Wednesday, September 30, 2009

Dorothy Del Favero’s 100th Birthday

[from billlifka, posted with his permission]
Dorothy Del Favero has achieved every woman’s dream. She’s reached an age where all listen to her talk, but she can’t hear them.

A balanced diet and strenuous exercise routine are the secrets to her longevity.

She eats sweet rolls, cookies, chocolate candy, mountain dew, deep fried onions and baked potatoes with a stick of butter and three ounces of salt. Each of these foods provides an antidote to some particular pill prescribed by her doctor.

As for exercise, can you bend from your waist to use a hand broom and dust pan on the floor?

Dorothy does a lot of walking; from her nap on the sofa to her nap on the recliner to her nap in bed. She carries her four-point cane at shoulder level so as not to impede her passage. She still clears the dinner dishes. The juggling of dishes from table to sink is an entertainment highlight. She still empties the dishwasher. We hope to find most of the dishes some day.

To be honest, Alice [her daughter, billlifka's wife] is the drill sergeant in charge of food and exercise and deserves the credit for Dorothy’s survival. Of course, Dorothy wasn’t always a senior senior.

She was born in the Friesland province of Holland, birthplace of old English. Her maiden name was Bijvoets which means, “by foot”. This suggests her ancestors walked into the Low Countries at the time family names were assumed. Her Bijvoets side is traced back 500 years to a tinsmith in Antwerp. In her early grammar school years, Dorothy’s family nearly starved during World War I. Her father was an archetypical entrepreneurial immigrant to America. After the war, it took him three tries before he finally established himself making sinks for Pullman railroad cars on Chicago’s south side. Then he brought his entire family to live with him in the new world. Dorothy was 17 at the time, the 6th of 12 children.

He started a business tinning implements for the Chicago stock yards. In time, this broadened its scope in plating processes. When Dorothy’s father died, the business was willed to his 4 sons and continues in the Bijvoets family. The 8 daughters were bequeathed the family home and, before that, encouragement to find good husbands. About a year after her arrival, Dorothy met a hunky young man at a Lake Michigan beach. Mario Del Favero had emigrated from Northern Italy in his teens to join an older brother successfully employed as a carpenter in Chicago. Photographs at the time suggest he was the kind of guy who attracts bathing beauties. As luck would have it, Dorothy qualified as a bathing beauty. I’m guessing they didn’t really share a language when they met. That may have contributed to their 58 year marriage. Mario died in 1987.

Mario and Dorothy produced Alice, Tom, John and Richard. Present count is 9 grandchildren, 16 great grandchildren and 1 & 8/9 great-great grandchildren. None are in jail and all are gainfully employed or doing well in school. Until recently, Dorothy could speak knowledgeably about each of them without being prompted. She still can with a little help in getting started.

I think she’s had a satisfying life far beyond her expectations when she left her mother country as a girl, full of apprehension. Hers has been a classic American immigrant story similar to most of our family stories. In celebrating Dorothy’s life, in a way we celebrate the America that was and the America that shall come again. Happy 100 years, Dorothy!

Sunday, September 27, 2009

Motivation and PASSION

The photo shows my water aerobics friends (I only wish!)

Joel is having trouble keeping motivated and wonders "is it worth the effort?" (See 1 and 2.)

He writes "I know that Ira's bicycling group ends their ride with a stop at Panera's for coffee, danish and conversation. Is this what gets them on their bikes from a cozy bed on a chilly morning?"

I thought about it while bicycling to water aerobics this past Saturday morning, again at Paneras with my bike club friends, and yet again at Chumach (Bible) Study at the synagogue that morning. Yes, the coffee and snacks are a definite draw, but it is mostly the people, my set schedule, and naps that keep me motivated.

As I turned the pedals, and watched the world go by, "People/Set Schedule/Naps" became "PSSN". That acronym, with the addition of vowels, morphed into "PASSION".


When young, motivation is easier. A close-knit, loving family had high expectations for me. My mom worked at my grandma's knitting shop. I was surrounded by women who doted on me. In those innocent days, it was considered safe even for young children to play outside. I had a nice nap every early afternoon. My dad, a letter-carrier, was up and out on schedule early every morning, but he also came home early and we spent quality time talking, working carpentry projects, and playing.

I walked to school on a set schedule with friends. In those days we had all-day kindergarden that included a noontime nap. The naps ended with first grade, but the set schedule, and a sense of duty to family and teachers went on through high school. I worked part-time at a shoe store and selling ice cream on the beach and in an office during those years and that motivated me to go to college so I could qualfy for non-menial employment.

Work as an engineer was challenging and often involved long hours of (unpaid) overtime and travel, but I was motivated by obligations to wife and children. Again it was the people in my family and at work and in the clubs and synagogue that kept me motivated. My wife and I had a full schedule of work, attendance at our daughter's school events, square dancing, and so on. I had bike and ski and kayak club friends. My employer paid for me to get my Masters and then my PhD and that kept me busy and intellectually alert.

