Non-Profit of the Month: December 2010 - Orthopaedic Hospital

Who is responsible for helping the helpless?

We are ... those of us who can help.

I wonder how many hospitals were built on that simple idea?

One such hospital in Los Angeles is the Orthopaedic Hospital.

It was founded in 1911. Below is an excerpt from their story:

Orthopaedic Hospital was founded by Charles LeRoy Lowman in 1911, beginning as a clinic for children with crippling disorders. Ever since, it has provided this care regardless of the family's financial circumstances. To support this mission, the Los Angeles Orthopaedic Hospital Foundation was established in 1917. Following that, in 1922 the first hospital completed construction. It was replaced by the second in 1959, and today the third is under construction. This new state-of-the-art facility is a cooperative effort with the University of California, Los Angeles (UCLA), as part of a Master Strategic Alliance to create the Santa Monica-UCLA Medical Center and Orthopaedic Hospital. Combined with the new Orthopaedic Hospital Outpatient Medical Center on our downtown Los Angeles campus and the Orthopaedic Hospital Research Center on the UCLA Westwood campus, these facilities have the capacity to lead advancements in musculoskeletal patient care, research, and education world-wide.

I wonder what would happen if more Americans with the same kind of vision as Charles LeRoy Lowman stepped up and got strong community support?

Would we need Washington DC to "reform" health care?

Please look around your community and see if there is a hospital or clinic or organization that helps provide health care to people in need and find a way to support their efforts!

Happy New Years and all the best in 2011!

Devotional Thoughts: Jesus is the Christ

Christmas is about Jesus born into this world to be the Christ.

The full meaning of that is far more than words can tell. But words are all we have!

You might wonder, what did the earliest believers believe about Jesus?

Below is perhaps one of the more notable statement of who Jesus was and is:

Who, being in very nature God,
did not consider equality with God something to be used to his own advantage;
rather, he made himself nothing
by taking the very nature of a servant,
being made in human likeness.
And being found in appearance as a man,
he humbled himself
by becoming obedient to death -
even death on a cross!
Therefore God exalted him to the highest place
and gave him the name that is above every name,
that at the name of Jesus every knee should bow,
in heaven and on earth and under the earth,
and every tongue acknowledge that Jesus Christ is Lord,
to the glory of God the Father.

For us in the USA, it is easy to forget. We get busy with shopping, office parties and family gatherings. All of those things are good. However, amidst the hub-bub, let's remember who Jesus was and is. If you already acknowledge that Jesus is the Christ and the Lord, be sure to spend some time in humble adoration of the grace, love and fellowship made possible by Jesus. And if you haven't trusted in Jesus, please give it some consideration. Don't allow people who dismiss this simple ancient faith to sway you. Think it through for yourself. Talk to someone who follows Jesus. Visit a church that takes Jesus' seriously.

G.F. Handel's Messiah, track 53
Worthy is the Lamb that was slain to receive power, and riches, and wisdom, and strength, and honour, and glory, and blessing.
Blessing, and honour, glory and power, be unto Him that sitteth upon the throne, and unto the Lamb for ever and ever.
Amen.

Merry Christmas where ever you are and have a great 2011!

Devotional Thoughts: The Messiah's Mission - take away the sins of the world

The next day John saw Jesus coming toward him and said, “Look, the Lamb of God, who takes away the sin of the world! This is the one I meant when I said, ‘A man who comes after me has surpassed me because he was before me.’ I myself did not know him, but the reason I came baptizing with water was that he might be revealed to Israel.”

Then John gave this testimony: “I saw the Spirit come down from heaven as a dove and remain on him. And I myself did not know him, but the one who sent me to baptize with water told me, ‘The man on whom you see the Spirit come down and remain is the one who will baptize with the Holy Spirit.’ I have seen and I testify that this is God’s Chosen One.”

John the Baptist is described here. When he was in the womb, John "knew" there was something special about Jesus because when Mary, pregnant with Jesus visited Elizabeth, mother of John ... as soon as the sound of your (Mary) greeting reached my (Elizabeth) ears, the baby (John) in my womb leaped for joy.

