Tag Archive for ‘archimedes movement’ at isaac holeman

Tag Archive for 'archimedes movement'

My 2 Hour Talk at Apollo College of Nursing

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Isaac

on November 8, 2008

in health care

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Isaac's Health Care Archimedes talk at Apollo College

View SlideShare presentation or Upload your own. (tags: archimedes policy)

(The following is cross-posted at my blog with the Archimedes Movement)
Since the community presenters training last spring I’ve been lucky enough to give a few presentations. The most recent was last Tuesday the 4th (election day!) for a class of nursing students at Apollo College of Nursing. I gave an hour long presentation to a different class at the same school in late August, but I had technical problems and scheduling difficulties, so I didn’t fee terribly successful. I was invited to come back though, this time for a 2 hour lecture on Health Policy, The Archimedes Movement, and Leadership in the health professions.

My powerpoint slides are based on the draft generic presentation that Liz gave us at the speakers training, but pretty extensively modified. Here are a few major differences.

1. I re-arranged the order of the slides so that it all fits into three questions. At the bottom of every slide I indicate which question the slide is addressing, to help them keep track of the overall scheme of the presentation

How did we get here (the broken system)?
What do we really want (our needs, what would a new system look like)?
How do we get there (agree on vision, political tension)?

2. To start, I ask them to give me a list (I wrote it on the white board) of why they want to be nurses. Throughout the presentation I continually refer to these motivators, how they are affected by each issue I talk about (e.g. cost-shifting). A major theme is that EVERYONE has their own unique list of motivators, and we have to understand that whatever solution we come up with WILL be the best compromise of everyone’s motivators, otherwise it won’t be a solution at all. I think this is more personal, and easier for them to apply in their lives than the “I commit to be a citizen first and stake holder second” idea.

3. I use funny pictures of Dr. Quinn medicine woman (from an old TV show), and an old french TB poster to introduce the infectious disease model of care.

4. Dr. Kitzhaber uses an analogy where the delivery system is like a car, it’s top speed is a product of the car, not how you “finance” the car. I’ve switched to a hover craft analogy. I say:

I transition by saying imagine an American frontier without roads. Without roads, a hover craft would be great - you can go 30 miles per hour over all kinds of terrain.

Now imagine an America with roads - on the highway your stupid hover craft only goes 30 miles per hour, it doesn’t have a sharp enough turning radius, stop time, or covering/protection on the top to even be safe when all the traffic is concentrated on these roads.

What we really need is cars that can go fast, stop quickly, turn quickly, and have protection and padding in the case of these new kinds of accidents (like colliding with other vehicles) that only happen in a world with roads.

Here’s why I like it better:

It emphasizes that the reason our health system has become inefficient is that the context of care has changed - we now can and do treat chronic diseases etc.

It emphasizes that the infectious disease model (hover crafts) is qualitatively different than a chronic disease model (cars). The hover crafts (infectious disease) are so different from what we need today that they aren’t even safe anymore.

It makes a solution seem more tangible. Switch from hover crafts to cars jives better with switching from infectious disease model to a triple aim-centric chronic disease model better than thinking about a car that just needs to go faster.

5. I included slides on Barack Obama’s and John McCain’s health care plans, emphasizing that both are talking mainly about financing rather than changing delivery models (I base it on Dr. K’s October 16th video). I also include a quote by John McCain saying that the solution to lowering costs is to deregulate health care like we did with banking (because it turns out banking isn’t doing very well with extreme/radical deregulation in the long term).

6. Finally, this lecture introduced these nursing students to a whole semester on the topic of leadership, so we discussed specifically how health care providers can be leaders. I was pleased that someone had said a motivator was “scrubs = respect.” I argued that the reason people respect professionals who wear scrubs is that they expect them to take responsibility in difficult situations. I even encouraged them to show up to a town hall or the capital in Salem wearing scrubs; it’s harder for legislators to ignore advice about our health system if it comes from someone wearing scrubs.

Some of the slides won’t make very much sense without me explaining them individually, and my notes are certainly incomplete, but I would be happy to answer an email if you have any questions.

I’m getting to the busiest part of my semester now, so I don’t know if I’ll be doing any more presentations until late December. I’ve really enjoyed them though, and I’m excited to have two more talks schedules for January. Let me know if you find any more opportunities!

cheers
Isaac

Archimedes Movement: “What do we actually do?”

Published

Isaac

on March 22, 2008

in civic engagement, health care, politics and stuff in my life

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The interim steering committee of the Archimedes Movement has been hard at work defining an operating structure for our Movement. For the last few days they have been busy gathering feedback from chapter leaders and other Archimedes members, and discussing the merits of many comments and concerns. Several times I have heard people express concern that our mission statement is not clear enough to really engage people. The mission statement really shouldn’t be part of the operating structure document, but it is so important and so up in the air right now that I think people are craving to find direction even in unlikely places.