Then, the children went away to college and had families of their own, ... and we retired!


There is a danger of "vegging out" in retirement if you are financially secure. Pension and Social Security checks come regularly, investments grow, and so do your waistlines! There is a temptation to sit and watch mindless TV programs, eat rich food and "enjoy life - you earned it!"

Fortunately, my life before retirement gave me the foundation for the PASSION (People, Activities, Set Schedule, Interests, Optimism, and, eventually Naps) that keep me motivated.

People - Particularly loved ones - your wife and family, but also friends, neighbors, co-workers and other acquaintances.

People are far and away the best motivators. Spouse and family provide a firm foundation. If you show up they have to let you in! Beyond that, what gets me up and out almost every morning are the people who are waiting for me.

As I bicycle down the street, people call out my name and I say theirs. Others nod to me - we don't know names but we shout "good morning!" as I bike and they walk their dogs or jog along. At the sports pool they (mostly women :^) are happy to see me. We exchange pleasantries, ask about travels, and kid around about who can hold his or her legs up higher and longer and so on. No better way to start a day than exercising in a heated pool. (My wife, Vi, goes to some of the same water aerobics classes, but she travels by golf cart, most often with a neighbor.)

If I'm meeting friends for a bike ride we are happy to see each other. Bicycling is probably the best form of transportation ever invented. You go fast enough to get someplace miles away, yet slow enough to talk, enjoy the sights and sounds, and "smell the roses". And, bicycles run on peanut butter sandwiches - "green" energy!

We eat out with other couples, go to parties and entertainment events, and enjoy life. It is my wife and all those other people who make it worthwhile!

Activities - Athletic and otherwise

The key to living a nice long life is to keep moving! It may be "sour grapes" but I don't think strenuous running or competitive sports are good for the body, particularly not an aging body. That is why I do "soft' exercises such as bicycling, water aerobics, kayaking, walking, and so on.

I try to put in at least an hour a day, but, I keep the civil service worker attitude in mind: "I'm paid by the hour, not by the mile!"

Set Schedule - Something to get you up early and out of the house almost every day.

When we retired we thought we were leaving set schedules behind. However, it turned out that our calendar is far more complicated than ever. Without scheduled events it would be so easy to stay in our cozy bed all morning, reading or watching TV, perhaps taking turns preparing breakfast in bed. To help prevent that, our alarm is set for 6:30AM every morning and we have no TV in our bedroom.

My morning schedule is set in stone: get the newspaper, feed the fish in the koi pond, read the paper over a light breakfast, and get outside! Monday, Wednesday, and Friday it is bicycling to regular water aerobics. Tuesdays I lead an easy neighborhood bike ride and end up at a different sports pool for deep-water aerobics. Thursdays I bike with a neighbor to a men's breakfast at Perkins and then to deep-water aerobics. Saturdays it is early deep-water aerobics and then a bike ride to Paneras. After bicycling home, it is into the hot-tub with a cup of ice cream and a magazine. Then, it is time for a nice nap!

The rest of the day is free, except for lunch or dinner with friends, shopping trips, volunteering at the synagogue office Thursday afternons, Friday evening services, and other odds and ends. My wife and I each teach an online grad course for the University of Maryland, so that takes a few hours every other day or so. I also have email to keep up with, my Blogs (The Virtual Philosophy Club, Curb Your Enthusiasm - Fantasy Episodes, 2052-The Hawking Plan, and 2052 Life, Liberty, and Technology), my Google Knols, websites I follow including The Drudge Report, Watts up With That, Reality Prime and several others. There are TV programs I watch regularly, some automatically recorded on our DVR. That keeps me busy and involved!

Interests - Intellectual and otherwise.

My interests are wide and varied. We get lots of magazines, mostly from trading in unusable airline miles. My wife buys me books, in a so far unsuccessful attempt to change my social and political views. (My father taught me to be frugal. therefore, any book or magazine we have paid for, including those from airline miles, and idiotic political screeds, has to be read.)

Optimism - Open outlook welcoming variety.

Take to heart Max Ehrmann's beautiful words of Desiderata "Go placidly amid the noise and the haste, ... be on good terms with all persons. ... the world is full of trickery. But let this not blind you to what virtue there is ... everywhere life is full of heroism. ... Take kindly the counsel of the years, gracefully surrendering the things of youth. ... You are a child of the universe no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be. And whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery, and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy."

Naps - Noontime slumbers to refresh body and soul.

This has been a protracted posting. Time for a nice long nap!

Ira Glickstein

Friday, September 25, 2009

Is it worth the effort Part 2

A joke that we've seen many times in film and TV, is a situation in which a overly serious actor says to the director "What's my motivation?" The situation generally involves no motivation or obvious motivation such as slipping on a banana peel or falling out of an airplane.

