Living Well Journal

"Dwight Eisenhower: Quiet Radical"

Dwight Eisenhower has long been a favorite of mine when thinking of effective, principled leaders in history. Few people would associate radical,innoative change with this unassuming man from Abilene, Kansas who became the Supreme Commander of all allied forces in WWII and later an innovative President of the US.

Some of the most effective leaders in history display the opposite of the sterotypical image of a successful leader:  humble versus arrogant; listening and learning versus pontificating;  leading courageously by example.

An article in Monday's Wall Street Journal offers compelling insights into the man as plans are made for a memorial in Washington, DC in his honor. "What is truly remarkable is that Ike was able to become an innovator without abandoning the basic values he had acquired in small-town America."

As healthcare faces seemingly intractable challenges, its leaders can learn much from Ike!

Dwight Eisenhower: Quiet Radical

"A Page Without Punctuation is a Life Without Spaces"

Real Life Happens ... 1440 minutes of every day.  

What does it mean for me to really live and breathe in any one of those moments?

From a most-insightful blog post: Are Smart Phones Making Us Smarter?

"A page without punctuation is like a life without spaces.

It happens to me constantly. I bet it happens to you too. Just this morning I scrambled around to get ready. Someone was picking me up for work around 8. I somehow managed to be ready a full 5 minutes before 8. I walked out onto the front porch and felt the cool morning air. Birdsong rang out from the trees. The garden still dripped dew. In response to that I sat down on the front porch swing, promptly pulled out my iPhone 4 and began to check email. That’s when it hit me.

A page without punctuation is like a life without spaces.

Everywhere we turn we see it happening people riveting their attention on a little rectangular device in the palm of their hand these devices for all the good they do can literally consume every square inch of space in our lives wherever there is a pause instead of a inserting a comma I pull out my phone and see if it’s my turn on Words with Friends on the short walk from my car to my office instead of inserting the (ellipses) my mind so desperately needs before launching into a full day of work I pull out my phone and fire off a text or two about who knows what on the short one mile commute from work to home instead of inserting a (question mark) and preparing my heart for home I pull out my phone and squeeze in a quick callback and most unfortunately after I arrive at home instead of the joyful interjecting exclamation marks of joy I pull out my phone and scan my twitter stream or update my facebook

A page without punctuation is like a life without spaces.

See what I mean? So much meaning is missed without proper punctuation. So it is with life. We miss so much of life’s every day meaning without those gifted spaces and brief interludes. Don’t get me wrong. I’m not giving up my iPhone. It’s not Steve Jobs fault. I’m taking back those little spaces. I’m learning to restore attention to the little mysteries offered by an ordinary day. So the next time I’m in an in between moment, instead of pulling out my phone, I’m going to put in a punctuation mark.

It’s really that simple."

 

 

Best Recap of What Has Changed 2 Years After Reform Law Was Signed

It's hard to believe 2 years have gone by this month since the landmark federal healthcare reform was passed into law.  In some ways it would seem little has changed and the world of healthcare is still trying to figure out what to do next.

But the attached article from Becker's Healthcare Review offers a really excellent recap of what has already changed and what the future holds.  It distills the key elements that are at the center of the bill: fee for service, value based purchasing, accountable care organizations, shared savings, bundled payments and the individual mandate.

"[T]here is more to healthcare reform than only the PPACA ... most people think of the federal legislation when the phrase "healthcare reform" is used colloquially, but for hospitals and other organizations, healthcare reform is and has been an ongoing process. "There are market-driven reforms and system improvements that are kind of taking place as a parallel process ... People like to talk about the healthcare legislation, and acknowledging that is important. But there is a healthcare system improvement occurring in real time that is independent of the legislation process."

A quick read for those inside and outside the industry. Healthcare Reform: Two Years Gone, Now What?

Can Medicare Be Reborn?

As I've said throughout this blog, the future of "fee-for-service" payment for healthcare lies in the crosshairs of reformers in Washington.  It must be replaced because it puts too much incentive upon volume and not enough incentive upon the coordination of needed, high quality care under the control of the individual.

The Patient Protection and Affordable Care Act of 2010 (aka ObamaCare) has as its purpose to replace fee-for-service payment with new forms of capitation which some observers argue belies a long term intent to move to a single payer system nationwide.  

Today's Wall Street Journal features an interesting op/ed piece about what has happen, in a quiet bipartisan manner behind the scenes, to Rep. Paul Ryan's "premium support" concept.  The author compares Medicare today to a defined-benefit plan and Premium Support as a defined-contribution.  Worth reading.

WSJ: Ryan's Medicare Revolution

Stage 2 Meaningful Use Is Here

Christina Thielst posts one of my favorite blog sites on healthcare ( Christina's Considerations ).  This post offers the latest view from CMS on Meaningful Use readiness coming out of the Federal Register last week:

CMS Fact Sheet on Stage 2 EMR Prep

For those who aren't healthcare nerds, the bottom line of all this is that the federal government has a multi-year incentive plan for all healthcare providers to become "wired" with electronic medical records (EMRs) that are interoperable ... connect to each other and share data ... so that such systems can be shown to be not just "installed" but in "meaningful use."

