So i changed the overall look of the blog, and the title because i realized that i was no longer inspired to write because things didn't feel like 'me' as i am now. so, here is my first attempt to align things more closely.
i also realized that i didn't really give this blog a direction. it was mainly a device for me to write about random things in my life the first year i moved to ann arbor. now i don't need a device, but rather have figured out something pretty meaningful to post about.
basically this past year i have come to understand my life as a dynamic equilibrium. In HS chemistry i was obsessed with this concept. the idea was just so....natural to me, yet totally changed the way i thought about equilibrium and states, etc. as with many other concepts in science, i totally extrapolated to everyday life. (I did the same with the Heisenberg Uncertainty Principle lol.)
i am constantly feeling tension between multiple factors in my life, yet ultimately i balance everything. i am inspired by many things and feel the need to act upon them. thus, me being pulled in many (in the most case just two main) directions. and while in the moment i feel in flux, i have been constantly reminded that this IS the way i want life to be. i am ultimately in balance when i respond to these multiple inspirations. and that's just who i am.
i definitely feel a constant pressure to choose one of these forces, to specialize, to mark things as hobbies vs. careers. while it may be foolish, for now i'm going to explore ignoring that urge. dynamic equilibrium!
ps. all you hard core chemists, i understand that this is kinda a huuuuge extrapolation of the concept. (originally its about forces in equal but opposite directions in a closed system). i think the idea can be extrapolated. be creative. :)
Friday, April 30, 2010
Thursday, January 21, 2010
Dance
So a good friend of mine asked me yesterday, why do you dance?
Especially, he said, when it seems like "There are times when you seem to be killing yourself with dance to the detriment of other things in a way I don't think I would for an activity..."
and it got me thinking....
I have thought about the question why do i dance before. my parents still often ask me, why are you still dancing? what does it mean to you? i always, of course, a little petulantly, say, "because it makes me happy!"
but what does that mean? And in the response to my friend, i started really trying to understand, what it is that happens when i dance, or draws me to dance.
first, its unstoppable. its an urge. its like, there is nothing else i can do but DANCE something out. its this feeling that i get when i hear music, or feel an emotion, or see a story, that all of a sudden coaxes my body into something, and i think to myself, i have to get myself to a studio now.
second, more than an urge to just move, its an urge to create. its like when something moves me, a piece of music, an emotion, a story, my mind naturally wanders to a visual scene that i want to create. i want to translate what i feel into something that someone else can understand and feel as well.
and third, i realized this when i talked to another friend of mine, a lot of times dance is able to express something for myself that words, music, art, can't do for me. Actually mostly just words. I used to diary a lot. write down a lot of my emotions, but there is a way that i did it where i noticed i censored myself. i think before i write it down, and in the translation onto paper or into words, i lose some of that raw feeling that i had in my head. to me, dance is sometimes a much more direct translation of how i feel.
in high school, when i first started to seriously choreograph, i dont think i even thought twice about why i loved it. it was an activity, and i threw 110% of myself into everyone of my activities. (YEA..i was THAT kid). So in HS it was just something I excelled at. but just recently, dance has become much more meaningful to me.
So yes, I sometimes give into that temptation, and sometimes it is to the detriment of everything else that I *should* be doing. I get very little sleep sometimes, don't eat properly, do a lot of crazy things...but hey, i'm in my twenties, and that's allowed, right?
And who defines what I *should* or *shouldn't* be doing to begin with?
Especially, he said, when it seems like "There are times when you seem to be killing yourself with dance to the detriment of other things in a way I don't think I would for an activity..."
and it got me thinking....
I have thought about the question why do i dance before. my parents still often ask me, why are you still dancing? what does it mean to you? i always, of course, a little petulantly, say, "because it makes me happy!"
but what does that mean? And in the response to my friend, i started really trying to understand, what it is that happens when i dance, or draws me to dance.
first, its unstoppable. its an urge. its like, there is nothing else i can do but DANCE something out. its this feeling that i get when i hear music, or feel an emotion, or see a story, that all of a sudden coaxes my body into something, and i think to myself, i have to get myself to a studio now.
second, more than an urge to just move, its an urge to create. its like when something moves me, a piece of music, an emotion, a story, my mind naturally wanders to a visual scene that i want to create. i want to translate what i feel into something that someone else can understand and feel as well.
and third, i realized this when i talked to another friend of mine, a lot of times dance is able to express something for myself that words, music, art, can't do for me. Actually mostly just words. I used to diary a lot. write down a lot of my emotions, but there is a way that i did it where i noticed i censored myself. i think before i write it down, and in the translation onto paper or into words, i lose some of that raw feeling that i had in my head. to me, dance is sometimes a much more direct translation of how i feel.
in high school, when i first started to seriously choreograph, i dont think i even thought twice about why i loved it. it was an activity, and i threw 110% of myself into everyone of my activities. (YEA..i was THAT kid). So in HS it was just something I excelled at. but just recently, dance has become much more meaningful to me.