Motivation can come from within or without and is therefore one of the great practical philosophical questions. It is the practical embodiment of "What is the meaning of life?" In solving my own problem of lack of motivation, I'm wondering whether it's possible to use ideas from those who motivate others to motivate one's self. For example, there are those who sell their motivational ability to corporations to motivate the sales staff. There are also books like "Who moved my cheese?" There are religious leaders who motivate people to act more morally. These miss my target in that they are centered on gain in some form or another (reward, reputation, competition or heaven). An example of transferring these notions to the self might be when I promise myself a piece of pie after I complete a chore. The trouble with this is that I'll weigh 300 pounds and become a diabetic, if I use this motivational technique too much. (I know that Ira's bicycling group ends their ride with a stop at Panera's for coffee, danish and conversation. Is this what gets them on their bikes from a cozy bed on a chilly morning?)

Community organizing is another well documented form of motivation. I went to a summary of Saul Alinsky's theories about motivating the masses. It's fascinating reading.

"But it is not enough for the organizer to be in solidarity with the people. He must also, said Alinsky, cultivate unity against a clearly identifiable enemy; he must specifically name this foe, and “singl[e] out”[44] precisely who is to blame for the “particular evil” that is the source of the people’s angst.[45] In other words, there must be a face associated with the people’s discontent. That face, Alinsky taught, “must be a personification, not something general and abstract like a corporation or City Hall.”[46] Rather, it should be an individual such as a CEO, a mayor, or a president."

Can I motivate myself to get out my oil paints and finish the painting that's been sitting half finished for a year, using Alinsky's methods? Can I fool myself into believing that the ghost of Picasso is preventing me from succeeding? Should I hang his picture on the wall of the garage with a knife in his heart? Maybe. Maybe I can get back to my ukulele by targeting the great Ota-san as my enemy. In some psychological sense he is. In Hawaii, I was shopping for an ukulele when Ota-san walked into the shop and started strumming. His masterful playing of this humble instrument was daunting. It was obvious that no matter how much I might practice, I would never reach his level. Alinsky has a lesson concerning that situation. You must motivate the group toward projects in which the probability of success is nearly certain in order to build confidence. (Using Ira again, he is virtually certain of finishing his morning ride and there is no competition involved.)

I'd appreciate any ideas you may have concerning how to move from theory (or daydreaming) to action. Here in my trailer out in the woods of Michigan I have my paints, my violin, my ukulele, my Spanish lessons, my Italian lessons and my book about Einstein. However, all I managed to accomplish yesterday was lay some traps for the trespassing mouse who's stealing my food. Perhaps I was able to do that, because I could visualize him as my enemy! -Joel

WIRED: The Villages Golf Carts Featured

The latest issue of WIRED Magazine features Tricked-Out Golf Carts Swarm Florida Communities, with special emphasis on The Villages, FL, where we live.

They make the point that golf carts might just be the future of energy-efficient and safe transpotation, at least for the growing numbers of senior citizens.

The photo to the left was taken by my wife, Vi, at a golf-cart parade here in The Villages. Yes, there is a golf cart somewhere under that Christmas tree!

There are several interesting photos in the linked story in WIRED.

The story makes it appear that most golf carts here are "tricked-out" and sell for $10,000 or more. The photos in the magazine show carts that look like classic cars or are illegally geared to go above the legal limit of 20 MPH. The truth is that most of us drive pretty-much "plain vanilla" golf carts. Ours for example, is a 2001 that served a year or two at a golf course and was rebuilt for us in 2003, with an added rear seat, and cost us about $4,500.

Here is a selection from the WIRED story:

It's 9 am in the Villages—practically midday for the chipper residents who often rise at four—as I drive my LC3 down to the Colony Cottage. I'm due for a quick primer in pickleball—sort of a Ping-Pong/tennis hybrid. I arrive to find dozens of fit retirees dashing around the courts, the ubiquitous row of shiny EVs [Electric Vehicles] parked outside.

There will be more carts fighting for space here soon. While the rest of the country wallows in the recession, homes are still being built and sold in the Villages at a rapid clip. The population of the community is expected to hit 100,000 by 2014.

The Villages embodies what environmentalists have been waiting decades for—a glossy future powered by electric vehicles. The slightly messy reality, though, is that it's not powered by pristine futuremobiles but by gaudy, overclocked golf carts.

But the lesson of the Villages isn't just about the vehicles we're driving—it's about where we're driving them. The future of transportation should be focused on the quick jaunts that make up most of our day-to-day driving.

The Villages is for people who've lived long enough to know that what they want now is a warm breeze in a quiet, open ride—going fast enough to hit both the golf course and the Walmart in the same afternoon but slow enough to take in the scenery along the way.

