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Saving Healthcare
"Let me frame healthcare for you in a big way," says Josh Green, state senator from Hawaii Island. "The big picture is that the rate of increase in the cost of healthcare is unsustainable. The U.S. is spending $3 trillion annually on healthcare – you can take that number to the bank. And as an aside, 10 percent of that, or $300 billion, is for diabetes alone."
In Hawaii alone, healthcare costs exceeded $8.8 billion, or more than 13 percent of the state's economy in 2009 and rising fast.
If you ask Green what the solution is, his answer is informed by his multifacted view of healthcare in Hawaii: He's chair of the Senate Health Committee, medical director of the 800-member Hawaii Independent Physicians Association, and a full-time emergency-room doctor and family-practice physician. For Green, and for many other experts, the best way forward is a set of concepts known as the Patient Centered Medical Home.
PCMH flips the priorities in healthcare, adding more resources to primary care for prevention and wellness programs. Advocates believe it will eventually change the curve on healthcare cost.
"Dealing with diabetes and other chronic disease is central to containing healthcare costs," Green says. "First, we have to do better on care. … Second, we have to contain costs. The concept of PCMH does both of those things. It allows people to have extra resources for prevention and health management up front so we don't just take care of people at the end, when they've already gotten so sick they've had a heart attack or had to lose a toe."
Primacy of primary care
Green is a major supporter of HMSA programs designed to foster PCMH and primary care. Hilton Raethel, senior VP for health services at HMSA, explains the roots of the company's new policies.
"We really believe that primary care in Hawaii – and across the United States – has been underemphasized for decades," Raethel says. "Let me give you one number: the ratio of primary care physicians to specialists. In Europe, for example, they have approximately two-thirds primary-care physicians to one-third specialists. In the United States, we have about 35 percent primary care physicians to 65 percent specialists." In other words, the ratios are flipped. "Studies also tell you that there's a direct correlation between that ratio and the total spend on healthcare," he says. "More referrals equal more tests."
Furthermore, Raethel believes that the de-emphasis of primary care is to blame for many of the problems in healthcare quality.
Steve Ribbink, HMSA's executive VP and CFO, points out that inefficiency in the system works both ways. "We know that the whole system is based on over-use, which creates wasteful spending. But there's also an under-use situation where someone didn't get medical treatment earlier, when they should have, and what could have been a non-event becomes an emergency. We want to change the delivery model to provide the right service at the right time in the right place."
Quantity vs. quality
The most effective way HMSA can influence how care is provided is by changing the way it reimburses physicians. "The current system rewards quantity, not quality," Raethel says. Doctors are usually paid for the number of patients they see and the procedures they perform. This encourages costly treatments at the expense of prevention and wellness care.
HMSA knows it can't change those incentives overnight because most of the healthcare system is built on the fee-for-service model. So it is starting by converting 15 percent of its reimbursements from fee-for-service to quality-care payments. These amount to per patient monthly payments for practicing clinically proven methods of preventive care – for example, making sure patients with diabetes get their annual eye and foot exams. The theory is that it's a lot cheaper to pay for early and regular screening than it is to pay for amputations or blindness later.
What does the change mean for a medical practice? Wearing his physicians association hat, Josh Green puts some numbers to the theory: "If you have a practice of 1,000 patients in the program, you get a minimum of $2 per member per month up to $7. It's usually about $5 per patient extra per month. That means a doc with 1,000 patients would be getting an extra $60,000 a year." The hope, he adds, is that practices will use that extra money to pay for resources that allow them to improve care: such as after-hours services, an extra nurse's aide or a nutritionist.
Green thinks HMSA's 2010 earnings report, showing the company's first "profits" in five years, is a sign the new program is already working. "They're definitely linked," he says. "I think that's what the CEO would tell you. There's absolutely a linkage in my mind." In any case, Green is encouraging HMSA to expand the program.
In April, nurse practitioners were added to the list of primary-care providers; the next group Green says he'd like added is OB/Gyn doctors. "I've asked HMSA to get to a point where a full 50 percent of their reimbursements to primary care providers are based on the management fee for maintaining a large panel of members."
