Jerry’s blog

Well, my good buddy, Steve Jobs, (NOT!  I hate the man...) recently emerged from a liver transplant procedure and he is doing very well all things considered.  While I hate the man with a passion that can't be comprehended by mortals, even I will admit that I am glad that he is doing well.  I know that going through such a thing is hell, its risky, and it can destroy a person.  I know that many people aren't aware of how the organ transplant process works in how it finds and matches donors, so I figured that I would shine some light on this subject.

Livers are a scarce resource. In any given year, only about one-third of the people on the national transplant waiting list receive one, and as of late June, more than 16,000 people were on the list.

Yet it sometimes seems that celebrities in need end up at the front of the line when they need a transplant, and people often assume they get preferential treatment. (Rumors about special treatment circulated after baseball player Mickey Mantle's liver transplant in 1995, for example.)

The truth is more complicated. No one can actually buy an organ in the United States (legally, that is). But getting a liver transplant, it turns out, is a lot like getting into college. Once you're on the waiting list, your chances of getting off it depend largely on your personal circumstances -- how sick you are and whether you are a good donor match. But getting on the list in the first place -- or on more than one list, as the case may be -- requires resources and know-how that most people don't have.

There are 127 centers in the U.S. that perform liver transplants. If you need an organ transplant, your doctor will refer you to one of these centers, where you will be evaluated, given a score based on the severity of illness, and placed on the center's waiting list, if you are indeed a candidate for transplant.

The center's waiting list feeds into a national database managed by the United Network for Organ Sharing (UNOS), a nonprofit organization that contracts with the federal government to manage the nation's organ transplant system.

UNOS works with 58 organ procurement organizations (OPOs) that coordinate organ distribution in their region of the country. When an organ becomes available, the OPO in that region searches the UNOS database for a local match using blood type (and other biological considerations), the patient's severity score, and the time spent on the waiting list. If a match can't be made within that region, the organization expands its search to neighboring regions.

The problem -- or the advantage for some patients -- is that not all OPOs are created equal. Some regions contain nearly 15 times as many people as others, and their waiting list times vary widely. Patients in the smaller OPOs tend to be less sick and experience shorter wait times before getting an organ. In the Tennessee OPO where Jobs received his transplant, the median wait for a liver between 2002 and 2007 was just over four months. The national average was just over a year, and in some OPOs it was more than three years.

Though there is always the possibility of preferential treatment once a patient is on a waiting list -- UNOS conducts periodic audits of transplant centers for exactly this reason -- it is unlikely that someone like Steve Jobs can "cut the line" of the transplant waiting list.

The reason that some people might be able to get transplants more quickly is that they're standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country -- and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) -- a patient can, in theory, be evaluated by all the transplant centers in the country.

"The system works at two levels," explains Arthur Caplan, Ph.D., the chair of the department of medical ethics at the University of Pennsylvania. "One, who gets in to a center. Two, who gets transplanted off a particular center's list when an organ becomes available. Most of the attention goes to stage two, but the biggest ethical challenges are really at stage one."

Since 2003, UNOS has required that transplant centers inform all candidates that they can be evaluated and listed at more than one center, and that they can also transfer their care from one center to another without losing the time they have accrued on the waiting list. However, not everyone can afford to fly around the country and be evaluated at more than one transplant center. In fact, many people can't afford a liver transplant, period.

According to the most recent estimates, the cost of a liver transplant is $519,600 -- a price tag that excludes roughly one-third of Americans because they don't have sufficient insurance (or any insurance), Caplan estimates. According to data collected for UNOS, only about 5 percent of liver transplants are paid for out of pocket.

"What your insurance covers is very different from everyone else's," says Anne Paschke, a spokesperson for UNOS. Some insurance companies won't cover evaluations at multiple transplant centers, Paschke explains, and in at least one case, an insurance company has restricted its coverage to a single transplant center that the company itself owned.

Obviously, the system is flawed and favors those with the means to work the system.  There have been attempts to reform the system, but they have all met their end in Congress.  Politicking has left the larger transplant centers against the smaller ones.  The larger ones wish to maintain the larger pool of available organs in their region, whereas the smaller ones were concerned that in a national organ allocation system, they would receive fewer transplants and be driven out of business.

