "bribe" when it's done in other countries, and a "campaign contribution" when it's done here?
The costs of running for office are a personal expense -- as are the upfront costs of establishing any other kind of business (which a seat in Congress certainly is). If you want to run you have to pay to do it. You have to pay for your food, clothing, housing and transportation while you're running. And you have to pay as many campaign advisers, workers, and media consultants as you think you can afford. Money is fungible. If you will pay for all of my food during the campaign there will be more of my personal income I can spend on the campaign. If you will pay some of my campaign costs I may be able to send my kid to a more expensive college. The super-wealthy do end up paying for a larger percentage of their personal campaign costs. It's certainly a personal expense for them. And it's also a personal expense for those candidates who beg for bribes from the corporate representatives who seek their votes.
How much money are we talking about? Try $5.3 billion -- for federal elections alone in 2008. "U.S. Election Will Cost $5.3 Billion, Center for Responsive Politics Predicts," Open Secrets Blog, October 22, 2008 ("The 2008 election for president and Congress is not only one of the most closely watched U.S. elections in years; it's also the most expensive in history. The nonpartisan Center for Responsive Politics estimates that more than $5.3 billion will go toward financing the federal contests upcoming on Nov. 4."). And that figure, of course, excludes the additional costs of lobbyists, said to run as much as a million dollars a day for Wall Street alone in its current efforts to block any meaningful reforms.
And what do the contributors get in return? Can you multiply $80-a-barrel oil times a 3-billion-barrel field?
Fourteen years ago I did the math -- not just for oil, but for a variety of industries. It turns out that bribing members of Congress pays even greater returns than Wall Street cons. The payback runs something between 1000-to-one and 2000-to-one. Give a million, you'll end up a billion dollars richer in return. Nicholas Johnson, "Campaigns: You Pay $4 or $4000,"Des Moines Register, July 21, 1996, p. C2.
The payback can take a variety of forms: a tax break, price supports, defense contract, bank bailouts, tariff protection, subsidies, pet project earmarks -- or, as we've recently seen, permission to drill in formerly forbidden multi-billion-dollar offshore oil reserves, notwithstanding the economic and other risks to others and the relatively slight impact on our insatiable and wasteful demands for environmentally destructive energy.
As pointed out in the headline on that column, public financing of campaigns might cost every American $4. But with the 1000-to-one return the contributors are now getting that might be one of the best bargains we've ever been offered.
Because it is we who end up paying for the campaigns now. How? We pay as both taxpayers and as consumers. It's the excess taxes we pay to fund the weapons manufacturers' profits from weapons we do not need, and other transfers of taxpayers' money to corporations. And it's in the increased prices we pay those who have made the contributions, in the cost of everything from automobiles, to pharmaceuticals, to airline fares, to gasoline, to food -- in total, probably well over the $4000 I predicted.
What we've learned this past month is that we pay in other ways as well: those who provide our seafood who have lost their way of life as well as their source of income, those who enjoy the Gulf beaches who have lost their favorite vacation spot, those who've lost their homes, all of us who have lost the wetlands and wildlife they sustain -- and let us not forget the 11 BP employees and 29 Massey Coal employees whose loss was that of life itself.
Capitalism may have its virtues, but when it dictates public policy as well, the price it exacts from all of us is enormous. _______________
* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source -- even if I have to embed it myself. -- Nicholas Johnson
Whether I will also attend his follow-up presentation Thursday, March 25, in the UI Field House is in the lap of the White House Web page gods -- the source of tickets for those the computer selects. [As it turned out I was able to attend thanks to "the kindness of strangers" -- actually not strangers, but very good and thougtful friends.]
The picture immediately above is from the White House Web page. For the White House version of the text of the President's remarks on March 25, and an excellent quality video of him and crowd shots, if you'd like to re-live that event, here's the link.
MoveOn.org, an activist organization that worked for health care reform, sent me an email with a useful summary -- with supporting footnotes -- of what's in this bill (signed into law by President Obama today):
10 THINGS EVERY AMERICAN SHOULD KNOW ABOUT HEALTH CARE REFORM
1. Once reform is fully implemented, over 95% of Americans will have health insurance coverage, including 32 million who are currently uninsured.2
2. Health insurance companies will no longer be allowed to deny people coverage because of preexisting conditions—or to drop coverage when people become sick.3
3. Just like members of Congress, individuals and small businesses who can't afford to purchase insurance on their own will be able to pool together and choose from a variety of competing plans with lower premiums.4
4. Reform will cut the federal budget deficit by $138 billion over the next ten years, and a whopping $1.2 trillion in the following ten years.5
5. Health care will be more affordable for families and small businesses thanks to new tax credits, subsidies, and other assistance—paid for largely by taxing insurance companies, drug companies, and the very wealthiest Americans.6
6. Seniors on Medicare will pay less for their prescription drugs because the legislation closes the "donut hole" gap in existing coverage.7
7. By reducing health care costs for employers, reform will create or save more than 2.5 million jobs over the next decade.8
8. Medicaid will be expanded to offer health insurance coverage to an additional 16 million low-income people.9
9. Instead of losing coverage after they leave home or graduate from college, young adults will be able to remain on their families' insurance plans until age 26.10
10. Community health centers would receive an additional $11 billion, doubling the number of patients who can be treated regardless of their insurance or ability to pay.11
Sources:
1. Final vote results on motion to concur in Senate amendments to the Patient Protection and Affordable Care Act, Clerk of the U.S. House of Representatives, March 21, 2010 http://clerk.house.gov/evs/2010/roll165.xml
2, 3, 4, 5, 6, 7, 11. "Affordable Health Care for America: Summary," House Energy and Commerce Committee, March 18, 2010 http://wwwd.house.gov/akamaidocs/energycommerce/SUMMARY.pdf
4. "Insurance Companies Prosper, Families Suffer: Our Broken Health Insurance System," U.S. Department of Health and Human Services, Accessed March 22, 2010 http://healthreform.gov/reports/insuranceprospers/index.html
5. "Affordable Health Care for America: Health Insurance Reform at a Glance: Revenue Provisions," House Energy and Commerce Committee, March 18, 2010 http://wwwd.house.gov/akamaidocs/energycommerce/REVENUE.pdf
8. "New Jobs Through Better Health Care," Center for American Progress, January 8, 2010 http://www.moveon.org/r?r=87402&id=19504-2992449-f08zBkx&t=2
9, 10. "Proposed Changes in the Final Health Care Bill," The New York Times, March 22, 2010 http://www.moveon.org/r?r=87403&id=19504-2992449-f08zBkx&t=3
11. "Affordable Health Care for America: Health Insurance Reform at a Glance: Addressing Health and Health Care Disparities," House Energy and Commerce Committee, March 20, 2010 http://docs.house.gov/energycommerce/DISPARITIES.pdf
_______________
Meanwhile, here's an excerpt for comparison, from my blog entry, linked above, of May 30, 2007:
If you're hoping for "universal, single-payer" health care (as I lean toward . . . ) -- as is provided to the citizens of virtually every other industrialized nation -- this ain't it. But until we get meaningful public financing of campaigns, I'm not sure that's in the cards from this "best Congress that money can buy." So maybe this is a much better plan in its details than the "universal, single-payer" critics give it credit for. Maybe it's the most that a pragmatic, politically savvy health care policy wonk can honestly and realistically put forward.