As my octogenarian opponent deftly whacks the pickleball past my reach, I look up to catch a glimpse of the future on the horizon. It's a gray-haired guy with a backward cap, cruising in his cart past a brand-new community center. A golden retriever stands on the passenger seat, tail wagging, and an American flag is displayed proudly right where the gas tank should be.

Ira Glickstein

Monday, September 21, 2009

Health Care

[from John] We’ve talked about various aspects of a Universal Health Care System; however, we’ve never addressed the mechanics of writing such a bill. We know that HB 3200 is more than 1000 pages long. Who wrote that bill? Staff members? Doubtful. What are the qualifications of those who wrote the bill? Were any lobbyists involved? Writing such a bill must be expensive, see the sample bill below. Where does the money come from?

I’m curious!

A Universal Health Care System

Section 1. Introduction
Section 2. Funding
Section 3. Transition (from Medicare Medicaid to the new system)
Section 4. Tort Reform
Section 2a. Registered medical practitioners.
Section 2b. Hospitals and clinics
Section 5. Standardized Electronic Accounting System
Section 6. Corporate/University/Government R&D programs
Section 6a. Medicines
Section 6b. Equipment
Section 6c. Procedures
Section 7. Re-apportion duties between Doctors, Nurse Practitioners and Nurses.
(allow NPs and RNs to perform routine medical duties now required of doctors.)
Section 8. Establish clinical system to relieve emergency rooms work load.
Section 9. Catastrophic Insurance
Section 10. Health Maintenance Accounts
Section 10a. Fund maintenance and accountability
Section 10b. Personal accounts
Section 10c. Functions and procedures
Section 11. Procedures not covered by Sections 9 and 10
Section 11a. Private health Insurance
Section 11b. Indigenous personnel

Sunday, September 20, 2009


[from Joel] I'm fascinated by the recent events concerning ACORN. A courageous young couple used the hidden camera style originally developed by shows like 60 Minutes to catch ACORN employees in illegal and immoral behavior. Demands for investigation of ACORN have fallen on deaf ears for years. The appearance of damning videos everywhere on the web (as well as on Fox News) finally forced action by the Congress despite the neglect by the mainstream media. The web seems to be fast becoming the mainstream, while the old news media have placed themselves in the fringe by overly filtering the news.

I attended a teaparty near Detroit a few days before the main demonstratio on September 12. The local media underestimated the turnout by a factor of ten. The coverage by the media was negligible considering over a million people showed up. As you can see from the photo, the protestors were mature and the signs weree grassroot sloppy. -Joel

Monday, September 14, 2009

END-OF-LIFE: Honest Brokers (not Death Panels :^)

President Obama, in a moment of unusual candor, expresses his views on end-of-life health care for those with chronic or terminal illness, published in the New York Times Magazine in April 2009 (full text from NY Times website, see section V).

“… government can … be an honest broker in assessing and evaluating treatment options. … when it comes to Medicare and Medicade, where the taxpayers are footing the bill …

“… using comparative-effectiveness studies as a way of reining in costs, …

“… the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here. …

“…there is going to have to be a conversation that is guided by doctors, scientists, ethicists. … you have to have some independent group that can give you guidance.”

The government funded "honest brokers" envisioned by Obama will be doctors, scientists, ethicists, and bureaucrats who will use actuarial data to compare alternative treatment options, and, based on cost-effectiveness, provide national guidance as to which should be used when public money is funding the treatment, such as Medicare.

As a case-in-point, the President brought up the hip replacement received by his terminally-ill grandmother mere weeks before she passed away. During his campaign, she was diagnosed with terminal cancer and then, probably due to a mild stroke, she fell and broke her hip. Her condition was analyzed by her doctors who told her she had three to nine months to live due to the cancer. They also told her that a weak heart posed risks for the invasive surgery hip replacement.

In the absence of cost-effectiveness data or guidelines to the contrary, she chose the hip replacement, which was approved by Medicare and done mostly at public expense. She passed away two weeks later, sadly just days before Obama won. It appears the stress of the operation may have shortened her life by several months.

I don't know if Obama's grandmother got approval for the hip replacement because she was related to a prominent person. That would be bad enough, but it would be even worse if we are giving hip replacements and other stressful and expensive treatments to all terminally ill grandmothers and grandfathers.
"... in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. ... So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here."


Once upon a time, there was a boy in China and he saw his father carrying a large basket on his shoulders. "What do you have in the basket?" he asked.

"Well," said the father, "It is your grandfather."

"What are you doing with grandpa?" asked the boy.

"Well," he replied sadly, "Your grandfather is quite old and he is so sick that we cannot take care of him anymore, so I am going to dump him in the river."

The boy thought about it awhile, and then he said: "OK, Dad, ... But remember to bring back the basket!"

Of course the point of the story is that the boy will learn from his father's actions and will, when the time comes, uses that same basket to dispatch his father.

