Alcohol fee = 'cause for harm' money: A funding idea whose time has come

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Image by Bright Meadow via Flickr

Booze, it seems, causes some people to do drunken things, get in trouble (i.e., do harm, at times), go off to the E.R., occasionally in an ambulance. So why not tax the booze to pay for the E.R. and ambulances? This is being proposed by San Francisco Supervisor John Avalos in one of a bunch of efforts to fill the gaping budget hole that this city, like virtually every city in the nation, is facing.

It is called a “cause for harm” fee. A fee, explains San Francisco Chronicle columnist C.W. Nevius, differs from a tax because it can only be spent for the specified purpose for which it was collected. We don’t like the word Tax these days.

No fair! say the bar and restaurant owners; five cents more per martini will kill the business! I doubt that. Having put in my time as a martini (among other things) drinker, I can absolutely certify that if you want a$6 cocktail you’re not going to pass it up at $6.05.

“Cause for harm” fees, in fact, seem like a pretty good idea:

  • Oil company digging fees (say, five cents a quart) for spills, etc.
  • Leaf-blower fees to mitigate noise, air and clogging-the-storm-drain pollution
  • A dead cell phone fee to ship dead cell phones to another planet if there’s one that wouldn’t really mind
  • Pigeon fees… well, just because

You can create your own list. Fees of this “cause for harm” type are collected in other states, though more often used to pay for things like treatment and education rather than transportation to the ER. In any event, they clearly make sense. And somehow the cause/effect principle seems like one that should pick up wider support.

Maybe Mr. Karzai could impose a few fees of his own, and use them to send all those troops back home.

Supervisor’s fee on alcohol a terrific idea.

On being treated to death – Part II

Is there a fate worse than death? Yes. In the U.S., often it is the fate of dying slowly: aggressively treated, over-treated and worn down by the system until that fate has made death truly a blessed relief.

Deborah Wright, an ordained Presbyterian minister and writer now working in secular fields while simultaneously serving as personal pastor to many, forwarded an article that proves out the fate-worse-than-death highlighted in this and recent other articles (see June 25 post below.) The fact that stands out, she comments, is that “the length of time we use palliative care services is growing shorter — because we start it too late.”

We start palliative care too late, we treat too aggressively and too long. The opening story in AP writer Marilynn Marchione’s thoughtful, poignant article just published in Daily Finance serves as a classic example:

The doctors finally let Rosaria Vandenberg go home.

For the first time in months, she was able to touch her 2-year-old daughter who had been afraid of the tubes and machines in the hospital. The little girl climbed up onto her mother’s bed, surrounded by family photos, toys and the comfort of home. They shared one last tender moment together before Vandenberg slipped back into unconsciousness.

Vandenberg, 32, died the next day.

That precious time at home could have come sooner if the family had known how to talk about alternatives to aggressive treatment, said Vandenberg’s sister-in-law, Alexandra Drane.

Instead, Vandenberg, a pharmacist in Franklin, Mass., had endured two surgeries, chemotherapy and radiation for an incurable brain tumor before she died in July 2004.

“We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her — not just torture her” in the hospital, Drane said.

Marchione tells other stories of patients who might have had far more peaceful final days — and of patients who chose extensive, aggressive or experimental treatment for a variety of reasons. It should be the individual’s choice. But the reality is that discussion of palliative care or hospice care (there is a difference: hospice involves declining further treatment; with the newer “palliative care” concept some therapies may be continued) simply doesn’t happen until too late. If it happened sooner, many of us — likely including Rosaria Vandenberg — would choose hospice care over aggressive end-of-life treatment.  But physicians are too busy talking treatment, and patients have not considered their other choices. Comfort and peace lose to the system.

An article posted today on the website of the National Hospice and Palliative Care Organization points the finger in the right direction, right at you and me. If we took the time and energy to write our advance directives, and talk them over with family and friends, millions of days of suffering and millions of wasted dollars would be saved.

Recent media coverage on the challenges patients and families face with overtreatment of a life-limiting illness brings the issues of hospice and palliative care and advance care planning to public attention.

“It’s important to remember that quality of life and a patient’s personal wishes, beliefs and values must be a factor when making care decisions brought about by a serious or terminal illness,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

“Discussions helping patients and families understand the many benefits of hospice and palliative care must be more common and held long before a family faces a medical crisis,” Schumacher added.

Advance care planning—which includes completing a living will and appointing a healthcare proxy—is somewhat like planning a road trip to an unfamiliar destination.  Very few people would expect to get to a destination safely and comfortably without having a well-thought-out map in hand.   Yet, it’s estimated that 70 percent of Americans have not completed a living will.