However, in the intervening years, did John have his doubts?

After all, perhaps he encountered Jesus occasionally while growing up since their moms knew each other and he would have seen what probably was a fairly ordinary Jewish kid.

But then one day, Jesus came to John to receive baptism.

Then Jesus came from Galilee to the Jordan to be baptized by John. But John tried to deter him, saying, “I need to be baptized by you, and do you come to me?” Jesus replied, “Let it be so now; it is proper for us to do this to fulfill all righteousness.” Then John consented. As soon as Jesus was baptized, he went up out of the water. At that moment heaven was opened, and he saw the Spirit of God descending like a dove and alighting on him. And a voice from heaven said, “This is my Son, whom I love; with him I am well pleased.”

Upon seeing this sign from God, John knew once again, there was indeed something special about Jesus.

G.F. Handel's Messiah, track 22
Behold the Lamb of God, that taketh away the sins of the world.

Merry Christmas where ever you are reading this blog from!

Devotional Thoughts: Waiting for the Messiah

Mary, Joseph and Jesus came to the Temple ...

There was also a prophet, Anna, the daughter of Penuel, of the tribe of Asher. She was very old; she had lived with her husband seven years after her marriage, and then was a widow until she was eighty-four. She never left the temple but worshiped night and day, fasting and praying. Coming up to them at that very moment, she gave thanks to God and spoke about the child to all who were looking forward to the redemption of Jerusalem.

Let's do the math: if she married as a teenager of say 16 which would have been common in that culture, then had 7 years with her husband; thus, she became a widow at 23. If she was 84 when she met Jesus, then she had been a widow of 61 years!

And now, whom she had waited to see arrived!!

One wonders what she said when she "spoke about the child to all?"

Simeon had spoken moments earlier to whom to most eyes would have been a fairly mundane mom and dad with their son,

Sovereign Lord, as you have promised,
you may now dismiss your servant in peace.
For my eyes have seen your salvation,
which you have prepared in the sight of all nations:
a light for revelation to the Gentiles,
and the glory of your people Israel.

This child is destined to cause the falling and rising of many in Israel, and to be a sign that will be spoken against, so that the thoughts of many hearts will be revealed. And a sword will pierce your own soul too.

Perhaps Anna reiterated what Simeon said. Perhaps she explained further what Simeon meant. In any case, she could not be stopped nor contained as she spoke/preached/proclaimed "to all who were looking forward to the redemption of Jerusalem!"

G.F. Handel's Messiah, track 9
O thou that tellest good tidings to Zion, get thee up into the high mountain; O thou that tellest good tidings to Jerusalem, lift up thy voice with strength; lift it up, and be not afraid; say unto the cities of Judah, Behold your God!

Arise, shine; for thy light is come, and the glory of the Lord is risen upon thee.

Merry Christmas to you wherever you have mouse clicked from!

Devotional Thoughts: The Jesus Prayer

In the Eastern Orthodox Christian tradition, there is a practice known as the Jesus Prayer.

I've heard that it can be as short as:

Lord, have mercy.

And as "long" as:

Lord Jesus Christ, Son of the Living God, have mercy upon me, a sinner.

For classical music lovers, we hear the same thought in portions of liturgical music in the Kyrie. Here is an example in Gregorian Chant.

For a discussion of the history and practice of the Jesus Prayer, check out Frederica Mathewes-Green's essay on the topic.

I've taken to using the prayer at various times during a typical day.

Green put its benefit this way: Mostly, it gets rid of the clutter.

I definitely have my share of "squirrel moments" during a typical day!



And so the prayer helps me get settled.

More thoughts from Green ...

I think it is wise that the Prayer asks for mercy, to remind us of the necessity of humility, rather than the narcissism that can accompany the self-designation “spiritual.” So the Jesus Prayer is not an end in itself, but a way of training the mind to remain always in his presence, no matter what else life brings.

