Is There a Doctor in the House?

I want to build a hospital with no doctors. Any takers?

Okay, the investors aren't queing up out the door. Yet.

Let's back up a second. We are looking for ways to cut costs in healthcare, right? So we have to keep all options open.

But we aren't supposed to flush quality of care down the toilet. Okay. No problem.

Doctors cost a lot. Why?

Because there aren't many of them and they cost a lot to train. Why?

A few factors. The American Medical Association keeps the number of doctors down like an ol' fashioned guilde from the middle ages. They limit the number of students who get to go to medical schools in toto, and make the process of becoming a doctor long and arduous. Its easy when everyone assumes that every doctor needs to know everything about everything - even though in practice that is not just impractical but with the huge amount of medical knowledge, it is literally impossible, and doctors, just like everybody else, generally know just what they need to know on a daily basis and how to look up the rest of it.

There are a few steps in the process of healing people--diagnosis, treatment, follow up--and each of these can be subdivided again into countless other jobs, each of which requires a precise set of knowledge and skills. Granted, the knee bone is connected to the leg bone, and the body is all connected, does that mean that every medical practitioner needs to be trained for upwards of six years?

You walk into the hospital, or are pulled in on a gurney by those who specialize in emergency responses (EMT's / Paramedics) you are examined by a diagnostician who can identify anything and specializes in medical histories and pathology, but has not be trained to perform procedures. In emergency situations the diagnosticians are "making the call" to an assembled emergency team of technicians. In a hospital visit, the diagnostician triages you and begins a standard file taking all relevant information. Then she builds a treatment plan, or refers you to a particular department (say a cardiac ward) with specialized diagnosticians to build a treatment plan.

Past the diagnastician we find a hospital peopled by proceduralists, nurses, and social workers and their teams. The proceduralists are specialized to know everything they need to know (and how to look up anything they don't) to conduct a handful of procedures. They are trained and certified with a merit badge system on top of a foundational base of extensive anatomy, physiology and basic pathology, from a host of competing institutions of medical studies. Nurses would prep and close surgeries, do diagnostics, and team lead assistants to conduct and monitor convalescence. They would be trained in similar institutions but probably would study for a shorter time and have no procedure merit badges. Social workers are the administrators, customer service, and business people of the Hospital. They liaise with hosptal workers on the one hand, and patients and their families on the other. Some social workers would coordinate teams of proceduralists and nurses, monitoring the activities on particular patients. Others would facilitate people coming into the hospital and post-proceduralists would study the hospital's effectivity while advising the future health and care for the patient and the patient's family.

But, "I want to see a doctor!" Why? A doctor doesn't remember very much from medical school anyways, they know three things: 1) what they need to do their job, 2) how to identify what they don't know, and 3) how to look it up. We want to see a doctor because we are just passed from one person to another and everyone just keeps shrugging and saying "I'm not the doctor." However, in a system designed with no doctors, responsibility for care would fall on a team of proceduralists, diagnosticians, nurses, and social workers whose whole job and raison d'etre would be to collaborate to provide individualized care for each patient. Simply by increasing the division of labor, we can cut costs and increase quality of healthcare.

So is there a doctor in the house? Who cares.

I loooove technology, but noooot as much as you. . . Always and forever.

"The means by which we live," taught Martin Luther King Jr. "have outdistanced the ends for which we live" Like so much of MLK's philosophy this perspective was respectfully lifted from Mohandas K. Gandhi's in his essay, "Ends and Means," and, while at first, we might say that the answer to this 'outdistancing' is simplifying our means, and (perhaps) buying a spinnign wheel, but an alternative answer might be to close the gap by increasing the scope and focus of our ends.

The last four hundred years have seen prodigious growth of material technology, fruit from the root and tree of the physical sciences, but we have seen no analogous enhancement, from psychology or religion, to our ends. I will suggest that the philosophy of the current Dali Lama is the successor in the debate of ends and means and offers an unformulated but radically new answer to the spiritual progress of human beings.

It is possible to view Buddhism disrobed of its various cultural and traditional garbs. What emerges is more than a cultural tapestry; at its epistemological heart, buddhism is a science that differes with all other science in one respect--the conclusions are not communicable.
Sciences, what we could call communicable sciences, such as chemistry, physics, biology, astronomy can meaningfully communicate their findings. Although all scientific 'facts' are conditioned, since they fail to be more than just hypothesis that haven't been proven wrong yet, they can still be explained, understood, and applied to technological problems. For instance, the knowledge of the ideal gas law can be applied in the world to make brakes and hydrolics. Moreover, the person who uses those brakes or hydrolics doesn't even need to know the principles at stake to find that technology useful.
The special science that Siddartha Gautama discovered (lower case 'b' - buddhism) produces 'facts' that are also conditioned by hypothesis, and it even yeilds a sort of technology; however, the 'facts,' although they can be put into phrases, the sense of those phrases cannot be apprehended by a listener until that listener discovers the truth of it for themselves, and the technology derived from these scientific facts is only useful to those who understand the priniciples invovled. It is as if you could not make a call on your cell phone until you understood the principles of elector-magnatism, and you could not start your car until you could calculate torque.