There is work to be done in this area.  No matter what side you fall on. 
Source: CNN Health
Source: Health.com: The real gift of life: How medical donations help

If the only way we compared the two systems – U.S. versus Canada – was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America’s health care problems…

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada’s taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada’s health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn’t when everybody is covered.
Source: Denver Post

Not so incidentally, single-payer systems run by the U.S. government can approach Canadian efficiency. Medicare and Social Security run at less than 3% overhead.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada’s government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

I am the last person to ever defend Canada on anything.  In fact, for some unknown and unwarranted reason, I hate Canada.  Go ahead and blame South Park if you want, but that isn't the case.  I will be the first to say that the healthcare system is better than what we have in the United States.  It CERTAINLY isn't perfect, but I am saying that it is better than what we currently have.

For some perspective, it's important to understand that I hate the medical industry.  I loathe going to the Dr. unless I am about ready to keel over.  I had an interesting discussion recently with a friend in Thailand (originally from the U.S.) where we discussed this issue rather heatedly.  I came to be of the opinion that unless you have to deal with the medical industry in a serious capacity (ie. some life-saving/changing/etc. surgery), then you can't truly see how broken our system is.  I think that once you have that perspective, you can then toss aside any preconceptions you may have and begin to truly wrap your head around the issues at hand.

Talking about health issues is tough for anyone.  It is especially tough for me, for personal reasons.  I won't espouse about any recent goings-on, but I will lament the experience afterward.  I think that by and large, the medical community has changed from an entity that's purpose was to provide the best possible care to its patients, to a business that is more concerned with maintaining relationships with insurance companies, the government agencies that pay out claims, and the bottom line.  (Jesus, this is horrible.  But it's 3:30 A.M...) 

I am not an idiot, and I am perfectly aware that hospitals have to make a profit.  I am with them on that front.  I contend that the real problem is the insurance industry.  With the advent of medical insurance, costs have risen at a very healthy rate for many, many years.  While I find the entire concept flawed, I will play devil's advocate here for a second.  In theory, you pay an insurance premium every month as protection against some catastrophic illness or accident.  Should such a thing occur, you pay a deductible, and the insurance company pays the remainder.  In practice, it NEVER works this way.  In practice, you pay a premium that rises astronomically if you have ever been very ill/hurt, your deductible is an enormous amount, and the insurance company pays only X% of the costs.  The problem is that if you have to have heart surgery, and the cost of the operation is $225,000 and your deductible is $1000 (if you are lucky), your insurance will likely pay either 70/80% of the cost.  So what does that translate to?  How about $46,000 out of your pocket not accounting for any costs post-op.  I know that there are some people who can afford this, but the reality is that the vast majority of Americans cannot afford such things.  At this point, the person or family is left facing an unpayable medical debt either way.  What is the way out?  Bankruptcy.  Over 60% of U.S bankruptcies are attributable to medical debt.  Ask yourself what the real difference is between a $225,000 debt and a $45,000 one.  It's likely that you wouldn't be able to afford either one.

It gets worse too.  The people whom are all-too-happy to take our money are rather stingy when it comes time to pay out.  Consider the recent discovery that health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.

At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."

The star witness at the hearing was a former public relations executive for major health insurers whose testimony boiled down to this: Don't trust the insurers.

"The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable -- publicly accountable -- health-care option," said Wendell Potter, who until early last year was vice president for corporate communications at the big insurer Cigna.

Potter said he worries "that the industry's charm offensive, which is the most visible part of duplicitous and well-financed PR and lobbying campaigns, may well shape reform in a way that benefits Wall Street far more than average Americans."

Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged, Potter said.

The report released yesterday alleges that insurers have systematically underpaid for out-of-network care. The issue had been brought to light previously in litigation, committee hearings and other investigations, including a probe by New York Attorney General Andrew M. Cuomo. But as politicians and interests groups clash over the current effort to overhaul the nation's health-care system, it took on new relevance.

Cuomo described it last year as "a scheme by health insurers to defraud consumers by manipulating reimbursement rates."

Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said.

