Archive | September, 2009

Quick response to Congressman Tim Walz as concerns #hcr

22 Sep

The current legislative proposals, especially the Baucus proposals are aligning with the fears I expressed earlier. To fix this, I propose the following.

1. Age related pricing ratios of 2:1 as proposed in HR3200 may not be viable for an insurance company in combination with all the other factors. However 5:1 as proposed by Baucus, without a govt option, or tight regulation is just a free gift to the insurance industry. Please find a middle ground, If no public option, then 2:1, if there is a public option 5:1 may be acceptable.

2. Please address the issues with medicare.

a. Shifting oncology and cardiac care to prevention is not the way to go, esp with a rapidly aging population who has not had the benefits of preventative care. If taxes need to go up to focus on prevention they do… but do not penalize the elderly over the young.

b. the donut hole is a disaster, and a gift to big pharma. Negotiate this away, with negotiated drug prices based upon volume usage. Ie if more people fall into the donut hole, taxes to the insurance company increase, or they negotiate prices.

c. physician compensation is a joke… it is not right to save money only on the part of the medical provider. Shift the cost savings burden by reducing subsidies to the insurance business, and regulate it such that they cannot pass it on to the customer… just as you do with physician reimbursement. It must be a shared pain thing.

3. Address the costs of healthcare by

a. uniform billing practices, its already in place for medicare, force it on private insurance business. This will reduce costs on the health care administration side, and will have negligible impact on the insurance side, being most already do this for medicare. However, it would seriously impact the ability to play accouting games…and that is a good thing.

b. consumer protection laws that require uniform disclosure of pricing. Healthcare is the only entity that sells you something, and then tells you the price months later.

c. consumer protection laws that require timely reimbursement of charges. The issue of reject and deny adds an incredible burden…. either A,its a valid charge, or B, its not… this can be accomplished via chargebacks to the insurance company. They will change their practices if it costs them money.

Beyond the above, I agree with the major points of the Obama administration. The problem is one of implementation, and a failure to really address the issue of escalating prices. We do need reform, and it may be that we can only get incremental reform… thats ok, as long as it does not set us back to 1940’s medicine in order to prop up the insurance business. Either public option, or much greater regulation. Free for all gifts to the insurance industry is not an option.

Repectfully

Ron Amundson

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If enough people were brought to Christ… #outlawpreachers

20 Sep

 

The Washington Post had a interesting article on the differences between conservatives and progressives. One of the first differences is pretty interesting.

1. “If enough people were brought to Christ, social ills would take care of themselves.”

67% of conservatives agreed, but only 13% of progressives agreed (and 61% of them disagreed).

I’m one of those 61% who disagree…

No way no how would social ills take care of themselves with one caveat. If enough people were brought to Christ, and followed his teachings, social ills would take care of themselves to a much greater extent, and likely with much more dignity than what Caesar could ever offer.

Instead, far too many Christians today

Walk past the injured guy along side the road, may pray for a Samaritan to pass by, or they go whoa, not my problem. They may cry out, Hey Caesar, this dude needs some help.

Tell the hungry guy they might pray for him… and go Hey Caesar, this dude needs some help.

For the thirsty guy, they might pray for him, ignore him, or tell him to be responsible and get something to drink, even if he is too weak to do so.

For the dude without a place to sleep, they call Caesar on him, so he gets awakened by the police, told to move and/or arrested. 

For the dude without clothes, they call Caesar on him, so he gets hauled off to jail for indecent exposure.

For the sick guy in prison, they will say out of sight, out of mind, besides the dude was not responsible being he is in jail. Caesar must care for him.

———————————————————————-

All the while, saying Caesar is not the solution…. well I agree, Caesar is not, but then why do you keep calling on him all the time?

Or they say, helping is enabling, and thus, it is better not to help, because the injured, sick, hungry, naked, or those in prison need to learn a lesson. Where on earth is enabling the injured, the sick, the hungry, the naked, or those in prison mentioned in the Bible? Dont even think of taking 2 Thessalonians 3:10 out of context, nor a isolated prooftext from Proverbs either.

Or they say, I’m too poor to help, because Caesar took my money away… but he didnt take all of it, now did he? Would it be ok, for you and your family to eat 20% less, in order to give 20% of your food directly to the hungry man?

What about what Jesus said in Matthew 25:31-43

 31“When the Son of Man comes in his glory, and all the angels with him, he will sit on his throne in heavenly glory. 32All the nations will be gathered before him, and he will separate the people one from another as a shepherd separates the sheep from the goats. 33He will put the sheep on his right and the goats on his left.

