Safeway carrot-stick plan a boon to reform

There was a little local pride in a key segment of the Senate Finance Committee’s health care bill reported today by Andrew S. Ross of the San Francisco Chronicle:

It’s not every day a local grocery has a congressional amendment named after it. Such an honor has been bestowed on Pleasanton’s Safeway Inc., whose stick-and-carrot health insurance program is the model for a “wellness provision” in a health care reform bill that passed the Senate Finance Committee last week by an unusually bipartisan 18-4 vote.

“Yes, it’s quite fair to call it the ‘Safeway amendment,’ ” said a spokesman for Sen. John Ensign, R-Nev., who co-sponsored the amendment with Sen. Tom Carper, D-Del. “He’s a big advocate of the Safeway program.”The provision, designed to “incentivize Americans to lead healthy lifestyles in order to lower their overall health care costs,” would allow companies with self-insurance programs to reward employees with bonuses and/or premium reductions of up to 50 percent if they follow health guidelines, like undergoing regular screenings, quitting smoking, losing weight, taking cholesterol-reducing medications and so on.

While some question the accuracy of reported cost savings, the measure has strong support among key politicians up to and including President Obama.

As a beneficiary of Kaiser‘s “wellness” program — a constant push toward healthy lifestyles and preventive medicine — I hope this piece of the legislation stays. As long as he’s not going to resign, Senator Ensign might as well be doing something useful over there.

via Safeway plan part of Senate health care debate.

Healthcare coding for Ayurveda – Why not?

Having taken up brain fitness (see below) a few days ago, this space today offers a few notes on Emotional Vibrancy and Wellbeing in this modern day and age. They come straight from a lecture of the same title by Sudha Prathikanti, MD presented by the UCSF National Center of Excellence in Women’s Health and the UCSF Osher Center for Integrative Medicine. Dr. Prathikanti, UCSF Professor of Psychiatry, Consultant in Integrative Medicine and an exceptionally lovely young woman, clearly has achieved balance in her mind/body systems. Plus, she has a power-point lecture clear enough for lay listeners within her mostly-medical-professional audience to comprehend.

Emotional vibrancy and well-being, Dr. Prathikanti explains, “spring from a life lived in balance where one’s spirit is strong and resilient, with the capacity to embrace and grow from the pain and loss which are a natural part of human life.” Whereas western medicine tends to approach disease as a battle to be joined and conquered, she says, almost all other cultures from Native American to Asian have a more holistic approach. If you’re feeling a little out of balance, these glimpses into Ayurveda — the wisdom tradition of India — might help.

Ayurveda, Dr. Prathikanti explains, is a full medical system based on the concept that we humans are made up of the five basic elements (5 Great Bhutas) — earth, fire, water, air and space. We embody three life sources (3 Great Doshas): Vata, Pitta and Kapha. Each dosha has specific expression; we come with all three in unique individual constitutions, and they are initially in balance. It’s when they get out of whack that trouble comes.

OK, perhaps this is sounding obtuse, but stick with it; you may discover something useful.

Vata (air, space, water) is all that moves — the beating heart, the blinking eye, the wandering mind. Pitta (mostly fire, a little water) has to do with heating — those digestive enzymes busy cooking up dinner, the fiery intellect. Kapha (earth/water — think clay) involves all that binds, the joints, body mass, memory. Ayurveda will seek to determine at what point your mind/body function was at its best — say, that summer you worked as a lifeguard on the beach and were doing graduate school classes at night — and keep you in that good balance.

Dr. Prathikanti conjured up three sample people and gave them a case of severe grief to illustrate how the different doshas work when things get out of balance. Vata, slightly built and having a quirky, creative mind, under such stress might wind up jumpy and restless, change jobs too much, have trouble making decisions. Pitta, owns her own business, the fiery mind etc, could wind up smoking and drinking and eating too many hot tamales. Kapha, earthy homemaker, might eat and sleep too much, become listless and withdrawn. The process of recovery would address each of these issues in ways to regain balance.