Those who oppose any changes in the health care system will oppose this plan, just as they would oppose any other. But those who have a major economic stake in the present system, have disproportionate political power in shaping future changes, and are aware that some changes are simply going to have to come, may well get on board, figuring that this is the least-worst of the possible scenarios.
(1) The super rich don't need (and many don't even want) President Bush's tax cuts for the rich. That's a realistic source of funding for Senator Obama to look to for the modest public investment in healthcare he envisions -- but repealing those cuts will certainly not be a "slam dunk" for any president. (And, even if successful, we're still left with the roughly $40 trillion in unfunded entitlement obligations scheduled to become due and payable within the next 20 years or so.)
(2) His program will continue to be administered by the plethora of insurance companies we have now, which means doctors and hospitals will still be dealing with a variety of forms and reimbursement procedures, and we'll continue to pay these companies' executives health care administrative costs many times those of other countries. That should take at least much of the sting out of what would otherwise have been the overpowering objections of this politically influential group.
(3) The system will still be (in terms of numbers of persons covered) an employer-based health care system. So it's not disruptive in that regard. Why should employers support a proposal that continues to leave much of the burden on them? Because he lightens their burden. He points out that 80% of the cost of health care goes to benefit 20% of the people. And he proposes shifting much of that 80% to the federal government. He represents that this will result in lower premiums for the insured. Well, perhaps. But we've all seen lots of instances when that didn't occur -- as when the price of oil declines and the prices of gasoline goes up. (a) What provisions are there to insure that this element of his program won't simply further enrich insurance companies and employers, rather than reduce premiums for employees? (b) And, given the rate of inflation in health care costs, how many years will it be -- even under the best case scenario, with all the cost-shift benefits going to employees -- before the premiums are back up to what they are now?
(4) As for the currently uninsured, or under-insured, or only-sometimes-insured, Senator Obama proposes that the federal government "subsidize" the cost of premiums for those unable to pay market rates. But what will be the practical effect, and benefit, for, say, an unemployed, homeless, single, high school dropout, male in his mid-thirties? I mean that as a real question, not an assertion.
Look, I don't claim any more expertise on this subject (economics in general, and the economics of health care in particular . . . than I do for any of the other subjects I write about. Moreover -- as also with those other subjects -- I quite regularly change my position once someone bothers to explain to me the errors in my thinking. So this is not, to borrow from the TV show, "my final answer." But it's what I'm thinking this morning.
That was three years ago -- May 30, 2007.
This is March 23, 2010. And unfortunately, it's still the case that "If you're hoping for 'universal, single-payer' health care . . . -- as is provided to the citizens of virtually every other industrialized nation -- this ain't it."
Nonetheless, it's still a landmark achievement for our President and congressional Democrats given current conditions in Washington and (in the absence of campaign finance reform) the ever-increasing influence of big money in the legislative process. _______________
* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source -- even if I have to embed it myself. -- Nicholas Johnson
There will be time enough in future blog entries to reflect upon the impoverished UIHC "leaders and staff," with their need to shake down patients for "voluntary" contributions to help make up for a $17 million shortfall, now heading off to an Orlando resort to think about it [B.A. Morelli, "Politician questions UI Orlando trip; Officials say Disney Institute the best around,"Iowa City Press-Citizen, November 6, 2009, p. A1], but meanwhile, this morning . . .
President Lyndon Johnson used to have a teletype in the oval office, so he could know about the latest AP news bulletins just as soon as they were "on the wire." My modern day equivalent is an iPhone with the AP "app," and a laptop, or desktop, with instant access to the New York Times and local papers' online editions.
As it happened I used the latter yesterday afternoon and saw the story that the Times said was then only one minute old: the shooting at Ft. Hood near Killeen, not that far north of my old stomping ground in Austin. This morning it's reported as Robert D. McFadden, "Army Doctor Held in Fort Hood Rampage,"New York Times, November 6, 2009, p. A1. During the night the story took up nearly one-half of each of the BBC's half-hour newscasts, and I suspect was reported by most of the world's major media.
But yesterday afternoon also brought me some better news that I'm going to reproduce for you in a moment.
The Times story notes that these seemingly unprovoked, mass, random killings are nothing new to America -- not that any of us needed to be informed of that fact: "The rampage recalled other mass shootings in the United States, including 13 killed at a center for immigrants in upstate New York last April, the deaths of 10 during a gunman’s rampage in Alabama in March and 32 people killed at Virginia Tech in 2007, the deadliest shooting in modern American history."
In fact, it's not the first in the Killeen area: "In 1991, Killeen was the scene of one of the worst mass killings in American history. A gunman drove his pickup truck through the window of a cafeteria, fatally shot 22 people with a handgun, then killed himself."
Look, I'm no psychiatrist -- though it appears yesterday's shooter was -- but it would seem to me that what's probably going on here is that he, what's the scientific psychiatric term? -- "snapped." So it's probably not a valid stretch to draw any "American character" conclusions from this single incident.
Still . . . we do tend to value, almost worship to the point of a mantra, the idea of "competition" -- competition on the playing field and competition in business and politics.
And while there are undoubted benefits from competition, there is also a downside, as when it leads to the conflict and verbal combat between the Democrats and Republicans in Washington. It seems pretty obvious that, at least for many of them, their single minded focus is, first, their own re-election, whatever it takes (including their taking of special interest money), and second, a "win" for their "team" (party) measured by which team has the majority, and therefore control, of the White House, Senate, and House of Representatives. And what "single minded focus" means is that if meaningful health care for the American people has to be sacrificed in the process, well, so be it. If it's necessary to handicap the domestic and international ability of the other party's president of the United States, well, that's just part of the "game."
(There is at least some speculation that an accumulation of the form of "verbal combat" we call "hate speech" may have played a role in triggering the action taken by the shooter yesterday.)
Even when the competition is in the relatively benign context of "sport," brawls occasionally break out -- regularly in hockey, occasionally in baseball -- and often among fans in the bars following the game.
Nor is it just verbal combat. We are at "war" in Afghanistan, with a vague and shifting mission (as was the case in Iraq), in a geographical area (it can't even be called "a country" in the way in which we think of that word) with challenges for which even the generals acknowledge there is no military solution. And yet we find it necessary to study for months, and debate, whether sending in even more troops will enable us to "win" (whatever that word might mean in this context). We're more comfortable with "combat," even when it is inappropriate and counterproductive, than the exploration of alternatives.