Quality Standards
But for quality payments to work, Raethel says, providers need standards – metrics they can use to measure their performance. To help provide that data, HMSA has sponsored an initiative called Advanced Hospital Care (AHC), a partnership with all the major local hospitals and with the Premier healthcare alliance, a national cooperative of hundreds of hospitals and healthcare systems that is establishing quality standards.
"They've been working for the last half-dozen years to develop a program around quality, safety and efficiency," Raethel says. "By partnering with Premier, instead of having to come up with our own programs, we get metrics designed by hospitals around the country."
Participation is a two-way street. "As a member, you agree to share all your results with the cooperative," Raethel says. "That data is transparent, so you get to see what the other hospitals are doing, and they get to see how you're doing. Transparency is a powerful motivator."
HMSA believes access to such data will change how Hawaii's hospitals operate. By joining AHC, Hawaii's hospitals have committed to improving their performance on the Premier standards. Each hospital compares its performance with peers around the country. That's important in Hawaii, where a big trauma hospital like Queens, doesn't have local peers.
"Now," Raethel says, "if Queens is working on a particular metric and, for whatever reason, isn't doing so well, they can look at similar hospitals that are doing well and see how they're doing it."
HMSA also provides quality data to physicians and medical practices. Last year, they launched HBI Online, a web service that lets healthcare providers measure their performance against clinical quality indicators. For example, HBI Online allows doctors to easily see how many of their diabetic patients have had eye exams.
HMSA isn't the first healthcare organization in Hawaii to embrace PCMH. "We've believed in this concept for a long time," says Geoffrey Sewell, executive medical director at Kaiser. "It's a core value at Kaiser."
In fact, Kaiser is a national leader in PCMH. For example, it pioneered the widespread use of electronic medical records, a key PCMH strategy. Nationally, Kaiser was an early intensive user of quality measures to improve care in its hospitals and clinics, using its own database to track performance at every level.
"For example," Sewell says, "we can tell how a group practice is doing compared to other group practices. Then, we can click down into the individual members of that practice. We can see the doctors, the medical assistants, the nurses. We can see who's completing the things that need to get done. And we can assist them when they set critical targets."
Ultimately, the program tracks every critical performance measure, comparing everything in a medical practice or a clinic or a hospital with national averages. "Our goal is to be in the top 10 percent," Sewell says.
But Sewell understands the challenges facing the rest of the healthcare industry. Whereas Kaiser doctors are paid a salary, most other doctors are compensated for each service. "They get paid in RVUs – relative value units," Sewell explains. "Every medical procedure, from an office consultation to brain surgery, they all have a certain number of RVUs applied to them. So, while you might get paid a little more for hitting quality targets, they still pay you fee-for-service for most of your time. That's what sets us apart: We pay folks a salary, then we monitor performance."
Sewell applauds HMSA's efforts, but he has concerns. "This is exactly where things should be going," he says. "The question is, what's the transitional state? And who survives the transition? That's the real challenge. At Kaiser, we're lucky in that we have a huge IT department, so we have experienced people who can come into the clinic to train staff. I don't know how private practice doctors would do that. I suppose they would have to hire someone to come in and do that."
Sewell notes that HMSA has supported physicians' move to electronic medical records, a critical step in the new healthcare model, and one required by the federal Affordable Care Act. Even so, he believes many doctors, particularly older ones, will balk.
"I know HMSA has programs where they help fund it." Sewell says. "That helps, but I think it's still a financial challenge, especially for independent doctors. People in group practices may have an easier time managing that. But even for them, down the road, how are they going to go from the current system?"
It's a concern shared by many physicians, says Darryl Kurozawa, associate medical director at Kaiser. "I was in private practice for about 10 years before I joined Kaiser, so I have a lot friends still out there. I can tell you, there's a core of doctors out there who are just going to retire. Doing all the quality measures required is just too much work, which probably means hiring staff. If they just have a few years left in their practice, they're going to give up."
Vermont's model
There are several state healthcare systems that might serve as good models for HMSA and Hawaii. One is the Vermont Blueprint for Health.
The first legislation establishing Vermont's program passed in 2011, and already Blueprint for Health has grown into a statewide program embracing 79 practices, 359 physicians and 353,333 patients.
