Tuesday, April 30, 2013

The Last Three Health Reform  “Cs” – Cost, Coordination, and Connectivity
Sailing the Seven “Cs” of Hospital-Physician Relationships – Competence, Convenience, Clarity, Continuity, Competition, Control, Cash
Title of Book, by James Hawkins, MBA, and Richard L. Reece, MD, PSR Publications, 2006
Seven years ago, James Hawkins, a hospital administrator, and I wrote on a book listing the seven Cs we considered essential for a harmonious hospital-physician relationship – competence, convenience, clarity, continuity, competition, control, and cash.
Today, as Obamacare undergoes its  implementation travails,  I would like to add "cost", "coordination", and c"onnectivity" to the orginal seven "Cs."

·         Cost - It is now clear Obamacare is going to cost at least twice, perhaps even three times, its original $900 billion estimate over the next decade – and the cost will come in human, access, and economic terms.   According to Daniel P. Kessler, professor of business and law at Stanford and fellow at the Hoover Institute,

In total, it appears that there will be 30 to 40 million people damaged in some fashion by the Affordable by the Affordable Care Act with  more than one in 10 Americans. .. We’ll hear more about innocent victims who saw their premiums skyrocket, who were barred from seeing their usual doctors, who had their hours cuts or lost their insurance – all thanks to the faceless bureaucracy administering a federal law.” ("The Coming ObamaCare Shock," Wall Street Journal, April 30, 2013)

·         Coordination -  It’s hard to turn your head these days when reading about health reform without hearing cries for more “coordination.”  What is proposed for coordintion  solutions are more primary care physicians,    more medical homes,   more hospitalists, more accountable care organizations,   and more large integrated care organizations with more doctors, nurses, other health professionals, and managers working together seamlessly  in teams.  The  article concludes
´Some medical centers have taken steps to improve communication, assigning color-coded ID tags or scrubs to staff members so patients know who's a nurse and who's a doctor, and installing white boards in patient rooms, where a nurse starting a shift can jot down his or her name. At some facilities, hospitalists write their names on those boards, and hand patients and their relatives business cards or sticky notes with their photos."
“A few hospitals have gone further. At the Mayo Clinic in Rochester, Minn., patients having surgery attend a pre-admission education class so they know "almost to the hour, let alone to the day, what's going to happen," said Chief Medical Officer Michael Rock.”
“In Pennsylvania, Geisinger Health System has developed a checklist on laminated cards that fit in caregivers' pockets. It includes questions that doctors and nurses need to keep uppermost when reviewing cases, such as: "Is the patient taking high-risk medications? When is the patient going home? Does the patient have any catheters or lines that should come out?"
“Virginia Mason Health System in Seattle completely overhauled how they did things after sending representatives to Japan to learn from Toyota. Now nurses spend 90 percent of their time near the patient “so the shift handoffs don’t happen at the nurses’ station anymore,” said Dr. Gary Kaplan, Virginia Mason’s chairman and CEO. “Patients don’t have to use the call button.”
“Consumer advocacy organizations, meanwhile, advise patients entering the hospital to have a relative or close friend, or even a hired hand, who can communicate on their behalf and be at their side through the hospitalization. “
·         Connectivity -  These days computer "connectivity"  as a universal solution for coordinating care is a huge and sprawling subject; The logic goes:  Once everybody is connected to everybody else via handheld mobile devices, smart phones,  embedded tracking implants,  the social media,  big data, and electronic health records that can communicate with one another, everything can be coordinated with nothing and nobody failing through the cracks. 

I suppose this may happen if one interprets  the current  IBM ad as gospel, “Few human technologies have transformed human behavior as quickly as mobile.  Two of three people in the world  keep mobile devices within reach as all times.  A typical user  reaches for the  device 150 times every day- sending messages, researching, collaborating.  There are four times as many mobile phones, in use as there or personal computers, and as many as there are TVs."

Or If you read  The Digital Age: Reshaping the Future of People, Nations, and Business,  by Eric Schmidt,  former Google CEO, and Jared Cohen, author, researcher, and top global thinker. 
I see only one problem with these lines of thinking –fear of loss of personal privacy and security, identity theft, and misuse and abuse of personal information, particularly that dealing with personal health.

Tweet: Higher costs, lack of coordination, and loss or privacy and economic security, are fears shaping the fate of the health reform law.

