First, Universal Coverage. Then, a New Framework.
George C. Halvorson is chairman and chief executive officer of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, headquartered in Oakland, California. Kaiser Permanente is the nation’s largest nonprofit health plan and hospital system, serving more than 8.6 million members and generating $40 billion in annual revenue.
George Halvorson serves on the Institute of Medicine Task Force on Evidence Based Care and the Commonwealth Commission for a High Performing Health System. He serves on the American Hospital Association’s Advisory Committee on Health Care Reform. He chairs the World Economic Conference Health Governors for 2009 and chairs the International Federation of Health Plans. He has received the Modern Healthcare/Health Information and Management Systems Society CEO IT Achievement Award. The Workgroup for Electronic Data Interchange also awarded him the 2009 Louis Sullivan Award for leadership and achievements in advancing health care quality.
Halvorson has written several health care reform books, including the newly released Health Care Will Not Reform Itself: A User’s Guide to Refocusing and Reforming American Health Care. He also wrote Health Care Reform Now!, Health Care Co-ops in Uganda, Strong Medicine, and Epidemic of Care as guidebooks for health care reform.
Halvorson served as an advisor to the governments of Uganda, Great Britain, Jamaica, and Russia on issues of health policy and financing. His strong commitment to diversity and inter-ethnic healing has led him to his current writing project, a new book about racial prejudice around the world.
Prior to joining Kaiser Permanente, Halvorson was president and chief executive officer of HealthPartners, headquartered in Minneapolis. With more than 30 years of health care management experience, he has also held several senior management positions with Blue Cross and Blue Shield of Minnesota.
Question: What are the steps we need to take to arrive at this perfect system?\r\n
George Halvorson: I think that we need two steps in the current process. I don't think we should think of it as just one big leap from here to where we are going. It's a two-step process. And the first step is: we have to get everybody covered. We have to have universal coverage; we have to have all the kids of America in a database where we can deal with asthma issues. We have to have everybody insured. Now that's the first stage. And we have to make them affordable.\r\n
And the second thing, and we have to do this very quickly, is we then have to improve care. Because we cannot afford the care of trajectory were on. We can't afford to have twice as many people with kidneys failing; we can't afford to have 23% of the people dying of sepsis in hospitals. That's the trajectory we can’t afford. We've got to fix that second. One bill can't fix both. One bill can't do all the insurance reform and to the care improvement reforms. So it's got to be a bill and a bill. It's got to be the bill and an agenda. Fill in a leadership and that is the model we have to use. And you can't get there just in one jump.\r\n
The hearings a year ago in the Senate were trying to deal with both of those issues at the same time and there were some very good conversations going on about the chronic care issues in America and the need to fix chronic care. And then there was a sense of who we're trying to figure out what step one and step two – that we have to get to step one as being the insurance part of the agenda, the coverage. Step two is to follow immediately thereafter. They can't follow two years from now or five years from now-- it has to follow months from now. And we need to jump on the agenda and fix a couple of those key issues and get people to pay out to do that. And I think America is ready for that. I think America is ready get healthier, but we have to be led there.\r\n
Question: What’s the logic in putting universal coverage first rather than first fixing the framework?\r\n
Halvorson: Well, number one; we’ve got to get those issues out of the way. If we try to fix diabetic care for the country, and we’ve got 30 million people, many of whom have high diabetic needs, not covered, we can’t do it. If we’ve got all those kids who have horrible asthma care not covered, in a care system, out of a care system, in an insurance plan, out of a care system, we can’t fix asthma care. We can’t do step two until we do step one. We’ve got to get everybody covered. Everybody in this country has to have access to care, and then we need to fix the care. But we need to fix it now. We needn’t fix it 10 years from now. And we know now what needs to be done for asthmatics. We know what needs to be done for people with congestive heart failure. We know what those issues are, we just have to get to them, but we can’t get to them until everybody has insurance. If somebody does not have an insurance plan and they have congestive heart failure, who, or what could possibly make their care better? Nothing. You’ve got to step one, step two. And if you think we’re going to somehow, playing with a horrible handicap, playing left-handed and blindfolded without everybody covered, we’re going to fix care, then after we fix care we’re going to come back and fix insurance. Anybody who thinks that way has never actually been involved in any care delivery or care financing. At Kaiser Permanente, we can’t fix care for the people who don’t have coverage. But we can do a lot for the people who do have coverage.\r\n
