EXAMINE YOUR LIFESTYLE.


The new year is here and I still cannot believe it. 2014 came and went at a seemly quicker pace. The truth is that the speed of time as not changed. What has changed is how we experience it. We continue to allowed procrastination to decrease how much we achieve. We over think and neglect to take the actions that would allow us to attain more of our goals. As we second guess our decisions the universe continues forward at the same pace we found it. We are achieving less and the feeling that time is going by faster is just a reflection of our lack of focus on the important things.

For the new year we all should stop thinking and start doing. I am a parent and want to leave a better planet for my children. What are you planing to leave to your children? The discussion about climate change is just one of those issues where we could improve the world for our children. The facts are not in dispute, the climate of earth is changing. I do not dispute that human activity is the cause. If you dispute that I hope we can at least agree that the climate is changing.

With that in mind I would ask you, how do you think climate change will affect your children or grand children? I would suggest that the most likely direct effect will be on the quality and quantity of food and water available. The current estimate of people around the world going hungry is about one billion annually. Concurrent with that is the fact that some of the most productive agricultural areas are in regions whose water supply is dependent on seasonal rain and snow falls. It is already evident from current objective measurable data that these regions are close to breaking point in their water balance. The drought in California, which is the current bread basket of the United States is worrying. The gravity of the danger is not being addressed. But if the level of the water in Lake Mead Nevada is any example we should all be much more concerned.

Our water usage patterns are unsustainable and more forthrightly has led us to a very dangerous place. Agriculture is the primary user of water both for plant and animal production. Animal production is an especially egregious drain on our every decreasing available water sources. The continuing willful deafness of many of our leaders to the coming and already present crisis is criminal. The low intelligence of many of the people on mass media discussing the topic is genocidal in their effect. As we continue to neglect the obvious the problem worsens and the solutions become evermore burdensome. The unfortunate consequence is that the poor all around the world are already experiencing the trauma of food and water insecurity. Even the wealthier among us are being affected. The difference is that most of us can afford the increasing cost of our basic supplies. The larger question needs to be asked, what will happen when the squeeze truly gets to the richer among us?

I am of the scientific persuasion and believe that all the evidence points to mans central impact in leading to climate change. However, I will acquiesce to those who have not attain that clarity. I need only you agree that no matter the cause climate change is occurring and that we need to act to protect our global society.

I would suggest that we start by examining our consumption patterns. Change your lifestyle and change the world. We are all apart of the change that we need.

WHERE IS THE CHECKLIST?


I have loved health care for as long as I can remember. I cannot imagine doing anything but providing care . What I have learned in the trenches is that the love of providing care is not enough. Over time i have realized that a fundamental problem with health care is not in the expensive of it but in the nature of the people in it. We want to provide care, but we bring into the system our biases. Those biases allow for less attention to be paid to some patients because of their language or skin color. We may say that we provide the same care to all patients, but as a black physician I see otherwise. My experience of the system at institutions where I am not known by members of staff is vastly different. The consequence of this uneven care is a system where those that can afford care and are the correction completion receive care that is more compassionate and timely.

How do we overcome the inherent bias in the system? The answer is not more training nor necessarily more diversity. The answer will be in the wide-spread use of evidence based payment structures. Our medical systems are complicated and expensive but are systems in name only. We have a complex string of components. All the parts are mostly well-trained and competent. However the results we obtain are not commensurate with the level of training nor the level of expense. The incongruity of expense and quality of results continues because those attempting to improve the system have not acknowledged or do not recognize the biases of the system. The gap in quality of outcome is most obvious in communities of color. The often given excuses are truly just that. Recognizing that there is a problem is the first step to a solution.

Paying for quality work is the only avenue to improved results. The question as to how we get better care for all patients is simple and complicated, but we have a great example in the aviation sector. My brother is an airline pilot and his training is extremity rigorous, but he starts his day with a checklist. He does not feel that his autonomy is being challenged, but that he is making sure that he does not kill himself. We in health care do not have any real skin in the game. Until the decision makers have some skin in the game we will not embrace what is necessary to make our constellation of components into a functioning system. Let us start delivering quality care by implementing checklists. Checklists are reminders of the quality in our options. The checklist is not for you it is for your parents and friends. That checklist is not for you, it is for that provider that is on her sixth surgery of the day. It is a nudge because she is tired. A checklist is for every one of us. It helps us by removing silly mistakes from our systems. For me the checklist is my hope that I will be treated like a patient deserving of care on the off-chance that I am a patient in a strange place where all that can be seen is the color of my skin.