Lord Jesus Christ, Son of the Living God, have mercy upon me, a sinner.

Life: Living donations are not without risk - surgery is never without risk

Interesting item at CNN.com about living donation of organs.

In some cases organs come from those who died who indicated a willingness to be a donor. In some cases the organ comes from a living person who is compatible to the recipient.

It should be said that transplanting a part of a liver is probably a bigger challenge than transplanting other organs. However, the reality is that in any organ transplant it is surgery and surgery is NEVER without risk. Of course, in the case of Laura Fritz, the donation saved the life of her mother but resulted in Laura nearly dying due to complications of the surgery.

6 years ago I had emergency surgery for a small bowel obstruction (SBO). The risk benefit calculation was that if nothing was done, the SBO could get worse and lead to the type of infection described in the CNN.com piece about Laura Fritz. By all accounts my surgery was uneventful.

However, since that surgery, I have been hospitalized three additional times for SBO. Fortunately, those episodes resolved without surgery. In a turn of medical irony, one side-effect of the surgical treatment for SBO is increased risk for future SBO.

My hat is off to those who willingly undergo surgery to donate an organ to someone. Having gone through surgery on an emergency basis, I'm not so sure I'd be willing to do so on a voluntary basis. I suppose knowing I might be saving the life of someone else would make the risk and pain worth it. I'd like to believe that is how I'd see it.

Economics: In defense of the drug companies

Who discovers the medicines that save people's lives?

Drug companies who hire armies of scientists who work their butts off to find something that works.



Medical innovation is hard work.

Life: Are we beginning to forget 9/11?

It is beginning to seem like ancient history in our 24/7 cyberspace linked fast paced world.

But it was only 9 years ago that 9/11 occurred.

The US held a day of prayer and remembrance after the attacks of 9/11. On that day, these words echoed in the National Cathedral and went out to all who watched and heard:

We are here in the middle hour of our grief. So many have suffered so great a loss, and today we express our nation's sorrow. We come before God to pray for the missing and the dead, and for those who loved them.
....
God's signs are not always the ones we look for. We learn in tragedy that His purposes are not always our own, yet the prayers of private suffering, whether in our homes or in this great cathedral are known and heard and understood. There are prayers that help us last through the day or endure the night. There are prayers of friends and strangers that give us strength for the journey, and there are prayers that yield our will to a Will greater than our own.

This world He created is of moral design. Grief and tragedy and hatred are only for a time. Goodness, remembrance and love have no end, and the Lord of life holds all who die and all who mourn.
....

Politics: One of the new voices of the GOP

Rep.-Elect Kristi Noem (R-SD) speaks on the priorities of the incoming House Republicans.

World: Terrorism in Stockholm

Not all bombings are performed by extreme Islamic individuals but many are.

Thus, eventually, the news reports confirmed such was likely the case in the bombing in a Stockholm shopping district this weekend.

Some people say that terrorism is driven by poverty. In some cases that is probably so. But time and again, we find out that the individuals often had what would be considered "normal lives" but turn out to be driven by extreme ideas.

The Telegraph of UK has a profile on the Stockholm suicide bomber. Excerpt:

It emerged last night that Abdulwahab, who was due to turn 29 yesterday, is a former physical therapy student at Bedfordshire University in Luton, and that his wife and three young children still live in the town.
.....
Tahir Hussain, 33, a taxi driver who lives nearby, said: “I used to see him around often. He didn’t say much but seemed nice. I used to see him walking with his kids.

“I was shocked when I heard what happened because I never thought he could do such a thing.”

Mr Hussain said that the couple had been living there for a year and that Abdulwahab used to go to Friday prayers at the Islamic Centre in Luton.

The BBC has an item on Taimour Abdulwahab al-Abdaly.
Excerpt:

"He had a bomb belt on him, he had a backpack with a bomb and he was carrying an object that has been compared to a pressure cooker. If it had all blown up at the same time, it would have been very powerful," he said.