When my mom's cancer roared up after a year of chemo and radiation, she decided to accept only palliative care. Our family travelled to San Francisco where they lived and said goodby. Hospice provided morphene and a hospital bed for their apartment. We spoke by phone every evening for about a month until she passed away.

My dad made it clear that was what he wanted when the time came.

About five years later he had a stroke and fell and was taken to the hospital where an MRI confirmed a major bleeding in his brain that was terminal. He could not speak or hear or see and was being kept alive with IV hydration and nutrition and oxygen to help his breathing. My brother and I asked the doctors to remove all artificial life support, including the IV and oxygen, and he passed away a few days later.

I have asked my children to do the same for me when the time comes. "Remember to bring back the basket!"

Although I did not vote for him, and oppose much of his economic policy, I agree with President Obama's remarks on end-of-life treatment.
I wish he and his Democratic allies would be similarly honest in more recent remarks and I wish the Republicans who are characterizing the issue as "pulling the plug on granny" would be more thoughtful and helpful and honest as well.
I do not like to hear people call these "honest broker" government medical and ethical tribunals "death panels". However, the 'honest broker" guidelines, when imposed on Medicare and other public-funded medical decisions, will, in effect, cause many of the terminally and chronically ill to be given palliative treatments that will undoubtedly shorten their lives.

Whatever you call them, I believe we need ethical end-of-life guidelines to prevent doctors and hospitals from ordering expensive treatments that are not cost-effective (and that may be done more for reasons of fear of malpractice suits and/or simple greed to increase their incomes).

I am not if favor of further nationalization of US health care. However, with Medicare the primary payer for nearly all of us over 65, we need national guidelines to prevent the program from going bankrupt. (See this and this for more details on my views of what we really need in cost-effective health care reform.)

Ira Glickstein

PS: For the record, and in case the NY Times takes the page linked above out of their free access, here is the full text of the applicable section of the document from which I quoted Pressident Obama's words.
V. Post-Reform Health careYou have suggested that health care is now the No. 1 legislative priority. It seems to me this is only a small generalization — to say that the way the medical system works now is, people go to the doctor; the doctor tells them what treatments they need; they get those treatments, regardless of cost or, frankly, regardless of whether they’re effective. I wonder if you could talk to people about how going to the doctor will be different in the future; how they will experience medical care differently on the other side of health care reform.THE PRESIDENT: First of all, I do think consumers have gotten more active in their own treatments in a way that’s very useful. And I think that should continue to be encouraged, to the extent that we can provide consumers with more information about their own well-being — that, I think, can be helpful.
I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.
And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to
Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.
And right now we’re footing the bill for a lot of things that don’t make people healthier.
THE PRESIDENT: That don’t make people healthier. So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies (see note below
) as a way of reining in costs, that’s not an attempt to micromanage the doctor-patient relationship. It is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.
Won’t that be hard, because of the trust that people put in their doctors, just as you said? Won’t people say, Wait a second, my doctor is telling me to take the red pill, and the government is saving money by saying take the blue —THE PRESIDENT: Let me put it this way: I actually think that most doctors want to do right by their patients. And if they’ve got good information, I think they will act on that good information.
Now, there are distortions in the system, everything from the drug salesmen and junkets to how reimbursements occur. Some of those things government has control over; some of those things are just more embedded in our medical culture. But the doctors I know — both ones who treat me as well as friends of mine — I think take their job very seriously and are thinking in terms of what’s best for the patient. They operate within particular incentive structures, like anybody else, and particular habits, like anybody else.
And so if it turns out that doctors in Florida are spending 25 percent more on treating their patients as doctors in Minnesota, and the doctors in Minnesota are getting outcomes that are just as good — then us going down to Florida and pointing out that this is how folks in Minnesota are doing it and they seem to be getting pretty good outcomes, and are there particular reasons why you’re doing what you’re doing? — I think that conversation will ultimately yield some significant savings and some significant benefits.
Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —
Yes, where it’s $20,000 for an extra week of life.THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.
So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.
And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.
I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.
And it’s going to be hard for people who don’t have the option of paying for it.
THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
So how do you — how do we deal with it?THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

Note: Comparative-effective studies — which are now done by academic researchers, but not systematically across the medical system — review data to determine which widely used treatments do not improve outcomes and which effective treatments are not used often enough.

Friday, September 11, 2009 - Joe Bastardi on Climate Change

The graph contrasts temperature rise, with error bounds, predicted by the IPCC in 2001 (upper pink fan of lines) with the jig-jag variations, with a generally downward trend we have actually experienced since 2001.

The John Madden-like scribbles in the image are by Joe Bastardi,'s tropical and long range weather expert, from his recent appearance on the highest rated national cable news program

See the text of Joe Bastardi's "open letter" and a link to the video on the AccuWeather site:

Here are some excerpts from Bastardi's "open letter" on the AccuWeather site:

An open letter to viewers from's tropical and long range weather expert Joe Bastardi.