Question: How should employers be treated in the model?\r\n
George Halvorson: Most of Europe provides universal coverage and uses private health plans in an employer based system. So, if you’re in the Netherlands, a percentage of your paycheck goes to your healthcare benefit and you choose from 120 health plans. And you pick the health plan and that health plan must take you. It’s an individual mandate. The heath plan must take you. No health screening. If you are in Switzerland, your employer deducts part of your paycheck and you get a health plan, and there are 70 health plans in Switzerland and you get to choose among them. Germany has 300 health plans. Everybody in Germany picks private plans. Those countries have no government system of any kind. They do not have anything resembling Medicare or Medicaid, anything. They just basically have private health plans and an employer-based system. And the employers use their leverage as purchasers to get better deals for their workers and also to get health improvement agendas and health spas and that type of thing. So, if you are in Germany, the employers will negotiate spa treatments on top of the basic health benefits for workers. So involving employers in the model works just fine as long as care is affordable.\r\n
All those countries deduct from the paycheck even if you go to France, where they have a mixed system. The France system looks an awful lot like the Medicare, Medicare supplement model in the U.S. Everybody has a basic benefit package from the government, but it’s low, so 92% of the people buy private insurance and that private insurance pays the difference between what the government pays and what the doctor’s charge. And again, that model is done by employer. And France actually has many healthcare coops and many employers and municipalities will get together and create a coop, libraries will get together and create a coop. There are a whole bunch of coops in France and the French coops purchase care for workers, but again it’s a worker-based system-- everybody pays a portion of their paycheck to buy it. So, most of Europe is a payroll deduction, just like Medicare in the U.S. Social Security in the U.S. They used the same model in those countries, and then you get to choose between health plans.\r\n
So, having employers in the link can be done and it works just fine. The problem in the U.S. the reason it’s failed here is because, in those countries, every employer must be in. In the U.S., it’s optional. Some are in, some are out. Workers don’t know if they’re going to have health coverage. There’s an inconsistency in the American model that doesn’t exist in those other countries. But having employers in can be done just fine.\r\n
Recorded on: September 21, 2009
Healthcare reform is off the ground. What now? Kaiser Permanente CEO George Halvorson outlines the next steps we need to take to arrive at the perfect healthcare system.
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How would the ability to genetically customize children change society? Sci-fi author Eugene Clark explores the future on our horizon in Volume I of the "Genetic Pressure" series.
- A new sci-fi book series called "Genetic Pressure" explores the scientific and moral implications of a world with a burgeoning designer baby industry.
- It's currently illegal to implant genetically edited human embryos in most nations, but designer babies may someday become widespread.
- While gene-editing technology could help humans eliminate genetic diseases, some in the scientific community fear it may also usher in a new era of eugenics.
Tribalism and discrimination<p>One question the "Genetic Pressure" series explores: What would tribalism and discrimination look like in a world with designer babies? As designer babies grow up, they could be noticeably different from other people, potentially being smarter, more attractive and healthier. This could breed resentment between the groups—as it does in the series.</p><p>"[Designer babies] slowly find that 'everyone else,' and even their own parents, becomes less and less tolerable," author Eugene Clark told Big Think. "Meanwhile, everyone else slowly feels threatened by the designer babies."</p><p>For example, one character in the series who was born a designer baby faces discrimination and harassment from "normal people"—they call her "soulless" and say she was "made in a factory," a "consumer product." </p><p>Would such divisions emerge in the real world? The answer may depend on who's able to afford designer baby services. If it's only the ultra-wealthy, then it's easy to imagine how being a designer baby could be seen by society as a kind of hyper-privilege, which designer babies would have to reckon with. </p><p>Even if people from all socioeconomic backgrounds can someday afford designer babies, people born designer babies may struggle with tough existential questions: Can they ever take full credit for things they achieve, or were they born with an unfair advantage? To what extent should they spend their lives helping the less fortunate? </p>