  • A living will charts the course for your healthcare, letting your family and health care providers know what procedures and treatments you would want provided to you—and under what conditions.
  • A healthcare proxy or healthcare power of attorney form, allows you to choose someone you trust to take charge of your healthcare decisions in case you are unable to make those decisions yourself.
  • Advance directives can be changed as an individual’s situation or wishes change.

Still, you and I put it off. Or you may be putting it off, at least, and if so you are taking an absurdly unnecessary risk. You could, instead, download free forms, fill them out and avoid that risk.

Deborah Wright has shepherded countless friends and family members through their final days, and knows what a blessing hospice and palliative care can be. Problem is, though, “we start it too late.”

Americans are treated, and overtreated, to death – DailyFinance.

Sarah Palin stirs up California

Sarah Palin speaking at a rally in Elon, NC du...
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Sarah Palin flew in for a much-ballyhooed speech Friday night, at a price still undisclosed — and which may never be known. Therein lies the rub. It also, as Palin is inclined to do, decidedly pumps up the politics.

Palin was invited some time ago to speak at  a fundraising event for the Cal State University Stanislaus Foundation‘s 50th anniversary celebration. How much she was paid — the event raised $200,000 for the school’s endowment — became a subject of much controversy and high political drama. Eventually it invoked an investigation by State Attorney General Jerry Brown, now facing off for Governor against gazillionaire former eBay CEO Meg Whitman, into whether public disclosure laws are being broken by the university’s refusal to say what she got paid. Along the way, sides are being drawn by incumbent U.S. Senator Barbara Boxer, whose opponent former Hewlett-Packard CEO Carly Fiorina rather famously criticized Boxer’s hairdo a little while ago and said more recently she is honored by Palin’s endorsement; and by Democrats in general who see the Palin Effect as fine ammunition to aim at state Republicans.

In other words, as San Francisco Chronicle reporter Carla Marinucci commented in today’s update, “They don’t call Sarah Palin the Thrilla from Wasilla for nothing.

After months of buildup, including investigations, outrage and celebration, the former Alaska governor’s trip to California’s farm belt over the weekend proved beyond a doubt that she delivers – for Republicans and Democrats.

State Attorney General Jerry Brown probably will be grateful that he was the focus of the 2008 vice presidential candidate’s barbed criticism as he investigates her compensation from the Cal State University Stanislaus Foundation for her speech Friday night at the nonprofit’s 50th anniversary event at the Turlock (Stanislaus County) campus.

Brown’s office is looking at whether the campus foundation violated state public disclosure laws by refusing to make public the terms of Palin’s contract for her appearance.

In her speech, Palin quipped of Brown: “This is California. Do you really not have anything better to do?”

The Democratic gubernatorial candidate’s response: “I don’t think she understands the process. It’s about the operation of the foundation to see if they handled things professionally.”

The Palin Effect played well in Republican primaries, but may not be quite so welcome as candidates now seek to broaden their appeal.  All of which makes watching the political high-wire balancing act, though sometimes tiresome, never dull.

Boxer’s campaign manager, Rose Kapolczynski, called Palin and Fiorina “two peas in a pod” and released a Web video aiming to remind voters that the Republicans’ “shared positions are out of step with Californians.”

On the GOP side, former Hewlett-Packard CEO Fiorina said that while she couldn’t meet with Palin on this trip, she was “honored” to be endorsed by Palin, who characterized Fiorina as a “commonsense conservative.”

“It’s the question of how she will play to the political middle. Will she take away votes?” said Bill Whalen, a research fellow at Stanford’s Hoover Institution.

He said that a close connection with Palin may be a concern for candidates like Fiorina, in part because Palin manages to stir it up, no matter what her forum.

“If you think people are tired and worn down by politics, Sarah comes into town and the circus follows, and the arguments break out,” he said. “Wherever she goes, there’s a dustup. … It gets everyone angry and yelling, and it stirs up divisiveness.”

It’s going to be a long, hot summer in California.

Palin’s Stanislaus visit shows political power.

Grim outlook for public transportation

Muni-Bus-Market-street-San-Francisco
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Can we have a functional, effective transportation system in the U.S.? Can we afford not to? Those were the questions addressed by former Secretary of Transportation Norman Mineta and a panel of experts at a full-house 9 AM event at San Francisco’s Commonwealth Club Friday. Oh — and how are we going to pay for it all? The program was titled “Funding the Transportation System of the Future.”