Wash Post: Senate Hears of a Raw Deal

This should be the last post of this series, and it is actually the original followup to the primary post.  I came across some shocking information regarding rape and sexual abuse in South Africa.  This hits home for me on several different levels.  I have personal experience with such matters, and someone very dear to me wants to go there soon to help out those in need.  I must admit that it scares me to some degree, but all of that is another story, for another time...

What information did I come across?  Well, according to a study into rape and HIV by the Medical Research Council (MRC), 1 out of 4 men in South Africa have admitted to raping someone.  Let's get some stats out of the way, shall we?

 Three out of four rapists first attacked while still in their teens, the study found. One in 20 men said they had raped a woman or girl in the last year.

Of those surveyed, 28% said they had raped a woman or girl, and 3% said they had raped a man or boy. Almost half who said they had carried out a rape admitted they had done so more than once, with 73% saying they had carried out their first assault before the age of 20.

Any woman raped by a man over the age of 25 has a one in four chance of her attacker being HIV-positive.

One in 10 men said they had been forced to have sex with another man. Many find it difficult to report such attacks to the police in subcultures where the concept of homosexuality is taboo.

A report published by the trade union Solidarity earlier this month said that one child is raped in South Africa every three minutes, with 88% of rapes going unreported. It found that levels of child abuse in South Africa are increasing rapidly.

Source to Study

That should be sobering for anyone.  With such astonishing figures, it is important to understand why.  Professor Rachel Jewkes of the MRC ahd this to say: 

"We have a very, very high prevalence of rape in South Africa. I think it is down to ideas about masculinity based on gender hierarchy and the sexual entitlement of men. It's rooted in an African ideal of manhood."

I must admit that I agree with her. Having spoken with two of my friends who reside there, they confirm that assertion.  I am aware of the lack of scientific merit behind such information, but you can't discount unbiased first hand knowledge.  There are others who feel the same way as well. Dean Peacock, co-director of the Sonke Gender Justice project, said:

"We hear men saying, 'If Jacob Zuma can have many wives, I can have many girlfriends.' The hyper-masculine rhetoric of the Zuma campaign is going to set back our work in challenging the old model of masculinity."

I think that it stems from the cultural belief and thinking that men are superior and held to a different standard.  There is a pervasive belief, practiced by many, with no real fear of punishment, and that inevitably leads to the widespread practice of such behavior.

  The government has been rather complacent as well in its efforts to address the issue.  In South Africa, only 7% of rapes ever lead to a conviction.  In fact, the leader of the country stood trial for the rape of a family friend.  His supporters demonstrated outside the court, verbally attacked his accuser and sang "burn the bitch, burn the bitch". He was eventually acquitted.

So what is the answer?  Honestly, I don't think that there is an easy one.  I think that there are two primary things that need to be addressed.  The leadership needs to take responsibility in making sure that such crimes are punished.  The need for a reform of the justice system, from the top down, is needed.  Without such a reform, you will never change the matter.  The second thing that needs to be addressed is the attitudes of the people.  If you create a real sense that there may be a punishment for such an act, then you have tackled a large part of this issue.  People are much less likely to do something if they know that they may face serious consequences for such behavior.  The old model of masculinity needs to be addressed as well.  This will be a much harder, and time consuming effort, but it is necessary if this behavior is to stop.  People need to be made aware that there are victims in this, that women are equals, and that there are risks involved for both parties such as a sky-high HIV infection rate. 

Given the current leadership, I don't suspect that much progress will be made in this area until new leadership comes to power.  I remain hopeful however, since change needs to come to South Africa (and Africa as a whole) very badly.   

I apologize for not really exploring the effect that economic aid has had in Africa.  So I have done a lot of digging and figured that I would shed some light on the reality of aid in Africa.  Do you remember Dambisa Moyo?  She is the author of Dead Aid (you should read it if you care about this sort of thing-and you should), and a rather intelligent lady.

Moyo, who earned her doctorate at Oxford and has worked for the World Bank and Goldman Sachs Group Inc., focuses her criticisms on low-interest loans and grants from governments and multilateral lenders. Together, these make up more than 50 percent of the national budget in many African states.

