Archive for June, 2009
In any discussion or debate about a “Big Idea” the quality of the discourse depends in part on the accuracy and specificity of the definition of terms, as well as the amount of agreement among the participants as to the actual question or idea that is under consideration. When the discussion is proceeding with the goal of establishing a solution to a “Big Problem” or crisis, it is also useful to have performed a root cause analysis of the crisis so that one can assess whether the “Grand Solution” is targeted at the true problem or simply aimed at a symptom of that problem (hey…I’m a doctor…I can’t help myself with the medical analogies). In short, in order to avoid the all too common trap of “talking past one another”, participants in this type of discussion must agree on premise and definition before embarking on the journey.
Unless, of course, the participants are politicians, government bureaucrats, or other creatures who feed with them and upon their offerings.
We are being bombarded with articles, speeches, broadcasts, and Tweets about the “Health Care Crisis” in America. In my reading there seems to be at least a dozen separate discussions occurring under this heading, mostly due to the fact that the above two rules about premises and definitions are being ignored, either inadvertently or willfully. So why don’t I offer up a couple of definitions that will allow us to explore the root cause of this so-called “Health Care Crisis”? Who knows? Perhaps a solution might arise.
Loosely defined terms allow a type of linguistic abuse in “Big Idea” discussions; this abuse usually involves some sort of secondary gain (money, power, legacy). The more loose the definitions the more abuse made possible. What is meant by “Health Care” and what should the definition really be? At present “Health Care” when combined with the term “Crisis”, means the cost of providing health care. “Health Care” is properly defined as the provision of medical care, cognitive, diagnostic, and procedural, that actively prevents or cures disease. I think anyone who has been paying attention would agree that we might very well have a “Health Care COST Crisis” in America right now. It’s really expensive to provide health care to everyone who needs it in America.
Do we have a “Health Care Crisis” in America? Are our hospitals, our doctors and our nurses providing inadequate or bad care? Pundits, politicians, and plain old people on the street point to the fact that the United States does NOT have the highest life expectancy among developed countries and say that the answer must be “yes”. They point out the regional discrepancies in treatment protocols and health care expenditures and say that this is proof that healthcare providers are not providing the best care possible. I would argue just the opposite. The actual “Health Care” that is provided in the United States is superior to that provided anywhere else in the world. I will show in a minute that this is actually part of the “Cost” problem.
These same people then point to the fact that, at any one time, some 47 million Americans are without “Health Coverage”, what we call health insurance, and that this lack of financial coverage preventing them from gaining access to health care is causing preventable deaths. These preventable deaths explain the lower life expectancy of Americans in comparison with, say, Swedes. It turns out that this, too, is a canard. A red herring. Americans without “Health Care Coverage” do in fact have access to health care, and access to “Health Care Coverage” or health insurance does not appear to affect life expectancy.
No matter how you slice it this discussion or debate comes right down to the most basic definition, which then establishes the most basic root cause of the problem. We do, indeed, have a “Health Care Cost Crisis” right now in America, but it all stems from the undeniable fact that we have a “HEALTH CRISIS”, and it’s getting worse. Our people are more and more unhealthy and our phenomenal ability to care for their diseases is allowing them to live unhealthy lives longer. This allows us to spend more money on keeping them alive.
The Eight Americas Study published in the People’s Library of Science examined life expectancy in America and the factors that influence it. (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030260) The population of the United States was divided into 8 cohorts based on age, race, county of residence, race-adjusted income, and cumulative homicide rate. Cause of death was recorded and variables such as whether or not the individual had health insurance were tabulated. The difference between the longest lived cohor and the shortest-lived is 35 years! The results are as surprising as they are counter-intuitive. While income is a weak factor underlying this difference neither “Health Care Coverage” nor access to health care is a factor.
“The eight Americas analysis indicates that ten million Americans with the best health have achieved one of the highest levels of life expectancy on record, 3 y better than Japan for females and 4 y better than Iceland for males. At the same time, tens of millions of Americans are experiencing levels of health that are more typical of middle-income or low-income developing countries… The health disparities among the eight Americas cannot be explained by single causes of death such as homicide or HIV. Nor are the largest sources of disparity in children and the elderly. The mortality disparities are most concentrated in young and middle-aged males and females, AND ARE A RESULT OF A NUMBER OF CHRONIC DISEASES AND INJURIES WITH WELL-ESTABLISHED RISK FACTORS.” (emphasis added)
Yes, we have a Health Crisis in the United States. It is a crisis born of preventable injuries and disease (vehicular accidents, alcohol-related homicide, diabetes, heart disease) with actionable underlying causes and risk factors (alcohol abuse, tobacco use, obesity). We have aided and abetted this Health Crisis because we do NOT have a Health Care Crisis; it is precisely our ability to treat many of these diseases that keeps many unhealthy Americans alive. We bear the financial consequences of this Health Crisis as a nation.
