Tuesday, December 28, 2010

End-Of-Life Planning Is Back!

     Just when you think President Obama has abdicated his leadership, he comes through with something to indicate that the ability is down there waiting to assert itself. For example, witness the flurry of progressive activity that he has got through the Congress since his party's “shellacking” on November 2 (see Dec. 23, “An Early Christmas for the President”).
     Now he has done it again. According to the New York Times, an early December Medicare regulation deals with annual wellness visits, and includes "voluntary advance care planning" as an item that will be covered. Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare "wellness visit." By having Medicare cover these voluntary consultations, beneficiaries will be able to get information that will help them make their own decisions about their care and what they would or would not want at life's end.
     As part of the preparation of a living will and the appointment of a health care proxy, the physician may ask such questions as, “If you have another heart attack and your heart stops beating, would you want us to try to restart it?” A patient dying of emphysema might be asked, “Do you want to go on a breathing machine for the rest of your life?” And a patient with incurable cancer might be asked, “When the time comes, do you want us to use technology to try and delay your death?”
     The end-of-life-planning consultation, Section 1233, was dropped from the original healthcare reform bill after Sarah Palin claimed it would set up “death panels,” which allegedly would pass judgment, not only on older people's right to healthcare, but on others' as well. House Minority Leader John Boehner (R-Ohio) also chimed in, saying the bill would "start us down a treacherous path toward government-encouraged euthanasia if enacted into law."
     Actually end-of-life-planning is something that most people of sound mind and body have been doing all along: getting advice and making decisions on how they wish to be treated in the event of fatal accident or illness. Virtually all entities that deal with the elderly: doctors, hospitals, hospices, counselors, etc. have been advocating such a procedure for years.
     Maria J. Silveira, MD, MPH, of the VA Center for Clinical Management Research and University of Michigan, and her colleagues found that patients who documented their wishes for limited or comfort care received it approximately 90% of the time. The few who requested all possible care didn't always get it (five of 10) but were much more likely to get aggressive care than those who didn't request all care possible, Silveira's group reported.
     But the dark clouds of ideology are beginning to gather. Elizabeth D. Wickham, executive director of LifeTree, which describes itself as “a pro-life Christian educational ministry,” said she was concerned that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death. “The infamous Section 1233 is still alive and kicking,” Ms. Wickham said. “Patients will lose the ability to control treatments at the end of life.”
     In an attempt to downplay excessive controversy the administration said Sunday that the end-of-life planning provisions aren't new to health care services provided by the government. According to White House spokesman Reid Cherlin, "The Times story is wrong. This benefit was signed into law under President Bush. The only thing new here is a regulation allowing the discussions - authorized in 2003 by the prescription drug benefit - to happen in the context of the new annual wellness visit created by the Affordable Care Act."
     If Palin, Boehner, et al have not already availed themselves of end-of-life-planning, they are even dumber than I thought.
     It is important to understand that the Spirit is operating throughout the entire universe simultaneously for all point/events. Imagine that each instant in time corresponds to a station on an assembly line. This organic line differs from the usual mechanistic assembly line in that there is no overall blueprint for the product being assembled. Each station must take whatever point/events are passed to it, and through the action of the Spirit, make its own transformation. In this way constructs are built up, and their constant expansion and jostling makes up the world we see. Each construct at all times attempts to adjust itself harmoniously to the other constructs in its environment.
     An In-depth Look At the Spirit's Activity – The Spirit Runs Through It

     The book or a free download is available in paperback or on Kindle.