“Africa is addicted to aid,” she says. “Like any addict, it needs and depends on its regular fix, finding it hard, if not impossible, to contemplate existence in an aid-less world.”

The West has funneled $1 trillion to Africa over the past 50 years, Moyo notes. Yet more than half of sub-Saharan Africa’s 700 million people live on less than $1 a day, and the poverty rate doubled between 1981 and 2002, she says, citing World Bank figures. Real per-capita income today is lower than in the 1970s.

Cutting off aid won’t affect most Africans, Moyo argues, because they don’t have access to it to begin with; only their governments do. The continent is full of aid-funded roads and schools that stand uncompleted while government leaders ride around in brand-new Mercedes-Benzes, stuff money into foreign bank accounts and travel abroad, sometimes in private jets.

Outright grants and low-interest loans are all too easy to steal, she says. Aid makes African leaders more responsive to Western donors than to their own people and engenders conflict by making government worth fighting over, she adds.
Source

It is my opinion that aid needs to looked at differently.  Rather than being given on the basis of promises of reform, initiatives, and improving the quality of life, I think that it has to doled on based on merit.  The only entity that has been able to display large-scale, consistent progress in regards to relief in Africa has been the Bill & Melinda Gates Foundation.  They look at it like a business, and those with the best plan are awarded the aid.  By tying the aid to something that is tangible, it therefore has real effects.  I think that this is the only way to dole out aid in Africa, otherwise I would have to agree that we are just throwing our money away. 

There is no doubt that Africa is a place in need of a lot of help, in a lot of different areas.  In this post, there are two issues that I want to focus on however, and to a large degree, they are mutually exclusive.

The first of which is that the G-8 countries (G-8) that had pledged to supply $21.5 billion in aid to Africa by 2010 to help the continent get out of poverty and help with healthcare and education.  With less than a year to go, there is a bit of a problem however.  So far, only $7 billion has come through, with the remainder nowhere to be found.  The two largest culprits are Italy and France, but there is more to this than the mere shirking of financial obligations. 

The leaders of the world's countries didn't anticipate the economic maelstrom that swept the globe when they made their pledges.  They were forced to spend billions of dollars bailing out their own economies (which was a contentious move in and of itself-and if you read this, then you know how I feel about it).  The horizon doesn't look much better for anyone's economy either.

"As governments look to cut deficits, they will look to cut all parts of their budgets, and these parts that are to help the poorest may or may not be cut as part of that process," Bill Gates told reporters in London on Thursday after the release of the DATA report. The Bill & Melinda Gates Foundation operates in numerous African countries, and its $27.5 billion endowment makes it a far more significant donor than foreign governments are in some countries.

Why Wealthy Nations Are Stiffing Africa

There is, and has been for some time, a severe problem with aid in Africa.  There is a fierce debate amongst aid and government officials about whether or not money for Africa is even worth it.  There was a best-selling book (a very good one, and I highly recommend it) called Dead Aid written by Zambian economist Dambisa Moyo in which she argues that $1 TRILLION of Western aid during the last 50 years has actually left Africa more poor and dependant.  Her sentiments were echoed by Rwandan President Paul Kagame, who wrote in the Financial Times last month that "as long as poor nations are focused on receiving aid, they will not work to improve their economies." But others have pointed out that carefully directed aid can play a critical role in removing obstacles to economic development. Gates told reporters that projects that focus on agriculture and health are "measurable and very impactful. The money had made a difference."
Source

I think that it is important to note two things not mentioned in this discussion however.  There is overwhelming evidence that many of the African leaders have funneled vast sums of this money into their own personal Swiss bank accounts.  Just as in any country, power corrupts.  I also find it interesting that China isn't mentioned at all.  China has-and does-donate more money to African aid than all of the G-8 countries COMBINED.  Granted, it has one of the better economies currently, but it is a country that certainly has its own issues to deal with as well.  I just find it rather curious that they are left out.  To me, it is an acknowledgement that the G-8 countries are a relic of a bygone era.  Formed with countries that had power and influence during the World War II era, I think that it is antiquated when looked at from a modern viewpoint that recognizes that China is one of the most powerful countries in the world.