One of its key features is a collection of organizations called community health teams. Healthcare payers such as Medicare fund CHTs on a per-patient, per-month basis, just as in the PCMH model, and they're designed to serve as a utility for all the medical homes in their district. Each CHT contains specialists selected to complement the work done by the primary-care providers, possibly including nurse coordinators, social workers, nutrition specialists, community health workers and public health specialists.
The Vermont system relies on data management. Treatment protocols and other medical standards are managed in a central registry. Reimbursement information is extracted from a multi-payer claims database. Patient histories are stored in a chart registry. Performance and quality measures are gleaned from national scoring data. Public health information resides in a public health registry. All this data allows healthcare providers to better track and coordinate care for their patients.
Proponents say the practical effect is that patients now receive their care where and when they need it instead of in an emergency room visit, which is often ten times as expensive. This isn't an abstract form of savings; it's the whole intent of the program.
North Carolina
Another program that Hawaii might emulate is Community Care of North Carolina. CCNC began as a way to use the PCMH model to deal with the poor, disjointed care system for Medicare recipients in largely rural North Carolina. Over time, CCNC has grown to 646 Medicare demonstration projects in 22 counties. It also includes three federally funded Beacon Communities, and a seven-county, multi-payer primary care demonstration that includes Medicare, Medicaid, Blue Cross Blue Shield and the North Carolina Employees Health Plan. CCNC now encompasses 4,000 healthcare providers and more than a million patients.
In just three years, the North Carolina program appears to have paid off, even though the number of Medicare recipients in the program has increased by more than a million. An assessment by Treo Solutions Inc., a healthcare information services company, found that the state avoided more than $650 million in costs in 2009 alone because of CCNC. This December, a study by the healthcare actuarial firm Milliman showed nearly $1 billion in annual savings. Clearly, it's numbers like this that are getting the attention of HMSA and the Hawaii healthcare establishment.
Hawaii's physicians
A recent study estimated the shortage of physicians in Hawaii at 20 percent, or 644 doctors, and many doctors fear that current trends in healthcare will exacerbate that shortage. Even so, the PCMH concept receives a lot of support in the healthcare community, particularly among primary care physicians like pediatricians, family doctors and internists. It's not only because of the extra income; many physicians support PCMH because of the increased care it allows them to give their patients and the renewed focus on evidence-based medicine. They're particularly enthusiastic about HBI Online.
Dr. Brijit "Brit" Reis, a pediatrician with the Castle Health Group, a Kailua-based PCMH, explains the value of the program: "Physicians, and I'll speak for myself as well, we always think we're doing a good job. HBI Online is something that we can log into and look at all our HMSA/Quest patients to see whether those patients are up-to-date or not. Who still requires services and what those services are? That's been great. Now, instead of just saying we're doing a good job, we can actually look at data and see."
But she notes that quality controls aren't all there is to a medical home. "A PCMH is truly a team," she says. "Care in your office is team-based, and you work at it from a partnership with patients and their families. You figure out what are their barriers to care. Then help them get the care they need. In other words, it's a little more holistic approach to the patient. It involves the patient more in the process."
One example, Reis says, is providing after-hours care. "If you're only open nine to four everyday, patients don't get in because they're working, so you're not really providing for their care." She says a lot of the PCMH is just practicing good medicine. "It looks at things like do you communicate well with specialists? Do you have a good system for tracking if your patients actually visited the specialist? Did you get back information after they went to see them? If not, why? Maybe they lost the phone number. Maybe the doctor said they wouldn't see them. But part of good care is tracking your specialist referrals. Do you have a system for looking at all these things?"
It's also how the team works together to coordinate care and "communication within the staff," Reis says. "It's holding daily huddles to see who's on the schedule today. Is there anything that needs following up on? It's basic communication stuff, but it doesn't always happen. And basic communication can be the difference between patients getting the care they need and not getting it."
Specialists' perspective
Not surprisingly, specialists are among the most skeptical about the PCMH and HMSA's new reimbursement policies. For some, like orthopedic surgeon Linda Rasmussen, the criticism stems partly from skepticism about a system that has steadily eroded doctors' earnings. "I've been here almost 18 years," Rasmussen says, "and every year my income goes down. When you look at what I make compared to how many hours I work, it's like $28 an hour. My sister is a nurse; she makes $36 an hour." She adds that it doesn't get any better when you look at it by procedure. "I used to get $4,000 for putting in a new hip. Now, I get $1,400."