Monday, April 29, 2013

Uncertainty, Physicians, and Health Reform
Today there is uncertainty about regulatory policy, uncertainty about monetary policy, uncertainty about U.S. fiscal policy and the national debt…At Vanguard, we estimate that policy uncertainty has created a $261 billion drag on the U.S. economy.
Bill McNabb, chairman and CEO of the Vanguard Group, “Uncertainty is the Enemy of Recovery,” Wall Street Journal,  April 29, 2013

The American College of Physicians hopes that the legislation will address key priorities on coverage, workforce, and payment and delivery reform. The goal of the PPACA is to help provide health coverage to most Americans, improve access to primary care, and lower costs.
Robert M. Doherty, “The Certitudes and Uncertainties of Health Care Reform”,  May 18, 2010, The Archives of Internal Medicine

Physicians say they are unsure where we will be and how we will fit in three years.  Ninety two percent of physicians in this survey agreed with that statement. Only 2.7% strongly disagree. There is tremendous uncertainty, and uncertainty always invites uncertainty and lack of confidence.
Interview with Walker Ray, MD, chairman of research committee, “Physicians Foundation Survey of 630.000 Physicians,  Chapter in New Voice of Health Reform: The 3Rs- Rhyme, Rhetoric & Reality,  Book Number Two, The Physicians Foundation – A New Voice for Physicians,  Medinnovation Press, 2013

The only certitude about the health reform law, aka Obamacare, is that it passed on March 23, 2010 without a single Republican vote.   Its fate has been uncertain and its unpopularity has persisted  ever since. 

Reform  uncertainties about Obamacare for physicians are legend.

·         Whether it will survive the November 2014 mid-term elections, or will be repealed or delayed.

·         Whether its health exchanges, the pillar of Obamacare, can be implemented, given their costs, and the decision of most states to cede responsibility for implementation to an unprepared federal government rather than to themselves.

·         Whether the uninsured and those 4 times below the poverty line will decide whether to participate in the exchanges, thus making them viable and reliable.

·         Whether Congress will modify or repeal the Sustainable Growth Rate formula for physicians.

·         Whether CMS will continue to reduce reimbursements for specialists,  who comprise two-thirds of the 550,000 physicians who bill Medicare and whether CMS will pay primary care physicians enough to attract and retain these physicians.

·         Whether the impact of increased premiums and lack of hiring by businesses will effectively derail or indefinitely delay implementation.

·         Whether mandates and incentives to install electronic health records will be sufficient to overcome the lack of utility of current systems and the costs to install and maintain EHRs.

·         Whether the concept of Accountable Care Organizations has legs  and whether it will actually achieve “savings” to offset costs of  establishing these new entities and maintaining them.

·         Whether becoming employees of hospitals and integrated care organizations  will achieve its promises of economic security,  balanced life styles, and malpractice avoidance without giving up physician  autonomy and integrity and raising patient costs.

Physicians’ concerns about uncertainties is not whether reform is on their side, but whether they can afford to pratice under its costs, rules, and regulations, and whether Obamacare is on the side of patients, their access to care, and cost of that care.

Tweet: Physicians have uncertainties about the health reform law, and these uncertainties  profoundly effect how they act and what they do.

It’s a Schramm Dunk:  Healthcare Innovation and Entrepreneurship
It’s a slam dunk.
Colloquialism, borrowed from basketball, something obvious and emphatic
Carl Schramm’s message is direct, clear, and unequivocal:  Foster, support, and incent entrepreneurs and innovators, and  the U.S.  economy will bloom,  health reform will take care of itself, and the United States will achieve its manifest destiny as  a destination and beacon of freedom and prosperity  for the rest of the world. 
Schramm and co-author, Robert E. Litan, economist and vice-president of research and policy at the Kauffman Foundation, have enunciated this message in their book, Better Capitalism: Renewing the Entrepreneurial Strength of the American Economy (Yale University Press, 2012)
·         By reducing rules and regulations hampering innovation

·         By loosening  restrictions for entry  and encouraging entry into U.S. for aspiring entrepreneurs from other countries