 34“Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’  37“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38When did we see you a stranger and invite you in, or needing clothes and clothe you? 39When did we see you sick or in prison and go to visit you?’  40“The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me. 41“Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

Lest anyone call me a hypocrite, I am one, I’ve blown all of the above at one time or another. The thing is, as individuals, we will all screw up at one time or another, but for a large group, not all are going to screw up all at the same time.

Statistically someone in the body of Christ, if each person in the body is following or trying to follow Christ’s words will take care of each and every one of those situations. No matter how many individual brothers and sisters in Christ screw up on a person by person basis, if the body of Christ is large enough, and said Christians follow His teachings.

 

 

Some notes on electroporation

20 Sep

Molecular cloning: a laboratory manual, Volume 3

 By Joseph Sambrook, David William Russell

http://books.google.com/books?id=9mO2Fx0CuEYC&dq=Molecular+cloning+By+Joseph+Sambrook,+David+W.+Russell&printsec=frontcover&source=bl&ots=CttWVkjWNt&sig=VEkJ7tFxipKJUUkQqIi0KZUguIk&hl=en&ei=xYK1SuefDIrkNeCS2NoO&sa=X&oi=book_result&ct=result&resnum=1#v=onepage&q=electroporation&f=false

Page 1.162

Length of pulse determined by capacitor and conductivity of medium

Field strength proportional to applied voltage, and inversely proportional to electrode spacing

Shape determined by design of electroporator

For most common strains of e-coli, a single pulse of 12.5-15KV/cm and pulse length of 4.5-5.5msec result in cell survival rate of 50%.

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Highly efficient transfection of mammalian cells by electric field pulses

Marie-Pierre ROLS 1 Denis COULET 1 Justin TEISSIÉ 1

1 Centre de Recherches de Biochimie et de Génétique Cellulaires du CNRS, Toulouse, France
Correspondence to J. Teissié, Centre de Recherches de Biochimie et de Génétique Cellulaires du CNRS, 118 route de Narbonne, F-31062 Toulouse cédex, France
Fax: + 33 61 33 5886.

We have transfected mammalian cells with plasmid DNA by application of electric pulses. Chinese hamster ovary cells were chosen as a model in order to study and to optimize the transfection protocol. A plasmid carrying the gene coding for β-galactosidase activity was used to determine transient expression of the electrotransferred acitivity at the cell level. Optimum transient expression for cells in suspension was obtained by application of 10 square wave pulses of 5-ms duration and 0.6-kV/cm intensity. Under the best conditions, transfection frequencies as high as 50–60% could be obtained and appeared to be highly dependent on the age of the cell culture. The method was applicable to plated cells growing in a petri dish or on microcarriers. The possibility of extension of the technique to large volumes of cells is presented. A flow system, composed of a peristaltic pump connected to the electropulser chamber, allowed large volumes of cells to be treated with flow rates in the order of several milliliters/minute. Transfection frequencies for the large volumes were 25% for cells in suspension and 35% for cells on microcarriers. These results open new perspectives in large-scale transfection technology of cells however they are grown.

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pre-existing conditions exclusions, c-sections, abuse, but not viagra

18 Sep

I came across this post http://thinkprogress.org/2009/09/17/csection-preexisting/ Its worth reading the whole post, albeit its pretty disgusting what insurance companies do in the quest for increased revenue.

C-Sections

When a woman isn’t currently pregnant, she often still cannot get coverage. Many insurers consider a Caesarean-section pregnancy a pre-existing condition and refuse to cover women who have had the procedure. From a 2008 New York Times story about a Colorado woman who had Golden Rule Insurance:

She was turned down because she had given birth by Caesarean section.Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.

 

Spousal Abuse

Earlier this week, the Huffington Post’s Ryan Grim reported on the fact that in seven states plus the District of Columbia, “getting beaten up by your spouse is a pre-existing condition.” The insurance industry figures that if “you are in a marriage with someone who has beaten you in the past, you’re more likely to get beaten again than the average person and are therefore more expensive to insure,”

An interesting comment

So why do insurance companies pay for Viagra?

I had heard that viagra was commonly covered, and based upon spam, it was not cheap… and yet C-sections are considered pre-existing. Thus I went to do some digging to see what the QALY values were.

Viagra

http://www.annals.org/cgi/content/full/132/12/933-a

The researchers calculated that Viagra costs about $11,290 per QALY that it produces. This amount is less than many other accepted health treatments. Most accepted health treatments cost less than $50,000 to $100,000 per QALY. The researchers also found that Viagra costs less than $50,000 per QALY if 1) fewer than 0.8% of the men who take the drug have a major treatment-related side effect, 2) fewer than 0.55% of the men die as a result of taking Viagra, 3) Viagra costs less than $244 dollars permonth, or 4) successful treatment of impotence improves quality of life by at least.05 on a scale of 0 to 1.