I'm not sure the case can be made that an exultation of competition leads inevitably to conflict and then to combat and finally to the kind of catastrophe that occurred at Fort Hood yesterday. But I do think there is some relationship, and I find it troubling.
We share the grief of the families of the 12 dead and 30 injured soldiers, innocent random bystanders all. And let us not forget the family and friends of the accused killer, and the other Muslims in and out of the American military who are as innocent as those who were shot, and yet may have to deal with some negative fallout from the incident.
And yet in the midst of the darkness brought on by competition, conflict, combat and catastrophe, there are those who light candles of hope as well as mourning.
There is another way.
You may be familiar with the training exercise in negotiation involving the "ugli [sic] orange." It's an effort to dramatize the difference between one's "position" and "interest" on the road to win-win solutions to conflict. There are many incarnations of the exercise. Here is one.
I don't think I can ever bring myself to believe, with Anne Frank, that "people are really good at heart." Many certainly are, but far from all, in my experience.
But what really helped me through the day yesterday was one example of the payback from "cooperation" as an alternative to competition, conflict, combat and catastrophe. It comes from, of all places, American business -- often seen as the most ruthlessly competitive institution in our society. Indeed, there are business leaders who would probably be tongue-tied if they could not draw upon sports analogies in heralding the virtues of competition.
It is an email received by a friend of mine from a Scott Westerman, a Comcast Area Vice President otherwise unknown to me, who is about to leave the position he currently occupies in order to apply for another. Here, with his permission, is the text of that email:
I got a call from a co-worker the other day. “Full disclosure,” he said. “I wanted you to know that we’re both competing for the same promotion.”
We’re friends. He said he didn’t want me to hear about it from someone else. I thought that was a classy thing to do.
Then I got a crazy idea.
“You know, both of us have strengths that could help the other during the interview process. Why don’t we prep each other so we can both can do our best?”
That sounds nuts on the surface. Why would you want to help a competitor win the job you desire? And why would anyone else who is competing with you even consider sharing his secrets?
My friend didn’t miss a beat. “That’s a terrific idea. Lets do it!”
We spent the next hour sharing nuggets from our areas of expertise, talking about how we would approach the job, sometimes debating the validity of an idea, but all the time trying to better understand the value that each of us brought to the table.
What followed was an email chain. I sent him the spreadsheets that helped me track progress, and explained sales strategies and my favorite management techniques. He sent me a blizzard of details on a section of the business where his expertise is nationally recognized.
We agreed that our joint goal was to help the company hire the best possible person for the gig and realized that, no matter how the chips fell, we would each enjoy working for the other.
I told my team members about the encounter. Some may have thought that their boss was crazy, but there was an interesting gleam in the eyes of others.
That gleam made sense to me two weeks later, when I learned that three of them were applying to succeed me in the role I was about to relinquish.
Naturally, I helped each of them prep for their first interview encounter. I know them well and shot tough questions their way, gave them feedback on their answers and tried to share the lessons I had learned in the role. It was enthralling to watch them work things through and gratifying to see that some of the ideas I had tried to teach them over our time together had taken root.
But the real surprise came later. I saw two of them heading out together at the lunch hour this week. When I asked what they were doing they said, “We’re sharing our knowledge with one another so that we can both be our best during the interview process.”
It turned out that all three of them had spontaneously agreed to help one another prepare.
Clearly, this approach only works if you’ve built a team who trust one another and are genuinely able to put the best interests of the group first. They have worked hard over time to build a unique bond. In our staff meetings, everyone pitches in to understand and assist with an individual’s challenge, even if its technically outside of their core competency. Sometimes, the best technical solutions came from our call center guy. And our marketing lead offered to off load some of the finance person’s work so that we could hit a forecast and customer communication deadline on time.
I can’t yet tell you who will get the two jobs that my buddy and I, and my three extraordinary team members are competing for. But my sense is that the likelihood of the right person being selected has gone up substantially.
Because we’re all in it together.
He got me to thinking -- about Senators John Kerry, D-Mass., Joseph Lieberman, I-Conn., and Lindsey Graham, R-S.C.,trying to fashion bi-partisan meaningful support for a climate change bill; that cluster of law students I saw who were studying together rather than competing,"Paper Chase" style; the football player I saw reach down and give an opponent a hand getting up; and those corporate executives helping each other face-to-face instead of placing knives in the backs of their "competitors."
Am I making too much of a single email? Maybe. But I don't think so. Because cooperation, working together for the benefit of all, is something that's possible every day in thousands of little as well as big ways. Whether it's the mission of our foreign and military policies, Comcast, health care reform, military units at Fort Hood and Afghanistan, politicians in Washington, or law students in Iowa City, we are, as Scott Westerman says, "all in it together." And the more often we behave as if we believed it the better off we all will be. _______________ * Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
Rather than killing off this idea as soon as it became buried under an avalanche of outrage, hostility and ridicule -- in my opinion, what would have been its wisest public relations strategy -- the UIHC spokespersons chose (or were instructed) to defend it as perfectly legitimate.
Unfortunately, in doing so, they chose to misrepresent (either unintentionally or deliberately) the practices of other hospitals. Not that other hospitals' practices would have justified UIHC's (a variation of the child's plea, "But Billy's mother lets him play with matches").
Do hospitals receive gifts from grateful patients? Of course. That's never been in issue. But there is a continuum in the medical ethics of how they go about it -- a continuum that finds the UIHC at the bottom of the cliff on the wrong end.
(1) The medical ethicist, quoted below, and I, believe the most ethical -- and possibly most effective and remunerative -- approach is to make community wide appeals through the media and mailings to all citizens. This could include mailings to all UI alumni, or all donors to the UI Foundation. Particularly in the Iowa City metropolitan area an enormous proportion of the population would be, in fact, present or former patients of the hospital. Those who wished to do so, and they are a significant number, will respond to such appeals. But no one is singled out as a patient.
(2) Somewhat worse is accompanying this with telemarketing. Yesterday a faculty member became increasingly agitated while relating to me the harassment of repeated phone calls during weekends and evenings, ending with the exclamation to the unrelenting pitch man that this once-very-generous UI contributor would never again give money to the University.
(3) Worse still, in my judgment (and that of the ethicist), are personal appeals to present and former patients as patients with mailings or phone calls. The delivery of health care by the UIHC is ethically distinct from the delivery of football tickets by the Athletic Department -- which also not only requests, but demands, "contributions" as a condition of granting permission to a fan to buy tickets -- not to mention getting a seat that will optimize the experience.
(4) More questionable, obviously, are person-to-person appeals to patients at any time, as they become even more coercive than a personal mailing.
(5) Personal appeals in the hospital, by hospital personnel are worst of all, for all the reasons discussed throughout this blog entry. Because patients cannot know when they may need to return to the hospital in the future for one reason or another -- and in some instances are involved in a known series of treatments requiring return visits over a period of weeks or months -- personal appeals for funds when they are leaving the hospital are only marginally, if that, any better ethically than personal appeals at check-in.