·         By making our cities and states hotbeds for innovation
 I enjoy  reading  the works of Carl Schramm,  a professor of information studies at Syracuse University. Carl J. Schramm is an internationally recognized leader in entrepreneurship, innovation and economic growth.  Schramm came to Syracuse following a decade as president of the Ewing Marion Kauffman Foundation in Kansas City.
Under his leadership, the Kauffman Foundation grew into a global institution, becoming the largest private funder of economic research related to growth and innovation. Schramm initiated many efforts in education, spearheading the Kauffman Campus Program at 17 universities and establishing the first charter school in the United States to be owned by a grant-making foundation.
An entrepreneur,  economist and lawyer, Schramm founded and co-founded several successful companies in the health care, finance and information technology industries, including HCIA, Inc., Patient Choice Health Care and Greenspring Advisors.
Enough about his background,  now onto his writings which celebrate and consecrate innovation and entrepreneurialism. 
Here are the titles  of eleven   of his posts in Forbes Magazine over the last 2 years.

1.       Common College App Should Encourage Entrepreneurialism , Not Narcissism, 2 weeks ago

2.      America’s Coolest Cities, 3 weeks ago

3.      Can Austin, Tx, Become the Dubai of the United States?, 3 weeks ago

4.      11 Hottest Industries for Startups, 5 months ago

5.      Death Spiral States, 5 months ago

6.      Global Entrepreneurship Week: Three Big Lessons for America, 5 months ago

7.      The Fiscal Cliff Is a Sideshow: It’s the Economy, Not the Budget, Stupid! 5 months ago

8.      Remember Steve Jobs by Celebrating the Life He Led, 1 year ago

9.      Our Economy Needs Innovation, New Ideas, and Scalable Businesses, 1 year ago

10.  Obamacare. The Government’s Cruel War on Innovation, 15 months ago

11.  Are We Thwarting Medical Innovation?, 2 years ago
From these titles, it is evident Carl Schramm favors entrepreneurialism as the choice for individuals, cities, states, health care, and the economy in general. It is also clear he regards Obamacare as detrimental to  health reform innovation.
According to Schramm, creative energy,  innovation, and entrepreneurialism are the essential ingredients of a formula for growing the economy.  Human capital, not political capital, or, if you prefer, not the political capitol, is what  counts if we are to have a vibrant economy and sound health refom.
Schramm believes entrepreneurialism will unleash our economy and  health system potential.
Tweet: Carl Schramm, Professor of Information Studies at Syracuse, believes innovators and entrepreneurs are key to U.S.  economic growth.

Sunday, April 28, 2013


What  Health Reform Will It Be?

Will it be social justice for all of us?
Will it be prosperity for the majority?
Will it be for all economic misery?

Will it be for all universal liberty?

Which will come to be?
The right answer is key.
That is the big political cake.
That’s baking that’s at stake.

Government may think it knoweth,
What is best for most of us,
But the market often bestoweth,
What is good for the rest of us.

Saturday, April 27, 2013

Health Measurement – End Results More Important Than Questions
The cause is hidden, but the result is well-known.
Ovid (43BC – 19AD), Metamorphoses
There is rarely anything  new under the sun. 
No matter how you slice it or how you compose questions for a health questionnaire,   people tend to fudge, exaggerate, or downplay their habits and personal behavior that got them to where they are – overweight, obese,  hypertensive, diabetic, or with adverse lab values – high glucose,  high hemoglobin A1C, or troublesome cholesterol, LDL, HDL, and triglyceride values.   It is human nature to make one’s self look good, or less bad.  
That being so,  it is simpler,  and there is value and  truth in measuring the body’s end results – BP, pulse, height, weight, waist size – and chemistry results,  rather than exploring one’s eating, drinking, and exercise habits.  
In other words, keep it simple , measure  the unfudgeable,  and state the results in terms the patient can understand.  
For these purposes, I advocate an overall health quotient (HQ – normal range 80-120) with an explanation of why the patient’s HQ is normal, low, or high.
See Medinnovation blog, April 20. 2013, “An Innovative Proposal: Routine  Health Measurements in Primary Care Practices and in Wellness Programs"
Or read the following from Kaiser Health News to see how complicated and difficult measures of health can be.
Oregon’s Dilemma: How To Measure Health?