I think we have a brilliant mission statement:

The mission of the Archimedes Movement is to create a new space for civic engagement outside our traditional legislative and governance structures to advance solutions to the common problems we face – starting with the crisis in the U.S. health care system.

But it doesn’t say what we actually do. It is the kind of visionary, 30,000 foot high mission statement that always makes people ask “so what are you doing to achieve that mission, what is it that you guys actually do?” This doesn’t mean it is a bad mission statement, it means we need a mission execution statement to explain exactly how we will execute our visionary mission statement. Last June our mission execution statement was as simple and persuasive as our mission statement:

In an extensive grass-roots process that has engaged thousands of Oregonians, we created Senate Bill 27, the Oregon Better Health Act. This bill contains a blue print for national health care reform, starting here in Oregon. We are currently working with legislators and special interest groups to rally the votes we need in the Oregon legislature to pass this awesome bill.

When SB 27 didn’t pass during the summer legislative session, our mission execution statement deflated in a big way, and we haven’t developed a very good one to replace it.

We have a speaker training soon, and a member meeting scheduled for May. We have set the goal of having a concrete mission execution statement ready for speakers before the upcoming speaker training. I would like to help speed that effort along, so I offer a few potential mission execution statements that we can all discuss.

When people get sick and die because they don’t have health care, they are the victims of a moral crisis in our nation. What most people don’t realize is that these sick people are only a fraction of the victims; we are also victimizing our children and their children because our health care system has such an inefficient structure that it is bankrupting our entire nation.

Right now our members are meeting up with local chapters, speaking in their communities, canvassing, tabling at public events, writing and engaging their legislators, and knocking on doors to educate people about these future victims. We are not doomed to ignorance or shortsightedness, we can do better. We can fix the sad structure of our health care system if we work together.

Or this mission execution statement:

When people get sick and die because they don’t have health care, they are the victims of a moral crisis in our nation. What most people don’t realize is that these sick people are only a fraction of the victims, we are also victimizing our children and their children because our health care system has such an inefficient structure that it is bankrupting our entire nation.

We are currently lobbying Oregon State Representative Mitch Greenlick, asking him to make modest changes in his proposed Hope Initiative so that we as an organization can support it. If we are successful, we will engage Representative Greenlick, other legislators, and thousands of Oregonians to pass this initiative in Oregon, and lay the foundation for health care reform in Oregon and the nation.

I think the first part is true to the Archimedes Movement, and to Dr. Kitzhabers most recent video “The Unfinished Business of the Baby Boom Generation.” I also think it is necessary to highlight the plight of future generations, because if we only care about offering our current broken system to more people, then it be more logical to just campaign for Senators Barack Obama or Hillary Clinton, both of whom intend to institute universal access to some kind of health care in the US. This frame of caring for future Americans, this perspective is what makes AM very important and very, very unique as a health care reform effort.

The second part is way more up in the air, and will change more as we go along.

Please discuss. Tell us all what you think.

Clinton vs Obama on Healthcare: Expanding Access To A Broken System Does Not Fix The System

Published

Isaac

on February 11, 2008

in civic engagement, health care, politics and stuff in my life

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The New York Times, whose editors endorsed Hillary Clinton for President, recently published an interesting op-ed strongly favoring Clinton’s health care plan over Obama’s. I think the article’s greatest failing is that it seems to imply that Clinton’s plan is affordable. In reality the Obama and Clinton plans, if enacted as proposed, would send us many times deeper into debt than the war in Iraq has. This is because just offering a “national Health Care Plan,” whether publicly or privately owned, is not the same as fixing the problems in our health care system. Providing care for everyone is really important, but expanding access will not address the major issues that make US health care wasteful and ineffective (e.g. focus of funding and research on late stage chronic diseases, misaligned cost incentives for practitioners, poor/non-existent organization of medical teams and information, etc.).

When I began researching presidential candidates, I thought health care would be my top issue, but sadly all of the candidates are being more pragmatic (in terms of getting elected) than visionary on this issue. Obama or Clinton health plans would continue to fund health care by mortgaging the nation, and hoping that my generation will be able to pay it off. The NYT op-ed argues that Clinton’s plan is much more affordable than Obama’s, but the difference is a pittance relative to the total sum we will spend if our current system is forced to accommodate the baby boomer demographic as they age. Both plans would solve the issue of access fairly well. Neither would begin to address the looming financial crisis.