(6) Clearly what the UIHC chose to do -- requiring/requesting the patient to make information about his or her clinic visit available to the UI Foundation for purposes of future solicitations -- at the time of check-in is the worst of all possible unethical options.
What's additionally very troubling, as I noted this morning in a comment on the Press-Citizen's online version of its editorial and story, is the repeated insistence that other hospitals are doing what the UIHC was proposing to do. ("To tell reporters (as they did) that others do this, when they don't, is either sloppy investigation of details, insensitivity to ethical nuance, or (hopefully not) deliberate disingenuousness.") As The Gazette's Cindy Hadish has repeatedly reported, below, "Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place."
To equate a community-wide appeal, or a literature mailing, or a discovery that a high percentage of a hospital's donors have been, in fact, former patients, to equate that with a one-on-one discussion with a new clinic patient upon arrival, and cite it as justification for doing so, is shocking.
Nor has the UIHC yet offered an apology, or a mea culpa for this ethical embarrassment -- let alone stopped the idea cold. It's only willing to delay it a bit, to "listen" to the avalanche of concerns, to try to tweak it (presumably with the aid of public relations advisers) to make it acceptable to those with ethical sensitivity.
This sad, sad story is far from over.
_______________
Update: November 4, 2009, 6:15 a.m.; Nov. 3, Nov. 2, Nov. 1; first posted, October 31, 2009, 7:00 a.m.
"Once 'revenue is needed' is the Polestar for a university's financial decisions its moral compass begins to spin as if it was located on the North Pole."
And this afternoon Cindy Hadish, who deserves the credit for breaking this story last Friday [Oct. 30] ,below, brings us the news that, "University of Iowa patient donor plan delayed,"Gazette Online, November 3, 2009:
The University of Iowa Foundation is delaying a plan to ask patients at UI clinics for donations.
“We want to take additional time . . . to listen to suggestions for how we might improve the program . . .," Jean Robillard, UI Vice President for medical affairs, said today in a statement.
No timeline has been set for refining or resuming the process. . . .
Under the program, patients would receive a letter at registration from Robillard and a form that authorizes the UI Foundation to contact them about donating money to the hospital. Patients who do not want to receive the information in the future would have to sign a form to opt out. . . .
A national watchdog organization, Patient Privacy Rights, had voiced concern about the program.
Founder Deborah Peel said the idea sounded coercive because patients are in a vulnerable position and may feel like they can’t say no.
Several hospitals contacted by The Gazette, including the Mayo Clinic and other universities, said they did not have similar programs.
I was especially impressed with the student editorial, "UIHC Donation Plan Would Inappropriately Pressure Patients,"The Daily Iowan, November 5, 2009, p. A4 ("[it's] like a surgeon placing a tip jar in the operating room"). As I commented on the DI's Web page for the editorial, "Like the boy in The Emperor's New Clothes, our students can spot nakedness of which their adult administrators are either too blind or too frightened to speak. Good editorial."
The concern with which I am left is: If an idea like this could even flit through the mind of a hospital administrator, if having done so it was not immediately rejected, if it was reviewed, approved, and prepared for by numerous persons, and when the ethical dilemmas it poses are pointed out the response is to defend the project, if the UIHC's "moral compass is spinning" -- what other projects that the media and public have not yet heard of is the UIHC capable of creating?
Here's a rumor of one; the first choice of fund raising for the UI Foundation, for which the publicized plan was a reluctant fall-back for UIHC's administrators: doctors were to notify the Foundation of the names of their patients whom the doctors believed might be able to make substantial contributions. I can't know if it's true; but if so we can all hope that this one really has been killed rather than merely delayed.
_______________
A Check-In and a Check (brought to you by FromDC2Iowa.blogspot.com*)
As if there weren't enough pressures from hospitals and sickness insurance companies during this time of a national health care debate, as if we weren't paying enough in the ever-escalating premiums, deductibles and co-pays (for those of us lucky enough to even have insurance), none other than the University of Iowa Hospitals and Clinics (UIHC) has decided that repeatedly pressuring patients at check-in for additional money -- a "voluntary" contribution to the UI Foundation on UIHC's behalf -- is a really nifty idea.
The Gazette has once again brought us this scoop that appears nowhere else in this morning's [Oct. 31] Des Moines Register or Iowa City Press-Citizen or other papers (so far as I know).
[In fairness, this afternoon [Oct. 31] at 2:00 p.m., during the last quarter of the Iowa-Indiana game, I discover that four hours after I posted this blog entry the Press-Citizen had an online story: B.A. Morelli, "Some question soliciting UIHC patients,"Iowa City Press-Citizen, October 31, 2009, 11:13 a.m. Presumably the paper will have even more on Sunday, in its first hard copy edition to be published after this morning's Gazette. [Nov. 1, 3:00 p.m.: Here is this morning's story, B.A. Morelli, "Some question soliciting UIHC patients,"Iowa City Press-Citizen, November 1, 2009.] At this time [Oct. 31 7:00 a.m.] the Register still had no story; nor could I find anything on the Daily Iowan's online site, though this five-day-a-week-hardcopy-paper did manage to have a report of the Iowa-Indiana game at halftime. This morning [Nov. 2] the DI published, Sam Lane, "UIHC Solicitation Raises Eyebrows; UIHC to Begin Indirectly Soliciting Through the 'Philanthropy Contact Consent' Program,"The Daily Iowan, November 2, 2009, p. A4 (including some new quotes from the defenders of the project; e.g., "[UIHC] rely increasingly on private gifts . . . This program will enable patients . . . to self-identify.").]
[Morelli's [Nov. 1] story contributes some pitiful quotes from UI spokespeople. As I noted in a comment appended to his story, "I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed to the light of day UI spokespeople would actually try to defend it, whether on their own or because ordered to do so." Here are some excerpts from Morelli's Nov. 1 story:
"'It is very low key, low pressure, ethical approach,' Moore said. 'The patient will receive world class care whether they fill out the form or not.'
Susan Shullaw, a senior vice president at the foundation, said the aim of the program is to benefit medical care and research. She said it was surprising people would question the program the same week UI announced a $26 million donation from the Pappajohn family to a new facility aimed at finding medical cures.
'I find it surprising that the same week (the donation was announced) the university is also being questioned about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,' Shullaw said. 'And, that is what this is about.'"]