THE ORIGINAL PROTECTIONISM.


I will argue that the world is a better place for the arrival of free trade. The system we currently have is not exactly free or fair, but we are getting there. The problem with the drive to free trade is that it is not our default nature. If we examine our evolution and specifically we look closely at the development of language we will see a very different direction. Nature trends towards diversity and chaos. The current struggle to create a unified and equitable economic system is thus in contrast to natures default.

As we examine the development of language a counter intuitive balance can be seen. This can be seen where areas with the most population density have the greatest density of languages. Often these languages are so different as to make communication impossible. Why would that be so? I propose that evolution developed language as a defense mechanism for each language community. For language to be communicated effectively context and history need to be common knowledge. In that way the outsider may learn the words but is not likely or will not easily attain the necessary historical context to truly understand. This barrier is what protects each language group. The knowledge of the group is passed on by language in context that only those born into that language are likely to understand. In language we have evolution of the first system of protectionism. For thousands of years language isolationism as protected the economics of each group. This protectionism was also the primary barrier to truly large-scale growth in many language groups. Those groups with the most economic power have always been those with greatest command of language. This fact remains the same today. With the spread of the English language we can see the development of a truly global language that is giving every group the possibility of participation in the a maturing economic system. We are evolving a unitary language system, that will be beneficial to the economic system.
The current economic system is deep into the transition from local and regional to global. The system is growing by breaking down the barriers between countries, ethnicities and tribes. The continuing withdrawal from protectionist measures is the basis of our ever-expanding global economic system. We are participants but we haven’t noticed the evolution from a community of languages to a community language. The global is now a small community evolving a common language to ensure our protection from outsiders.

With the transition came a complex problem. What will be our common language? English in its many forms is that currency of communication. The form of English you speak will not be the Queen’s but we will understand each other without much difficulty. It is the nature of evolution to have competing systems, but I would suggest that as of now English is ahead. Once this acceptance as occurred and the language becomes rich with local context and history we as humans will have attained the necessary skills to become a galactic people. With a common language and economic system we will become more productive. How long will it take us to get there? If the twentieth century  is our guide I’d suggest that the twenty-first will be that final stage of our transition. Will your offspring be ready to take advantage of the opportunities to come?

 

TERM LIMIT CONGRESS PLEASE.


I am often struck by the disconnect in our political life about what our government spends money on. We hear the clamor for reduced spending and the false equivalency to a household budget. The intellectual dishonesty of the argument is clear if only we would look even superficially. The budget of the American State is primarily about moving money from the coasts to the rest of the country. It is about paying off the rich for their service to the entrenched political class. Who is actually getting our money? Look at your representatives in congress to find the answers.

Our political system is a construct where there are three branches of government with supposed equality of power. However, on close inspection it is clear where the real power lies. It lies with the body that controls the purse. The budget of the US federal government is controlled by the congress. They are the holders of the passbook, they alone can authorize the use of funds. The lie that the President of the United States, whomever he is, controls spending is a lie told to the uninformed. Unfortunately the majority of the electorate is among that group and hence getting to the real problem in American government is not possible.

If we recognized the facts of the economics of the federal system the discussion would not be so hollow. First, we have a state welfare system in which the richer states support the poorer ones. This is how the poor southern states got money for new infrastructure while the states in the northeast cannot afford to maintain their own. In principle the richer states helping the poorer to better the circumstances of their citizens is an admirable goal. If we examine the post civil war era called reconstruction we can see where the interests of the south, the primary beneficiary of the federal transfers, lies. The current aversion to anything that would help the working poor comes directly from the language of that era. This disdain for the working poor is not new, the purveyors have just regained power. The south lost the shooting war but has won the long-term economic struggle. My analysis is rough and you may say without merit, but I suggest you take a closer look.

The entrenched political class is the congress of the United States of American. They need to be term limited. No congress person should be able to serve longer than the President of the Republic. The current system disengages the congress from the people they should be representing. The people who get representation are those with the economic ability to buy time with their representative. The resource poor many are left to the vagaries of the market, while the insiders are protected. Term limiting congress persons would be a great place to start in fixing the debacle called American Government.