So yes, I sometimes give into that temptation, and sometimes it is to the detriment of everything else that I *should* be doing. I get very little sleep sometimes, don't eat properly, do a lot of crazy things...but hey, i'm in my twenties, and that's allowed, right?
And who defines what I *should* or *shouldn't* be doing to begin with?
Wednesday, January 20, 2010
2010 resolutions...
a little late but stuff i have been thinking about:
1. have a "me" day at least once every other week. a "me" day is defined as having NOTHING and NOWHERE for me to do or be. I can wake up in the morning, and decide what i want to do right there and then.
2. cook more. eat better. eat less fast food. (urbanite may be my huuuuge exception.)
3. be more financially responsible. (ie. keep a budget. and stick to it. and start saving.)
4. get more sleep.
5. learn to say "no". (ie. condense my schedule).
6. don't do anything i don't want to do. do things that make me happy.
7. keep better in touch with friends.
8. cut myself some slack. life is a process, i don't need to get things done RIGHT HERE AND RIGHT NOW.
9. dance unapologetically.
10. call home more.
10 things to do for 2010!
1. have a "me" day at least once every other week. a "me" day is defined as having NOTHING and NOWHERE for me to do or be. I can wake up in the morning, and decide what i want to do right there and then.
2. cook more. eat better. eat less fast food. (urbanite may be my huuuuge exception.)
3. be more financially responsible. (ie. keep a budget. and stick to it. and start saving.)
4. get more sleep.
5. learn to say "no". (ie. condense my schedule).
6. don't do anything i don't want to do. do things that make me happy.
7. keep better in touch with friends.
8. cut myself some slack. life is a process, i don't need to get things done RIGHT HERE AND RIGHT NOW.
9. dance unapologetically.
10. call home more.
10 things to do for 2010!
Thursday, January 7, 2010
in transition
Jan. 7, 2010
LAX
As a child I used to love jumping back and forth between hot and cold temperature swimming pools. Some cringed at the drastic temperature change, but I prided myself in being one of the few who could rapidly immerse my body in the two temperatures in succession, seemingly demonstrating my body’s superior adaptability. The point of the exercise was to cleanse the body. The hot temperatures opened your pores, allowing toxins in your body to be released, and the cold temperature pools washed these toxins away. This was supposed to leave your body cleaner, healthier, and ultimately, stronger.
I thought about this metaphor on my plane ride from Asia to the US this time around. Experiencing stark differences can make someone stronger, whether it’s stark differences in water temperatures at the swimming pool, or transplanting oneself from one culture to another. Yet, although the end product is something “good” or beneficial, if one wanted to impart a value judgment on the process (as a sociologist I feel like I am being trained to be value neutral…as if that is possible), the process is harsh. I felt the harshness particularly during this trip, though perhaps I have always felt this in the process of leaving Asia and coming to the United States, or vice versa. The 24 hour period that I am traveling between my homes, in hindsight, is merely a small blip in time compared to the rest of my year. However, during the experience, it is always a painful and heart-wrenching process.
Sometimes its hard to comprehend that within the blink of an eye I can be in two completely different places, with different histories, different cultures, different societies…sometimes its hard to remember that humanity across all geographies possess similarities. Although I know a 24 hr travel period is not necessarily a “blink of the eye”, just think—it used to take people months to travel between continents. They had months to contemplate their journey, and adjust themselves to the thought of being in a new place. They had time for acceptance. Modern technology allows us to be in completely different places, within the day. We process change at much faster rates. Yet, do we process the change, or merely note the differences and move on with our individual lives?
Furthermore, the buffer zone feeling that exists while I am between my two homes is gone after the 24 hours of travel time. Once immersed in a setting, I adapt. Some may argue that is what third culture kids (TCKs) learn to do. I argue that its always been in my personality to adapt. Whatever the cause, once I’m in a place, I’m there. I thrive and become the person that society recognizes. I am lucky to have a great support network in both homes (thus making me feel that both are my homes, as opposed to giving priority to one over the other) and when I leave one to enter the other, I still enter a welcoming atmosphere.