[Why not just admit the mistake and move on? Mistakes can happen in the health care industry, whether an amputation of the wrong leg, or . . . The Des Moines Register awards "roses & thistles" occasionally, and Sunday morning, November 1, awarded a "half thistle to Wellmark Blue Cross and Blue Shield for an incorrect phone number in a recent mailing. Seniors who called the number listed expected to hear about Medicare drug plans. Instead they got a recording that offered chats with 'nasty girls who will do anything you want for $3.99 a minute.' The insurer apologized and sent new mailings with the corrected number - but not before raising the blood pressure of the over-65 crowd." "Roses & Thistles,"Des Moines Register, November 1, 2009. There, UIHC, do you see how it's done? If Wellmark can apologize for its mistake surely you can apologize for yours. After all, you're not even asking patients to contribute $3.99 a minute.]
There are many ways to revive the declining newspaper industry. The Gazette -- one of the few remaining locally-owned newspapers in America, competing with the likes of Gannett (USA Today, 83 daily newspapers, 850 other publications) -- is succeeding, in part, by bringing back the equivalent of the newsboy on the corner shouting, "Extra! Extra! Read all about it."
After all, it was only four days ago that The Gazette was the only paper to report that (a) a grand jury was looking into the 2004 Spence labs break-in, and (b) to bring us news from inside that grand jury's legally confidential proceedings (an almost unprecedented revelation). Nicholas Johnson, "UI Spence Break-In: Gazette Scoop Illustrates Issues," October 27, 2009.
A significant amount of newspaper content is "repeating not reporting." It's from an AP wire story, a release from a corporation's public relations firm, a White House news conference, or a U.S. Senator's text message.
The Gazette is reporting. (My response to the concept of "investigative reporting" has always been, "What other kind of reporting might there be -- non-investigative reporting?")
Although UI spokesperson Tom Moore is mentioned in the Gazette's story, the sense I get is that the exchange between the reporter and Moore, on this occasion, was initiated by the reporter, not Moore.
Anonymous, uninformed sources inside the UIHC were saying there were sketchy rumors of this patient shakedown plan, but I simply dismissed them. For starters, the idea was so outrageous I couldn't believe it would even quickly flit through the imagination of any respectable hospital administrator anywhere, let alone any of those at our beloved UIHC -- or that, if thought of, it wouldn't have been immediately rejected out of hand. Moreover, I had neither a credible source to confirm or deny the rumor, nor enough details (if true) to report.
"The donor program, known as philanthropic contact consent . . . could [start at over 200 outpatient clinics] this winter, spokesman Tom Moore said. . . .
[A] medical privacy advocate [Dr. Deborah Peel, founder of Patient Privacy Rights, a national watchdog group] said the practice is coercive to patients. 'They’re in a vulnerable position, and they may feel like they can’t say no. . . . One party is sick and scared . . . and they don’t want to say "no" to the system they’re dependent on for living.' Under the program, patients will receive a letter at registration from Jean Robillard, UI vice president for medical affairs, and a form that authorizes the UI Foundation to contact them about donating money to the hospital. . . .
Peel said the better approach is a community-wide appeal, and 'the people who are grateful will want to give freely.' . . .
Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place. . . ."
The Gazette does not provide any documentation in the form of internal memos, forms or instructions for those who will be carrying out this program. But based on the rumors (which, I must say, now have a little more credibility than when they first came to my attention) I will add a couple of details.
(1) Although I don't know the form it takes, there are apparently some instructions, or training programs, for the check-in clerks -- or whatever you'd call those charged with putting the arm on the suffering patients.
And the rumor was that there was at least some awareness on the part of whoever came up with this scheme that some patients might have anxiety about whether the existence, and amount, of their potential "voluntary contribution" might affect how much longer they'd have to wait to be seen, whether they'd be seen by a doctor or a medical student, and the quality of care they'd receive. (Presumably the clerks would be instructed how to respond to such concerns; although what reassurance could possibly be effective once those concerns entered a patient's mind is hard to imagine.)
Thus, the issue is not so much whether "donations" will affect the availability or quality of UIHC's service in fact ("of course not," we're assured); it's whether patients might perceive that to be the case.
On the other hand, such patient anxieties might be warranted. There was a CBS "60 Minutes" piece last night [Nov. 1] regarding a Yakuza (Japanese Mafia) godfather moved to the head of the liver transplant list at UCLA's Medical Center because of . . . well, a very generous "voluntary contribution." Here's the text from an excerpt:
Two families, Eisenberg's clients, both lost loved ones waiting for livers at another transplant center in the same area: Salvador Ceja was number two on the waiting list; John Rader was number five.
"Do you think, for one second, that this was legitimate? That they stood in line and waited just like your husband did?" Logan asked Rader's widow Cheryl.
"Absolutely not," she replied. "No. Because nobody gets a liver that quickly."
"I think they were playing God," Yolanda Carballo, Ceja's stepdaughter, added. "Now, I think they were picking and choosing who they wanted to give a liver to."
"So, in your minds, what was this about?" Logan asked.
"Money," Rader said. "Spoke loud and clear. And they listened."
"That's what it was all about. Money," Carballo agreed. Three of Goto's Yakuza cronies also got liver transplants at UCLA. For them, money was no object. UCLA says each of their transplants cost about $400,000 dollars; the Yakuza all paid cash.
The hospital also acknowledged Goto and another Yakuza each made $100,000 donations to the transplant center.
Adelstein says Goto paid even more. "According to police documents and sources, a million dollars for Goto. A million dollars," he told Logan.
"A million dollars for one liver?" she asked.
"A million dollars for one liver," Adelstein said. . . .
Of course, I can't know if this story is true. But if not, CBS is looking at a rather formidable defamation suit.
Could cash affect UIHC care like it apparently did on this occasion at UCLA? Of course not. We're Iowans after all, not Southern Californians.
But we're talking about appearances here. And they're not good.
I don't know which is sadder: that anyone would try this unethical UIHC scheme in the first place, or that once it was exposed to daylight UI spokespeople would try to defend it, whether voluntarily or because ordered to do so. (It's one of those "which would be worse, in a way?" choices.)
(2) Hadish's story states that, "Patients who do not want to receive the information in the future have to sign a form to opt out." Obviously, her sources are much more authoritative than any rumors I've heard.
But my impression was that any patient who refused to sign the form -- granting permission for the Foundation to contact the patient repeatedly for contributions, presumably throughout the patient's lifetime (in other words, "to opt in") -- would continue to be asked at every visit whether they wished to do so.
There was to be no "form" to sign by which a patient could "opt out." The only "form" for opt-ing was the form to "opt in."
But it was not quite as bad as the lyrics of Michael Jackson's song in "The Wiz": a game in which "you can't win, you can't break even, and you can't get out of the game."
It would be possible to get out of the UIHC game, but only if the patient was willing to compose a letter, find a typewriter or computer with printer, prepare the hard copy, find an envelope and stamp, know the person and address to whom to send it, and carry it (or be pushed in their wheelchair with it) to the Post Office for mailing. (Apparently, the UIHC's new $60 million computer is incapable of receiving email.)