Give Me Socks!

OK, this is just too cool!

My brother-in-law's son, Mark DiPaolo, is serving with NATO in Afghanistan. Every day he encounters kids in the city of Kabul who want to sell handmade bracelets to him. One day a little girl simply asked him if she could have a pair of socks: she was standing in 30 degree weather in sandals with no socks. From this experience a beautiful idea was born: GiveMeSocks Blog 

He started this blog to invite folks back home to mail boxes with warm socks and gloves to Kabul where he and other NATO personnel personally hand them to needy kids.

Read the blog .... I dare you not to fall in love with these kids' stories!

"Life is short... don't run so fast you miss it."

From Dan Buettner's book, Blue Zones, on lessons learned from people living the longest, healthiest and happiest lives on the planet:

 

Slowing life's pace may help keep chronic inflammation and aging at bay.

Raffaella Monne lives in the Sardinian village of Arzana: she is 107 years old.  "The day we met, Rafaella sat peeling an apple as I peppered her with dozens of questions about her diet, level of physical exercise, the relationship with her family, and so forth.  Her answers were laconic and unrevealing.  Finally, exasperated, I asked her if after 107 years she had any advice for younger people.  She looked up at me, eyes flashing.  "Yes," she shot back. "Life is short.  Don't run so fast you miss it."

"In the Western world, accomplishment, status, and material wealth are highly revered and require most of our time... Few cultural institutions exist to encourage us to slow down, unwind and de-stress."

In Sardinian culture, all centanarians interviewed drank a glass or two of Cannonau red wine every day. "Cannonau wine has two to three times the level of artery-scrubbing flavonoids as other wines. Moderate wine consumption may help explain the lower levels of stress among these men."

The ability to effectively shed stress, enjoy the present, and relish close relationships are common denominators among the longest lived, healthiest and happiest people on earth.

 

Health Care's Coming Price Revolution

An excellent Op/Ed piece in the Wall Street Journal (2/23/12) ...  "The maket is naturally creating an ObamaCare alternative, and the moment for structural reform may be riper than Washington rhetoric suggests.  'Health-care reform' is inevitable.  The only question is whether it will run in the direction of prices and choice or more government control."

Health Care's Coming Price Revolution

A Lesson in Longevity: "Ikigai," or Living with Purpose

From Dan Buettner's book, Blue Zones, on lessons learned from people living the longest, healthiest and happiest lives on the planet:

Kamada Nakazato is a centenarian living in Okinawa, one of the four Blue Zones identified by the research. Hers is just one of many fascinating stories of these amazing people.

When asked her secret to living to age 102, she said: "I used to be very beautiful... I had hair that came down to my waist.  It took me a long time to realize that beauty is within.  It comes from not worrying so much about your own problems. Sometimes you can best take care of yourself by taking care of others.  Eat your vegetables, have a positive outlook, be kind to people, and smile.

"Older Okinawans can readily attribute the reason they get up in the morning ("ikigai").  Their purpose-imbued lives gives them clear roles of responsibility and feelings of being needed well into their 100s."

" A sudden loss of a person's traditional role can have a measurable effect on mortality... Kamada remains functioning longer because she feels needed."

Researchers found a clear evidence of this purpose-driven attitude in the longevity, health and happiness of centenarians across all four Blue Zones.  One 11-year study found that "individuals who expressed a clear goal in life -- something to get up for in the morning, something that made a difference - - lived longer and were sharper than those who did not."

A Lesson in Longevity: Hara hachi bu

Taken from Dan Buettner's book, Blue Zones, on research of four areas in the world with the longest-lived individuals:

Kamada Nakazato is a 102-year old woman living on the Motobu Peninsula of Okinawa, an island archipelago 1000 miles southwest of Tokyo.  Okinawa was identified by the researchers as one of 4 "blue zones" in the world where people live the longest, healthiest and happiest lives.

During the authors' visit with Kamada, they observed a pattern of eating among people in this area:  mostly plant-based foods grown in their gardens, some fish and tofu,lots of green tea and only occasional meat.  

"Before each meal she takes a moment to say hara hachi bu, and that keeps her from eating too much... All old folks say it before they eat.  It means 'Eat until you are 80 percent full.'" 

"Okinawa may be the only human population that purposefully restricts how many calories they eat, and they do it by reminding themselves to eat until they're 80 percent full.  That's because it takes about 20 minutes for the stomach to tell the brain it is full.  Undereating, as the theory goes, slows down the body's metabolism in a way such that it produces less damaing oxidants - - agents that rust the body from within."

Low caloric intake was a practice that researchers found among centenarians in all four Blue Zones, averaging 1900- 2000 calories per day.  Compare this to one typical fast-food meal of a large hamburger, large fries and a large soft drink containing nearly 1500 calories.