Rasumssen also doubts the practicability of the new system. She points out that many of the qualitative measures used in primary care simply don't work in some specialties. "Nationally, we've been trying to come up with quality measures. But even HMSA has agreed that, with orthopedics, there's nothing to come up with."
Rasmussen offers some examples of how specialists could game the system: Physicians could cherry-pick patients, choosing not to serve groups, like the morbidly obese, that could lower their quality-care ratings. Similarly, specialists could foist some services onto the primary care physician, such as a doctor who refuses to prescribe simple painkillers like Motrin or Advil. "He made them go back to their primary care doctor. He got a $2,000 bonus because he didn't prescribe any drugs, but really he just didn't want the liability. It's this game, and you get tired of playing the game."
Rasmussen also isn't sure that focusing on primary care will render the savings that healthcare professionals expect. "Primary care doctors will just have to run more tests, which will drive up costs. I don't need an MRI to tell me your ligament is torn. I can tell on exam. After all, that's all I do all day."
The focus on quality controls also doesn't address malpractice law, which she sees as a major driver of healthcare costs. "I don't see a lot of waste going on," she says. "When I look at things, the waste that I see is doing things to avoid malpractice lawsuits." She notes that she once got sued for failing to perform an MRI even though the insurance company denied coverage for an MRI. "So, do I get an MRI on everyone now, just to avoid a lawsuit in the future? … In this country, the cost of defensive medicine has reached $86 billion."
To Rasmussen, PCMH isn't all that different from the failed managed-care model of an earlier generation. "It's the soup du jour," she says. "But it won't work."
Is it inevitable?
Even PCMH's most ardent supporters, like Josh Green, acknowledge that changes in the healthcare system pose challenges for many doctors, particularly those in solo or small practices. "The jury's still out on whether or not this is sustainable for small practices, especially solo practices," Green says. "Maybe they'll band together a little more. For example, if they have to provide after-hours care, maybe two or three practices, though they won't actually merge, will agree to partner up on that particular issue, and all their patients will have access to the service."
But the trends in healthcare seem inescapable: a growing emphasis on team care, increased use of data to manage care, and the growing prevalence of preventive medicine.
"Small practices can't survive unless they evolve, because overhead has gotten too large," Green says. "Part of the evolution for small practices has to be something like PCMH, which brings them more resources."
Many of the main ideas embodied in PCMH and the HMSA's new programs are gradually being codified into law. Green points out, "The idea to move more resources into primary care and preventive care is essentially what the Affordable Care Act – Obamacare – is all about. It's 2,800 pages of different tricks and nuances and pilot programs all built around putting more money into primary care so we can prevent hypertension from getting out of control, and prevent diabetes from getting out of control, and make sure people take their medication properly. Ultimately, PCMH kind of mirrors that."


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subset: commoncrawl


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[Over the years we've noted the Indiana bench and bar's unusual attention to legal history. Here's another example.]
The Indiana Supreme Court will host a free Commission for Continuing Legal Education (CLE) event, celebrating Black History: The Life and Times of Dred Scott on Tuesday, February 28, 2012 from 3:30 P.M. - 5:00 P.M. in the Gathertorium on the campus of Martin University in Indianapolis.
Utah Attorney General Mark L. Shurtleff, the author of "Am I Not a Man?-The Dred Scott Story", will speak about the book, a historical novel which tells the remarkable story of Dred Scott, events leading up to the Supreme Court Ruling decided March 6,1857, the election of President Abraham Lincoln, and ultimately, the abolition of slavery. The book was first released to commemorate February's "Black History Month" designation.
Attorney General Shurtleff will discuss the Constitutional analysis and legal underpinnings of this landmark ruling and the implication of Chief Justice Roger B. Taney's 7-2 decision in which every Justice, beside Taney, wrote a separate concurrence or dissent. This decision greatly impacted the national political landscape and helped Abe Lincoln win his Presidential race. General Shurtleff will also provide perspective on the legal reasoning regarding the Fourteenth Amendment in the context of the Dred Scott ruling: and the current legal arguments in the context of comprehensive immigration reform as to whether the Fourteenth Amendment should be altered.
Lynn M. Jackson, great-great granddaughter of Dred and Harriett Scott, will offer her personal perspective on her family and the ruling. She is President and Founder of the Dred Scott Heritage Foundation in St. Louis, Missouri.