Sexuality dilemmas<p>Sexuality presents another set of thorny questions. If a designer baby industry someday allows people to optimize humans for attractiveness, designer babies could grow up to find themselves surrounded by ultra-attractive people. That may not sound like a big problem.</p><p>But consider that, if designer babies someday become the standard way to have children, there'd necessarily be a years-long gap in which only some people are having designer babies. Meanwhile, the rest of society would be having children the old-fashioned way. So, in terms of attractiveness, society could see increasingly apparent disparities in physical appearances between the two groups. "Normal people" could begin to seem increasingly ugly.</p><p>But ultra-attractive people who were born designer babies could face problems, too. One could be the loss of body image. </p><p>When designer babies grow up in the "Genetic Pressure" series, men look like all the other men, and women look like all the other women. This homogeneity of physical appearance occurs because parents of designer babies start following trends, all choosing similar traits for their children: tall, athletic build, olive skin, etc. </p><p>Sure, facial traits remain relatively unique, but everyone's more or less equally attractive. And this causes strange changes to sexual preferences.</p><p>"In a society of sexual equals, they start looking for other differentiators," he said, noting that violet-colored eyes become a rare trait that genetically engineered humans find especially attractive in the series.</p><p>But what about sexual relationships between genetically engineered humans and "normal" people? In the "Genetic Pressure" series, many "normal" people want to have kids with (or at least have sex with) genetically engineered humans. But a minority of engineered humans oppose breeding with "normal" people, and this leads to an ideology that considers engineered humans to be racially supreme. </p>
Regulating designer babies<p>On a policy level, there are many open questions about how governments might legislate a world with designer babies. But it's not totally new territory, considering the West's dark history of eugenics experiments.</p><p>In the 20th century, the U.S. conducted multiple eugenics programs, including immigration restrictions based on genetic inferiority and forced sterilizations. In 1927, for example, the Supreme Court ruled that forcibly sterilizing the mentally handicapped didn't violate the Constitution. Supreme Court Justice Oliver Wendall Holmes wrote, "… three generations of imbeciles are enough." </p><p>After the Holocaust, eugenics programs became increasingly taboo and regulated in the U.S. (though some states continued forced sterilizations <a href="https://www.uvm.edu/~lkaelber/eugenics/" target="_blank">into the 1970s</a>). In recent years, some policymakers and scientists have expressed concerns about how gene-editing technologies could reanimate the eugenics nightmares of the 20th century. </p><p>Currently, the U.S. doesn't explicitly ban human germline genetic editing on the federal level, but a combination of laws effectively render it <a href="https://academic.oup.com/jlb/advance-article/doi/10.1093/jlb/lsaa006/5841599#204481018" target="_blank" rel="noopener noreferrer">illegal to implant a genetically modified embryo</a>. Part of the reason is that scientists still aren't sure of the unintended consequences of new gene-editing technologies. </p><p>But there are also concerns that these technologies could usher in a new era of eugenics. After all, the function of a designer baby industry, like the one in the "Genetic Pressure" series, wouldn't necessarily be limited to eliminating genetic diseases; it could also work to increase the occurrence of "desirable" traits. </p><p>If the industry did that, it'd effectively signal that the <em>opposites of those traits are undesirable. </em>As the International Bioethics Committee <a href="https://academic.oup.com/jlb/advance-article/doi/10.1093/jlb/lsaa006/5841599#204481018" target="_blank" rel="noopener noreferrer">wrote</a>, this would "jeopardize the inherent and therefore equal dignity of all human beings and renew eugenics, disguised as the fulfillment of the wish for a better, improved life."</p><p><em>"Genetic Pressure Volume I: Baby Steps"</em><em> by Eugene Clark is <a href="http://bigth.ink/38VhJn3" target="_blank">available now.</a></em></p>
Answering the question of who you are is not an easy task. Let's unpack what culture, philosophy, and neuroscience have to say.
- Who am I? It's a question that humans have grappled with since the dawn of time, and most of us are no closer to an answer.
- Trying to pin down what makes you you depends on which school of thought you prescribe to. Some argue that the self is an illusion, while others believe that finding one's "true self" is about sincerity and authenticity.
- In this video, author Gish Jen, Harvard professor Michael Puett, psychotherapist Mark Epstein, and neuroscientist Sam Harris discuss three layers of the self, looking through the lens of culture, philosophy, and neuroscience.
The newly discovered galaxies are 62x bigger than the Milky Way.
- Two recently discovered radio galaxies are among the largest objects in the cosmos.
- The discovery implies that radio galaxies are more common than previously thought.
- The discovery was made while creating a radio map of the sky with a small part of a new radio array.
