4 posts tagged “reform”
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
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:
Obama and the AMA
"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.
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.
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.
During the campaign, two words were pushed into the public lexicon: change and maverick. During the campaign, they were both used to convey the same thing to the public. They were meant to imply that the respective candidate wasn't part of the status quo in Washington and because of that, they were able to bring forth the changes needed on Capital Hill to connect with the American public.
I don't believe that John McCain had it in him to vehemently pursue reform to the system. Even if he did, I don't think that he would have been able to accomplish them. I believe Obama had more resolve to actually attempt and push forward his reforms. His is a strange case...actually, now that I think about it, it really isn't...his approval rating is sky high and he is a media darling. Naturally, this means that almost anyone and everyone wants to attach themselves to the Obama gravy train.
This phenomenon actually works to benefit the American people (and Obama) for a change. Whatever it is that he wants to push through the system, he is recieving little resistance. Of course, I view this as beneficial only because I happen to agree with the majority of his policies.
Washington has been run by lobbyists for over 40 years. Whether it has been a religious group, Detroit, the military, energy companies, or teachers unions, etc. the need for change was obvious to any clear thinking American. For better or worse, (can it get worse? ...really?) it would appear that Obama is bringing that change with him. His recent statement about reclaiming Washington actually made me feel proud to be an American.
"The system we have now might work for the powerful and well-connected interests that have run Washington for far too long," Obama said in his weekly radio and video address. "But I don't. I work for the American people."
[snip]
"I know these steps won't sit well with the special interests and lobbyists who are invested in the old way of doing business, and I know they're gearing up for a fight," Obama said, using tough-guy language reminiscent of his predecessor, George W. Bush. "My message to them is this: So am I."
http://www.huffingtonpost.com/2009/02/28/obama-to-lobbyists-bring_n_170724.html
The best part is that lobbyist groups can't openly oppose him for fear of running head on with his popularity. It is this popularity that will allow him to get things done in Washington.
The Josephson Institute's Center for Youth Ethics released a survey saying that today's kids are becoming completely unethical in every way. Fully 40 percent thought that you cannot succeed in the U.S.A. without lying, cheating, or stealing. I think this number is a little high, but I can see how many kids could feel that way, when they look around and see so many successful people who are found out to be dishonest.
The problem stems in part from the lack of controls in an increasingly laissez-faire business environment, where monopolistic and anti-consumer methodologies are encouraged. But it may be more complicated than that.
Here are some highlights from the press release announcing the results.
"STEALING. In bad news for business, more than one in three boys (35 percent) and one-fourth of the girls (26 percent) — a total of 30 percent overall — admitted stealing from a store within the past year. In 2006 the overall theft rate was 28 percent (32 percent males, 23 percent females)."
"Students who attend private secular and religious schools were less likely to steal, but still the theft rate among non-religious independent school students was more than one in five (21 percent) while 19 percent who attend religious schools also admitted stealing something from a store in the past year…."
"CHEATING. Cheating in school continues to be rampant, and it's getting worse. A substantial majority (64 percent) cheated on a test during the past year (38 percent did so two or more times), up from 60 percent and 35 percent in 2006. There were no gender differences on the issue of cheating on exams. Students attending non-religious independent schools reported the lowest cheating rate (47 percent) while 63 percent of students from religious schools cheated…"
"Responses about cheating show some geographic disparity: Seventy percent of the students residing in the southeastern U.S. admitted to cheating, compared to 64 percent in the west, 63 percent in the northeast, and 59 percent in the midwest. More than one in three (36 percent) said they used the Internet to plagiarize an assignment. In 2006 the figure was 33 percent."
"IT'S WORSE THAN IT APPEARS. As bad as these numbers are, it appears they understate the level of dishonesty exhibited by America's youth. More than one in four (26 percent) confessed they lied on at least one or two questions on the survey. Experts agree that dishonesty on surveys usually is an attempt to conceal misconduct. Despite these high levels of dishonesty, these same kids have a high self-image when it comes to ethics. A whopping 93 percent said they were satisfied with their personal ethics and character."
These are the kids that will be working for us in the years ahead—a charming group of reprobates already. And the fact that they think they are angels is the icing on the cake. I would personally like to thank the self-esteem movement for that little attitudinal gem.
Now, in defense of this next generation, perhaps ethics have changed. Should we redefine "cheating," for example? Stealing from a store is a bad sign of things to come, that's for sure. But when it comes to cheating on a test or lifting things from the Internet, I've never been convinced that this has been approached correctly.
For one thing, the days of the closed-book test should have ended years ago. In today's world you don't get anywhere by memorizing the birthdates of Abe Lincoln or Christopher Columbus. It proves nothing to know this information. And most of the information that kids have traditionally scribbled on their hands or now text message about is actually trivia.
For most subjects outside of math or physics, it would be hard to cheat if tests were properly designed and more thoughtful.
Now here's the kicker: I argue that given the way things are designed within the school systems today (and this has been the case for decades), cheating is encouraged. In fact, in some instances, cheating is demanded. Furthermore, what's the typical punishment? A slap on the wrist and the subtle message, "if you're going to cheat, don't get caught!"
In fact, children in school are trained to cheat better and better over time. Want to stop cheating in classroom testing? Put the kids in a supervised room of cubicles where they cannot see each other—and put a cell-phone jammer in the room. There would be no cheating. If there were any concern whatsoever about rampant cheating (as there should be), then every school in the country would have one of these rooms for testing.
Plagiarism is also being handled incorrectly. The Internet should be a tool for helping students write papers. Children should be encouraged to rip text from sources and put it into their papers. But it should all be accounted for with simple citations. Lift whatever you want and tell the teacher where it came from, then comment on it—just as a blog post would. I'd even encourage kids to buy term papers online and add them to their own papers, with a critique of the bought item. "In this paper, which is sold on the Internet to students for $2, the author claims that the war was planned in secret. This contradicts the account cited in Wikipedia…." Or whatever.
This type of thoughtful and detailed exercise of public documents would get an "F" in today's school system, when in fact the student will have learned more from the exercise than he would have from trying to synthesize a textbook and two lectures on the topic.
And let's take modern education to the next level. Why are today's students forced to perform with 19th-century methodologies? Why do they have to write essays at all? Why can't they produce a PowerPoint presentation? Or create a video? Or a podcast?
When some student actually produces a multimedia report, she ends up on the 6 o'clock news as some sort of interesting freak. The teachers never know what to make of the presentation, and it's back to writing thoughtful essays that are seldom thoughtful and rarely worth reading.
The result is cheating, and this in itself may be fostering the other behaviors.
The point I want to get back to is that this sort of survey, which indicates that increasingly devious legions of students are being unleashed on the business world, needs to be taken a step further. We need to find out exactly how kids who lie, cheat, and steal come to the conclusion that this is all good, and find out why they are happy with their ethical profile.
There's something wrong with this picture, and I for one would like to know what it is.
John Dvorak hits the nail on the head. The self-esteem movement is extremely detrimental to our kids. And ultimately ourselves.