The solution to this problem becomes rather clear once we have the appropriate definition of the problem and once we identify the underlying cause of the problem. It appears that we cannot afford to pay for all of the health care that will be necessary to keep Americans alive if we continue to go on with things as they are; we have a “Health Care Cost” problem. The root cause of our financial problem is that a large percentage of Americans are not healthy; we have a “Health Crisis” and this is largely due to problems that can be prevented. No amount of “Health Care Reform” that involves changes in how we pay or who ultimately pays for healthcare will solve our “Health Care Cost Crisis” unless we solve the underlying problem of unhealthy Americans. The solution to this problem is a PUBLIC HEALTH strategy that will improve the health of Americans, and it is here that funding and reform should occur.
Now, when this inevitably fails to occur because there is no near term secondary gain to be had we can have a discussion about the “Leadership Crisis” in America.
How many friends do your have? And just what IS a friend nowadays, anyway? What with work friends and school friends and neighbor friends now joined by Facebook friends and Followers on Twitter it’s harder than ever to figure this out.
When I was younger I thought everyone I knew was my friend. Remember those days? That’s how you described pretty much everyone in your life; each person was “my friend” from somewhere or something. Do you remember when you figured out that this wasn’t really how it works, that everyone you knew wasn’t really your friend? We all learn this lesson in some version of the “hard way.” My lesson came courtesy of my Dad around the time of an epic hitchhiking trip to the beach to join “my friends”, a trip my Dad was thought was quite a bit less important than I did since the players involved were probably not really friends. It was my first lesson in the difference between friends, friendly acquaintances, and people you’ve met. My Dad was right, of course, when he pointed out that one is quite fortunate to have one or two real friends at any one time. I was meeting up with 15 or 20 people from college during Senior Week. I have been in contact with exactly ONE of those “friends” over the last 25 years or so. I’m still not sure I forgive Dad for being right on this one, but right he was.
I think about this a lot I guess. It doesn’t take much to prompt me to go to this topic. I spent yesterday in the company of true friends, friendly acquaintances, acquaintances, and that growing brand new category of internet “friends and followers.” Crossfit, and my experience at the Crossfit table, has taught me about friends and friendship in this age of uber-connection. Our worlds are like a bullseye with our very few true friends in the middle surrrounded by our friendly acquaintances. This ring is encircled by everyone else we’ve either met or “cyber-met”, and this bullseye is orbited by a (hopefully) small number of enemies we may have acquired over the years, all floating along in the vast sea of those yet unmet.
Lots of research is emerging that suggests that the number and quality of your friendships can actually affect your health and longevity. People who study this stuff seriously, real psychologists and the pseudo-scientists and pop-psychologists who ride on their coattails, talk about the differences in the way men and woman make and keep friends and friendships. Woman tend to be much more open, especially verbally; they tend to share more about their experiences and their feelings about those experiences. Women tend to be more open to the possibility of making new friends throughout life, and the “verbal” nature of their communication can be fostered over any distance with all of our new ways to communicate (email, IM, Twitter, Facebook, etc.). There’s a nice new book about 11 or 12 women who grew up together in Ames, Iowa, “The Girls from Ames” by Jeffrey Zaslow, who have managed to stay connected as friends this way while spread out all over the country.
Men, on the other hand, tend to form their friendships through shared experiences. Our best and closest friends usually come from our younger days, those days spent together on some ball field or in some locker room, or in the special case of the Crossfit community, in some military setting. We deepen our ties by continual, longitudinal exposure, coming together in shared activity perhaps but shared proximity certainly. Our friend-making and friend-keeping depends on physical presence.
In all friendships of all levels of depth and commitment there seems to be a process of development. We meet, or nowadays “meet”, enjoy the interaction, and allow or encourage another one. We are now acquaintances. In time we become friendly, not too very sure that we know all that much about each other but liking pretty much everything we know so far. We are now friendly acquaintances. It is in this fertile garden that we grow our friendships, where we cultivate true friends. The process is dynamic with movement going in all directions.
At 49 and change I guess I’m in mid-life now. This is when men tend to have the most trouble making new friends, and frankly when they tend to have the most trouble keeping old friends, especially if distance has been added to time. Women tend to both circle the wagons and draw their friends closer at this stage, while at the same time welcoming and growing new friendships.
Crossfit is the first “virtual community” that I have known personally. The “Comments” section on the Crossfit.com main page is a virtual gym, a kind of proximity, a new type of shared space. We certainly have shared experiences and shared pain there, too! I watch those first encounters as people introduce themselves, and I know from careful listening that those first public greetings have been followed by more private next steps. I rejoice that my virtual community is such a fertile garden for the growing of friendships. Here in mid-life Crossfit has become my place to find new friendly acquaintances. You can never have enough friendly acquaintances.
We should remember, though, that ALL friendships, whether it’s between women or men, require at some point REAL proximity. The move from friendly acquaintance to friend requires presence. A real handshake. A physical “full-frontal” hug. “Side-hugs” and virtual high-fives in the cyber-gym are wonderful, but in the end neither Crossfit.com nor Facebook, neither email nor IM, neither @Twitter nor PM can substitute for the real thing. For men OR for women.