So, it is not the thought of “going somewhere” that is the painful part of this process. I don’t feel this way because I dread coming back to America, or dread going back to Asia. Rather, it is knowing that you are leaving, and knowing where you are going, and being so acutely aware of the differences between the two places, that causes the angst. As opposed to immigrant generations, who have a definite “home country” and “destination country”, I feel like the global citizen gives equal priority to all of their homes. Perhaps I feel this even more since although I am a TCK, I have really only lived in one country abroad: Singapore. Therefore my heart is definitely divided equally between two places—Singapore and the US.
What is even harder sometimes to make sense of is the feeling of being a foreigner and a local at the same time in multiple places. When I go back to Singapore, I love it like a local. I love it with the love of having grown up in the place for over 10 years. While the place has changed, the texture, color, and sensation of the place remains the same. Yet, I am not Singaporean. The way I dress, the way I talk, even some of my values and viewpoints, are not Singaporean. I am always confronted with the question, especially when I speak in Chinese for some reason, “Ni shi na li ren?” (What country are you from?). (Actually in Taiwan I get “Ni shi wai guo ren ma?” Are you a foreigner? While they are similar, to me there are subtle differences in meaning.) Similarly, when I go back to America, I love it with the love of having spent most of my adult years in the place. Yet again, there is the disjuncture—no I’m not from any particular state/city within the US, I usually answer “Most recently from Chicago”, and yes sometimes I say “carpark”, “Air Con”, “ toilet” instead of “parking lot”, “AC”, and “restroom”, which cause many to laugh and jokingly say, “oh that’s right you’re not from here”. Although these incidences are really minor, they are just a smattering of experiences that add up to a general feeling of being a foreign local.
It’s not only that, but I am a different person in the two different places. They are not extremely different, but I notice that I put on different acts in the different countries. I am acting, but I’m not. They are all parts of me, I just learn to turn one part on or off, depending on the context. One learns to observe situations. Read signals. Body language is very different in the two countries. Facial expressions. I have to adjust my threshold of sensitivity to body language and signals accordingly.
So if I am a foreign local in both places, why is it so hard to leave one to head to the other? If both places give me the same feeling, shouldn’t I be ambivalent to either country? For me, the answer is no. (Perhaps for some other global citizens, they find this transition easier.) The transition to either side is equally difficult. Because as soon as I feel like I am tipping the balance between foreigner and local in one place, I up and move back to the other place. I am reminded, with that experience, that I am also as much a local and a foreigner in another country. Thus the dilemma: just as I feel like I am becoming more “local” in one place, I leave. And again become a “foreigner” in both places again.
Perhaps I am being naïve. Perhaps this is the way it should be. Perhaps it is not time for me to have a place for me to feel like a local in. Or perhaps I will always feel most at home, but also most disturbed, in an airport.
I know some may make the argument, just as dipping oneself into two extreme temperatures of swimming pools in succession, that exposure to multiple experiences and cultures makes one’s views more broad, and oneself stronger. Perhaps it does. But it doesn’t make the process any easier to think about, knowing those outcomes.
In reality, these concerns also exist within the space that I inhabit when I’m between homes. And in another 12 hours, these feelings will be gone as I immerse myself into one of my homes once more.
LAX
As a child I used to love jumping back and forth between hot and cold temperature swimming pools. Some cringed at the drastic temperature change, but I prided myself in being one of the few who could rapidly immerse my body in the two temperatures in succession, seemingly demonstrating my body’s superior adaptability. The point of the exercise was to cleanse the body. The hot temperatures opened your pores, allowing toxins in your body to be released, and the cold temperature pools washed these toxins away. This was supposed to leave your body cleaner, healthier, and ultimately, stronger.
I thought about this metaphor on my plane ride from Asia to the US this time around. Experiencing stark differences can make someone stronger, whether it’s stark differences in water temperatures at the swimming pool, or transplanting oneself from one culture to another. Yet, although the end product is something “good” or beneficial, if one wanted to impart a value judgment on the process (as a sociologist I feel like I am being trained to be value neutral…as if that is possible), the process is harsh. I felt the harshness particularly during this trip, though perhaps I have always felt this in the process of leaving Asia and coming to the United States, or vice versa. The 24 hour period that I am traveling between my homes, in hindsight, is merely a small blip in time compared to the rest of my year. However, during the experience, it is always a painful and heart-wrenching process.
Sometimes its hard to comprehend that within the blink of an eye I can be in two completely different places, with different histories, different cultures, different societies…sometimes its hard to remember that humanity across all geographies possess similarities. Although I know a 24 hr travel period is not necessarily a “blink of the eye”, just think—it used to take people months to travel between continents. They had months to contemplate their journey, and adjust themselves to the thought of being in a new place. They had time for acceptance. Modern technology allows us to be in completely different places, within the day. We process change at much faster rates. Yet, do we process the change, or merely note the differences and move on with our individual lives?