By Kristian Foden-Vencil, Oregon Public Broadcasting

Apr 26, 2013
There are hundreds, if not thousands, of ways to track the health of a population: the average blood pressure of a large group of people, the rate of mental illness, the average weight. Epidemiologists have been collecting this kind of data for years, but now, in Oregon, there is cold, hard cash riding on these metrics
In a special experiment that is part of the health law, the Obama Administration gave Oregon almost $2 billion to come up with its own system to coordinate care better. The idea is to get doctors, nurses, hospitals and other caregivers to work together – and get paid well -- to keep people healthy and to get rid of wasteful, unnecessary care.
But which metrics should Oregon and the federal government look at to decide if the experiment succeeds? The federal dollars will go to the providers who do a good job, so first the state had to figure out what constitutes good coordinated care.
Sarah Bartelmann of the Oregon Health Authority’s Metrics and Scoring Committee says it was hard to boil down the list. There was "a lot of discussion and the conflict was where the data would come from and if it was something the state could easily report on," she says.
Oregon decided on 33 measurements that cross the medical spectrum.
A look at one of them shows how quickly it can get complicated. Bartelmann explains the effort to measure how often doctors ask patients if they're abusing drugs or alcohol.
"So there are a couple of ways a practice could do this,” she says. “They could start with a pre-screen, that would be just one question that a doctor would ask. It could be part of your vital stats, when they're taking your blood pressure, weighing you in. They could also ask, ‘Do you use alcohol? Do you use drugs?’ And if the patient indicated that they did, to either one of those, that would then trigger a longer screening."
The goal is to get doctors to refer patients to a service -- patients don't actually have to go to be counted, but they have to be referred. But it's a measure that Oregon has created on its own, so there was no national standard.
To figure out where to start, Oregon Health and Science University studied how often doctors currently ask patients about drug or alcohol abuse -- not just whether they smoke or drink, but specifically about abuse of those substances. The answer was virtually never.
"This is a difficult subject for doctors to talk about with patients," says Lori Coyner of the Oregon Health Authority.
So, since doctors aren't asking the question now, the baseline was set at zero. The state then had to decide where to set the goal.
The university looked at one group of local doctors who started asking about substance abuse and found that after a couple of years, 44 percent had managed to set up a system to do it on a regular basis. So that’s where Oregon's Metrics and Scoring Committee set its goal.
"The committee wrestled with setting a benchmark that seemed so high, 44 percent compared to approximately zero percent right now,” says Bartelmann, “and whether that was truly achievable by CCOs."
Not everyone is happy with the new measurement.
Rick Hangartner, who runs an electronic health records company, thinks it doesn't go far enough to help people battling drugs or alcohol.
"The big problem is finding a treatment program that can actually take them that works for them,” Hangartner says. “If the whole point is improving health, which is what the claim is about [coordinated care organizations], we've got to show some follow through."
The state is wrestling with questions like this for all 33 of its chosen metrics.
On top of that, Oregon has to worry about timing. For instance, rehab for drug abuse or alcoholism could save the state a lot of money in the long-run by preventing dire diseases. But in the short-term, rehab is expensive.
The federal government has given Oregon just five years to prove it can reduce increases in medical costs for Medicaid. If the state fails -- it faces some substantial fines.
This story is part of a reporting partnership that includes NPR, Oregon Public Broadcasting, and Kaiser Health News.
Tweet:   The end results of how much one exercises, eats, drinks, or uses drugs is usually reflected in one's vital signs and chemistry values.

Switching Gears from Father to Son
When power leads man towards arrogance, poetry reminds him of his limitations.  When power narrows the areas of man’s concern, poetry reminds him of the richnes nd diversity of his existence. When power corrupts, poetry cleanses.
John F. Kennedy (1917-1963), Address at Amherst College October 26, 1963
I have composed  2792  Medinnovatiom blog post on health reform and innovation.  I am organizing these posts into  12 books on the history of reform and its various manifestations under the title of New Voice of Health Reform: The 3Rs – Rhyme, Rhetoric & Reality.  
Today’s post has nothing to do with health reform and medical innovation.  Instead it reprints a column from the Miami Herald on the work of my son, Spencer.  Spencer is a poet and an Episcopal priest.  He is hell-bent on salvaging the lives of Honduran orphan girls by teaching them to express themselves in poetry and watercolors.
This is his story, as told by Joan Chrissos in the April 26, 2013, Miami Herald.
Poetry project of Honduran schoolchildren attracts Inaugural poet Richard Blanco
Rev. Spencer Reece, a Miami Episcopal priest, is teaching a Honduran girl how to write poetry in Our Little Roses in San Pedro Sula, Honduras. Reece, a Fulbright fellow, and Richard Blanco, the poet who spoke at President Obama's inauguration, are collecting the Honduran schoolchildren's poems to be published in a book. Actor James Franco is producing a documentary about the project.