Even if they (the leadership) are dicks.  

The problem with Washington is that it is controlled by special interest groups.  They are entrenched in the fabric and operations of this country.  What upsets me about all of this is that it prevents (at worst) - hampers (at best) - any sort of reform to the operations of the government.  A government that is clearly in need of changes to its modus operandi.

The latest example of all of this comes from Obama's recent meeting with the American Medical Association.  He was at the meeting to promote his health care reform initiative.  On one side, there was the AMA, representing 200,000 doctors in America.  They want limits on how much money a patient can sue them for for medical malpractice.  Doctor's pay an exhorbitant amount of money for malpractice insurance, and naturally, they would like that lowered.  Obama wasn't necessarily keen on that idea, and when he expressed such:

"I want to be honest with you. I'm not advocating caps on malpractice awards," the president said, greeted by a smattering of boos, a remarkable public response to a popular president accustomed to cheering audiences.

Obama and the AMA

The group actually booed him.  While I find it remarkable that a group consisting of 0.07% of the population (roughly-considering rough total pop. estimates) can get an audience with the President (groups like that certainly donate heavily...), I must admit that it takes some large cojones to push forward your interests at the expense of those of the populace.  It is this discourse however, that makes this country great.  Understand that I feel that they pay too much for insurance as well.  I feel that the real problem lies with the insurance companies however. 

On the other side, we have the scums of the earth.  I am sorry, I mean trial lawyers.  Though he offered no support for limiting lawsuits, Obama raised the antennae of trial lawyers' groups just by mentioning the issue.  These plagues upon modern societies had issues with anything that may potentially close the vent on their bread and butter.  To be fair, I hate lawyers, so it is impossible for me to be impartial in this.  I can't stand groups that segregate themselves from society, protect themselves, and change the laws of this country in such a way as to force their existence (Christ, have you read something as "simple" as a website terms of service?  Something that should be 3 paragraphs, but is actually 48 pages of fine print!?) 

The Center for Justice and Democracy, which says it advocates for injured consumers, attorneys and others, released a letter to Obama signed by 64 survivors of medical malpractice saying they were "extremely concerned that the rights of medical malpractice patients may be stripped away as part of your national health care proposal."

"The notion that 'defensive medicine' is leading to higher health care costs is not supported by empirical data or academic literature," Les Weisbrod, president of the American Association for Justice, the main lobby for trial lawyers.

Obama and the AMA

I can't stand that reform is being halted (not even reform that I completely agree with, mind you) by special interest groups.  Change needs to happen.  I am not saying that Obama's plan is some cure-all, in fact I most certainly don't think that,- but the bottom line is that something has to be done.  And his something is better than the status quo.  I don't want the same things out of Washington.  Obama instilled a sense that change is on the horizon, in Americans.  I don't want it squandered by the entrenched bureaucracy. 

 

I remember this story, and I remember blogging about it on one of my blogs.  Do you remember that P.O.S teacher Wendy Portillo?  She was the Kindergarten teacher infamous for permitting neurotypical students to vote a boy with a form of Autism out of her class.

In May of 2008, Ms. Portillo led her students in a reality TV-like exercise in which Alex Barton, then 5 years old, was made to stand in front of the class while classmates listed reasons they didn't like him. Classmates called Alex "disgusting" and "annoying," among other things. Then, the class took a vote and by a margin of 14 to 2 chose to exclude Alex from class. He was made to leave the Kindergarten classroom and spent the rest of the day in the school nurse's office.

 

Alex Barton reportedly has not returned to school since the incident. Shortly after Alex was voted out of class, his mother said he was so traumatized that he was unable to even ride past his former elementary school in a car without screaming and begging not to be forced to return to school.
Wendy Portillo Sucks

Well, guess what?  This disgusting, waste of air, and abomination to the teaching profession has been allowed to return to her job.  As someone who has taught young people, I find this sick!  Teaching is a sacred profession in my opinion (and one that is a massive FAIL in the U.S.) and it is people like her, with the help of one of the worst organizations in the U.S (The Teacher's Union), that give teachers and teaching a bad name. 

I am pissed off, and I will be frank:  I would be happy if someone kicked her ass.