Furthermore, the buffer zone feeling that exists while I am between my two homes is gone after the 24 hours of travel time. Once immersed in a setting, I adapt. Some may argue that is what third culture kids (TCKs) learn to do. I argue that its always been in my personality to adapt. Whatever the cause, once I’m in a place, I’m there. I thrive and become the person that society recognizes. I am lucky to have a great support network in both homes (thus making me feel that both are my homes, as opposed to giving priority to one over the other) and when I leave one to enter the other, I still enter a welcoming atmosphere.
So, it is not the thought of “going somewhere” that is the painful part of this process. I don’t feel this way because I dread coming back to America, or dread going back to Asia. Rather, it is knowing that you are leaving, and knowing where you are going, and being so acutely aware of the differences between the two places, that causes the angst. As opposed to immigrant generations, who have a definite “home country” and “destination country”, I feel like the global citizen gives equal priority to all of their homes. Perhaps I feel this even more since although I am a TCK, I have really only lived in one country abroad: Singapore. Therefore my heart is definitely divided equally between two places—Singapore and the US.
What is even harder sometimes to make sense of is the feeling of being a foreigner and a local at the same time in multiple places. When I go back to Singapore, I love it like a local. I love it with the love of having grown up in the place for over 10 years. While the place has changed, the texture, color, and sensation of the place remains the same. Yet, I am not Singaporean. The way I dress, the way I talk, even some of my values and viewpoints, are not Singaporean. I am always confronted with the question, especially when I speak in Chinese for some reason, “Ni shi na li ren?” (What country are you from?). (Actually in Taiwan I get “Ni shi wai guo ren ma?” Are you a foreigner? While they are similar, to me there are subtle differences in meaning.) Similarly, when I go back to America, I love it with the love of having spent most of my adult years in the place. Yet again, there is the disjuncture—no I’m not from any particular state/city within the US, I usually answer “Most recently from Chicago”, and yes sometimes I say “carpark”, “Air Con”, “ toilet” instead of “parking lot”, “AC”, and “restroom”, which cause many to laugh and jokingly say, “oh that’s right you’re not from here”. Although these incidences are really minor, they are just a smattering of experiences that add up to a general feeling of being a foreign local.
It’s not only that, but I am a different person in the two different places. They are not extremely different, but I notice that I put on different acts in the different countries. I am acting, but I’m not. They are all parts of me, I just learn to turn one part on or off, depending on the context. One learns to observe situations. Read signals. Body language is very different in the two countries. Facial expressions. I have to adjust my threshold of sensitivity to body language and signals accordingly.
So if I am a foreign local in both places, why is it so hard to leave one to head to the other? If both places give me the same feeling, shouldn’t I be ambivalent to either country? For me, the answer is no. (Perhaps for some other global citizens, they find this transition easier.) The transition to either side is equally difficult. Because as soon as I feel like I am tipping the balance between foreigner and local in one place, I up and move back to the other place. I am reminded, with that experience, that I am also as much a local and a foreigner in another country. Thus the dilemma: just as I feel like I am becoming more “local” in one place, I leave. And again become a “foreigner” in both places again.
Perhaps I am being naïve. Perhaps this is the way it should be. Perhaps it is not time for me to have a place for me to feel like a local in. Or perhaps I will always feel most at home, but also most disturbed, in an airport.
I know some may make the argument, just as dipping oneself into two extreme temperatures of swimming pools in succession, that exposure to multiple experiences and cultures makes one’s views more broad, and oneself stronger. Perhaps it does. But it doesn’t make the process any easier to think about, knowing those outcomes.
In reality, these concerns also exist within the space that I inhabit when I’m between homes. And in another 12 hours, these feelings will be gone as I immerse myself into one of my homes once more.
Thursday, August 27, 2009
Tuesday, June 23, 2009
Cooking Fun!
Ok, so, I also decided, that this may be in part a food blog, as I discover and start to make, more interesting foods.
Tonight's recipes were:
1. Black Bean and Corn Salad
2. Chicken Stew
Tonight's recipes were:
1. Black Bean and Corn Salad
2. Chicken Stew
First up is the Black Bean and Corn Salad:
I got the idea after having some black bean and corn salad at a little buffet lunch I had with Jess Deng about a week ago. I also realized that this is not a bad way to get a good healthy amount of fiber, and to eat beans, which I usually don't like to do. I searched online for some recipes and ended up combining a couple of ideas, and then improvising with whatever materials that I had.