“We live in a world that’s full of hate.” So begins the poem of Katherine Marisol Murillo, a 15-year-old girl who recalls the circumstances that led her to Nuestra Pequeñas Rosas, a haven in the middle of San Pedro Sula, Honduras. It’s a city known for its maquiladoras (apparel plants) and murder rate (No. 1 in the world), where abandoned children live in cardboard boxes on street corners and find their nourishment from the charity of others or the city dump.

“My mother is dead and I never knew my father. At the age of 6, I came here. I felt I was in paradise."

Katherine, whose poem is titled I Was Six Years Old, is one of 30 students from the school at Nuestra Pequeñas Rosas — Our Little Roses in English — who are being taught how to express themselves, often scraping shattered souls, through poetry.

Their teachers: Spencer Reece, an award-winning poet turned Episcopal priest, and Richard Blanco, the Columbus High and Florida International University grad who delivered his poem, One Day, at President Obama’s inauguration in January. The two are collecting and editing the poems, written in English and Spanish, from the children. The plan is have them published in a book of poetry, illustrated with watercolors from the children, to be called, The Season of Singing Has Come (Song of Solomon, 2:12).
They’ve also teamed with a film crew producing a documentary on the project. James Franco, the Oscar-nominated actor from 127 Hours , is the executive producer and singer-songwriter Dar Williams is composing the soundtrack. They hope to premiere the film next year at the Sundance Film Festival.

Reece, Blanco and director Brad Coley will appear Friday at St. Philip’s Episcopal Church in Coral Gables to read the poems, preview the film and raise funds for the documentary.

Reece, a Brooks Brothers salesman in an earlier incarnation, is the visionary — albeit an accidental one.

He first went to Our Little Roses in the summer of 2010 to learn Spanish. Reece was in the process of becoming a priest and would be working under The Rt. Rev. Leo Frade, bishop of the Episcopal Diocese of Southeast Florida and the former bishop of Honduras.

Frade’s  wife Diana had founded Our Little Roses in 1988, after teaching in Honduras and witnessing scores of homeless girls scrounging the streets. She started with a rented three-bedroom, two-bath home and 26 girls.

Over 25 years, Our Little Roses has evolved into a walled sanctuary in San Pedro Sula, showering hundreds of girls with love, respect and perhaps most importantly, an educational ticket to transform their lives. (Full disclosure: I have gone to Our Little Roses a week every summer with St. Philip’s and my family for the past seven years.)

Shortly after starting the home, Diana opened a school, beginning with one classroom. (The city of San Pedro Sula donated a five-acre plot to build the complex in the early ’90s.) Today, Holy Family Bilingual School has more than 250 girls and boys, including children from the surrounding city. The two-story school spans preschool to high school, complete with kindergarten graduations, middle school algebra and, this June, its first high school graduating class.

Diana’s vision has been to change Honduran society one girl at a time. Twenty-five years later, she’s doing it. The first generation of girls have graduated from Honduran universities as teachers, engineers and business executives. One of the girls, Jensy, who arrived at Our Little Roses as a 9-year-old after her mother contracted AIDS, went to university in San Pedro Sula, graduated and enrolled in dental school at the university. Today, she is a dentist and operates Our Little Roses’ first dental clinic, serving the girls and the community.

“None of these girls will go back to where they came from,’’ says Diana. “The only direction they can move is forward.’’

All this in a country that is the second-poorest nation in the Western Hemisphere, behind Nicaragua, where thousands live in bordos, shantytowns where children gather water from brown, brackish rivers and pick food scraps from trash piles.

“Honduras?” Reece said, upon hearing of Frade’s recommendation to learn Spanish at Our Little Roses. “I grew up in Minnesota. I think, ‘Honduras? Where’s that?’ ”

Reece, 49, was on his own journey. A graduate of Wesleyan University in Connecticut , Reece spent 12 years working for Brooks Brothers, first as a salesman in its Mall of America store near Minneapolis, then transferring to the Gardens Mall store in Palm Beach Gardens as assistant manager.