... I have always had an open mind on man's input into the climate system. However because I have to be acquainted with long term patterns of changing weather, which is what climate is for any one site, I need to know where we stand against the course of history.

Because of that, I have to be acquainted with the global warming issue in much more than a casual way. It is to my advantage as the chief long range and hurricane forecaster here to develop a working knowledge of where we are and where we are going in the overall global pattern.

To be sure, the cooling now is happening faster than it should because it got so warm in the first place via the super nino of 97-98. The last warm cycle reached its peak in the late 50s when we actually surfaced submarines at the north pole in 1959... IN MARCH! I often wonder what global temps would have been measured at then if we had the ways of measuring we do now. ...

One can pull out as many cases of bad weather in the 30s, 40s and 50s as they can now. I still believe the 3 greatest examples of how bad a hurricane can get in relation to latitude are the 1938 hurricane with 186 mph wind gusts at Blue Hill Mass, the 1944 hurricane that destroyed the Atlantic City boardwalk, and Hurricane Donna which gave hurricane force winds to every state from Florida to Maine. The 1944 hurricane had winds 600 miles in diameter ...

Unlike many people, I am well acquainted and respect the co2 warming idea, but in its pure form, which actually allows for the cooling coming now! There in lies the problem. We can't know till after the period that is coming up through 2030 whether co2 is really a player or not. The threat of not only oceanic cycles cooling the earth, but the suns lack of intensity and increased volcanic and seismic activity could mean that as some papers in the early 90s (and dismissed by many) opined we would be as cold as back in the early 1800s. ...

Common sense dictates that a trace gas needed for life on the planet would not be the cause for destroying life on the planet. Common sense dictates that what has happened before without man can happen again with man. ...

Bastardi's views are similar to mine, as expressed in various Topics on this Blog, see all my related postings at

Also of interest is this 2007 ABC news video ABC 20/20 "Give me a Break" Video.

Ira Glickstein

Tuesday, September 8, 2009

How American Health Care Killed My Father

When I saw the title of the health care story in the current issue of The Atlantic:

How American Health Care Killed My Father by David Goldhill

I expected a horror story that ended with a desperate call for a single-payer solution. My suspicions were intensified when Goldhill identified himself as a Democrat!

Instead I found a well-reasoned, long and detailed analysis of problems with American health care that I mostly agreed with, plus a solution approach that has some merit, though I do not buy it completely.

I strongly recommend you read it all at

In brief, Goldhill's 83 year-old father checked into "a well-regarded nonprofit hospital in New York City" with a case of pneumonia. Some weeks later, he went out feet first, dead from a hospital-acquired infection. His wife received a bill for over $636,687.75, all but about $992 paid by insurance.

Goldhill blames the hospital, of course, for the hospital-acquired infection. Clearly, some doctor or health-care worker failed to properly wash his or her hands. However, he does NOT take the conventional "lesson" that more government regulation and rules would have solved the problem. Nor does he blame the insurance company and Medicare for a lack of monitary support in this case. Quite the contrary, he blames the availability of Medicare and insurance money for both the high cost and lack of quality of American health care!

Please read the whole story, but here is the final part:

Ten days after my father’s death, the hospital sent my mother
a copy of the bill for his five-week stay: $636,687.75. He was charged $11,590
per night for his ICU room; $7,407 per night for a semiprivate room before he
was moved to the ICU; $145,432 for drugs; $41,696 for respiratory services. Even
the most casual effort to compare these prices to marginal costs or to the costs
of off-the-shelf components demonstrates the absurdity of these numbers, but why
should my mother care? Her share of the bill was only $992; the balance,
undoubtedly at some huge discount, was paid by Medicare.

Wasn’t this an extraordinary benefit, a windfall return on American
citizenship? Or at least some small relief for a distraught widow?

Not really. You can feel grateful for the protection currently offered
by Medicare (or by private insurance) only if you don’t realize how much you
truly spend to fund this system over your lifetime, and if you believe you’re
getting good care in return.

Would our health-care system be so outrageously expensive if each
American family directly spent even half of that $1.77 million that it will
contribute to health insurance and Medicare over a lifetime, instead of
entrusting care to massive government and private intermediaries? Like its
predecessors, the Obama administration treats additional government funding as a
solution to unaffordable health care, rather than its cause. The current reform
will likely expand our government’s already massive role in health-care
decision-making—all just to continue the illusion that someone else is paying
for our care.

But let’s forget about money for a moment. Aren’t we also likely to get
worse care in any system where providers are more accountable to insurance
companies and government agencies than to us?