Ingredients:
1 Can of Black Beans
about 3/4 a bag of frozen sweet corn
1 tomato (I had an extra half of a plum tomato and then half a hothouse tomato, but I feel like 1 tomato on a vine or one hothouse tomato will be good. tho I think plum tomatoes are the sweetest)
1 avocado
A couple handfuls of cilantro
Seasoning:
a pinch of ground cumin
salt and pepper to taste
lemon juice
a splash of olive oil
The cool thing is, is that you don't have to do anything with the frozen corn. just pour it into the mixture with all the ingredients, and let it slowly defrost, and it cools the whole salad really quickly. (picked this up from Rachael Ray's recipe)
Second up is the Chicken Stew:
Ingredients:
1 Can of Black Beans
about 3/4 a bag of frozen sweet corn
1 tomato (I had an extra half of a plum tomato and then half a hothouse tomato, but I feel like 1 tomato on a vine or one hothouse tomato will be good. tho I think plum tomatoes are the sweetest)
1 avocado
A couple handfuls of cilantro
Seasoning:
a pinch of ground cumin
salt and pepper to taste
lemon juice
a splash of olive oil
The cool thing is, is that you don't have to do anything with the frozen corn. just pour it into the mixture with all the ingredients, and let it slowly defrost, and it cools the whole salad really quickly. (picked this up from Rachael Ray's recipe)
Second up is the Chicken Stew:
This one I basically pulled from this Food Network recipe. I recently have had a craving for soups and realized I've never really experimented in making my own soups. So this is the first one that I thought I could try. I basically followed everything in the recipe, except I used just plain chicken breasts (no bone), added about a cup and a half of fresh spinach at the end, and used dry basil leaves and dry thyme. I also used a whole 32 oz box of chicken broth to make things a little more soupy and to account for the extra vegetables that I was chopping into it. I also used a large sweet onion as opposed to a small one, and I feel like the carrot and onion really make the whole soup very very sweet, but the basil and the thyme add a nice herb-y taste and smell. I definitely wanted a more vegetable, natural taste, so i only did small pinches of salt and pepper, and extra vegetables.
Conclusions: SO GOOD!!!
I think next time I'm going to crush the cilantro for the black bean salad more (rip it into smaller pieces) and use a little less of it, just because getting a big bite of a cilantro leaf is a little more bitter than I would like. Adding the avocado was a great idea and definitely puts a more Southwestern feel to the whole thing. I think also, usually this kind of salad has chopped red onion in it, but i'm not a big fan, so I skipped that.
The recipe for the stew calls for serving with crusty bread, but I'm going to add some rainbow rotini instead for lunch tomorrow.
Yay! So I don't "just" ponder society and health and such. Haha.
Ok now back to more prelim reading...oh boy...
Conclusions: SO GOOD!!!
I think next time I'm going to crush the cilantro for the black bean salad more (rip it into smaller pieces) and use a little less of it, just because getting a big bite of a cilantro leaf is a little more bitter than I would like. Adding the avocado was a great idea and definitely puts a more Southwestern feel to the whole thing. I think also, usually this kind of salad has chopped red onion in it, but i'm not a big fan, so I skipped that.
The recipe for the stew calls for serving with crusty bread, but I'm going to add some rainbow rotini instead for lunch tomorrow.
Yay! So I don't "just" ponder society and health and such. Haha.
Ok now back to more prelim reading...oh boy...
Thursday, June 18, 2009
What is the "crisis" mean in the phrase "Healthcare Crisis"?
So I recently read a fascinating article in The New Yorker about a specific node of the "healthcare crisis". It's a little old, but apparently its been "required" reading at the White House. If you haven't read it, I really recommend giving it a quick look, because to me, it highlighted a number of the nuances of this "crisis" that we are in without indulging in the blame game that many articles enjoy playing while writing about this problem (feel free to disagree!). I enjoyed that it coupled not only statistical evidence regarding healthcare expenditures, but had clear scenarios and interviews to elucidate the mechanisms through which healthcare expenditures have been rising. To me, it is one of the most fair perspectives on the whole issue that I've read so far.
It made me think: what exactly is in "crisis" with the healthcare system? How we choose to define the problem allows us to prioritize what kinds of changes to need to happen in the future. The first thing that people think about when they think healthcare crisis is "healthcare costs". Obama has stated that this is the single most important threat to the fiscal safety of America: skyrocketing healthcare costs. Even though I claim to study healthcare, there were still many details about healthcare economics and the current state of our healthcare system with which I am unfamiliar. So I decided to do a little mini research project and find out what this healthcare crisis really means.