“Within the next two decades,” Mineta said in his introductory remarks, “the Census Bureau estimates that the U.S. population will increase by as many as 50 million people. This population growth, combined with a growing backlog of overdue maintenance work on roads and transit systems, creates a need for significantly expanded transportation revenues. However, the current political climate is generally unfavorable to tax increases.”

The ensuing discussion continually returned to two general points: first, that our parents and grandparents funded the transit infrastructures and systems we now enjoy and it is incumbent upon us to do the same for our children and grandchildren; and second, as Mineta and others repeatedly said, that there is no political will anywhere to do the latter. One illustration of the first point was cited by panelist William Millar, president of the American Public Transportation Association, who observed that “the New York subway system was built 106 years ago for $35 million — and you couldn’t get a feasibility study today for $35 million.”

Given the fact that most cities and counties could spend $35 million on overdue maintenance alone, most panelist comments and audience questions concerned the issue of finding funds at a time when tax increases are not very popular. “Creative funding” solutions appear to be the answer, even if there is currently far more creativity around than funds.

Asha Weinstein Agrawal, Director of the Mineta Transportation Institute‘s National Transportation Finance Center, cited a public opinion poll released yesterday (“one of those phone calls at dinner time…”) that surveyed 1500 people in English and Spanish to test receptiveness to eight variations of a possible gasoline tax. In general, opposition to such a tax is high, she said, but acceptance increases in proportion to benefits which individuals can see: tie the tax to emissions per vehicle and thus reduce greenhouse gases, for example. Agrawal recommended consideration of taxes linked to environmental effects.

Panelist John Horsley, Executive Director of the American Association of State Highway and Transportation Officials, said that because of funding cuts and declining revenues (from road usage fees etc), the U.S. Highway Fund will be insolvent some time between August and October of 2011, with the resultant loss of approximately 1 million jobs. He cited a few bright spots such as several states going ahead with high speed rail projects, “four states have actually raised gas taxes, Kansas has increased the sales tax, and New Hampshire sold itself a bridge” (which will get paid off through tolls.) High occupancy toll lanes were another potential funding source Horsley said could help until “fiscal sanity returns: investing in something good (rather than) borrowing forever.”

The consensus was aptly covered in one summation by California Senator Alan Lowenthal: “It’s a very difficult time for transportation.”

Whereupon this reporter got back on the #1 California Muni bus (catch a back seat, work on your computer for 30 minutes, no parking fee, no traffic hassle) and went home.

Life: does longevity trump quality?

“We have to get out of the way,” she said; “make room for other, new people on the planet.” Accomplished author/editor Cyra McFadden, at a recent dinner party, was talking about a group of women scientist friends’ excitement over discoveries they have made which show promise of extending life a fraction longer. Cyra was in fierce, though silent, disagreement.

It may be time for those of us who disagree with the rampant prolong-life-at-all-costs theories  to stop being silent.

Americans are, in fact (as reported in Epoch Times below, and elsewhere) living longer all the time. Sometimes that’s just fine, especially if we’re in reasonable health. But what if we’re not? What if we’d just as soon be getting on with whatever follows this temporary time on earth? Millions and millions of people are living for hours, days or extended months and years in circumstances they would not choose simply because we have created a culture that says we must be kept alive no matter what.

Average life expectancy continues to increase, and today’s older Americans enjoy better health and financial security than any previous generation. Key trends are reported in “Older Americans 2008: Key Indicators of Well-Being,” a unique, comprehensive look at aging in the United States from the Federal Interagency Forum on Aging-Related Statistics.

“This report comes at a critical time,” according to Edward Sondik, Ph.D., director of the National Center for Health Statistics. “As the baby boomers age and America’s older population grows larger and more diverse, community leaders, policymakers, and researchers have an even greater need for reliable data to understand where older Americans stand today and what they may face tomorrow.”

Where do we stand right now? Well, the same source that says we’re living longer and enjoying better health and financial security (hmmmm on the financial security business) reveals that Americans are “engaging in regular leisure time physical activity” on these levels: ages 45-64: 30%; ages 75-84: 20%; geezers 85 and over: 10%. Hello? Better health and financial security, just no leisure time physical activity? Could it bear some relationship to obesity factors in the same data: 30+% for men, 40+% for women?

Does living well need to be assessed in the compulsion to live long? Why not? Everyone should have the right to live at whatever weight and whatever level of inaction he or she chooses. But the system is weighted toward keeping us alive under all conditions, and bucking the system is not easy. A poignant, wrenching tale of her father’s slow decline and death — and her mother’s refusal to go down that same path — was recently told by California writer/teacher Katy Butler in the New York Times Sunday Magazine.