His Holiness the Dali lama wouldn't argue that Buddhism is not a religion, nor does he argue the epistemics of the issue. He simply appeals to our common sense and common humanity. And it turns out that 'common sense' and 'common humanity' is just a very limited, unsystematic, and imperfect amount of buddhism that everyone has experienced just from being alive. Practicioners of buddhism use meditation and other experiments as the scientist uses her bench. They observe (all of percpetion, mind, consciousness and materiality), take note (in memory), and come to conclusions which change and are modified as new evidence emerges.
Buddhism the science suits modernity very well. As the division of labor and capital infurstructure enhances individuality increases, and unlike the forcably communitarian ethos of ideologies of the past, buddhism promises each individual their own individually tailored goals and serenity. Just as science has no biases, moral or otherwise, niether does buddhism. And for the practicioner who starts with those biases, their first hurdle in their practice will no doubt be to discover the impermanence of such biases.

Buddhism, in this devested respect is neither psychology, nor a religion, but a separate branch of knowledge whose nearest of kin is modern science, and its technology promises to close the 'outdistancing' of modernity between ends and means. The next step is to do the philological legwork necessary to create as complete a cannon of buddhist experiments and increase the acceptance of secular buddhism as a new branch of knowledge.

Mackey is Wackey!

I don't know which is used more the word 'right' or duct tape.

When wire taps and net neutrality were the order of the day, it was the 'right to privacy.'
Now, when healthcare overhaul balloons over the horizon like a Zepplin, we hear about the 'right' to healthcare.

In a controvertial and probably unprofitable move the other day, John Mackey, CEO of Wholefoods alienated a huge contigent of his clientelle's political sensibilities when he denied that healthcare was a right in an op-ed for the WallStreet Journal. His argument is that this 'right' cannot be found in the Declaration of Independence or the Constitution. His reasoning is flawed, as is the reasoning of his opponents who employ the word on their side.

A right is like the 'right of way.' What would happen if no other human being got in your way? What would you do? If no one got in your way, you would go on through the intersection. In the minds of creators of limited government and a free society, Rousseau, Locke, Hobbes, Jefferson, Jay, and Washington, a right is what a human being does if no other human being gets in there way. For instance, we all will breath, we all will move around at our will. Hence the rights of life and free movement.

The sad truth is niether privacy nor healthcare are a right, and the word is employeed in their favor incorrectly and ends up destroying a concept central in all philosophies of freedom and justice.

What we do not, or cannot do on our own is either called a privaledge or a service. Healthcare, Mackey rightly concludes (but wrongly argues) is not a right, but a service that ethically ought to be provided to all. Privacy is an example of a privaledge that ethically ought to be assured to all. Services are best provided by unhindered, transparent, and fair human cooperation. Privaledges can only be assured by good government--that is laws, police, and judges who work to stop people and instituitions from troubling each other. The fourth amendment to the constitution, against unlawful searches and seizures (by government) of people's papers and effects, is a wonderful example of assuring the privaledge of privacy, but it only serves to protect against government's invasion of citizen's privacy.

Ron Paul is going to do it!

Buy Ron Paul's New BOOK! End The FED.

The FED is the central bank of the US, just like the central bank of Europe or China. The economy of the most advanced nations are changing, and the central banks are holding the advance ment of an egalitarian, super creative, even spiritually enlightened society in the dark ages of big dumb cooperations, big dumb government, and consumerism (which is in itself big and dumb).

For those of you who are not American: this revolution effects all of us. Central banks used to be the way to develope a modern economy out of a rural one, but now that that development has run its course in modern countries, these institutions work only to centralize power and money in the hands of a banking elite that run big business and big government.

Ron Paul ran for president against John McCain, and had he won there he would have faced off against Obama. He is a Republican, but a very unique one who follows in the traditions of Goldwater and Senator Taft. He believes that the constitution of the US should be obeyed. Presently it is violated in many, many ways by the government that pretends to gain its legitimacy by it.

Viva la Revolucion!

And In The Darkness Bind Them

Q: What are the three hottest issues in Washington?

A: Health care, the economy, and global climate change

Let's get a policy solution that can solve them. What's going to happen? Everybody's going to get a little thinner, along with the wallets of some cooperate agro-businessmen. Who wins? the globe, sick people, small to medium sized family farmers. . . everybody.