First, the number often quoted is exactly how much we Americans spend on "healthcare" ($2.2 Trillion, which is about $7,421 per person or 16.2 percent of the nation's Gross Domestic Product, as of 2007. Statistics here.) These numbers are always stated with a tone of extravagance--that clearly the United States is spending "too much" on healthcare. Stating that costs are skyrocketing, and we are spending too much, implies that we have in mind some ideal spending amount, with some ideal distribution. What is that amount? What is too much, and what should we be getting for our dollars?
Some numbers may aid in our decision:
The National Heath Expenditure Accounts estimate (with same data as above) that 31% of this expenditure is in hospital stays, 21% are in physicial/clinical services, 10% in prescription drugs, and 25% other. The other category includes dentist services, other professional services, home health, durable medical products, over-the-counter medicines and sundries, public health, other personal health care, research and structures and equipment. On a closer examination, less than 2% of this expenditure is spent on research for prevention programes and less than 3% of this expenditure is on government public health programes, which include epidemiological services, vaccination and innoculation services, and disease prevention programes. 20% of the healthcare expenditures are in Medicare, 16% in Medicaid, and 54% in private insurance. 94% of expenditures are spent on health services and health supplies purchased through various insurance/reimbursement means, by people. It is also interesting to note that "skyrocketing" costs may be a little bit decieving: change in percentage growth of healthcare expenditures has actually decreased--at 10.5% in the 60s to 6.1% in 2007. Interestingly, a large deceleration in healthcare costs comes from prescription drugs, with a percent change dropping from 8.6 in 2006 to 4.9 in 2007. NHEA states that this is due to an increase in generic drugs and slower growth in prescription drug prices. However, on the other hand, visits to hospitals, physicians, as well as a large increase in use of home health care and nursing homes increased.
Moreover, after disaggregating for age, since as we all know, medical expenses are going to vary by age, because disease varies by age, an average of $14,797 was spent on persons 65 yrs or older in 2004, while $2,650 was spent on children, and $4,511 were spent on those working aged. No doubt, this amount varies by region, socioeconomic status, neighborhood composition, etc. This is also interesting given that the proportion older than 65 is expected to more than double in the next 50 years according to census projections.
So where is the crux of the "cost" crisis? Are we spending "too much" per person, or are we facing an increase of people who just need more care? (By no means am I blaming the elderly for this, but rather trying to say that of course we will face a natural rise in the need for healthcare as the population ages, and we have to prepare for it.) Does the answer to that problem come from cutting back services or reorganizing services? What is too much to spend per person? And what are the right things to be spending on? Is it possible to see a decrease in health dollars spent on hospital and clinic care if we invested more money in preventive care and healthcare education?
The second thing that people think about when they think healthcare crisis is this number: 47 million Americans are uninsured, which is 15.8% of Americans (Census info here). Meanwhile, the number of people possessing any kind of health insurance has stayed the same, while the percentage having employment based insurance has actually decreased. Research then suggests that the reason that we have an increase in the uninsured is due to a drop in employment based insurance. (Urban Institute Findings). Obama has also aimed to address this issue by cutting costs now in order to facilitate some sort of state sponsored insurance plan that will get insurance coverage for everyone. (see fact sheet here).
Therefore, not only is there a crisis in spending too much by the people who already have insurance and can access healthcare supplies and facilities, but there is also a crisis in people not getting the care in the first place. Then, when we do provide insurance to those who lack it, what are the guarantees that this insurance necessarily equals access to the appropriate care? And once we do provide insurance, what's to stop the costs of care from skyrocketing again? As the article in the New Yorker suggests, healthcare costs don't relate to quality care, and sometimes, higher healthcare expenditures can occur in lower income neighborhoods to communities that are more likely to lack health insurance. (An interesting sociology article by Karen Lutfey and Jeremy Freese shows an interesting link: that physicians in low income neighborhoods tend to prescribe aggressive treatments because they are less likely to trust their patients to take care of themselves outside of the clinic, and therefore try to do what is medically necessary while they have the patients in front of them. See article here).
How do we solve these two "crises"? Are they separate problems or part of the same overarching problem?
The reality is, when people refer to the "crisis" in healthcare, we are not talking about absolute dollars spent, we are talking about fundamentally different perspectives on HOW dollars should be spent, and WHO should be benefiting from these dollars. Furthermore, we are also in disagreement as to who can judge who gets the care, and how they should get the care. (Should the AMA be the final decision maker, or Congress? What about patient/consumer rights organizations?) Not only that, but we have to add in a dimension of time--who benefits now, and who gets to benefit in the future. Can we sacrifice dollars spent on "curative" care now, to invest in "preventive" care now, in order to benefit those in the future? If we add insurance coverage (covered by private insurers, the government, some hybrid mix, it doesn't matter) where do people then go for access to care, and what guarantees that quality of care?