None of this is likely to make it into the health reform bill. But since we have finally begun to acknowledge that AMA-guided traditional American medicine may not know everything there is to know — Kaiser, when I considered acupuncture recently for a chronic pain issue promptly sent me to their Chinese Medicine class — perhaps a little ancient Indian wisdom will be useful.

By the end of the lecture I had figured out I’m a predominant Vata married to a definite Pitta, and is that good? Dr. Prathikanti assured me that understanding one’s doshas and keeping them in balance is indeed advisable, but she rather gently suggested that having a consultation with an ayurvedic practitioner for starters is wise.

In other words, it’s a good idea to know what you’re talking about. Still, we offer the above as a toast to your health.

Bluegrass for World Peace

A million or so music fans and sun seekers found themselves in Golden Gate Park this weekend listening to the likes of Emmylou Harris, Steve Martin, Hazel Dickens, Earl Scruggs, Boz Skaggs & the Blue Velvet Band, and a long list of other music makers you will recognize if your bluegrass credentials are up to date. There were about 75 bands in all, on six stages scattered around several meadows. I missed The Brothers Comatose, and Booker T & the Drive-by Truckers, and I worried a little about The Flatlanders tooling around these San Francisco hills, but for sheer exuberant free entertainment, Hardly Strictly Bluegrass 9 could hardly have been beat.

The free part is thanks to local billionaire Warren Hellman, a banjo-picker, bluegrass enthusiast extraordinaire and one-man stimulus package — he does a little investment banking on the side — who has thrown this party for the past nine years and has now endowed it so it will be around in perpetuity. The fact that much of the music sung by these musicians is pure anti-billionaire dampens no spirits, Hellman’s least of all.

(The top ticket, of course, was our weekend houseguest Don Betts, faithfully YouTube’d by his wife Annie as he performed that great American classic “I just don’t look good naked any more.” Betts was introduced by Hellman, whose  group The Wronglers kicked off Saturday on Porch Stage. In addition to making money and playing banjo, Hellman is an an avid champion of the sport of Ride & Tie, and Betts is current R&T Association president… but that’s probably another blog. )

A little bluegrass celebration has never been needed more. What with the world having pretty much gone to hell, there is something immensely comforting in hanging out with a few thousand fellow sufferers grooving to songs about bad whiskey and love gone wrong — problems you can identify with and get your mind around. Not to mention damning corporate greed and evil rich guys, pausing every now and then for a standing ovation for one of Them who just dropped a few million in household change on your glorious weekend out. It all somehow fits right in with a tanked job market and universal political comedy.

A few decades back this music — or what sounded exactly like this music — was called Country. It was rousing and redneck and not cool. Bluegrass is cool. Hellman’s buddies came in every race, creed, color and national origin, ranged from in utero to way-80s, recycled everything and smiled whiled jostling for dancing space. I submit bluegrass as palliative care for the world.

How's your brain fitness today?

Pick five random numbers, say them out loud. Now say them backward. No fair using props. You have now exercised your brain, and your brain appreciates it.

Alvaro Fernandez, co-founder and CEO of SharpBrains, author of The SharpBrains Guide to Brain Fitness, enthusiastic speaker on healthy brains and how to keep them, addressed a group at the New York Library — great spot for exercising brains — recently and another in San Francisco a few days later. If you’ve ever despaired over forgetfulness or worried about some day getting Alzheimer’s, Mr. Fernandez will brighten your day. Much as the gym trainers promise you your muscles can be strengthened, Alvaro Fernandez can convince you those neurons can multiply and prosper. With an energy and demeanor to match his several degrees, he may one day be the Jack Lalanne of brain fitness.

The San Francisco audience was made up of members of San Francisco Village, the second such aging-in-place organization in California. (Other village-concept communities are springing up across the country, preferred options for many seniors who want to stay in their homes.) Most of them highly active and engaged, they were receptive to Fernandez’ proposals about how to stay that way.

Fernandez began by offering facts to debunk a few popular myths about brain function: Lifelong neuroplasticity means we can always help our brains evolve through lifestyle and activities; brain function can be affected by a variety of things, from yoga to cognitive therapy; and nothing is carved in stone that says brains deteriorate with age. In short, you might not be able to avoid Alzheimer’s completely if it’s in your genes and your karma, but you might well be able to forestall it with vigorous exercise.