[The paragraph immediately above was written on Oct. 31, 7:00 a.m. At least some of those putting comments online following the Press-Citizen's story who have some pretty direct knowledge of all this seem to share my intuitive guess as to what's required. "JoeSchmoe5106" wrote on Oct. 31 at 6:13 p.m., "If the answer is 'no' they have to write a letter to the Privacy Officer. They can't just check a box and say 'no.'" And again at 7:10 p.m., "I have seen the form. Check the very bottom of the form where it says, 'If you do not want the UIHC or the UI Foundation to contact you for fundraising efforts, you must notify our Privacy Officer in writing,...' which is followed by the address."]
Fund raising is difficult -- in part because of the challenge of keeping imaginative and energetic folks within the bounds of moral and ethical decency in doing so. Heavy handed efforts usually backfire.
o The notion of locking potential donors in a room, embarrassing them, and keeping them there until a fixed amount has been pledged always seemed to me a little heavy handed.
o Iowa Public Radio and National Public Radio have started using an even more offensive approach. Listeners are urged to "turn in" friends and family members, Stasi-like, so that Ira Glass can call them on the phone, shame them, record the conversation, and then broadcast it to the nation -- a kind of entrapment into self-defamation. (And no, neither I nor anyone I know personally was subjected to this treatment.)
o Similarly, I don't think a hospital should ask individual patients, as patients, for financial contributions at any time under any circumstances. Putting aside the financial burden on patients of the charges already exacted for insurance and medical services (much of which, admittedly, is through no fault of doctors and nurses), asking them for contributions is always going to create at least some sense in a patient's mind that there may be a connection between the size of their contribution and the quality of the service they'll get. [See the reference to the Nov. 1 CBS 60 Minutes piece, above, regarding such a case at UCLA.]
On the other hand, I see no problem with accepting gifts from grateful patients who volunteer to do so without any contact from health care providers; as Dr. Deborah Peel puts it (quoted above), "the people who are grateful will want to give freely." Nor do I see a problem with including information about the UI Foundation in a literature rack along with pamphlets about diseases and healthy life choices -- so long as patients are not directed to it by employees. I see no problem with including literature sent to all UI alumni, or past UI Foundation donors (not just those who happen to be patients; even though a significant percentage of them will have been UIHC patients at one time or another), about UIHC programs and needs.
I do see a problem with fund raising appeals going to patients, as patients.
This is not the equivalent of the pay-to-play bribery exacted from citizens in Afghanistan, Iraq, and third world countries for goods and services that should be free from the state, or provided at posted prices, and I'm not asserting that it is. (In Washington, D.C., it's legal; the payments are called "campaign contributions.") But it does have a bit of that aura -- or might reasonably create it in the patient's mind.
And what is truly unconscionable, in my judgment, is to do this fund raising at a patient's time of greatest anxiety, stress -- and often pain: when they are checking in to a clinic.
Equally baffling is how and why such a proposal did not lead to the immediate firing of the person proposing it -- or at a minimum an immediate and unequivocal rejection of it by top administrators.
Presumably, what Paul Harvey used to call "the rest of the story" will gradually emerge as the other local media get on it and track down how it came to pass that one of America's greatest academic research hospitals is now as down on its luck as the unemployed Americans of the 1930s:
Bing Crosby sings the 1931 song, "Brother Can You Spare a Dime?" lyrics by Yip Harburg, music by Jay Gorney.
[Press-Citizen readers' comments below:] _______________ * Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
Note: These readers' comments are reproduced here as merely a sample of the range and consistency of at least these readers' disapproval of the UIHC's patients "voluntary" contributions program. I neither represent, nor reproduce them here (1) because they are factually "true" (because I cannot know), although they seem intuitive when factual, (2) because I share all the opinions, for I may not, or (3) because they are a scientific sampling of public opinion (obviously they are not). They do, however, represent, merely by their number (compare the number of news stories in local papers that get no online comments), and content, that what the UIHC has done in this instance has struck a nerve with at least these readers.
There is a shared, almost instinctive, reaction that what the UIHC is doing is wrong, and that it ought to have been equally obvious to those who are doing it that it is wrong. Although I have no one's approval to reproduce these comments here, because I could not find out, and do not know, who any of them are, I feel the authors have knowingly made them public, albeit anonymously. (If anyone wishes me to remove theirs from this blog entry, just let me know and I'll delete it.) -- N.J.
User Image Dave, The Elder wrote: If the group or department in charge of this planning is surprised at the response, that should say much about their knowledge of people and appearances. They are, it is perceived, taking advantage of of sick folks. They should go back to the drawing board and come up with a different plan. This one is sick.
Dave, The Elder 11/1/2009 5:03:28 AM
User Image NickIowa wrote: I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed to the light of day UI spokespeople would actually try to defend it, whether on their own or because ordered to do so.
For an analytical look at what's going on, what's wrong with it, some ethical judgments, and alternative approaches that could save this ethical and public relations disaster, see
"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.
http://fromdc2iowa.blogspot.com/2009/10/uihc-sick-brother-can-you-spare-dime.html 11/1/2009 7:06:37 AM
User Image sparkymalone wrote: Shullaw, go home. Dave and Nick are exactly right.
Why is it that every week UI gives me something new to be ashamed of? Just yesterday I was reading about the plagiaristic exploits of a tenured English prof, Kevin Kopelson, laid out last year by himself in psychologically ill memoir fashion in the London Review of Books. He's still on faculty here, still being funded to wander off to conferences and talk, presumably, about how ludicrous is academe, which shakes a stern finger at undergrads about plagiarism and then continues to employ a lifelong plagiarist like him. I suppose this is transgressive and clever, you see. No doubt Lacan has something to say about it. Makes up for filthy theft. I actually have the issue of LRB and never read the piece, mustn't have looked interesting.
Anyway, that, & employing undergrads as TAs for no money, & pushing the kids to go dig themselves deeper debt holes, and now this. I expect greed in a U, but all this is just in poor taste. 11/1/2009 9:19:45 AM
User Image sparkymalone wrote: Oh, and very nice. This from the Gazette (what's going on, P-C? Brian and the rest, are you muzzled, or just asleep?):
"Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place."
Yeah. Trust us, reporters. And patients, trust us, no one will know whether you've opened your wallet to the hospital or not. I think any such form should carry information about Shullaw's salary ($143,325) and Moore's ($70,644) along with the Gazette stories, and ask patients whether they'd like to contribute to Shullaw and Moore's future employment. 11/1/2009 9:46:13 AM
User Image tvolm wrote: The plan lacks conpassion, understanding and empathy for the sick and ill.
All I can say is it is amazing how callous people can be to the plight of others.