It is a crisis that is not reducible to the dollar amounts that we spend in healthcare. Indeed the trends in spending, as well as the trends in insurance coverage, are signs to what is wrong with our healthcare system. But these are just specific manifestations of a much larger crisis: what is the role of healthcare in our modern lives? Is healthcare merely a commodity that we consume? Therefore, the physicians in McAllen are just taking advantage of the market nature of this turn of events. On one side, the free-market paradigm of healthcare seems to promote patient choice in care, but on the flip side, it also means that patients then offer up their bodies and the price of their well-being to be determined by the mechanical (if you believe in the invisible hand so to speak) forces of market dynamics. Guwande's example hits it straight on the head with this conversation:
We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”
It is pretty ridiculous to imagine that a patient and a physician can negotiate and bargain over goods and prices. Sometimes it just seems a little silly to take compromises when it comes to health, no?
On the other hand is healthcare a consulting service? Are the consequences of this service to be judged by healthcare economists, actuaries, the state, medical opinions about the quality of life and mortality statistics, insurance companies, or patient advocates? It seems in this article, that some of the best models out there were actually physician-self run community groups that held a common goal of patients first in their group. (This is interesting because many believe that once physicians get together and control the healthcare giving system, it will only result in market domination, physician control of prices, and skyrocketing healthcare expenditures. such were the arguments agains the Fee for Service system. Interesting that this is not necessarily true). But the extreme end of this argument also largely promotes a medical hegemony, where whatever medical advice is offered should be taken as truth.
Therefore, what is in crisis are the fundamental views regarding healthcare in America. WHO gets to get healthcare? WHAT kinds of healthcare should they receive? WHO gets to decide what is "enough" healthcare and "enough" spending? And HOW should the balance between spending and quality be justified and delivered?
How would you answer those questions?
It made me think: what exactly is in "crisis" with the healthcare system? How we choose to define the problem allows us to prioritize what kinds of changes to need to happen in the future. The first thing that people think about when they think healthcare crisis is "healthcare costs". Obama has stated that this is the single most important threat to the fiscal safety of America: skyrocketing healthcare costs. Even though I claim to study healthcare, there were still many details about healthcare economics and the current state of our healthcare system with which I am unfamiliar. So I decided to do a little mini research project and find out what this healthcare crisis really means.
First, the number often quoted is exactly how much we Americans spend on "healthcare" ($2.2 Trillion, which is about $7,421 per person or 16.2 percent of the nation's Gross Domestic Product, as of 2007. Statistics here.) These numbers are always stated with a tone of extravagance--that clearly the United States is spending "too much" on healthcare. Stating that costs are skyrocketing, and we are spending too much, implies that we have in mind some ideal spending amount, with some ideal distribution. What is that amount? What is too much, and what should we be getting for our dollars?
Some numbers may aid in our decision:
The National Heath Expenditure Accounts estimate (with same data as above) that 31% of this expenditure is in hospital stays, 21% are in physicial/clinical services, 10% in prescription drugs, and 25% other. The other category includes dentist services, other professional services, home health, durable medical products, over-the-counter medicines and sundries, public health, other personal health care, research and structures and equipment. On a closer examination, less than 2% of this expenditure is spent on research for prevention programes and less than 3% of this expenditure is on government public health programes, which include epidemiological services, vaccination and innoculation services, and disease prevention programes. 20% of the healthcare expenditures are in Medicare, 16% in Medicaid, and 54% in private insurance. 94% of expenditures are spent on health services and health supplies purchased through various insurance/reimbursement means, by people. It is also interesting to note that "skyrocketing" costs may be a little bit decieving: change in percentage growth of healthcare expenditures has actually decreased--at 10.5% in the 60s to 6.1% in 2007. Interestingly, a large deceleration in healthcare costs comes from prescription drugs, with a percent change dropping from 8.6 in 2006 to 4.9 in 2007. NHEA states that this is due to an increase in generic drugs and slower growth in prescription drug prices. However, on the other hand, visits to hospitals, physicians, as well as a large increase in use of home health care and nursing homes increased.
Moreover, after disaggregating for age, since as we all know, medical expenses are going to vary by age, because disease varies by age, an average of $14,797 was spent on persons 65 yrs or older in 2004, while $2,650 was spent on children, and $4,511 were spent on those working aged. No doubt, this amount varies by region, socioeconomic status, neighborhood composition, etc. This is also interesting given that the proportion older than 65 is expected to more than double in the next 50 years according to census projections.