Saturday, December 25, 2010

The Best Christmas Ever

     In his column this morning, Andy Rooney asked the question, “What is the best Christmas present you ever got?” In thinking about it, I don't know the answer. I do know that I have had many very good Christmases, but I also realize that the good/bad rating of Christmas had nothing to do with what gifts were received.
     When I was three years old, I went to live with my grandparents on the farm because of the Great Depression. I don't know where my grandparents got the tree, but I do remember filling the bucket from the coal bin to hold the tree. Next the bucket had to be wrapped in tissue paper, usually red, and filled with water. That was supposed to keep the needles from falling off, but it didn't work very well - there were needles all over the place when the tree was taken down.
     Then the lights had to be strung. It was necessary to test the lights first, because if one bulb was burned out, the whole string went dark. You had to check each individual bulb in order to find the guilty one. Even though multicolored lights were popular, Grandma always liked blue ones.
     Of course, to me as a kid, the success of Christmas did actually depend upon the gifts received. At that time if you wrote a letter to Santa, your name and what you wanted was read on the radio. I don't know when Santa decided not to go on the air, but that was always exciting to hear him read your letter – you could be sure he had received it.
     One year the hootenanny, a drawing toy, was the toy of choice – every kid wanted one. It was later reintroduced as the Spirograph (see http://www.retrowow.co.uk/retro_collectibles/60s/spirograph.php). (This is not exactly the same thing, but it is very similar.) Anyway, I was delighted when Santa put it under the tree.
     Another year I wanted a cowboy suit and pearl-handled six-shooters. Again Santa came through, and again Christmas was wonderful.
     Perhaps the most joyous Christmas occurred while I was awaiting permanent assignment after completing basic training at Fort Knox. I was unexpectedly given a ten day pass just a couple of days before Christmas. To the surprise of my parents, I arrived home on Christmas Eve. It was wonderful!
     I also remember another Christmas Eve when I was busy assembling toys, installing batteries, etc. until 4:00 am. The boys usually woke up by 7:00 on Christmas day - If they didn't, we awakened them - but in spite of the short night, I enjoyed every minute of it.
     There have been many other happy Christmases, but the point is, it is not the gifts that made them happy; it is an intangible spirit that I can't explain, nor do I need to explain it to anyone who has experienced it. As the song says, ”Oh, if we could only see such spirit through the year.”
     And above all, there is the story which Luke recounts in his second chapter, preferably in the beautiful language of the King James Version.

Thursday, December 23, 2010

An Early Christmas for the President

     Apparently Santa Claus has decided not to wait until Christmas Eve to start making his annual deliveries. President Obama, in particular, has received an early visit from the Christmas Eve flier, raising the conjecture among Washington's “in” crowd that the sprightly old elf is a Democrat. Be very careful, Mitch McConnell, you may wind up on the naughty list.
     As evidence of St. Nick's presidential visit, observe what has happened since the “shellacking” the Democrats received in the mid-term election. Along with almost everyone else, I expected that the remaining two months of the lame-duck Congress would exhibit a gridlock that would make Los Angeles freeways look like kids playing with toy cars in a sandbox. But lo and behold, the Congress came up with a bipartisan output that must have had Mitch wondering whether the “party of no” members had all gone home for the holidays. Observe:
     Congress passed a two year extension of the Bush tax cuts. The President had to give up his request not to extend the cuts for taxpayers making more than $250,000. As part of the same package, the Republicans agreed to extend unemployment benefits through 2011.

     The START Nuclear Arms Treaty with Russia was ratified by the Senate. The Treaty was originally signed on April 8, and has been awaiting Senate approval ever since. The President has lobbied long and hard for its passage, claiming it is the vital centerpiece of his relationship with Russia. Opposition centered upon what was considered to be an inadequate verification system, and the treaty's possible interference with a potential missile defense system.
     Proponents claimed that if it had been negotiated by a Republican president, it would have been ratified months ago.
     The “don't ask, don't tell” policy toward gays and lesbians in the military was repealed. The repeal was approved by the Secretary of Defense and the Chairman of the Joint Chiefs of Staff. In addition, a Pentagon review found that allowing gays to serve openly posed only a “low risk” of disruption.
     Opponents of the bill fought to the bitter end: As late as Tuesday Senate Minority Leader Mitch McConnell was trying to move, without debate, an amendment to the defense authorization bill that would have required the military service chiefs to individually certify the process.
     The Health and Compensation Act for 9/11 workers and survivors has passed. Opponents focused on the cost of the bill, which was originally set at $6.2B. The amount was reduced to $4.3B to assure passage.
     After the November 2 election, chances of any of these bills passing were estimated to be practically zero. That they passed is due to compromises from both sides of the aisle; apparently Republicans responded to their constituents' demands for action, while the President realized that he needed to move toward the center of the political spectrum.
     It appears that the official congressional leaders of the Republican Party, John Boehner and Mitch McConnell, are as dedicated as ever to making President Obama a one term president. Fortunately, individual members of the party voted for what they believed was best for the country instead of for the party line.
     In the TV show, A Charlie Brown Christmas, the song Christmas Time Is Here contains a line ,”Oh, if we could only see such spirit through the year.” Although not intended by the songwriter, the line has Congressional implications.
Merry Christmas
     It is easy to see how ever expanding constructs can interfere with each other. Thorns can choke out plants, changing economic conditions can ruin a business, and cats can wipe out a colony of field-mice. Within the human brain, bigotry can destroy understanding, and fear can prevent creative thinking.
     An In-Depth Look At the Spirit's Activity – The Spirit Runs Through It.