A car containing gas canisters blew up first in a busy shopping street in the area of Drottninggatan at 1700 local time (1600 GMT) followed minutes later by a explosion in a street about 300m (985ft) away that killed the bomber.

Abdaly was named as the registered owner of the car.
......
Mr Lindstrand said Abdaly was completely unknown to Swedish security services before the blasts.

However, he pointed out: "He didn't live in Sweden; he lived in the UK. He left Sweden maybe 10 years ago."

The UK Guardian reported that the bomber clashed with some of the leaders of the Mosque he was attending.

Qadeer Baksh, chairman of Luton Islamic centre, said Abdaly showed up at the mosque during Ramadan in 2006 or 2007 and made an instant impression with his "very bubbly character" but they soon clashed over his views.

"We were challenging his philosophical attitude to jihad," said Baksh. "He got so angry that he left. He was just supporting and propagating these incorrect foundations [of Islam], so I stepped in."

He said Abdaly believed scholars of Islam were "in the pocket of the government" and proposed a "physical jihad".

Baksh said he thought he had talked Abdaly round to a more moderate position but the Iraqi-born Swede then came back with more arguments. "I had no idea it would escalate to where it escalated," said Abdaly. "I thought that when he stormed off he was just angry at me. I heard afterwards that he was criticising the mosque in general and me in particular at the university. He said we were working for the British government and that we were in the pocket of Saudi Arabia. He was trying to defame our honour."

Despite the clashes, Baksh said it was not for him to report Abdaly to the police or security services. "It's the police's job, the intelligence service's job to follow these people up, not ours," he said. "You can't just inform on any Muslim having extreme views. In the past many Muslims have had extreme views but have become good balance Muslims."

I have visited Stockholm on three occasions and on each of those trips, I walked around that shopping district where the bomber struck. And that is what terrorists want to do: to bring fear into day-to-day life and to kill the infidel (unbeliever).

In our interconnected world, it is getting harder and harder to think of the terrorist problem as being "somewhere else." All it takes is a motivated individual to strike. And at the same time, organized terrorists bands plot for dramatic attacks to maximize death and chaos.

They love death as much as we love life so they believe we will cower in fear.

We do love life but we will not cower in fear.

Politics: Tax and Spend - the numbers as percent GDP

Lots of data at usgovernmentspending.com

Here are two charts I generated at their site that shows Federal tax as a percentage of GDP and Federal spending as a percentage of GDP while I have been alive.

As you can see taxes have been around 17.5% of GDP.

As you can see spending has been around 20% of GDP. However, currently, and for the next five year, it is projected to be consistently above 20% while taxes consistently below 20%.

It isn't rocket science: we want more government services than we are willing to pay for with taxes leading to deficits. We have to either cut services or raise taxes or some combination of both.

And so what are the government services?

See the pie chart.

Est for 2011 (total = $3.8 trillion)
Defense $928.5 billion
Health Care $898 billion
Pensions $787.6 billion
Welfare $464.6 billion
Etc...

Its nice to get tough on "earmarks" and "pork projects" but these four areas are where the pots of money are.

We either cut back on them, raise taxes or both.

Defense:
We either decide we aren't going to be the policeman of the world or we raise taxes and start selling war bonds to explicitly link our global security commitments to our pocketbooks.

Health Care:
We either have to ask the senior citizens to pay more in premiums and co-pays in the Medicare program or raise taxes on everyone else to pay for it or both. Ditto for Medicaid. But since Medicaid is for the poor, we really can't ask them to pay more in premiums so we need to raise taxes to help fund it. I do wonder if "voucherizing" the program will make it more efficient?

Pensions:
We have to look at raising the retirement age another year or two. We have to look at lowering the cost-of-living increases going forward and maybe even reduce benefits. We have to look at raising taxes on current workers to sustain the solvency of the fund.

Welfare:
We either have to raise taxes to cover these costs or we cut back on the benefits.

As the saying goes, "there is no free lunch."

A family can't buy steak if they only have a budget for hamburgers.