By day, Reece, with his horn-rimmed glasses, receding hairline and pin-striped suits, waxed eloquently about windowpane sports coats, suede bucks and navy blazers with names like two-button classics.

Poetry by night

By night, he wrote poetry. He submitted poems to The New Yorker, poetry journals and myriad literary competitions. For 23 years he wrote, his only recognition coming from an estimated 1,000 rejection letters.

One night 10 years ago he picked up a message on his answering machine at his Lantana apartment. It was from Louise Glück, the Pulitzer Prize winning poet. She called to say that a collection of Reece’s poems, called The Clerk’s Tale, had won the Bakeless Prize for new authors awarded by the Bread Loaf Writers’ Conference at Middlebury College in Vermont.

“When I got the message in January, I had just folded down the cashmere sweater table at Brooks, closed down the store after the Christmas rush, got into my beat-up Dodge Neon without AC,” he wrote in an email from Honduras. “I must have gotten home by 11. I played the message again and again. I could not believe it. I thought I was the runner-up. I could not put into my head I had won.’’

Pivotal call

Shortly thereafter, he received another phone call, this from the poetry editor of  New Yorker at the time, Alice Quinn. The magazine wanted to publish the collection’s namesake poem, The Clerk’s Tale,on its back page on Father’s Day 2003. It begins:

I am thirty-three and working in an expensive clothier, selling suits to men I call “Sir.”

These men are muscled, groomed and cropped —

with wives and families that grow exponentially.

Mostly I talk of rep ties and bow ties,

of full-Windsor knots and half-Windsor knots,

of tattersall, French cuff, and English spread collars,

of foulards, neats, and internationals,

of pincord, houndstooth, nailhead, and sharkskin.”

Seed planted

The poetry prize and New Yorker poem planted a seed in Reece. When he was in his early 20s, Reece earned a master’s degree in theological studies at Harvard Divinity School. He thought about the priesthood but wasn’t ready.

He still wasn’t sure and continued to work at Brooks Brothers. He began, however, to volunteer at hospice.

“I realized one day at hospice that I had once wanted to be a priest but I’d forgotten about it. … I wondered if it was still possible, if it wasn’t too late. Sometimes in middle age we realize we lose sight of some original intention and wonder if we can reclaim it.”

In August 2009, Spencer worked his last day, a Friday, at Brooks Brothers in Palm Beach Gardens. On Monday, he began studying at Berkeley Seminary at Yale Divinity School in New Haven, Ct.

While training to be a priest, Reece took a post as chaplain at Hartford Hospital. One night a mother and son from Puerto Rico were rushed into the emergency room. The boy had been stabbed 25 times in the chest in a gang-related fight. He died the next morning. Reece tried to console the distraught mother, but she spoke only Spanish. He spoke only English.

He called up Frade. “This is not going to work,” he told him, “for me, a nearly 50-year-old gringo, to return to your diocese and not speak Spanish.”

Frade responded: “I have just the place for you.”

In the summer of 2010, Reece spent two months at Our Little Roses. He picked up some Spanish, talked with the girls, but said he felt “pretty useless.”

The night before he was to return to Miami, he had walked around the complex several times and was going upstairs to his dorm room to pack his bags. He noticed one of the girls waiting for him at the bottom of the stairs. Her name was Wendolyn.

“I heard that you are leaving tomorrow,” she said.

“Yes,” Reece answered. “Do you want to tell me something?”

She looked up at the stars, then looked at him and whispered: “Don’t forget us.”

“It chilled me to the bone,” Reece said. “I think it resonated really deeply because I had a cousin who was murdered at a very young age.”

On the flight home and for days and weeks thereafter, he mulled over how he could honor her wish.

“I’m not a social justice person, I’m not even that smart … but what I did know was something about writing,” he said.

Spanish studies

He applied for a Fulbright fellowship, proposing he would write a book of poems about Honduras, including translating Honduran poets. He was a finalist but didn’t make the cut. He then won a grant to study Spanish in an immersion program in Spain.

After becoming more adept at Spanish, Reece reapplied for a Fulbright. This time, he proposed he would teach the Honduran schoolchildren how to write their poems. He enlisted Blanco, whom he had met years earlier at a poetry reading at Books & Books.