Indiana Attorney General Greg Zoeller will introduce the speakers and moderate the discussion portion of the program. Dr. Charlotte Westerhaus-Renfrow, Acting President of Martin University, will provide welcome remarks.
Hat tip/more.


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He Said-She Said: Relationships with Non-Christians
- Cliff Young & Laura MacCorkle Crosswalk.com Contributing Writer & Senior Editor
- 2008 2 Oct
EDITOR'S NOTE: Each He Said-She Said column features a question from a Crosswalk.com reader with responses from a male and female point of view. If you've got a question about anything related to singleness, please CLICK HERE to submit (selected questions will be posted anonymously).
QUESTION: I know a Christian woman who is dating a non-Christian man, but won't admit she's actually dating him and will try to hide the fact when she spends any time with him. I try not to be judgmental, especially since I dated a non-Christian woman soon after I was saved (which turned into one of the biggest mistakes of my life). It's become difficult though, and I'm starting to think I should just give up on the friendship and walk away. What are your thoughts on relationships with non-Christians, especially with the opposite sex? How good of friends should we become with non-Christians of the opposite sex?
HE SAID: Relationships are difficult. They have become more complicated as the years pass by, not only because I have aged, but how the world's view of them has evolved over that time. How we see dating depicted on television and in the movies couldn't be shown in public twenty years ago. Sex and the City has become a dating guide for many. Our culture has legitimized sex, teen pregnancy, homosexuality, divorce, and adultery. It is no wonder that Christians in the world have difficulty not being of the world.
Don't team up with those who are unbelievers. How can goodness be a partner with wickedness? How can light live with darkness? What harmony can there be between a partner with an unbeliever? And what union can there be between God's temple and idols? For we are the temple of the living God (2 Corinthians 6:14-16a).
I am a huge proponent of having friendships with unbelievers, both male and female. We are called to be a light of the world. The only means to do this is to have interaction with those who do not have a personal relationship with Jesus. The trouble comes when we don't live out our beliefs in front of those around us, our emotions are drawn in a non-platonic way to an unbeliever of the opposite sex, or we become enticed into situations that lead us away from our walk with the Lord.
In order to abstain from compromising situations, we must have a close relationship with Jesus and be in His Word, be in prayer for discernment and wisdom, acknowledge our weaknesses, determine our boundaries and have a plan of attack in the event the relationship moves toward a direction that is not holy.
These boundaries and plan of attack must be set in advance, before we enter into any relationship (friendship, dating or otherwise), so we are prepared for any temptation or struggle we may face.
In order to be a man or woman of integrity, it is imperative we have a foundation based upon God and Scripture. Relationships are hard enough when we are trying to do the right thing with the Lord, let alone doing what we know is to be wrong without Him.
He (Job) is the finest man in all the earth—a man of complete integrity. He fears God and will have nothing to do with evil (Job 1:8).
When I am in a dating relationship, I want all of my friends to meet and know her—not only to show her off (as a proud boyfriend), but also to get insight from people I trust. If your friend is "hiding" the fact that she is spending time with a guy, chances are she already knows in her heart what she is doing is wrong.
As a friend, the first thing to do is pray for her. In Philippians 4:6, we are told to pray about everything. This is one of those situations where you need to allow the Lord to speak to you and guide you. Consider when you were in her situation and reflect upon how you would have received a friend's rebuke.
When you approach your friend, do it out of love not condemnation (leave that for the Holy Spirit). 1 Corinthians 13 is not limited to marriages, but applies to all of us:
Love is patient and kind. Love is not jealous or boastful or proud or rude. Love does not demand its own way.
The Lord and His Word do not need our help to transform lives. Sometimes we need to get out of the way for God to work. Be careful to not force your thoughts, beliefs and opinions on her or wave verses in her face to make her change. Share your own experience and what God has taught you—but do it with love.
But the way of the wicked is like complete darkness. Those who follow it have no idea what they are stumbling over (Proverbs 4:19).
Oftentimes when we are in a relationship, we lose focus on the things that are most important in our lives; we don't even realize the relationship is leading us astray.
SHE SAID: When I first read your question, the first image that popped into my mind was Robot from Lost in Space. Remember that campy, '60s sci-fi television show?