The Democrats want to tax the rich to pay for these programs but in the end there isn't enough money there to pay for all the programs so we run deficits.

The Republicans talk about cutting budgets and holding the line on taxes but in the end they don't really cut budgets and thus saddle future tax payers with the deficits.

UPDATE:
Reason.com says the magic number is cuts of 3.6% per year which will bring things in line in 10 years. They use a pork tenderloin roast to illustrate.

Politics: Health insurance coverage matrix

One government study put the uninsured at 16 percent of the US population. This USA Today item puts the number at 46.3 million.

From this matrix, there are four groups of people:

Group 1
These people can afford insurance and buy it. It might be a strain on the budget but these people realize it is a good idea to have health insurance and thus try their best to buy it and do so.

Group 2
There are those who can't afford it but want to buy it. They want to be responsible but because of a combination of low income and high insurance premiums they are unable to buy. Some people in this category qualify for Medicaid and thus wind up in Group 1. But some don't qualify for Medicaid and can't afford health insurance.

Group 3
Some people actually earn enough money to buy health insurance but for whatever reason do not buy health insurance.

Group 4
Sadly, there are people who belong to this group who are unable and unwilling to buy health insurance.

Thus, the 46.3 million uninsured fall into one of the three categories of uninsured.

How does one help move people from the three other boxes into box one?

One idea of how to help the folks in the 3 uninsured boxes is to blow up the matrix and have the government run the whole thing. There are two ways the USA can do this:

(1) Nationalize health care providers
Just as the Federal government took over airport security in creating the TSA, the Federal government could directly hire and pay the salaries of health care professionals and run hospitals and clinics. An example of how this works in the USA is the VA medical system for the veterans.

(2) Nationalize health insurance
Under this approach, doctors and hospitals are paid from a government run insurance plan. We have some experience with this approach as Medicare is the USA nationalized health insurance for senior citizens. Also, Medicaid is a variant where Federal and States organize health insurance for the poor.

Thus, in the USA, some aspects of health care delivery and insurance are already nationalized and so some believe the nationalization should be extended so that all health care/health insurance be brought under one system.

However, for now, the question remains what will happen to health care as run by private entities. They are regulated at state and federal levels and the recent health bill expands those regulation.

I don't know how the regulatory climate compares to electrical utilities. One could make the comparison that both are essential services that should be heavily regulated and are. The debate is what degree of regulation.

If one retains private entities in the provision of health care, how does one address the 3 boxes of the matrix of uninsured?

One way is to provide vouchers to those who need help to buy insurance. Food stamps are essentially vouchers to buy food. Why not develop a program for the purchase of health insurance?

Instead of government agencies that run Medicare and Medicaid, why not trim their responsibilities to determining eligibility and issuing vouchers to those who qualify?

Of course to pay for those vouchers, the money committed to Medicare and Medicaid would have to be transferred to the voucher program and additional taxes might still be needed to cover people in group 2.

But what about group 3?

The stick of an insurance mandate may or may not survive legal challenge. But even if the mandates are eventually upheld, how does one enforce them? At what level of monetary fines will someone in group 3 decide to buy insurance? In the end, the uncompensated care provided to group 3 individuals is cost shifted to group 1.

As for group 4, they will remain in the realm of uncompensated charity care no matter what is done and their costs shifted to group 1.

Ultimately, even in a nationalized system, there is "cost shifting" because those who pay higher taxes are subsidizing those who pay less taxes. Thus, in my mind "cost shifting" is something that will always exist no matter what system is devised.

The dream of equal access to high quality health care is nice to strive for but unrealistic. The rich could always find a way to buy better services. Thus, the practical goal should be to design a system that maximizes access to a reasonable level of quality. Alas, the definition of reasonable quality is hotly debated.

Politics: Unintended consequences of new health bill (a.k.a. Obamacare)

One of my friends who is an MD has taken a look at the health bill and points out some problems which I've tried to summarize below.

1. New mandates
Because there are additional requirements placed on health insurance policies being offered, the premiums have risen to pay for those new features. In the recent open enrollment at my work place, most plans showed a rise in monthly costs.