     The book or a free download is available in paperback or on Kindle.

Tuesday, December 21, 2010

Impressions of the Western Caribbean

     I came away from my recent trip to the Western Caribbean with a few impressions I would like to share with you.
     Of the three places I visited - Roatan, Belize and Cozumel - I got the best vibes from Cozumel. It is too bad the big ships have so few places to dock on the islands; like the railroads always go through the seediest places in town, the ships always dock in a not too nice area.
     Roatan and Belize have managed to “beautify” the area directly adjacent to their docks, but unfortunately, once you leave that immediate vicinity you have to go through the slums to get anywhere.
     On Roatan, some really nice houses have been built, mostly by immigrants. High points both figuratively and literally, these spacious and luxurious homes have a breathtakingly beautiful 360 degree view of the entire island.
     I also visited a tropical beach: a showplace complete with the obligatory fine white sand, palm trees, an outdoor bar, and of course, a luxurious hotel. I could envision spending some time there.
     Belize was a disappointment for me. Although the real estate ads assure me that there are some very nice homes available, I didn't see any.
     After an hour and a half bus ride through what I can only describe as jungle, the Mayan ruins were magnificent. But we returned through Belize City, which for poverty, garbage in the streets and barely inhabitable housing, can match any of the slums in our big cities.
     In both Roatan and Belize I would suggest to the powers that be that they make an effort to show tourists some of the nicer aspects of the area.
     Cozumel has built up an attractive and prosperous area along its entire seawall. In addition, there is Mexico Park, which has an excellent display of Mexican art. The bright colors and extremely fine detail on some of the exhibits are attractive and cheerful. In addition there are many beautiful models of Mayan ruins, cathedrals and other public buildings. Add an extremely knowledgeable docent to the mix, and it makes a very interesting day.
     For pictures of all these places, log on to http://cruisethewesterncaribbean.shutterfly.com and click on more... > Slide Show.
     I learned two things on this trip:
     (1) A GPS is worth its weight in gold. When one is barreling through a city at 65 miles per hour, it is great to have a voice tell you, “In .9 mile take exit 42 to the left, then bear right.” You don't get that from a map.
     (2) Never again will I drive all day on four successive days. My legs can't take it.
     A comet is captured by the gravity of the sun; subsequently it falls into a path which will take it from deep space to within a few million miles of the earth. Long before it is visible to the unaided eye, a modern astronomer spots it through a telescope. Immediately he informs NASA, which has been waiting for just such an opportunity. After a few months of feverish activity, a space probe, which will pass through the tail of the comet and return information regarding its chemical composition to earth, is launched. The probe is successful. Because of the current civilization’s belief in the importance of science, a great deal of information regarding the early makeup of the universe is now widely available.
     In the meantime, when the comet becomes visible to the human eye, it is spotted by a primitive tribesman deep in the jungles of West Papua. The tribe’s Shaman declares that this is a sign that the gods are angry. The tribe immediately begins a series of activities designed to appease them: huge bonfires, dances and other rites. Since the omen eventually passes from sight without incident, the tribe believes its appeasement efforts have been successful.
     Concepts for Understanding the Spirit – The Spirit Runs Through It

The book or a free download is available in paperback or on Kindle.