The University Hospital is acting like a private business, operating like a large corporation, perhaps the State should privatize the hospital? 11/1/2009 11:00:22 AM
User Image IowaCityGirl wrote: "The consent form allows the hospital to pass information to the UI Foundation, a philanthropic arm of UI, so the foundation can contact the patient with medical programs and research to which the patient might want to contribute, Moore said. The program would not disclose any diagnostic or medical information about the patient"
They may not disclose specific diagnostic or medical information, but in order to decide which programs a patient might want to cotribute to even discolsing which clinic they were in is too much information and reveals what that patient was seen for. Without some pertinent information how are they to decide where that patient might contribute? It is disgusting that they would even consider approaching a patient in any way, shape or form. If a patient has extra money and chooses to give it to the hospital they already know where it is located.
11/1/2009 11:31:27 AM
User Image IH8IC wrote: This completely negates internal training called "Service Leadership." In fact, it's plain disgusting. This from two "frontline" UIHC employees. The program is designed as an "opt-out" and the Gazette reported that patients must sign a form to refuse the information being revealed to the UI Foundation. It should be an "opt-in" at best, and perhaps would be better received if the request came along with a "patient satisfaction survey" after the healthcare was provided.
The UI Foundation has had some disgusting methods of raising money, including selling off all of the student information in credit card campaigns. This just goes to show how the UI Foundation conducts itself. It has no shame and will do whatever possible to keep its internal salaries funded.
Absolutely disgusting. If I was a patient, I would take my business elsewhere. The UIHC can't be trusted to provide the best of care when these disgusting things happen. 11/1/2009 12:11:25 PM
User Image iowahawkeye wrote: The only acceptable method would be a mailing. Shouldn't be forced to say no to someone at the hospital. By the way, UIHC has been sending "begging" letters to employees for at least the past year. Next thing UIHC will probably try is to have the atm programmed for a 5% withdrawl fee/donation. 11/1/2009 12:58:30 PM
User Image guyinic1 wrote: The next thing with their begging, UIHC will be trying to tell us they are one of the original mendicant orders of friars and nuns. IMHO, there is no place where begging should come into the UIHC patient care equation. Isn't the local, state and federal support they receive enough? Evidently not! This is another example of the University and UIHC's bureaurocratic administrations gone bizerk! If UIHC was privatized like some have suggested, they would fall flat on their face inside a week. They can only compete with the private sector because of their tax subsidies and the special treatment they receive by Medicare and other third party payors. Now they are going after individual patients trying to solicit "donations"! Geesh! 11/1/2009 1:37:02 PM
User Image rd2serfdom wrote: No wonder UI just announced a change to the employee health plan: co-pays for UIHC office visits are going down from $10 to $5, while co-pays for Mercy or another hospital (with better patient service) will go up from $15 to $20. There are other financial "penalties" for out-of-UIHC care, to "encourage patients to utilize UIHC's services". Maybe unethical practices like these are a good reason they need to incorporate these penalties to force their own employees to use UIHC? 11/1/2009 2:19:23 PM
User Image JoeSchmoe5106 wrote:
Replying to rd2serfdom:
No wonder UI just announced a change to the employee health plan: co-pays for UIHC office visits are going down from $10 to $5, while co-pays for Mercy or another hospital (with better patient service) will go up from $15 to $20. There are other financial "penalties" for out-of-UIHC care, to "encourage patients to utilize UIHC's services". Maybe unethical practices like these are a good reason they need to incorporate these penalties to force their own employees to use UIHC?
Having a lower co-pay to incentivize employees use UIHC as their preferred provider is NOT unethical. THIS plan is unethical. 11/1/2009 2:41:46 PM
User Image guyinic1 wrote: Soliciting "donations" and "gratuities" from patients and their family's is not the same as twisting the arms of University employees to use UIHC facilities. I think denying UI employees total freedom of choice in selecting their health care providers is wrong and another of the University's cheap tricks. I think that approaching any patient for money for any reason other than what is due for their care is unethical. How would any of you feel if you went to your private physician anyplace other than UIHC and your doctor or their office staff ask you for a "tip"? You'd be appalled at their audacity and I think the Board of Medical Examiners would hear about it---and act on it! What's the difference here? 11/1/2009 4:22:27 PM
User Image iowamars wrote: Kopelson hardly admits to being a life-long plagiarist. It is a handful of examples - across his entire academic career. None are pertinent to his career. Inexcusable - maybe. But hardly unusual - and have little to no bearing on his current success. As far as the plan to reduce co-pays at UIHC and increase them elsewhere - P/S and faculty are self-insured. The FRIC committee is made up of staff and faculty appointed by both governing bodies. The governing bodies are in turn elected by those they represent. The committee has to address the hyper-inflation in health care costs with limited funds. I would expect no less of them - then cutting the best deal possible to keep health care costs to employees down. Co-pays go to the provider - and offset the cost of insurance to the individual. All Mercy Hospital has to do is accept the same reimbursement rate as UIHC with a $5 co-pay -it is Mercy's decision not to do that, not the FRIC committee or UIHC.
11/1/2009 6:04:33 PM
User Image fnmct wrote:
Replying to guyinic1:
The next thing with their begging, UIHC will be trying to tell us they are one of the original mendicant orders of friars and nuns. IMHO, there is no place where begging should come into the UIHC patient care equation. Isn't the local, state and federal support they receive enough? Evidently not! This is another example of the University and UIHC's bureaurocratic administrations gone bizerk! If UIHC was privatized like some have suggested, they would fall flat on their face inside a week. They can only compete with the private sector because of their tax subsidies and the special treatment they receive by Medicare and other third party payors. Now they are going after individual patients trying to solicit "donations"! Geesh!
The only tax subsidies UIHC receives is Medicare, Medicade, and IowaCare. And they lose money on those.
11/1/2009 6:42:08 PM
User Image NickIowa wrote: Would "volunter contributions" ever affect the quality of medical service -- or, indeed, the availability of medical service at all? Of course not, we are assured.
But I'm sitting here at the moment watching a CBS "60 Minutes" piece about a Yakuza (Japanese Mafia) godfather who was moved to the head of the list for a liver transplant at the UCLA Medical Center (another leading academic medical school/hospital like UIHC) because of . . . well, a very generous "volunteer contribution."
Is the story true? How would I know? But CBS is looking at a significant defamation suit if not.
Could money help improve your medical treatment at Iowa? Of course not. We're Iowans, not southern Californians, after all.
Still, even Iowans would be well advised to avoid the risk of the appearance of that possibility. 11/1/2009 6:52:34 PM
User Image tvolm wrote: A sick solution to a sick business in a sick state in a sick nation.
All good christian greed, god bless, mr bush. 11/2/2009 8:48:52 PM
Here are some more highly edited comments from Morelli's October 31 version of the story (to which readers were continuing to attach comments on November 1):
monashaw wrote: Sounds fairly ghoulish to me. Not to mention out of touch with reality. Most patients are already too stressed about money . . .. 10/31/2009 12:25:30 PM
guyinic1 wrote: I think it is totally inappropriate for UIHC and/or the University's foundation to solicit "donations" from patients. The next thing they will be doing is putting up signs that say "Gratuities gladly accepted!" Even suggesting such a move to me indicates their desparate, juvenile way of thinking. I'll bet anyone the idea came from bureaurocratic administrators and not from the health care providers. More and more I get the idea that most if not all University administrators need to be housed together in a facility adjacent to Psych Hospital. They are bizarre to say the least! 10/31/2009 1:42:01 PM
NickIowa wrote: I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed UI spokespeople would (whether voluntarily, or in response to orders) try to defend it.
