La Crosse, Wisconsin: the town that is willing to talk about death

Excellent story by NPR. It's a long way from the Republican scare stories about "death panels":

People in La Crosse, Wisconsin are used to talking about death. In fact, 96 percent of people who die in this small, Midwestern city have specific directions laid out for when they pass. That number is astounding. Nationwide, it's more like 50 percent. In today's episode, we'll take you to a place where dying has become acceptable dinner conversation for teenagers and senior citizens alike. A place that also happens to have the lowest healthcare spending of any region in the country.
This piece reminds me that one of the main problems with the United States is that we cannot have meaningful conversations. This is refreshingly different. And important: One-quarter of health care spending occurs in the last year of life.

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Letter from Bernie Sanders

Today I received this mass-emailing from Bernie Sanders. This is as detailed as it is passionate. Sanders sees things more clearly than most politicians, and is one of the few to show a willingness to speak frankly: Thank you so much for the support that, over the years, you have given me. As Vermont's senator and the longest serving Independent in American congressional history I am helping to lead the fight in Congress to protect the middle class and working families of our country against the greed and recklessness of Big Money interests. In that struggle you have been with me step by step, battle after battle - and I appreciate all that you have done. In the midst of the most severe economic and political crisis in the modern history of our country, I am once again writing to ask for your political and financial support. The unprecedented struggle that we're engaged in now against the Billionaire Class is not just about preserving Social Security, Medicare and Medicaid, or whether we create the millions of jobs our economy desperately needs. It's not merely about whether we raise the minimum wage, make college affordable, protect women's rights or take the bold initiatives we need to reverse climate change and save our planet. It's not just about creating a health care system which guarantees health care to all as a right, or addressing the abysmally high rate of childhood poverty. THE STRUGGLE THAT WE'RE ENGAGED IN RIGHT NOW IS MUCH MORE THAN ALL THAT. IT IS WHETHER WE CAN PREVENT THIS COUNTRY FROM MOVING TO AN OLIGARCHIC FORM OF SOCIETY IN WHICH VIRTUALLY ALL ECONOMIC AND POLITICAL POWER RESTS WITH A HANDFUL OF BILLIONAIRES. I know that some of you think I am exaggerating when I say that. I'm not. In my view, there are now three major political forces in this country. The Democratic Party, the Republican Party and the Koch brothers led Billionaire Party. As a result of the disastrous Citizens United Supreme Court ruling which regards corporations as people and allows the super-rich to spend as much as they want on elections, the Billionaire Party (aligned with the Republicans) is now the major political force in the country. [More . . . . ]

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The failure of AA (Alcoholics Anonymous)

What would it seem like if ONLY those who successfully completed a program were featured in the media? What would we think about a school where 85 out of 100 students flunked, but only the graduates showed up to say how good the program was? That is the starting point for Dr. Lance Dodes and Zachary Dodes' article in Salon: "The pseudo-science of Alcoholics Anonymous: There’s a better way to treat addiction."

Rehab owns a special place in the American imagination. Our nation invented the “Cadillac” rehab, manifested in such widely celebrated brand names as Hazelden, Sierra Tucson, and the Betty Ford Center. . . . The fact that they are all extraordinarily expensive is almost beside the point: these rehabs are fighting the good fight, and they deserve every penny we’ve got. Unfortunately, nearly all these programs use an adaptation of the same AA approach that has been shown repeatedly to be highly ineffective. Where they deviate from traditional AA dogma is actually more alarming: many top rehab programs include extra features such as horseback riding, Reiki massage, and “adventure therapy” to help their clients exorcise the demons of addiction. . . . Why do we tolerate this industry? One reason may sound familiar: in rehab, one feels that one is doing something, taking on a life-changing intervention whose exorbitant expense ironically reinforces the impression that epochal changes must be just around the corner.
Who is studying the effectiveness of these programs? Not the programs themselves or, at least, they are not making their data open. That makes these authors suspicious:
Efforts by journalists to solicit data from rehabs have also been met with resistance, making an independent audit of their results almost impossible and leading to the inevitable conclusion that the rest of the programs either don’t study their own outcomes or refuse to publish what they find.
What is the solution? Rather than preach to addicts about a "Higher Power," the authors suggest that they need something far more personally empowering: sophisticated self-awareness."

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A personal perspective on Obamacare

My family just signed up for an extremely expensive "Bronze" policy with Obamacare. It is shameful that there are only two companies "competing" for our dollars in St. Louis (it's worse than shopping for a phone company). It's shameful that none of the policies in the bronze or silver range include Barnes Hospital (St. Louis' premium teaching hospital) in their network. It shameful that even though we are paying $1,000/month for a family of four, that the annual deductible is in the range of $4,300 for indiv and $8,600 for family, with annual out-of-pocket deductible for our family being $12,700. There is no real competition here, and I have yet to see the any reason to believe that the ACA will pressure providers to lower their costs. In America, we pay many times the amount for basic services (e.g., MRI scan) than people in other countries. Our economic side of our hospitals, including "non-profit" hospitals, are a joke, with their executives getting exorbitant salaries while they are on a shopping spree to buy up the local medical practices so that there is no meaningful competition, even your local doctors. I recognize that the ACA forces insurance companies to provide certain minimum coverages and that they can no longer cherry-pick patients based on pre-existing conditions, which was rampant and immoral. The ACA is certainly better than nothing. The most shameful thing of all, however, is that even with the faults of Obamacare, the Republicans want to destroy the modest protection it offers many of us, and the substantial protection it offers low-income families. They propose to replace it with nothing at all. The Republican proposals I have seen would send all of us back to ravages of the dog-eat-dog for-profit health market where cherry-picked customers pay unregulated prices, where premiums have been skyrocketing for decades, where many folks are offered paltry coverage that they have no way of paying for, and where many people are deemed "uninsurable." If politicians can only convince us to keep watching lots of sports events and movies, maybe we will never force them to enact meaningful reform. We need single-payor coverage, like most other civilized countries. For more on the dreadful situation we currently have, check out Stephen Brill's excellent article. I'll end with this somber reality from Brill's article:

The health care industry seems to have the will and means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and healthcare product industries, combined with the organizations representing doctors, hospitals, nursing homes, health services and HMO’s, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

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Orchid Show at Missouri Botanical Garden

I visited the Missouri Botanical Garden today, not knowing that it was the last day of their annual orchid show. After I found this out at 4:30 pm when I was at the entrance to the show. I ended up staying 15 min after closing time--I was the last one out.

IMG_2315 orchids

Looking at the wide variety of orchids reminds me of Charles Darwin, who extensively studied orchids, along with finches and everything else he could get his hands on. Just on aesthetic level, viewing these living beings is phenomenal. Just last night I watched Episode 2 of the new version of Cosmos, a broadside attack on creationists, where Neil deGrasse Tyson commented that many people are unnerved when compared to the other primates. Then he mentioned trees, asking how it felt that we are related to them too. I immediately knew how I felt, because I've written about the fact that trees are my cousins. That idea is a wonderful idea, that we are all one big (capital D) Diverse family. I had that same feeling today looking at the extraordinary variety (and beauty) of orchids. It didn't help things that some of the orchids have what appear to be faces (see the first photo). IMG_2340 orchids   IMG_2274 orchids While I was trying to photograph some of the orchids, a woman asked me, "Do you grow?" I hesitated for a second, to figure out what she was asking, then confessed, "No, I don't grow." She said, "You should. They are surprising easy to grow." For more photos, click the title and then visit the thumbnails on the gallery at the bottom of the post.

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