As a young child in the '70s, I remember watching the reruns of it on the weekends, as the Robinson family (yes, it was a space-age version of Swiss Family Robinson) was stuck in space and trying to figure out how to get back to Planet Earth.
Precocious, youngest son Will Robinson was always getting into some sort of mischief in the space ship or on the random planet that the family had landed on, while drifting out in the cosmos. When Will was about to do something foolish, Robot (with flailing "arms") was always nearby to warn: "Danger, Will Robinson! DANGER!!!"
And so to you, dear reader, I offer the same advice for your friend today: "DANGER!"
Dabbling in dating relationships with non-Christians is like playing with fire. It is not harmless, and you will get burned (whether you feel it or not). I speak from personal experience, and I also speak as a friend who has seen other friends slide quite easily down this slippery slope.
Even if you choose to skip over the entire book of 2 Corinthians in your Bible, no one can deny that chapter 6, verses 14-16, is ultra clear on this subject matter:
Do not be yoked together with unbelievers. For what do righteousness and wickedness have in common? Or what fellowship can light have with darkness? What harmony is there between Christ and Belial? What does a believer have in common with an unbeliever? What agreement is there between the temple of God and idols? For we are the temple of the living God. As God has said: "I will live with them and walk among them, and I will be their God, and they will be my people.
So, in essence, don't even go there. Don't even strike a match. Step away from the matchbox. "Danger, fellow Christian! DANGER!"
Sure, we all understand this and know that God has set up these unequally-yoked perimeters to protect his children. But that doesn't mean that it is easy for us to follow these instructions (2 Corinthians 10:5).
Apart from Christ, the heart wants what the heart wants. It can easily deceive us (Jeremiah 17:9), and we are wont to rationalize circumstances into what we want them to be and to fit our agendas. The world says, "You can't help who you fall in love with." But the Bible says, "Um, yes you can" (Titus 2:11-14).
This seems to be what is going on with your friend right now. She wants what she wants and what feels good. But she knows that it is not right (hence, hiding the fact that she's dating a non-Christian). At this point, her heart may also be hooked and she may think she's in love. She is deceiving herself, and when we don't want to let go of something then it is very hard to walk away from it.
On a related note, you ask just how close a Christian should become with a non-Christian. I think that is debatable. Each person knows when their heart has gotten involved beyond a platonic level. If a man and woman truly only feel friendship toward one another (like a brother and a sister), then friendship should be an option (and also seen as an opportunity for outreach and witness). But if the Christian sees that this friendship with a non-Christian is pulling him or her away from Christ, then it's time to reassess the nature of the relationship and establish some safeguards.
When in doubt, and if you don't trust yourself, your actions or your interior pitter-patters (if present), then keep your friendship relegated to a group-only type of setting. Don't spend alone time together, so that you may guard your heart and protect yourself from making bad decisions (Proverbs 4:23).
Since you have been there and understand this struggle when it comes to dating or having close friendships with non-Christians, then your friendship, your honesty and your compassion are invaluable to your friend right now (Galatians 6:2, John 13:34).
I know you are struggling with whether or not you should walk away, since the friendship has become increasingly difficult. But before you do so, have you had a heart-to-heart discussion with your friend? Have you lovingly confronted her on her actions and told her how you feel? Can you share that you still love her in Christ, even though she is choosing to disobey God's Word? (Joel 2:13). Can you share with her that you want God's best for her, and that his best never contradicts his Word?
You may be the only person in her life right now who is willing to reach out and say these things to her. You may be the tool that God wants to use to "break through," help her see the light and turn from her ways.
Before you throw your hands up in frustration and quit, be sure that you take this matter to the Lord in prayer. How does he want you to respond to your sister in Christ? If nothing else, please continue praying for her—that her heart would soften (Hosea 12:6) and that her eyes would be opened to see her situation for what it really is.
Show me your ways, O LORD, teach me your paths; guide me in your truth and teach me, for you are God my Savior, and my hope is in you all day long (Psalm 25:4-5).
HE is … Cliff Young, a Crosswalk.com contributing writer and a veteran single of many decades. He has traveled the world in search of fresh experiences, serving opportunities, and the perfect woman (for him) and has found that his investments in God, career and youth ministry have paid off in priceless dividends.