Almost without their consent, Butler’s gifted, educated parents had their late years altered to match the system’s preferences:

They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Given the limitless sources of victimization floating around, we should not have to add just-try-to-keep-them-alive-forever health care to the list.

My husband and I, having long ago signed advance directives with additional specific issues sheets (“If this happens, do that; if that happens, don’t do this,” etc) recently got them out and talked things over again, a very good thing to do for EVERYbody over 18. We will add dementia provisions to the existing documents while we can remember to do that (the closest you can come to avoid being warehoused in a memory-loss facility for umpteen years.) We are clear, and our friends and family understand, about having no interest in hanging onto life in a greatly diminished state if such an opportunity presents itself; for increasing thousands, it presents itself every day.

All this being said, there’s still a reasonable chance that I’ll be out of town one day when I’m in my 80s (which aren’t that far off), get wiped out by a speeding cyclist and picked up in a seriously mangled state by the paramedics, taken to a hospital that’s not Kaiser (which has all my directives on file,) miraculously brought into some heavily-sedated state of being because the hospital doesn’t consult Kaiser or the living will registry (which also has my directives) and kept alive by assorted mechanisms. By the time my husband or children get there to insist everything be unplugged — which of course will involve long hours and possibly court action — hundreds of thousands of dollars will have been needlessly spent.

I consider myself a highly valuable member of society, and my life a gift from God. But would those dollars not be better spent on a few kids needing specialized care?

Epoch Times – Americans Are Living Longer, According to Federal Report.

Cell phone radiation danger: true or false?

from Grandview Park in San Francisco
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Head-zaps, otherwise known as cell phone radiation levels, messing with your brain? Nobody knows. What we do know is that cell phones emit radiation, just as radio and TV stations do at somewhat higher levels. What we also know is that nobody cares much. The back-and-forth going on between legislators and cell phone industry lobbyists suggests that a few people do care… but it’s a long road from caring to understanding to any kind of meaningful action.

In California, where local and state efforts to increase information made available to consumers have met with mixed results, an explanation in the Letters section of today’s San Francisco Chronicle offers some interesting perspectives. To understand them, it helps to know about the city’s Sutro Tower (above), a looming structure completed in 1973 and now furnishing transmissions for 11 TV stations, 4 FM radio stations and about 20 wireless communication services.

Local electrical engineer Bill Choisser has this to say:

The power of radio waves falls off as the square of the distance. This means one watt an inch from your head (typical for a cell phone) has the same effect as 1 million watts 1,000 inches from your head. The strongest TV signals on Sutro Tower run i million watts. A thousand inches is about 83 feet. Whether putting your head 83 feet from Sutro Tower every time you talk on the phone bothers you, is up to you.

San Francisco’s board of supervisor’s voted last week to require disclosure of the measure of cell phone radiation next to sales displays, something unlikely to make the tiniest bit of difference to sellers, buyers or anyone else. The FCC has a similar requirement likely to make even less difference.

CNET’s Christina Jewett, on her California Watch blog, summed up some of the action at the state level, where Sen. Mark Leno‘s bill to make radiation level information more accessible recently died. Leno emphasizes, in a statement on his website that there’s no definitive evidence that cell phone radiation causes cancer or other illnesses. Supporters argue that there are potential health effects dangerous enough to warrant making more information available, Jewett explains, while opponents termed the whole business expensive and unnecessary.

When the bill was a going concern, it did little to slow the never-ending party that lobbyists for AT&T Inc., one of its chief opponents, tend to host at Arco Arena. The firm spent about $535,000 on lobbying during the first quarter of this year. From Kings games to Disney Stars on Ice to a Valentine’s Super Love Jam, legislative staffers continued to enjoy the hospitality. (Details below).

Whether the lobbying effort led to the bill’s demise may never be known. But the debate at least is bringing out more information on the issue, one that regulators and scientists pledge to keep watching.

Given the number of Americans walking around (or sitting, or standing in place) with cell phones plastered to their ears, I for one am happy that somebody is watching… and that Bill Choisser is explaining.

State hangs up on expansion of San Francisco phone law | California Watch.

Robo-seals invade U.S. nursing homes — perhaps a gadget too far?