2. Dropped coverage
In some cases (mini-med plans), employers have had to drop coverage because those plans didn't measure up to the new regulations. Many companies have applied for waivers to keep offering these plans and have been granted temporary waivers by HHS. One wonders how many weren't granted waivers? Also, what will happen when the waivers expire?

3. Medical loss ratio
The new regulations require that insurance companies must spend 80-85 percent of their costs on patient care. He thinks this is a bad idea and explained it this way:

This "medical loss ratio" rule is like the government telling restaurant owners that 80 to 85 cents out of every dollar that the consumer pays must go to food that can "actually" be eaten by the consumer. That will, at least in theory, make sure that the restaurant owner will not overpay in his mortgages or spend money on unnecessarily expensive silverware. How much the owner pays the waitress or the electric company is also included in the "operation" side and not in the "food" side of the ratio. The business of serving food is food; hence it is entirely logical that 80-85% of what the consumer pays must go to actual food and not wasted on the "operation" of the business.

The unintended consequence of the "medical loss ratio" is that:
(A) the government decides what constitutes actual care increasing the regulatory power of the government; will explicit wage/price controls be next?
(B) some insurance companies will get out of the health insurance business leaving less choice for the consumer
(C) insurance companies will "overpay" for items that the government calls "actual care" so they can be in compliance with regulators.

Regulating the health insurance industry is a complicated thing. It may be well intentioned that insurance policies be required to cover more things but it costs money to do so and less robust but more affordable plans will get dropped. "Medical loss ratio" is one step removed from wage and price controls which is fools gold for "bending the cost curve."

Faith: Re-telling the Christmas Story

Amidst the busy schedules of our lives and the reality that the story of Christmas has been diluted in our society, it was refreshing to see this video that simply re-tells the Christmas story!

The story teller is Keira, a child who was helped by the work of Union Rescue Mission.

When we think of the Christmas story, we often think of "no place at the inn." But looked at another way, some individuals in the community of Bethlehem provided space (may not have been much but they opened it) for Mary and Joseph so that Jesus could be born. They may not be recorded in the Gospels but that good deed would be recorded by God.

And so please consider supporting Union Rescue Mission or a like-minded organization in your local community that is helping those in need! You would be standing in a long line of people who have helped like those who did in Bethlehem.

UPDATE: Came across this item that discusses the "no place at the inn" feature in most our thoughts of the Nativity. According to Ben Witherington, a Biblical Scholar, a more accurate reading of the story is as follows:

When it came time for Mary to deliver the baby, the Greek of Luke’s text says--- “she wrapped him in cloth and laid him in a corn crib, as there was no room in the guest room”. Yes, you heard me right. Luke does not say there was no room in the inn. Luke has a different Greek word for inn (pandeion) which he trots out in the parable of the Good Samaritan. The word he uses here (kataluma) is the very word he uses to describe the room in which Jesus shared the last supper with his disciples—the guest room of a house.

Archeology of the area shows that houses in Bethlehem and its vicinity often had caves as the back of the house where they would keep their prized ox, or beast of burden, lest it be stolen. The guest room was in the front of the house, the animal shelter in the back, and Joseph and Mary had come too late to get the guest room, so the relatives did the best they could by putting them in the back of the house. Bethlehem was indeed a one stoplight town off the beaten track, and we have not a shred of archaeological evidence there ever was a wayfarer's inn in that little village in Jesus' day.

In other words, all this silliness about ‘no room at the Holiday Inn’ for the Holy family, is not at all what Luke is talking about. This is not a story about ‘no room in the inn’ or about the world’s giving Jesus the cold shoulder. It's a story about no inn in the room! It’s a story about a family making do when more relatives than expected suddenly show up on the doorstep. It’s a story most of us can relate to in one way or another. Jesus was born in his relative’s home, in the place where they kept the most precious of their animals. One can well imagine the smell in that room, and probably the shock of the Magi when they saw where the King was born.