C-Sections

http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=22001001263

An incremental cost-utility analysis was performed to combine the costs and QALYs of the two delivery approaches. The authors used the widely accepted threshold of $50,000, above which the intervention was not considered cost-effective. The incremental cost per QALY of elective repeat Caesarean delivery relative to VBAC was $112,023, which was well above the threshold. Thus, the cost-effective option was VBAC. This conclusion was sensitive to the probability of successful vaginal birth after VBAC. When such a probability was less than 0.65, elective repeat Caesarean delivery was the dominant option. When the probability was between 0.65 and 0.74, the cost-effectiveness ratio of elective Caesarean was below $50,000. When the probability was between 0.74 and 0.76, the cost-effectiveness ratio of elective Caesarean was above $50,000. The results were also sensitive to the costs associated with neonatal outcomes, while the conclusions of the analysis were robust to variations in the remaining factors.


Pretty much this means women of child bearing age are relegated to large employers, thus taking a huge talent pool out of the picture for startups and small business. Private insurance is really not an option for many based upon the greatly increased usage of C-sections.

The thing is… how long until large employers start removing benefits. They already have increased deductibles, in some cases upwards of $5000. They’ve shifted more and more of the ~$10,000-$20,000 family premium to the employee, some will see a 5-10% takehome paycut come January. Many this fall are deciding they can no longer provide for family coverage. Many have already removed some coverage, more and more is on the way. Do folks really think the status quo is the best way to go?


 

 

 

 

 

Pondering on the 99+1 deal again #outlawpreachers

14 Sep

I’m a pain in folks sides, being I tended to argue for the 1, not the 99… others always kept saying, what about the 99. We need to be there for them, if we leave the 99 in search of the 1, what will they do… they could stumble, or worse. I wrote about this deal a couple years ago with the inverted parable of the lost sheep Here is an opening snippet.

When a shepherd has a hundred sheep, and one wanders off, he lets it go to the world, such that he can focus on the care and feeding of the remaining 99, lest they feel any discomfort or uneasyness with their shephard being gone for a bit.

The subject came up again this AM, when I visited MMI. 

 

From @ToddRhoades http://mondaymorninginsight.com/blog/post/how_do_you_as_a_pastor_deal_with_the_really_needy_people/

Here’s the harsh reality:  Every church (EVERY CHURCH) has a small group of really needy people that will dominate your time, energy, schedule, and agenda if you let them. We all have those types of people. As soon as I mentioned the topic, their pictures were emblazened on your mind. The question is… how do you deal with them? It’s hard not to give them time; but too much time, like Perry says, can drive you to a place of insanity.

Todds post was due to the following attributed to Perry Noble, discussed at http://www.pajamapages.com/?p=2921 where pretty much it ends up being a bash and defend Perry Noble, bash and defend Megachurches, etc.

 

Too many pastors … let the expectations and demands of needy, clingy church people (notice I didn’t say Christians) DRIVE them to a place of insanity.

Here is the deal…. Todd is right, and Perry is right, to deny that such exists is putting ones head in the sand, and/or totally ignoring the needs of ones flock.

The issue, is not whether or not such folks exist, but more so, what is an appropriate response. Certainly Jesus is pretty clear about tending to the 1, rather than the 99… but then some would suggest, hey the 1 is saved, so we can blow them off. Others might suggest, well the structure and order of the church is more important, so we can blow them off. Yet others might suggest, my clergy work and home life is more important, so we can blow them off. The problem is, I never saw any wiggle room in Jesus words such that we can blow folks off.

I think the problem is individualistic theology, a failure to embrace the priesthood/gifts of all believers, and a tendency of the congregation to dump all the problems on the pastor, and for the pastor to accept all the problems.. I wrote about this before in saying no to God.

Individualistic theology has hosed over many a fine brother or sister in Christ, its wrong thinking…. The primary difficulty of the individualistic approach, is one doesnt see all of the capabilities, gifts, skills, and help available. Even Paul traveled with a group… The second issue is a failure to make the call early on that problems exist, and that more help is needed. Acts 6, where a set of dudes were chosen to serve the widows is a prime example of this. It shows not only the problem of being spread too thin, but utilizing the resources at hand, and the power of a group… they didnt just dump the problem on one guy, and say here you go.

**************************some random notes****************************

Some situations, esp those requiring confidentiallity can not be delegated, nor handled in a distributed fashion

Many situations may work very well in a distributed fashion, CPE as part of Chaplain education presents an interesting model

Some situations are far beyond the scope of a pastor, but such does not preclude the pastor assisting with direction to the appropriate resources within the community of faith. Or if such doesnt exist, outside of it.