An extremely active galaxy<p> <br> </p><p>Radio galaxies are galaxies with extremely active central regions, known as nuclei, which shine incredibly brightly in some part of the electromagnetic spectrum. They are known for emitting large jets of ionized matter into intergalactic space at speeds approaching that of light. They are related to quasars and blazars. It is thought that supermassive black holes are the energy source that make these galaxies shine so brightly. </p><p>What makes these two galaxies (known as MGTC J095959.63+024608.6 and MGTC J100016.84+015133.0) so interesting is their size. Only 831 similar, "giant radio galaxies" are known to exist. As study co-author Dr. Matthew Prescott explains, these are particularly large even for <a href="https://www.forbes.com/sites/jamiecartereurope/2021/01/18/we-just-found-two-mysterious-galaxies-62-times-bigger-than-our-milky-way-say-scientists/?sh=76edf29c2892" target="_blank" rel="noopener noreferrer">giants</a>:</p><p>"These two galaxies are special because they are amongst the largest giants known, and in the top 10 percent of all giant radio galaxies. They are more than two mega-parsecs across, which is around 6.5 million light-years or about 62 times the size of the Milky Way. Yet they are fainter than others of the same size."</p><p>The smaller of the two is just over two megaparsecs across, roughly six and a half million light-years. The larger is almost another half megaparsec larger than <a href="http://www.sci-news.com/astronomy/giant-radio-galaxies-09266.html" target="_blank">that</a>. <br></p><p>Exactly how these things get to be so massive remains a mystery. Some have proposed that they are ejecting matter into unusually empty space, allowing for the jet to expand further, though some evidence contradicts this. The most commonly suggested idea is that they are simply much, much older than the previously observed radio galaxies, allowing more time for expansion to occur.</p>
How does this change our understanding of the universe?<p> While exciting and impressive on their own, the findings also suggest that there are very many more of these giant galaxies than previously supposed. If you were going off the previous estimates for how typical these galaxies are, then the odds of finding these two would be 1 in 2.7×10<sup>6. </sup>This suggests that there must be more, given that the alternative is that the scientists were impossibly lucky. </p><p> In the study, the researchers also apply this reasoning to smaller versions of these galaxies, saying:</p><p> "While our analysis has considered only enormous (>2 Mpc) objects, if radio galaxies must grow to reach this size, then we may expect to similarly uncover in our data previously undetected GRGs with smaller sizes."</p><p> Exactly how common radio galaxies and turn out to be remains to be seen. Still, it will undoubtedly be an exciting time for radio astronomy as new telescopes are turned skywards to search for them.</p>
How did they find them?<iframe width="730" height="430" src="https://www.youtube.com/embed/c1ZW3nVfe5A" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> The new galaxies were discovered by the amusingly named <a href="https://www.sarao.ac.za/gallery/meerkat/" target="_blank" rel="noopener noreferrer">MeerKAT</a> radio telescope in South Africa during the creation of a new radio map of the sky. The MeerKAT is the first of what will soon be the <a href="https://en.wikipedia.org/wiki/Square_Kilometre_Array" target="_blank" rel="noopener noreferrer">Square Kilometre Array</a> of telescopes, which will span several countries in the southern hemisphere and make even more impressive discoveries in radio astronomy possible. </p>
The father of all giant sea bugs was recently discovered off the coast of Java.
- A new species of isopod with a resemblance to a certain Sith lord was just discovered.
- It is the first known giant isopod from the Indian Ocean.
- The finding extends the list of giant isopods even further.
The ocean depths are home to many creatures that some consider to be unnatural.<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzU2NzY4My9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYxNTUwMzg0NX0.BTK3zVeXxoduyvXfsvp4QH40_9POsrgca_W5CQpjVtw/img.png?width=980" id="b6fb0" class="rm-shortcode" data-rm-shortcode-id="2739ec50d9f9a3bd0058f937b6d447ac" data-rm-shortcode-name="rebelmouse-image" data-width="1512" data-height="2224" />
What benefit does this find have for science? And is it as evil as it looks?<div class="rm-shortcode" data-media_id="7XqcvwWp" data-player_id="FvQKszTI" data-rm-shortcode-id="8506fcd195866131efb93525ae42dec4"> <div id="botr_7XqcvwWp_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/7XqcvwWp-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/7XqcvwWp-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/7XqcvwWp-FvQKszTI.js"></script> </div> <p>The discovery of a new species is always a cause for celebration in zoology. That this is the discovery of an animal that inhabits the deeps of the sea, one of the least explored areas humans can get to, is the icing on the cake.</p><p>Helen Wong of the National University of Singapore, who co-authored the species' description, explained the importance of the discovery:</p><p>"The identification of this new species is an indication of just how little we know about the oceans. There is certainly more for us to explore in terms of biodiversity in the deep sea of our region." </p><p>The animal's visual similarity to Darth Vader is a result of its compound eyes and the curious shape of its <a href="https://lkcnhm.nus.edu.sg/research/sjades2018/" target="_blank" rel="noopener noreferrer dofollow" style="">head</a>. However, given the location of its discovery, the bottom of the remote seas, it may be associated with all manner of horrifically evil Elder Things and <a href="https://en.wikipedia.org/wiki/Cthulhu" target="_blank" rel="dofollow">Great Old Ones</a>. <em></em></p>
Daydreaming can be a pleasant pastime, but people who suffer from maladaptive daydreamers are trapped by their fantasies.