On June 27th of 2009 the journal Health Affairs collaborated with a leading nutrition expert at the Center for Disease Control and Prevention to publish and estimate of the social healthcare costs of obesity. Here are the numbers. with more than a quarter of Americans obese, the treatment of the health complications and illnesses associated with obesity cost a whopping $147 billion a year in medical expenses, nearly double what it did in 1998, and about 10 percent of the nation's medical spending.

Do people need to eat less and more healthily and exercise more. Yes. However, before we reduce obesity to a purely individual moral problem, we have to face facts. The diet of our society has been constrained and mutated by federal government interventions in agricultural production causing market distortions that have caused social double-chin. Subsidies for producers and tariffs on lower priced international foods keep a few rich agro-businessmen and their lobbiests in business and the rest of us counting calories and paying the price. Simply put, it is hard to become healthy because healthy food is expensive and high calorie, low nutrient food is cheap.

The economy is contracting and where do people feel it the most: at the grocery store. When you get sacked and your grocery's for the week for your family cost 200 bucks, it doesn't feel good. When prices first spiked at the store, pundits blamed federal ethanol production subsidies for straining the food suppy, and hence raising prices. But there are bigger forces at play than this and over a longer time frame.

Agriculutral subsides were introduced during the great depression as sort of bail out for farmers. In 1935, the number of farms in the United States peaked at 6.8 million as the population edged over 127 million citizens. The majority of these being family farms, meaning about 6-12 people per farm, that is about 45 million of the 127 million citizens. The New Deal introduced agricultural subsides as a way to bail out mainstreet. However, now we live in a world where less than 1% of people claim farming as an occupation, 2.3% of the biggest farms account for more than 50% of sales in agricultural products (USDA, 1997 Census of Agriculture data), medium-sales ($100,000-$249,999) and large-scale farms received 78 percent of commodity-related government payments in 2004, and most farms—61 percent in 2004—receive no government payments and are only indirectly constrained and influenced by these price distorting projects. Most 'farms' are owned as a lifestyle with other sources of income. Most 'farmers' are either in retirement 14.1% of farms, or live on farms as a residence and lifestyle 40.4%. Agricultural subsides are actually hurting real Rockwell family farmers by making their large competitors so much more economically viable. In essence, these subsides and the price distortions caused by tariffs are just being pocketed by the largest farm companies.

Note that the largest cooperate farms are generally held in trust by families, and therefore live under the sentimental mantel of 'family farmers' which is purposefully perpetuated by populist politicians, the media, and even the US census bureau.

But without tariffs we would be overrun with the imported cheaper food of other countries. Wait, THAT'S AWESOME! The US would still produce food, but we would buy a lot more food from other nations because its cheaper and just as delicious or more delicious (have you ever had a Spanish tomato, or Thai basil?). In return, foreign national traders would be stuck with the dollars we gave them for the food and would be happy to buy our exports with those dollars. In the end, we, who are better at designing micro chips, computers and financial services and not very good at making corn, can buy our corn from them and they can buy our microchips, computers, and financial services. Both the poorer communities in agricultural economies, and richer communities in sophisticated information/design economys become wealthier. All this amounts to a real bottom up (rather than top down federal fiscal or monetary) economic stimulus plan. I seem to recall a much talked about presidential campaign that promised that bottom up thing. . . hmmmm.

Lastly, although everybody talks about cars when they talk about global climate change, and a few smarter people talk about building efficiency and healthy urbanism, in fact the IPCC also states that from 1850 to 1998, about 136 (+ 55) Gt carbon has been emitted as a result of land-use change, predominantly from forest ecosystems. For comparison, 270 (+ 30) Gt carbon has been emitted as carbon dioxide into the atmosphere from fossil fuel burning and cement production (Bierregaard, Richard; Claude Gascon, Thomas E. Lovejoy, and Rita Mesquita (eds.) (2001). Lessons from Amazonia: The Ecology and Conservation of a Fragmented Forest.). If you break down burning fossil fuels into its constituent parts like cars, planes, electricity production, and then separate cement production, the percentage biggest contributor of CO2 to the atmosphere since the industrial revolution is land use changes. The biggest contributor in the biggest category? Agriculture. It turns out a swamp or a forest holds down a whole hell of a lot of CO2, and a corn field that is regularly harvested and replanted, almost none.

So, get rid of the tariffs and subsidies and what do we get? Cheaper, higher nutrient food, freer farmers, more prosperous small and local farms, a huge decentralized market driven plan to create millions of CO2 sinks called forests, swamps, bogs, and marshes, and a bottom up economic stimulus plan. Nobody but a few agro-business men and the purse of the federal government get hurt, and these two have been hurting the rest of us for long enough.