For all of the emails, Crossfit.com posts, and Message Board chatter, it was a cramped hotel room at the 2008 Crossfit Games that led to the friendship between bingo, Dale, and Apolloswabbie, three 40+ men from very different walks of life who first met in the cyber-gym that is Crossfit. For all of our communication over a span of 3 or so years, it was a hug and a kiss that cemented the friendship that has grown between bingo, and Greg and Lauren Glassman when they finally met at the base of a dusty hill in Aromas, California. It was the REAL connection that cemented the friendships.
You can never have enough friends.
Why don’t we see any more three-sport athletes in college sports? I think it’s because we rarely see any STUDENT-athletes at the highest level of college sports.
Heck, we rarely see any more TWO-sport athletes. Gone are the likes of Bo Jackson and Dion Sanders in Division I. Gone, too, are athletes like me (football, lacrosse), my sister Tracey (field hockey, track) and countless other athletes at the Division II and III level. It seemed like all of the athletes I played with in College at Williams played more than one sport and played them all well. Most of them doing so much better than I to be sure. Most sightings of multi-sport athletes in Division I have traditionally occurred in the Ivy League but no more. The three-sport athlete is dead and gone, and the two-sport athlete is following quickly.
Why is this so? Is this just the logical extension of the death of the three-sport high school athlete? Are ambitious, selfish, narrow-perspective coaches the cause of the demise of the collegiate multi-sport athlete? Or is it the parents, blinded by the false promise of scholarships who allow themselves to be swept up in the fallacy of early specialization, who are to blame?
The answer is “yes” at the lower levels of collegiate sports, Division III in particular. Parents especially shoulder the blame here, pushing their children to specialize early, to forgo multiple sports played just for the fun of it in the hopes that a single sport will be the wildcard that gets their child into that super-selective college. Without any evidence that playing multiple sports will reduce the chances that a child will play a sport in college, parents allow themselves to be seduced by coaches who have only their own interest at heart.
What of Division I you might ask? What about a situation where a scholarship is possible? A situation where an athlete may get a free ride in return for playing a sport in college? Well, here we introduce the holy grail, an athletic scholarship in return for helping a Division I college make money. Here, at the highest level of sport is where money ultimately has soiled the playing field. For every sin that a high school coach has committed in the pursuit of a victory there is a college coach and a college athletic director and a college president who has committed the same sin. The college coach, AD, and president have the added PROFIT incentive to monopolize the college athlete, and their sins are correspondingly magnified.
Need an example? How about looking at Florida State, home of the Seminoles and alma mater of the outstanding college football and baseball player Dion Sanders. Here, right now, we have a college president openly lobbying for a ruling that will not result in the forfeit of 14 football games as a result of an academic indiscretion on the part of a significant number of football players. We have a college president and an AD more concerned with the legacy of a millionaire coach and the affect on the reputation (and fund raising) of a football program than with the reputation of the academic institution.
The three-sport college athlete died shortly after the STUDENT-athlete died.
Need another example? Two weeks ago the WSJ published an article on sports in the Ivy League, “Can the Ivy League Get Its Game Back?” The basic theme was that there was something wrong with Ivy League sports and that the solution was that they should become more like major Division I programs and that they should compete in ALL post-season competitions. Tommy Amaker and Harvard are held up as examples of what should be done, that lowering academic standards is priority one. Next is the institution of league tournaments to generate interest and money. Finally, it is proposed that Ivy League schools should offer non-need based athletic scholarships.
Rather depressing at first blush, but this may actually be where salvation may lie. This may be where the student-athlete is reborn and along with him or her the three-sport athlete. What if the Ivy League DID compete at the highest level and won WITHOUT changing their academic standards like they did pre-1960? What if the best high school student-athletes chose to attend Harvard or Princeton instead of Ohio State and Michigan? If the majority of college athletes do NOT go on to make a living playing their sport wouldn’t it make sense for them to attend the most selective college possible, just like every other kid? What if the Ivy League applied the same criteria to admitting athletes as they do for the rest of the student body and looked for the well-rounded athlete? The three-sport athlete? What if Dartmouth and Columbia started to win?
I think the schools of the Ivy League should stand up and lead. By offering athletic scholarships to EVERY athlete who makes a varsity team they will remove the economic disadvantage they presently have when competing for the top STUDENT-athletes. Unlike other institutions of higher learning the Ivy League schools are more than able to handle the dollar costs involved. In doing so they will undoubtedly find that they can fill each of their teams many times over with student-athletes who would start at most Division I colleges without changing the admission criteria for athletes one iota.
In fact, the truer they are to the entirety of their stated admission criteria, to produce a college class of diverse, well-rounded individuals, the more likely they are to seek the well-rounded athlete. If the Ivy League were to return to its athletic roots while maintaining its academic ideals and identity the best and the brightest high school athletes will beat a path to the door of its member schools. The Ivy League will have “Its Game Back” and we will once again see Yale in a Bowl Game, Harvard in the Frozen Four, Princeton in the Final Four, and Penn in the College World Series. We will see them win. If they will lead they will win.
And perhaps, just maybe, a coach or a parent will say to a boy or girl who is doing homework after the last game of his or her Fall sport, “Hey, when is the first basketball practice?”
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