So where is the crux of the "cost" crisis? Are we spending "too much" per person, or are we facing an increase of people who just need more care? (By no means am I blaming the elderly for this, but rather trying to say that of course we will face a natural rise in the need for healthcare as the population ages, and we have to prepare for it.) Does the answer to that problem come from cutting back services or reorganizing services? What is too much to spend per person? And what are the right things to be spending on? Is it possible to see a decrease in health dollars spent on hospital and clinic care if we invested more money in preventive care and healthcare education?
The second thing that people think about when they think healthcare crisis is this number: 47 million Americans are uninsured, which is 15.8% of Americans (Census info here). Meanwhile, the number of people possessing any kind of health insurance has stayed the same, while the percentage having employment based insurance has actually decreased. Research then suggests that the reason that we have an increase in the uninsured is due to a drop in employment based insurance. (Urban Institute Findings). Obama has also aimed to address this issue by cutting costs now in order to facilitate some sort of state sponsored insurance plan that will get insurance coverage for everyone. (see fact sheet here).
Therefore, not only is there a crisis in spending too much by the people who already have insurance and can access healthcare supplies and facilities, but there is also a crisis in people not getting the care in the first place. Then, when we do provide insurance to those who lack it, what are the guarantees that this insurance necessarily equals access to the appropriate care? And once we do provide insurance, what's to stop the costs of care from skyrocketing again? As the article in the New Yorker suggests, healthcare costs don't relate to quality care, and sometimes, higher healthcare expenditures can occur in lower income neighborhoods to communities that are more likely to lack health insurance. (An interesting sociology article by Karen Lutfey and Jeremy Freese shows an interesting link: that physicians in low income neighborhoods tend to prescribe aggressive treatments because they are less likely to trust their patients to take care of themselves outside of the clinic, and therefore try to do what is medically necessary while they have the patients in front of them. See article here).
How do we solve these two "crises"? Are they separate problems or part of the same overarching problem?
The reality is, when people refer to the "crisis" in healthcare, we are not talking about absolute dollars spent, we are talking about fundamentally different perspectives on HOW dollars should be spent, and WHO should be benefiting from these dollars. Furthermore, we are also in disagreement as to who can judge who gets the care, and how they should get the care. (Should the AMA be the final decision maker, or Congress? What about patient/consumer rights organizations?) Not only that, but we have to add in a dimension of time--who benefits now, and who gets to benefit in the future. Can we sacrifice dollars spent on "curative" care now, to invest in "preventive" care now, in order to benefit those in the future? If we add insurance coverage (covered by private insurers, the government, some hybrid mix, it doesn't matter) where do people then go for access to care, and what guarantees that quality of care?
It is a crisis that is not reducible to the dollar amounts that we spend in healthcare. Indeed the trends in spending, as well as the trends in insurance coverage, are signs to what is wrong with our healthcare system. But these are just specific manifestations of a much larger crisis: what is the role of healthcare in our modern lives? Is healthcare merely a commodity that we consume? Therefore, the physicians in McAllen are just taking advantage of the market nature of this turn of events. On one side, the free-market paradigm of healthcare seems to promote patient choice in care, but on the flip side, it also means that patients then offer up their bodies and the price of their well-being to be determined by the mechanical (if you believe in the invisible hand so to speak) forces of market dynamics. Guwande's example hits it straight on the head with this conversation:
We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”
It is pretty ridiculous to imagine that a patient and a physician can negotiate and bargain over goods and prices. Sometimes it just seems a little silly to take compromises when it comes to health, no?
On the other hand is healthcare a consulting service? Are the consequences of this service to be judged by healthcare economists, actuaries, the state, medical opinions about the quality of life and mortality statistics, insurance companies, or patient advocates? It seems in this article, that some of the best models out there were actually physician-self run community groups that held a common goal of patients first in their group. (This is interesting because many believe that once physicians get together and control the healthcare giving system, it will only result in market domination, physician control of prices, and skyrocketing healthcare expenditures. such were the arguments agains the Fee for Service system. Interesting that this is not necessarily true). But the extreme end of this argument also largely promotes a medical hegemony, where whatever medical advice is offered should be taken as truth.
Therefore, what is in crisis are the fundamental views regarding healthcare in America. WHO gets to get healthcare? WHAT kinds of healthcare should they receive? WHO gets to decide what is "enough" healthcare and "enough" spending? And HOW should the balance between spending and quality be justified and delivered?
How would you answer those questions?
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