Four “pillars of maintenance” will keep the brain fit, Fernandez says: good nutrition, stress managment, physical exercise and brain exercise. Potato chips and TV are not on the pillars list. The best comment of the event, in fact, probably came from author/healthy aging expert and SF Village advisory board member Walter Bortz, MD, who quoted a Harvard study that revealed “watching TV is like staring at a brick wall.”

Your brain is, when you come right down to it, not interested in the TV.

Modeling how to die

My remarkable friend Mary died yesterday, after showing us how to do it. Not when, mind you, because she was far too young and energetic — just how. How to question and oppose, to look at options, and eventually to accept the fact that life is fine and finite and go with grace into whatever lies ahead.

Diagnosed with pancreatic cancer barely a year ago, Mary began what would be a studied exploration of traditional and experimental interventions to see if she might wrangle some extra quality time on the planet that she had carefully nurtured throughout her life. Almost as importantly – most importantly to her host of concerned friends – she and her husband Tom signed up on CaringBridge. Immediately, her host of friends also signed on, forming a sort of cybercircle around the family.

As the journey progressed, they would post pictures and notes about their travels and travails, filled with exuberant photos, irrepressible humor and a clear-eyed view of our shared mortality. Friends and relations would sign in with their own comments. Sometimes the latter would include off-beat ideas for something else to fling in the face of the disease; more often they would be notes about how Mary and Tom were brought spiritually into other circles when they couldn’t be physically present. Sometimes they would be long and rambling; more often they would be simple affirmations of how the couple and their family were being held close in so many hearts.

It was an extraordinary gathering. With their three grown children and a few others on site, there was relatively little taking-of-casseroles over these months, though Mary was always the first to show up with a giant jug of homemade chicken soup whenever some affliction struck at my house (and many others.) The cybercircle kept us regularly informed, assured us that we were part of the journey, and served, I believe, as a constant reminder to Mary and Tom that dozens and dozens of their friends were at their virtual side along the way. It helped that both of the central characters – and they were central characters in all the best senses – were thoughtful and eloquent writers.

While preparing for a new round of treatment not long ago, Mary and Tom learned that her tumors had returned with a vengeance. So instead of setting out for one adventure they settled in for another. Hospice was called in, their children gathered even closer. Postings in cyberspace documented the passage of those days, from occasional sunset walks into the nearby hills to readings of comments from friends, as Mary grew weaker, that might win what Tom described as the ultimate honor, “the coveted arched eyebrow.”

As she died, Mary’s family fluffed the pillows and administered “magic drops and potions, all of which helped only sort of.” Afterward, Tom opened the window as a friend had prompted, ” to free her spirit, not that she needed any help from me” and hung their Revolutionary War era ‘Liberty’ flag out front.  And sent a final note into cyberspace for the ever-expanding circle of friends: “All hail, Mary, so very, very full of grace.”

Saying Goodbye to Ken Lewis

I am not sorry to see Ken Lewis leave his cushy Bank of America post. This has nothing to do with understanding what’s really going on at BofA, or the economy, or finance in general. It has to do with the frustrations of middle America, to which I belong. Especially aging middle America.

When my father died in 1987, leaving small amounts of his hard-earned estate to his daughters, I put a little of my small amount into a small-town bank stock. Eventually that bank was bought by a bank that was bought by BofA. Nice. My stock increased from very tiny number of shares to very small number of shares — but still enough to give me a couple hundred dollars every quarter and pay off my church pledge with the shares of which I now have more than my extensive portfolio should have. (I don’t understand any of this either, but am fortunate to have an in-house economic advisor.)

Yesterday I received my dividend check, in the amount of slightly over $4. Lord only knows what my shares are worth, if anything. I am very lucky to be healthy and still in the workforce more or less, and not reliant on my personal investment portfolio.

Not long ago there was a story in the New York Times about a woman my age, widowed a few years ago, now having to move in with her son because she and her husband had done exactly the same thing: invested in their small-town bank in order to have investment income for her to live on. It was bought by a bank that was bought by BofA. With the fall of BofA, she could no longer afford to pay the bills and was about to lose her house. I remember thinking how easily she could be me.