SHE is … Laura MacCorkle, Crosswalk.com's Senior Entertainment Editor. She loves God, her family and and her friends. Singleness has taught her patience, deepened her walk with the Lord and afforded her countless (who's counting anyway?) opportunities to whip up an amazing three-course meal for one.
DISCLAIMER: We are not trained psychologists or licensed professionals. We're just average folk who understand what it's like to live the solo life in the 21st century. We believe that the Bible is our go-to guide for answers to all of life's questions, and it's where we'll go for guidance when responding to your questions.
GOT A QUESTION? If you've got a question about anything related to living the single life, PLEASE SUBMIT HERE (selected questions will be posted anonymously). While we are unable to answer every inquiry, we do hope that He Said-She Said will be an encouragement to you.
**This column first published on October 2, 2008.


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When you surf the Web, your life is an open book. Not only can you be tracked by techniques such as cookies, but even your IP address leaves behind digital tracks that can be used to identify you and invade your privacy. If protecting your privacy is important–and you're willing to pay for it–Anonymizer Universal may buy you some peace of mind. At $80 per year, it's not a decision to make on a whim.
Anonymizer Universal uses Virtual Private Networking technology to keep your IP address private. In addition, it encrypts all of your communications as your data travels across the internet, using L2TP/IPSec, in essence creating a secure, encrypted tunnel for you. It's also useful for those who use public Wi-Fi hot spots and are thus justifiably worried about their privacy. As with your desktop PC, it creates a VPN connection and encrypts all of your communications.
Anonymizer Universal has practically no interface. Run the program and click a connect button–and that's it. Apart from a screen that lets you customize whether to launch it at startup, and whether to automatically connect, you won't see anything else–apart from a system tray icon, and a screen that appears when you double-click the icon–telling you if you're connected or not. In fact, that's one of the program's strengths. Run it, connect, and you're protected.
So is it worth paying the $80 annual fee for this program? If you're worried about your privacy, and especially if you use public Wi-Fi hot spots a good deal, you may decide that it's worth the cost. It all depends on how safe you believe you are, and what price you put on privacy. There is a free alternative, called Hotspot Shield, but it works only with Wi-Fi, and it delivers ads as it works.
You may experience some setup problems with Anonymizer Universal. If you receive an error message that you can't install the software, try installing again, and uncheck the boxes next to Add shortcuts to Desktop and Quick Launch. That might solve your problem. In addition, some firewalls or anti-malware software may not allow Anonymizer Universal to connect. I experienced a conflict between Anonymizer Universal AVG Internet Security and had to temporarily disable AVGIS to work around it.


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PROPONENTS of compul sory, government-designed health insurance can't seem to understand why others disagree. Perhaps the public is realizing that these proposals are fundamentally about redistributing health?
Health-care "reform," that is, aims to shift costs and benefits of health insurance from some groups to others. And the losers are turning out to be less docile than politicians had hoped.
All the leading proposals involve massive redistribution from people with healthy lifestyles to those who take more risks. As the Congressional Budget Office explained, "Premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market . . . because the new policies would have to cover pre-existing medical conditions and could not deny coverage to people with high expected costs for health care."
That is, because the politicians want people who've already fallen ill to be able to buy insurance at the same rates as the healthy, rates would rise for everyone who has insurance now. That's why the bills would all force healthy people to buy this overpriced insurance, under threat of fines or prison.
There would also be redistribution from people with employer-paid insurance (particularly in risky jobs with high premiums) to those who would be induced to shun such benefits in order to qualify for taxpayer subsidies.
By far the largest redistribution, however, is from those on Medicare to those who'd become newly eligible for Medicaid or federal subsidies.
The major proposals, the AARP Bulletin explains, "include around $500 billion in savings carved from future growth in Medicare spending over a 10-year period."
Even in the Obama era, $500 billion is a lot. Yet we're supposed to believe that less is somehow more — that seniors will benefit from these spending cuts. "The Obama administration and congressional leaders," intones a recent New York Times editorial, "are hoping to save hundreds of billions of dollars by slowing the growth of spending in the vast and inefficient Medicare system that serves 45 million older and disabled Americans. The savings would be used to help offset the costs of covering tens of millions of uninsured people."