Stuffed seal
Image by matsuyuki via Flickr

What with human affection so hard to come by these days, wouldn’t Granny be happy with a fuzzy mechanical toy? That, presumably, was the reasoning behind Japanese inventor Takanori Shabata’s idea for the nursing home’s new best friend, Paro the robo-seal. $15 million dollars later, Paro had hummed and buzzed his (her?) way into the hearts and homes of some 1300 Japanese adults who don’t want the hassle of real, live pets. Now cleared as a Class 2 medical device — a category enjoyed by his brethren the motorized wheelchair and similar less-cuddly items — Paro’s newest destination is U.S. nursing homes.

“Some of our residents need more than we as human beings can provide,” says Marleen Dean, activities manager at Vincentian Home, one of four facilities run by Pittsburgh-based Vincentian Collaborative System. Vincentian Collaborative recently used a $55,000 grant to purchase eight Paros and finds them especially comforting to patients with dementia. “We’ve tried soft teddy bears that talk and move. But they don’t have the same effect.”

Bill Thomas thinks it’s inhumane to entrust the task of emotional support to a gadget.

“If you give me a robot that helps perform mundane tasks associated with caregiving, such as vacuuming or doing the dishes, I’m all for that,” says Dr. Thomas, founder of the Green House Project, a campaign to make nursing homes smaller and more like regular houses. But “if we wind up with nursing homes full of baby-seal robots, the robots will be trying to fulfill the relationship piece of caregiving, while the humans are running around changing the beds and cooking the food.”

This space sides with Bill Thomas. At $6,000 per robo-seal, it just seems that some less anti-bacterial real creature could be found to serve the same purpose. But Paro has made believers in several U.S. nursing homes such as one in which a dementia unit resident is quoted as whispering to it, “I know you’re not real, but somehow, I don’t know, I love you.”   The question of whether offering Paro for love and affection (and often just for calming down the agitated folks who tend to populate nursing homes) is ethical and proper is stirring debate both here and in Denmark, where more than 100 Paros have found homes.

Sherry Turkle, a professor in the Science, Technology and Society program at the Massachusetts Institute of Technology, acknowledges Paro’s potential as a communication aid, but warns against regarding it as a companion. “Why are we so willing to provide our parents, then ourselves, with faux relationships?” she asks.

Danish filmmaker Phie Ambo, who spotlighted Paro in her 2007 documentary on interactive robots, “Mechanical Love,” dismisses such concerns. “When I came into nursing homes and found people sitting in rocking chairs with dolls, no one lifted an eyebrow.”

DTI (European distributor Danish Technological Institute) requires caregivers to attend Paro seminars, where they discuss such issues as whether it’s OK to leave an elderly person alone with a Paro, and whether patients must be told it’s a robot. Don’t allow someone to “escape into a strange seal robot’s universe,” cautions Lone Gaedt, senior consultant at DTI.

Admittedly, we carry on with perfect strangers in the parallel worlds of cyberspacial social networks. But somewhere, somehow, a few lines of human interaction might be better off left un-blurred.

What do you think?

Paro the Robo-Seal Aims to Comfort Elderly, but Is It Ethical? – WSJ.com.

Latest boomer gadget: tombstone microchips

Microchip e microciop
Image by Un ragazzo chiamato Bi via Flickr

This may be one step farther than some of us want to go. But for those seeking to live, somehow, forever, the Canwest News Service reports on a new e-gimmick on the market and apparently targeting the boomer generation. There are several more paragraphs in writer Misty Harris‘ report, but this space suggests that the following, and particularly the last sentence, cover everything you really need to know.

Ensuring virtual life after death, new microchip-enabled headstones allow the Me Generation to share their stories from the grave, with passersby simply swiping markers with a cellphone to retrieve biographical details — everything from the deceased’s political beliefs to their favourite recipes.

“My wife and I had just lost relatives and found it so underwhelming, in a sense, to know that these people had contributed so much and yet their lives were being summed up with just names and dates,” says John Bottorff, founder of Objecs, the Arizona company behind the RosettaStone grave markers.

The palm-sized tablets can be mounted to existing headstones or installed on new ones. Each is engraved with custom symbols representing the deceased’s life — an Rx for a pharmacist, for example, or a sheriff’s star for a police officer — and contains a Near Field Communications radio-frequency identification tag, which allows biographical data to be loaded onto any NFC-enabled phone with the wave of a hand (NFC is expected to be standard on new mobile phones in North America by 2012).

A unique web ID is also engraved so people without NFC can raise the dead — or at least their personal histories — on any computer.

As early as 2015, seniors will outnumber children for the first time in Canadian history, while the number of centenarians is projected to triple — perhaps even quadruple — by 2036.

For end-trepreneurs, this represents a killer opportunity.

Microchip tombstones latest boomer gadget.

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