Now we read (New York Times October 1) that Mr. Lewis “is fed up with the criticism” about his buying Merrill Lynch. And that he returned from vacation in Aspen with a full beard to announce his resignation. Well poor, poor Mr. Lewis.

Middle America used to trust its bankers. Mine, earlier, was named Mr. Trivett and he advised me to put $10 into savings for every $100 I was ever able to accumulate. Another, earlier, was named Mr. Harris and he once wrote a personal letter to my daughter advising her to keep her college grades up because she needed to justify the loans he had backed for her.

Somehow I missed out on that sort of a relationship with Ken Lewis. Somehow the banking industry has lost that connection — any connection at all — with its consumers. And its everyday shareholders. And other things like accountability and consideration and good, honest business practices.

I wish Ken Lewis could know what it feels like to be unable to pay the bills.

Texting as anti-social networking

A faithful reader of this space, among the several faithful readers enjoyed by this space, weighed in on the texting truck driver (see Sept. 27th below) to say I ought to write about the real problem: texting while conversing. Conversational texting may not be as lethal, except in terms of mortally wounded relationships, but it does indeed seem a growing threat to humankind.

We checked with several members of the Under Twenty generation (is there a generational designation for today’s teens and sub-teens?) who assure us they would never be guilty of such a thing but we’re not convinced they’re telling the whole truth. It is the Boomers and Beyonders, though, who have come late to this perpetual connectedness and pose the greater threat. Faithful Reader confessed to having a close personal relation whom she is about to disinherit because he will not stop surreptitiously, perpetually, rudely texting beneath the table while pretending to carry on a conversation. Or sometimes not even bothering to pretend.

In a former life I had a husband — I no longer have this particular husband — who was prone to walk into a room, immediately pick up the remote and click on whatever ball game happened to be in progress. Guests found this disconcerting; wife found it maddening. The message, similar to the message of incessant texting-while -supposedly-conversing is that something afar is infinitely more important than anything at hand.

If you are a reader of this space, you are surely too cultured and polite to commit inappropriate texting. But you are invited to e-mail it to any texting truckers or friends you may have, in the interest of general civility.

Will Anti-Abortionists Sink Health Reform?

Already the right wing, Catholic officialdom and Sarah Palin have won their battle to make sure that I, and countless other millions, will likely die only after expensive, prolonged, futile, aggressive, undesirable treatment rather than peacefully at home as I choose. Now they want the generations younger to be sure that any accidental, criminal or otherwise unplanned pregnancy results in another unwanted child coming into this overpopulated world. An assault on health reform is their latest battleground. I am careful to say Catholic officialdom, because all of the lay Catholics I know, many of them Good Catholics, support both reproductive and end-of-life choice. I am careful to mention Sarah Palin just to prove I have absolutely no resentment over the fact that whereas I can’t interest publishers in my several excellent book projects, she has a planned first run of 1.5 million on her dashed-off memoir.

But back to the problem at hand. Writing in Tuesday’s New York Times, David Kirkpatrick presents the new scary problem:

As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

Never mind that Obama has promised that no federal funds will go for elective abortions, and the current policies would remain unchanged, here is a handy opportunity to make points with conservatives and throw a monkey wrench into the works of reform.

Lawmakers pushing the abortion restrictions say they feel the momentum is on their side, especially because the restlessness of other Democratic moderates is making every vote count.At least 31 House Democrats have signed various recent letters to the House speaker, Nancy Pelosi, urging her to allow a vote on a measure to restrict use of the subsidies to pay for abortion, including 25 who joined more than 100 Republicans on a letter delivered Monday.

Representative Bart Stupak of Michigan, a leading Democratic abortion opponent, said he had commitments from 40 Democrats to block the health care bill unless they have a chance to include the restrictions.

So it’s all about halting abortion — maybe — or all about halting reform — maybe — but some of us who simply, desperately, wish better care and a few decent options for our less-advantaged citizens are left to wonder what it’s really all about.

Abortion Fight Complicates Debate on Health Care – Readers’ Comments –

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