January 2008
OUT LOUD is St. Luke's Health Initiatives' monthly (September-June) online newsletter of provocations, prognostications, and peregrinations across the Arizona health care and policy landscape.
"He who cannot see through the rules cannot see except through the rules." Ojibway elder
"Data are not essential to certain arguments about social policy, and indeed can get in the way. The terms of debate can be grounded wholly about how the world ought to be, not how it is." Charles Murray, Losing Ground
Murray is a leading intellectual in conservative circles. The thesis is that conservatives engage the conversation from a set of core values. Arguably, that's why they've been successful in fashioning social policy. Liberals, on the other hand, bombard the public with all manner of disturbing data, but don't engage in the values debate. They claim objectivity and neutrality. True or not? What are "liberal" values? Is this even the right way to frame the debate?
Gray Land: Housing for Persons with Serious Mental Illness is now available online. Hard copies will be mailed within the week. This is an in-depth look at a multi-faceted problem facing over 19,000 people in our community, with a plan for collaboration and action. We have also published A Recent Literature and Case Studies in Permanent Supportive Housing, which provides examples of what's working in other communities across the nation. That's online only.
You can't tune into the news today without being inundated with dire warnings about the future of the planet and the unsustainability of our growth-addicted way of life. Global warming, the yawning gap between the rich and poor, social and cultural wars, terrorism - the bad news casts a depressing pallor over the civic conversation, which itself has become anything but civil.
Our world is coming apart at the seams, driven by competing interests, ideologies and the frenetic pace of what passes for communication these days. We live in a hyperculture saturated with exaggerated images and disputed claims, a dazzling display of choices that, in the words of Bruce Springsteen, can feel like "57 channels and nothing on."
The noise of the hyperculture, however, masks a more disturbing and potentially deadly signal beneath its mediated surface diversity, and that is the wholesale creation of a vast monoculture.
And what is the 'monoculture?' Read one version in January's The Drift.
What's 'Public' About Public Hospitals?
A recent article in the NY Times examined how Grady Memorial Hospital in Atlanta, one of the nation's largest public hospitals and safety net providers, faces a huge financial shortfall. Nobody - not the country, not the state, not the feds - wants to help pick up the tab, even though Grady provides "vital services to the entire region."
This is tragic - but predictable. We've been talking about the future of the Maricopa Integrated Health System (MIHS), the Valley's own public hospital system, for years, including two reports (Squeezing the Rock and Squeezing the Rock II) on Maricopa County's health safety net and a policy primer on the future of public hospitals. The recent announcement that MIHS received a preliminary denial of accreditation from the Joint Commission, the loss of accreditation for its premier orthopedics residency program, a deteriorating physical plant, jostling for a position in the anticipated medical research complex downtown, a growing number of uninsured patients showing up at their facilities - the profile is not that different from the scene in Atlanta and other public hospitals across the country.
The $40 million or so from the Special Health Care District certainly helps, but it's not enough. Slowly - some would say inevitably - the 'public' is being squeezed out of public hospitals that are compelled to compete in the privatized, fragmented and cutthroat world of American health care. MIHS has done everything in its power to operate efficiently and balance its budget, but it still lacks sufficient resources to upgrade its facilities, attract physicians to practice and refer there, and still serve a low-income population that nobody else wants to serve.
We need to have a public conversation about our public hospital, and why we ignore it to our collective peril. Gee, here's an original thought: Let's start by reducing the number of people without health insurance. Then maybe more of them would be able to pay their bills at MIHS and other safety net institutions in our community.
Recently, we had a conversation with two bright young women, both recent graduates of ASU's new Master's Program in Nonprofit Leadership and Management. One of them, in talking about job prospects in the nonprofit sector and what she hoped to be doing in the future, expressed frustration with what she perceived as a condescending attitude toward younger people by some of the veterans in the field, and their expectation of finding the perfect candidate with years of experience before offering them a job.
"I have the right skills and could contribute a lot," she said. "I just want to be taken seriously."
Well, we should. Some predict a coming "leadership crisis" in the nonprofit world, with three out of four senior execs planning to leave their positions within the next five years, and a need for up to 640,000 new nonprofit managers by 2016. More young people are entering the field, but some surveys suggest that up to half of the young professionals in the sector aren't sure they want to stay in it. Perhaps one reason is that some of the aging boomers aren't taking them seriously.
But there's another reason, and it's the changing nature of the nonprofit sector itself. Young people are tuned into the social and cultural trends, and for that reason alone, we need to start paying attention. For one take on what a future nonprofit career might look like, we've posted a slide show on Not-for-Profits in the Hyperculture, which we presented at an ASU forum on nonprofit effectiveness last year.
Is one suggestion for what we ought to call "high performance enhancement drugs." A recent spate of articles document the growing trend of college professors, students, professional poker players, surgeons and others taking drugs like Adderall (developed for ADHD) and Provigil (developed for sleep disorders) to boost concentration, alertness, focus and short-term memory. Sales of Adderall alone were up a whopping 3,136 percent over the past four years; Provigil sales were up 360 percent for the same period.
Hypes are a rapidly expanding market: well people taking drugs to enhance performance. We get bent out of shape when pro athletes take steroids, but nobody seems to care whether a student drops some Provigil to book an all nighter before an important test, or a professional poker player takes it to play the table for ten hours straight.
Should we care? Plastic surgery started out as a series of techniques to help people disfigured by accidents or genetic defects; today millions of us without disfigurement use it to enhance our appearance. What's the difference whether, say, a high-priced trial lawyer takes a cognitive enhancer to give him an edge in a critical trial, a surgeon takes a pill to ensure that she's fully alert during a long and complicated operation, or a pilot takes a stimulant for a long flight ahead? This would be a good thing, right?
Of course, people have been doing "cognitive doping" for ages. Some of us can't get started in the morning without a jolt of caffeine, others take herbal enhancers like St. John's wort or ginseng. If you were a biotech exec, where would you be investing your research dollars: developing smart pills for people with money or drugs to eradicate diseases in underdeveloped countries filled with poor people unable to buy your product?
Enhancing the mind is the next frontier, and it could well eclipse the enhancement of the body and sexual function. There are huge ethical and regulatory issues, such as the potential for an even wider gap between people able to purchase a "winner's edge" and losers who cannot. This is a conversation that so far hasn't advanced too far up the public policy pole, and with our current obsession with the economic development aspects of biotechnology alone, it isn't hard to see why.
CONTENTS
What's 'Public' About Public Hospitals?
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