No where have I ever found justification for a pastor being completely hands off

No where have I ever found justification for a pastor or church to direct the one lost sheep to Caesar and walk away

Zech 11:15 Then the LORD said to me, “Take again the equipment of a foolish shepherd. 16For I am going to raise up a shepherd over the land who will not care for the lost, or seek the young, or heal the injured, or feed the healthy, but will eat the meat of the choice sheep, tearing off their hoofs. (interesting verse #16 is… context is interesting too)

 

 

Escape Velocity in Church, Knowing, Loving, and Leading

12 Sep

Know your folks

  • Who are the influencers… it could be the loud and vocal, but it could be the proverbial quiet little old grandma who appears the wallflower, but behind the scenes is the most massive prayer warrior you could ever meet.
  • Who are the champions? Who if given a vision will grab hold, latch on and run with it? Maybe not the exact vision you have, but likely something better, or very close to where you want to go.

Love your people

  • Who could experience the most growth, the least growth? How do we love them?
  • Who could be negatively impacted? How do we show them the love of Christ through this?
  • What if the change leaves people behind? How do we love them…. what do we do proactively knowing that such will happen to some.

Lead your people

  • Expect adversity…. its not human nature to embrace change. In some cases, things can get pretty ugly, its not unexpected. Its not that adversity in and of itself is to be avoided, but how one reacts and leads in face of it.
  • Be rock solid. Just as Jesus is your churches rock… be solid like one in leadership. This does not mean being like a mack truck as concerns the opposition… do listen, do engage those fearful of change, do not hide, do not waver. But, if a course correction is needed midway, do not let pride get in the way, or other factors. Better to have egg on face in front of congregation, than egg all over entire congregation as you blew it.
A couple methods
  • Seed influence…

This is one way to propagate change in a larger organization, but its slow, and requires a ton of effort and care. I’ve never done such on a small scale, but I think it would work their too.. but ymmv.

Invisible Change starts and must propagate from the top. Ie, if sr pastor is not on board… its not going to fly. If only sr pastor is on board, and the rest of the leadership team is wishwashy… making change without 100% buyin on leadership is like working in molasses. Possible, but a bear… but far too often results in interpersonal conflicts and fiefdoms building on other than the matter at hand resulting in significant distraction and disfunction.

Visible Change starts and must propagate from the bottom, but does require invisibe change support and infrastructure ready to roll. Leadership in such cases is loving, supporting, and encouraging… they have prebuilt a path during the night, but its filled with debris, scary stuff, and is messy. The path is not dictated by any means, and some plodding here or there is expected, as members see bits and pieces here or there, but as folks see fewer and fewer barriers, momentum starts to build. If given a chance, visible change from the bottom leverages the momentum of the masses, and that can be pretty powerful, in many cases, much more powerful that the resulting casualties due to dictatorial change.

The Priesthood of all believers is where visible and invisible change come together, pretty much irrespective of eccliesiastical structure. Leaders and followers exist, not so much as a means of social strata, or caste, but more so gifting, and order. Each person has different gifts. Just as the quiet wallflower type may not a dynamic sr pastor make, nor should an exhuberant yongster be expected to fill the needs of chaplaincy for the post 70 crowd. Yet… within a change in a congregation, all play a role, as they all become ministers of one type to one another. Even the gruff old type best exemplified by Clint Eastwood in Gran Torino is a huge part of this. As such, this is where knowing and loving end up being nearly as big a deal as traditional leadership.

Plan, dictate, and roll with it

A traditional approach, sort of like ripping off a band-aid or for my friends in the EU, a plaster as quickly as possible to minimize the pain. Expect some collateral damage… otoh, in small groups, or even in leadership teams, often times attacking change head on is the only way its going to happen. Otherwise the naysayers will put up new barriers everytime you take down another one… and such has derailed or plateued many a visionary idea, it doesnt matter how scriptural or devout one is… a few individuals can make a real mess of things, and in the process drive a pastor to dispair. On the other hand, eccliesiastical structure may preclude plan dictate and roll…

No matter the approach, knowing, loving, and leading is key

Some stats on the value of human life

12 Sep

Its sort of goofy how the US prioritizes life.

  • A year of an uninsured citizen’s life in the US is valued at $5500 
  • A year of a typical insured citizens life in the US is valued at $50,000-$100,000 
  • The last year of a exceedingly well insured cancer victims life in the US was valued at $300,000  
  • Jurys median award for wrongful death for women over 80 is $322,920 
  • The payout from the 911 victims fund averages $1.8 million
  • The Dept of Transportation sets the value of human life for planning purposes at $5.08 million

 

sources

http://www.marylandinjurylawyerblog.com/wrongful_death_claims/

http://en.wikipedia.org/wiki/September_11th_Victim_Compensation_Fund

http://theoncologist.alphamedpress.org/cgi/content/full/11/2/90

http://www.sas.upenn.edu/~baron/153/19healthcare-t.html