I’m going to base my voting decision on these candidate’s more substantive differences, like fund raising ethics, propensity to bridging dogmatic/party devisions, and the way they inspire ordinary people to do extraordinary things. No current Presidential candidate will create a sound and sustainable health care system, unlesss We demand it of them. However, a certain kind of President is more likely to help us in our work towards a sustainable health system and economy (not accepting money from lobbyists = less beholden to fiscal stakeholders that oppose reform, less partisan = less political gridlock, inspiring average Joe = better for the grass-roots efforts that will be needed to fix health care).

I’m voting for Barack Obama. I think he will move our country in the right direction, even though his platform, as it stands, would not solve our health care financial crisis. The prospect of tens of trillions in unfunded Medicare/Medicaid liability still scares me terribly, so I’m working with the Archimedes Movement instead of pretending that any of the current presidential plans is sufficient. I think Clinton is a stronger candidate than we’ve had in a while (at least since the last Clinton), Obama is a whole lot more exciting, but when it comes to health care, We Can Still Do Better.

CNN easy on repuglican presidential candidates during YouTube debates

Published

Isaac

on December 2, 2007

in civic engagement, health care, politics and stuff in my life

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A few days ago I watched the CNN YouTube debate with the major Republican presidential candidates from a hotel room in Havana. The format of the YouTube debates revolves around short video questions which are submitted by citizens and selected by CNN to be discussed by the candidates. CNN claims this new approach harnesses technology to enable unprecedented popular participation in the debates.

I think that position is a little less tenable after seeing the questions that CNN selected. Although Health Care is a top domestic issue for Democrats, Republicans, and Independents, not a single question regarding health care was posed to the candidates. CNN found questions such as “What does the confederate flag mean to you?” relevant, but chose to ignore all 40 video submissions regarding health care.

Joe Brewer of the the Rockridge Institute wrote a short piece about this on the Huffington post. He quotes the health care diarist nyceve at Daily Kos as saying:

I waited.

And waited.

And kept waiting.

But a single question about the plight of 47 million uninsured Americans, or the rest of us who have to wage an unending true holy war against the for-profit insurance industry, just didn’t make the CNN cut.

This is the vacuum the Archimedes Movement needs to fill. Major “unbiased” media outlets allow Republicans to avoid discussing the topic at all. In the process, they grant a perception of legitimacy to Democratic candidates who are really only discussing narrow aspects of health care finance, without looking at the system as a whole. Presidential elections are important, they are so important. There is also a lot of valuable information to be had from CNN and similar outlets. We should remember though that the real debates happen here, via word of mouth and other mediums controlled by people who aren’t just looking for a profit, because we can do it better than they can.

Using public health care to realign incentives for the private sector

Published

Isaac

on November 28, 2007

in health care, politics and stuff in my life

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Over at the Archimedes Movement’s blog, a few of us have been sharing stories and talking about the failings and the future of health insurance in the US. Many people have flat out said that insurance needs to go. I recently posted about insurance generally, what it’s good for, and how we can improve it.

I think the the pertinent idea behind insurance is pooled resources to protect against a shared risk. In that sense, I think the government, which we all pay for and which protects us all (or should) is a kind of insurance. Considering how often I feel it fails us, I like having a government really well!

What we need to consider changing is the private management of health insurance. A lot of people think private ownership, and the competition that can result, is necessary to bring down costs, which is an interesting myth because in reality private ownership of health care has made costs skyrocket. Here’s why. When private companies compete, they don’t actually compete to lower costs, they compete to increase profits. In some cases companies compete to increase value, which includes developing a better product and lowering costs to attract more customers, and thereby more profits (profits are still the only real goal here). HMO’s and Private Health insurers haven’t been doing this.

Rather than competing to increase value, the standard has been to sign up as many paying customers as possible, and then hire fancy lawyers to convince as many as possible that they don’t actually deserve what they payed for. The profit incentive is no longer aligned with the better product incentive - more refused care = more profit when you’re just competing to trick the customer. Why has everyone been getting away with tricking the customer?

If every ipod you purchased broke after 3 days, you would teach Apple a lesson by buying a different brand. If all mp3 players of all kinds broke right when you needed them most, everyone would teach the whole industry a lesson by not buying any more mp3 players until producers realized they needed to start competing for value again. The problem in health care is that we can’t decide to stop purchasing health care because it’s not a luxury, it’s a necessity.

So how do we get private companies to start competing for value again? I’ve heard the book Redefining Health Care has some good ideas, though I haven’t read it myself. In my opinion, we use public money, which we already have enough of, to provide for health necessities and let the free market optimize everything else. This would give customers the power to resist purchasing from shoddy providers and realign the sector from an economics of exclusion to an economics of value and price optimization. The basic care must always be sufficient that people feel empowered to stop purchasing from private companies if every single HMO and private insurer in town is just waiting to rip them off.

isaac holeman