Before we further remove ourselves as direct consumers of health
care—with all of our beneficial influence on quality, service, and price—let me
ask you to consider one more question. Imagine my father’s hospital had to
present the bill for his “care” not to a government bureaucracy, but to my
grieving mother. Do you really believe that the hospital—forced to face the
victim of its poor-quality service, forced to collect the bill from the real
customer—wouldn’t have figured out how to make its doctors wash their

A few weeks ago I posted We Need COST-EFFECTIVE Health Care Reform, in which I called for three basic changes:

1) Universal digititized patient data, securely accessible by any doctor chosen by the patient. This part should be easy to sell to both political parties and all medical specialties. It has been technically feasible for a decade an it is past time we do it.

2) Tort reform to eliminate high malpractice premiums and defensive medicine with unnecessary tests that add up to 10% to costs. This will be a hard sell to the majority party that is in the pocket of trial lawyers.

3) Outcome-based reimbursement to eliminate costly surgery and medications that do not yield comparative effectiveness based on quality-adjusted life years. This will be a hard sell to the minority party, some of whose members originally proposed it but who have backed away due to the onslaught of opposition based on "pulling the plug on granny".

After reading the above story, I would add the following:

4) Mandatory Catastrophic Insurance coverage for all that would cover only medical costs incurred in any one year of over $50,000 or a chronic condition that incurs costs of over $5,000 per year for ten years. That coverage would include a voucher for a basic checkup once a year. The government would subsidize coverage for those who could not afford the relatively low premiums for catastrophic coverage. Goldhill estimates a yearly premium of $2,000 for this type of coverage. (By comparison, my wife and I are paying around $10,000 each if you include our out-of-pocket insurance and Medicare costs plus the contribution of my former employer and of government Medicare funding.)

5) Mandatory Health Savings Accounts for all that would be tapped into for actual medical costs incurred, but would remain the property of the owner of the account (you, or your heirs) if not fully expended. Employers and employees/retirees would pay into the Health Savings Accounts the difference between what they are currently paying for comprehensive insurance and out-of-pocket medical costs now and the lower cost of Catastrophic-only insurance. (For example, my wife and I would see about $8,000 per year for each of us pass into our Health Savings Accounts.) Young, healthy families with low medical expenditures would see their Health Savings Accounts grow by thousands of dollars per year, accruing as savings to prepare themselves for the likely increasing medical costs as they age. Those not so fortunate, who incur medical costs, would expend the funds in their Health Savings Accounts until the accounts were tapped out, and would then pay the remainder out of their pockets and savings, until they hit the catastrophic limits and then Catastrophic-only insurance would kick in.

The point would be to make the recipients of health care more conscious of the actual costs. Instead of calling an ambulance for every event, they would be more likely to drive the injured person to the hospital or use public transit if possible. Instead of accepting the first doctor's advice for expensive medicines or tests or procedures (that may be in the doctor's self-interest - he or she may have a boat payment due) they would be more likely to shop around for lower-cost options. That would drive down the costs of medical care for everybody and make the providers more responsive to their customers, who would be the actual recipients of health care rather than the government and insurance companies.
Ira Glickstein

Sunday, September 6, 2009

Is that worth the effort?

[from Joel] As I get older it becomes more and more difficult to motivate myself to do things. Getting out of bed in the morning is a struggle. There's no depression associated with this, just a "what's worthwhile?" If you think about life you see that it consists of various periods of different motivational level. The motivational level is probably fed by hormones not intellect. It is logical that evolution should have made it this way. People who are unmotivated have difficulty reasoning their way out of the condition. It usually take drugs that mimic brain hormones. Nature doesn't find it efficient to keep too many old people around and fixes it so that they go quietly.

The question "why bother?" has various answers that are hormone driven. The responses "I'm hungry, I'm horny. I'm sleepy. I'm cold. I'm wet." are obviously not intellectual. However, the solutions to these "problems" call upon the brain. As we grow older, accumulated wisdom provides us with solutions, but we may lack the initiative to actually care enough to be motivated to implement them or even convince others to implement our ideas. This is probably why people speak of the elderly as "mellowing with age." It seems to me that one of the beauties of religion is that it provides a stimulus to older people just when their hormones (or lack thereof) are telling them that none of it really matters. Fear of the unknown is a great motivator.

Friday, September 4, 2009

Some Interesting Comparisons (part 2)