For an analytical look at what's going on, what's wrong with it, along with some value judgments, written early this morning in response to the Gazette's scoop, see
"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.
mak52245 wrote: They might as well install a toll booth at each entrance. Then they could get money from visitors and staff as well. 10/31/2009 3:12:35 PM
JoeSchmoe5106 wrote: "Susan Shullaw, a senior vice president at the foundation, said the aim of the program is to benefit medical care and research. She said it was surprising people would question the program the same week UI announced a $26 million donation from the Pappajohn family to a new facility aimed at finding medical cures...I find it surprising that the same week (the donation was announced) the university is also being questions about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,” Shullaw said. “And, that is what this is about.”
This quote proves that these people are so out of touch! How many patients are of the status of the Pappajohns? The Pappajohns are not indigent patients, unemployed Iowans, patients on their Nth round of chemotherapy owing UIHC thousands already.
Shullaw is unbelieveable. 10/31/2009 3:43:15 PM
pharma wrote: UIHC should take a look at their extraneous expenses and make appropriate cuts, instead of counting on patients to pick up the mismanagement slack at UIHC. . . .. 10/31/2009 3:58:19 PM
thetruthman wrote: Here's my donation; Get serious. Thanks for making the hospital look second rate. 10/31/2009 4:15:35 PM
Curls wrote: What lack of class.
As patients of UIHC myself and my family already receive letters requesting donations to the "patient care fund." These letters are also tacky. . . . 10/31/2009 4:27:52 PM
TWinter wrote: It would be fine if they wanted to put donation brochures in the waiting rooms or even include them in mailings, but asking medical personell to get involved is extremely tacky. I hope most doctors and nurses at the hospital would simply refuse to do this because it would be so unprofessional. 10/31/2009 5:02:13 PM
IowaCityGirl wrote: “I find it surprising that the same week (the donation was announced) the university is also being questions about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,” Shullaw said. “And, that is what this is about.” Ummmm, I am pretty sure that any grateful patient can locate the Hospital once they are fully recovered to make a donation, if they choose. They should NOT ask for them. Comparing the everyday patient to the PapaJohn family is ridiculous! 10/31/2009 5:04:26 PM
JoeSchmoe5106 wrote:
Replying to hawkigirl05: "I wish people would realize . . . If they say no, they sign a paper and they will not be contacted. . . ."
If the answer is no they have to write a letter to the Privacy Officer. They can't just check a box and say no. The simple fact is, it shouldn't be done. It's inappropriate and sick and/or confused patients shouldn't be bothered with this at the time of a clinic visit. Period. 10/31/2009 6:13:37 PM
JoeSchmoe5106 wrote:
. . . I have seen the form. Check the very bottom of the form where it says, "If you do not want the UIHC or the UI Foundation to contact you for fundraising efforts, you must notify our Privacy Officer in writing,..." which is followed by the address. It's the fine print . . .. 10/31/2009 7:10:36 PM
sparkymalone wrote: Oh, for shame. Shame on Shullaw and Moore both. This is unconscionable. To take sick people by the arm, in the hospital, and say "Come on out and say out loud you don't want to be bothered, and see what kind of care you get next"? Because that'll be how it's perceived.
Oh, I love the excuse-making, too. "Well, my mendacious friends over there do it, so it must be OK, Mom." My God. I hope they're both paid well for the ordure they have to make come out of their mouths.
Shame, shame, shame. Next we'll see one of them giving a course in medical ethics! 10/31/2009 9:50:20 PM
Lina58 wrote: Patients are in the hospital to heal and anticipate when they are well enough to go home where they feel they belong. The very LAST thing they ever need is to be asked for a monetary donation to the UIHC when they haven't even gotten a bill for the current visit there. Perhaps in the back of their mind they are wondering where they are going to get the money to pay for this visit. TOTALLY out of line and insensitive. Keep asking 'The Papajohn's" of the world for money. NOT SICK PEOPLE!!!! 11/1/2009 8:41:50 AM
IowaCityGirl wrote: They should NOT be bothered with this at all. As I previously stated...Should a gratefull patient be fortunate enough to have expendable/extra money that they wish to donate they know where the hospital is. This should not be happening. 11/1/2009 11:13:26 AM
wardedinburgh wrote: Foundation fundraising is a necessity, and has to be handled very sensitively. Soliciting donations from current patients is NOT a sensitive way to go about it.
I'm currently an Oncology Patient, with a semi-orphan form of ovarian cancer. If I had the income, and if Title 19 would cover it, I'd be going to Mayo. Each time I hit the UIHC for a visit, I feel as if I'm being trampled by a herd of clowns who are unable to navigate in their floppy shoes. The quality of care is relatively good, but the various departments seem unable to communicate with each other, or with me. Some of the problems are probably due to lack of funding for enough staff members--perhaps the executives should take paycuts so that the "grunts" who really have patient contact, and who most closely affect proper communications, can be rehired or have their numbers increased to an acceptible level. This institution doesn't have a hope of becoming a MAGNET MEDICAL CENTER until there are more support staff. 11/1/2009 3:16:37 PM
ahhah wrote: As often is the case, it is the method not the objective in dispute. It used to be you made an appt, checked in, sat down, waited for your name to be called, were seen, and if lucky went home. You felt anonymous and you felt your care was objective not subjective. It has become such an offputting process from beginning to end for both patients and employees. They should have made it a letter plus envelope handed to the patient and checked off on the computer by the receptionist with the date of delivery. Once a year after expiration date, you hand them another one. You also have them available in the racks and on the tables for those who like to read while waiting. 11/1/2009 4:01:48 PM
IowaCityGirl wrote:
Replying to ahhah: Nope...it is the objective I disagree with as well. NO health care facility should ask patients for donations, EVER. If someone has the money to donate they know where the hospital is. 11/1/2009 6:36:15 PM
User Image NickIowa wrote: Could "donations" affect the availability or quality of UIHC's service? Of course not, we're assured.
But there's a CBS "60 Minutes" piece tonight about a Yakuza (Japanese Mafia) godfather moved to the head of the liver transplant list at UCLA's Medical Center because of . . . well, a very generous "voluntary contribution."
I don't know which is sadder: that anyone would try this UIHC scheme in the first place, or that once it was exposed to daylight UI spokespeople would try to defend it, whether voluntarily or because ordered to do so.
For an analytical look at what's going on, what's wrong, value judgments, and some readers' comments from this and the Nov. 1 versions of the story, see
"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.