President Obama, in an Aug. 16 Times op ed, made such redistribution seem easy and painless: "We'll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid," he said.
Such efforts to appease seniors are not working because they are transparently dishonest.
First of all, the Congressional Budget Office figures that cutting "waste, fraud and abuse" might save $200 million a year — that's millions, not billions.
Second, the hundreds of billions in "savings" are to be carved out of the hides of Medicare providers and Medicare Advantage benefits, not Medicaid. In the Senate Finance Committee proposal, Medicaid gets $345 billion more money from 2014 to 2019.
Third, Medicare is already headed to insolvency. As its trustees openly warn, the program's trust fund will be empty in six to nine years, because its spending continues to grow far faster than the taxes that support it.
That is, Medicare will undoubtedly be slashed again and again in the years ahead, and fees increased — simply to keep the program from eating into the general budget (which is already groaning under unprecedented deficits).
This harsh reality does not turn the insolvent Medicare mess into a congressional piggybank, so that cutting Medicare payments to doctors can be magically transformed into a newfound source of free money to lavish on Medicaid and health-insurance subsidies.
The Times claims the cuts should actually make Medicare better "for most beneficiaries," partly by "helping keep Medicare solvent." That is either a hoax or fraud. If "the savings would be used to help offset the costs of covering tens of millions of uninsured people," as the Times says, then the same savings can't also be used to shore up the Medicare trust fund.
In any case, the proposed Medicare cuts are unbelievably huge. As the CBO explains, the Senate Finance proposal "would increase payment rates for physicians' services for 2010, but those rates would be reduced by about 25 percent for 2011 and then remain at current-law levels. . . . Under the proposal, increases in payment rates for many other providers would be held below the rate of inflation."
Amazingly, the AARP Bulletin describes these draconian cuts as "paying doctors more for practices that improve quality of care and save money; and paying providers (notably hospitals and home health agencies) a little less of an increase each year."
Sorry: Slashing physician payments by about 25 percent in a single year (and 5.5 percent in later years) is not "a little less." And holding other fees below inflation translates to a perpetual drop in real wages for health-care employees.
Proponents of raiding Medicare to finance "reform" (redistribution) pretend that cutting Medicare payments for services, procedures, tests, devices and drugs is not at all the same as cutting benefits. Nonsense. If we pay health-care providers far less, then they will provide fewer services to Medicare patients. As President Obama suggested, just tell grandma to skip the hip surgery and pop pain pills instead.
The president and his allies in Congress believe they can use deep cuts in Medicare — plus steep new taxes on health insurance, drug and medical device companies — to pay for a vast expansion of Medicaid and new health-insurance subsidies.
These grandiose redistribution schemes are grounded in lethal economics and suicidal politics. Because bad ideas are hard to sell, politicians and journalists have been peddling health redistribution with the rhetorical and statistical equivalent of waste, fraud and abuse.
American voters, particularly seniors, don't like to be lied to. They are just as leery of the political redistribution of health as they are of the redistribution of wealth.
Alan Reynolds (a senior who carefully avoids signing up for Medicare) is senior fellow with the Cato Institute.


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Posts Tagged 'the pencil guy'
Pencil it in…
"I'm known as the pencil guy," laughed Dalton Ghetti, 49. "I don't mind that at all."
The Bridgeport artist creates impossibly detailed miniature sculptures on the tip of a pencil.
He shuns a magnifying glass and uses simple tools like razor blades and needles to create delicate little figures – from a tiny, jagged handsaw to a minibust of Elvis in shades…
Readers can find the full, photo-laced story in The NY Daily News (and more in The [U.K.] Daily Mail); and readers in the Northeast can see the Brazilian-born carver's work at the New Britain Museum of American Art, as part of its "Meticulous Masterpieces" exhibit, through this Sunday.
(Many thanks to reader PL.)
As we ponder altogether new meanings for "sharpen my pencil," we might recall that it was on this date in 1940, at the New York World's Fair, that the world' first Parachute Wedding was conducted. Arno Rudolphi and Ann Hayward, were married on the Parachute Jump, a 26-story high ride created for the World's Fair (though now working on Coney Island). The entire wedding party– minister, bride, groom, best man, maid of honor & four musicians– was suspended aloft until the newlyweds completed their vows.