Maladaptive daydreaming<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTUwMjgyMy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0OTUxNzc3Nn0.yVIUGnZl6VnJhfevESkBpb1TEvwKrHcLtobwNJV55HI/img.jpg?width=1245&coordinates=0%2C63%2C0%2C63&height=700" id="713cf" class="rm-shortcode" data-rm-shortcode-id="e2d24a66284b3aa58ad16b66c135dc9d" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
One maladaptive dreamer spent hours a day dreaming he was a powerful man who could solve the world's problems.
(Photo: Pixabay)<p>Daydreaming is an indulgence of the mind and imagination, one provided courtesy of the <a href="https://www.sciencedirect.com/topics/neuroscience/default-mode-network#:~:text=The%20default%20mode%20network%20(DMN,and%20Exercise%20Psychology%20Research%2C%202016" target="_blank">default mode network</a>, a network of interacting brain regions that is active even when the conscious mind is not. But like so many of life's indulgences—wine, steak dinners, video games, and even <a href="https://www.healthline.com/health-news/why-too-much-exercise-can-be-bad-042514" target="_blank">exercise</a>—too much daydreaming can be harmful to our well-being. When daydreaming crosses that threshold, it can be considered maladaptive.</p><p>This disorder was first identified by <a href="https://haifa.academia.edu/EliSomer" target="_blank">Eli Somer</a>, a professor of clinical psychology at the University of Haifa, School of Social Work, in <a href="https://link.springer.com/article/10.1023/A:1020597026919" target="_blank" rel="noopener noreferrer">a 2002 paper</a>. That paper looked to six patients in a trauma center whose daydreaming habits replaced human interactions or interfered with their standard life functions, such as going to school or holding down a job. </p><p>Since then, other case studies have looked at <a href="https://www.healthline.com/health/mental-health/maladaptive-daydreaming#:~:text=Maladaptive%20daydreaming%20is%20a%20psychiatric,life%20events%20trigger%20day%20dreams." target="_blank" rel="noopener noreferrer">maladaptive daydreamers</a> and compiled a list of potential symptoms. These include vivid, richly-detailed daydreams; abnormally long daydreaming sessions; daydreams triggered by real-life events; daydreaming sessions that interrupt sleep; and repetitive motions or whisperings while daydreaming. On average, one study reported, maladaptive daydreamers spend <a href="https://bigthink.com/bps-research-digest/people-with-maladaptive-daydreaming-spend-an-average-of-four-hours-a-day-lost-in-their-imagination" target="_self">four hours a day</a> housed in their imaginations.</p><p>"This is not like rehearsing a conversation that you might have with a boss," <a href="https://www.cnn.com/2016/12/30/health/maladaptive-daydreaming-feature/index.html" target="_blank" rel="noopener noreferrer">Somer told CNN</a>. "This is fanciful, weaving of stories. It produces an intense sense of presence."</p><p>While such symptoms are common, though not comprehensive or guaranteed, how maladaptive daydreams manifest are naturally individual to the dreamers. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426361/" target="_blank" rel="noopener noreferrer">In one case study</a>, researchers analyzed the diary of a man codenamed "Peter." Peter described investing as many as 14 hours a day online. The news and images he happened upon would trigger related fantasies. For example, he may envision himself as a multimillionaire genius who could prevent bad news from occurring or self-insert himself into the power fantasies of superhero movies or police procedurals for hours at a time.</p><p>"When I felt this pain as a child, I started imagining how things could be different. I created stories which never happened. To suppress that pain I would hug my pillow or quilt, thinking I was being comforted by someone else," Peter wrote.</p><p>In an interview with CNN, Cordellia Rose described her maladaptive daydreaming like a drug and noted that her daydreams developed into intricate storylines that could last for years. These stories proved so distracted that she was unable to complete everyday tasks such as driving lessons.</p><p>"You get hooked on it, because it can be like an action movie in your head that's so gripping that you cannot turn off," Rose told CNN. "This [condition] needs to be public, because these are people suffering, and badly."</p><p>To be clear, maladaptive dreaming is not a <a href="https://www.webmd.com/schizophrenia/guide/what-is-psychosis#1" target="_blank" rel="noopener noreferrer">psychotic disorder</a> like schizophrenia. Daydreamers such as Peter and Rose are aware that their fantasies are as unreal as they may be unrealistic. Because of this, many maladaptive dreamers understand the difficulties they face and the real-life losses they have endured for the sake of their fantasies. </p>