“Spencer’s enthusiasm in the project has been contagious,” said Blanco, who encouraged Reece to reapply for the Fulbright. “I told him that everything I’ve ever gotten in my life is the second time around.”

Back together

Reece won the Fulbright and is spending a year at Our Little Roses, teaching eighth- to 11th-graders to write poetry. Blanco will join him there later this year.

Reece also reached out to Franco, who had made a movie from Reece’s poem.

“I worked with Spencer previously adapting his poem The Clerk’s Tale into a beautiful movie,” Franco said. “We became friends during that process. After he was ordained, he went to Honduras and he discussed this project with me. It seemed like another great combination of poetry and film for a great cause, so I was happy to be involved with it.”

Teaching poetry to teenagers hasn’t been easy, especially given where the girls have come from. Their back stories sting. Stories such as the 4-year-old girl and her 11-year-old sister left on the sidewalk by their mother, who told them to wait for her return. She never came back. Or the toddler who was beaten and locked in a barrel. Or the children whose mothers died of AIDS and who have never known their fathers.

‘abandonment issues’

“This is not an ordinary student population,” Reece said. “These girls have been through abuse and abandonment issues beyond what you can ever imagine. But they are writing poetry.”

And pouring their souls into it.

Said Katherine, “I just opened my heart and all that stuff came out.”

Tweet:    Spencer Reece, a poet and an Episcopal priest,  is teaching Honduran orphanage girls to express themselves in poetry

Friday, April 26, 2013

“Messy” and “Exemptions” – Two Words Describing Obamacare Implementation
Nothing is perfect. Life is messy. Relationships are complex. Outcomes are uncertain. People are irrational.

Hugh Mackay, Australian social researcher
There is no exception to the rule that every rule has an exception.
James Thurber (1894-1961), American humorist
Two words that describe the Obamacare rollout scheduled to take full effect on January 1, 2014, are “messy” and “exemptions.”
This should not surprise us.
Democracy, particularly a capitalistic meritocracy, is an inherently messy process.  But it may be preferable to the alternative, a state controlled centralized government.   It’s a choice between “messy’ capitalism, with its irrational economic swings, and “rational” socialism, with its economic stagnation and predictable equal sharing of misery.
With Obamacare, there’s an escape clause between the choices. 
It’s called “exemptions,” which are now on full display.
·         Robert Pear reported in yesterday’s New York Times,   Democratic senators, at a caucus meeting with White House officials, expressed concerns on Thursday about how the Obama administration was carrying out the health care law they adopted three years ago. Democrats in both houses of Congress said some members of their party were getting nervous that they could pay a political price if the rollout of the law was messy or if premiums went up significantly?.
·         There was also talk on the Hill that Nancy Pelosi has asked Congress to consider an exception exempting federal legislators and their staffs from participating in the health exchanges, so legislators and staff would not have to pay “out-of-pocket” to join the exchanges like the rest of Americans.   
To which the Republicans naturally responded,” Why not exempt all Americans by repealing Obamacare?”
Exemptions  are becoming the rule to avoid Obamacare.
·         HHS has offered exemptions to some 1300 organizations, mostly unions, who complain Obamacare is too economically burdensome.
·         Small businesses, our economy’s backbone, are exempting themselves from Obamacare by self-funding and downgrading full-time employees to part-time 30 hour hours to avoid the dreaded 50 workers or more rule that they must pay for Obamacare –approved health plans.
·         Physicians are exempting themselves from Obamacare by establishing concierge and cash-only practices and by becoming hospital employees for economic security and to exempt themselves from malpractice payments. 
·         Five Red-State Democratic senators, who voted for Obamacare, have decided to retire and exempt themselves from angry voters rather than defend the law in what surely would be a nasty, perhals, losing re-election effort.
·         Millions of the uninsured may effectively have  exempted themselves from joining exchanges because they do not understand the law, which has not been explained to them in language they understand that would cause them to sign up for the exchanges.

·         Young working adults have exempted themselves from paying for health insurance as dictated by the Individual Mandate by not buying health coverage, instead accepting the penalty for not paying.
The question is:  When  exemptions  become the rule and not the exception, will Obamacare be workable, or a forgotten  figment of the progressives’ fertile imaginations?
Tweet: The number of exemptions from the various provisions of Obamacare is growing, among businesses, unions, young people, and physicians.