[from John] I am going to initiate this as a new Topic although it is an extension of the Some Interesting Comparisons Topic. The following is the last comment from Ira Glickstein from that Topic [in italics]. I am also going to show my comments in blue for clarity.
Thanks, John, for your comments. You probably noticed that I chose King Solomon "dividing the baby" as the image at the head of your posting. The Bible presents him as a benevolent dictator skilled at determining who was the true mother of the baby. For a Capitalist Republic to stand, we need a process that moderates, like Solomon, between the immediate needs (and wants) of the people and the long-term solvency and stability of the government. Somewhere in my studies I was told the reason the Constitution is so hard to change is to prevent impetuous change to address an immediate problem which in the long term may be deleterious to the nation. What comes to mind is the amendment banning alcohol. I would amend one word in your statement …stability of the government to … stability of the nation.
In a pure democracy, once the majority of the voters figure out they can vote for candidates who pay them benefits out of the national treasury, the country is guaranteed to go bankrupt sooner or later. That is the "tipping point" - when fewer people are, on net, paying-in and more are, on net, on the dole. If you tax those who work and give benefits to those who don't, you should not be surprised when more and more people don't work (or don't work very hard)! Unfortunately this also applies to a republic – our Republic!
I think history, as far back as Greece and Rome, and up to more modern times in the UK and USA, shows that the most stable governments are multi-party, where two (sometimes three) major parties coexist and take turns at the head, with the legislature and judiciary and state governments sometimes in the hands of the opposition. I agree with the exception of the judiciary. To the degree humanly possible the judiciary should be exempt of politic especially the Supreme Court whose sole objective should be interpreting the Constitution. Even though we may not agree on all of the choices for the Supreme Court members or all of their decisions I believe they have done a good job over the years.
Looking at the historical record, it is amazing that power is handed over peacefully when a different party wins 52% to 48% or even closer. The only reason that happens in the US is that both major parties have more philosophical and geographic overlap with each other than basic differences. Therefore, both strive to find the middle to pick up the independents and cross-over voters who make the final decision.
I don’t agree. GW Bush’s second election proves my point. Our nation was up in arms and divided through his full last term and has carried over into Obama’s first term. The reason that power has been handed over peacefully is we are a nation of law. We respect and trust the law. Even though there was great resentment when the Supreme Court ruled in that election it was accepted because we trusted them. I might add our nation is stable and economically well to do. While we have pockets of poverty the majority of the people are relatively comfortable economically so there is no underground outpouring of resentment toward the government. Comfortable people do not want to upset the apple cart.
In countries with a larger number of smaller, more narrow parties that are sometimes quite regional, change of government can be threatening and may lead to national strikes and riots. Afghanistan is a good example - tribal law dominates. There is no effective central government or central legal system. Additionally Afghanistan is a poor uneducated nation. Tribal grouping find the optimum stability for the people.
In your original posting, you seemed to be unhappy that candidates are "chosen by two political parties rather than by the people", and, in your most recent comment you ask "How else can an elected representative or senator be almost guaranteed of retaining his seat indefinitely as long as he remains a true party hack?" Well, IMHO, that system promotes balance and compromise within the structure of each party and between them. I personally think things were better when party hacks in the proverbial "smoke-filled room" hand-picked candidates prior to our primary election system. As I said in my previous comment I do not have a better system although I might recommend a change to the present system. I wonder if a tri party system would work better. Our system, as it operates today does not promote balance it promotes partisanship . It is this or that. A principal goal of a party is to seize and retain control. Compromise and balance exists only to the extent that a party must kowtow to the middle to retain power. A tri party system, on the other hand, would tend toward cooperation and compromise because a party’s hold on government would be tenuous, insecure and dependent upon cooperation. The re-election cycle as stated in the constitution would remain.
My other concern about our present system is the ease for an elected official to retain his seat forever thus creating a career path for professional politicians to hold the seats of government. I would prefer term limits. We could argue upon the length of the terms. We would want to give them enough time to understand the needs of our national government without providing a career for elected officials.

Wednesday, September 2, 2009

Curb Your Enthusiasm

Last month my brother visited and, with cult-like pleasure, we enjoyed several episodes of Curb Your Enthusiasm, the HBO comedy series about to enter its seventh season.

Although our political viewpoints are totally opposite, I think Larry David, who stars in Curb and previously co-created Seinfeld, is a comedy genius.


Some years ago, while asembling a wooden cabinet, I had a disastrous experience. I got too cocky and made a mistake that caused the partially-built cabinet to collapse "like a house of cards". It was deeply disturbing at the time, but is hilarious in retrospect.

That experience inspired me to write a story concept where Larry David, who portrays himself in Curb as a clutz when it comes to manual skills, is shamed into tackling a do-it-yourself project. In my story idea he, in his inept way, ends up doing a better job than an expert cabinet maker.

Since Larry David does not accept story ideas from the general public, my story outline has mouldered away on a computer disk in my closet somewhere. After my brother's visit, I decided to resurrect the story idea and "free" it on the Internet.


Football fans play "Fantasy Football", so why can't sitcom fans play "Fantasy Episodes" of their favorite series? I've started a new blog devoted to "Curb Your Enthusaism - Fantasy Episodes". Read the Welcome posting and the first Fantasy Episode DIY Larry.

The seventh season of Curb starts on HBO on this month (20 Sep). Here are some short highlight clips of past seasons of Curb and a tickler for the new season as well as a trailer for a new Woody Allen movie staring Larry David.


Ira Glickstein