Just Be And You Are

Jay’s always writing sensibly, especially when it comes to healthcare. His ideas are offbeat, novel, and make you do a double-take in your head about what’s really going on in the world.

His doing more, buying less post struck a chord on a different level. The picture in the post reminds me of Will Hunting’s room in Good Will Hunting, one of my favorite movies of all time. Just a place to crash, recharge and start anew.

Living simply is difficult at first because you’re forced to prioritize. To each his own though; personalized living. Some earn money and do great things for stuff, which may be their personal drive. Cant knock that. Problems arise (as in the current financial crisis) when people start buying into what others are doing, just because.

What’s your own definition of living? Cut out the media, your friends, your family, your social status and what’s “required” of you. How would you choose to live?

Watch your thoughts; they become words.
Watch your words; they become actions.
Watch your actions; they become habits.
Watch your habits; they become character;
Watch your character; it becomes your destiny.

I got the above from an email chain and it struck a chord. It all starts with you.

John Robb does a fantastic job discussing bandh dynamics in this post. Bandh means “closed” in Hindi and in this case is used to describe various close-outs that occured in India over the last few weeks. In Punjab, it was a clear case of an “eye-for-an-eye”. The events go like this:

1984

2009

I was in India for the Punjab Bandh and it was a ghost town that day. I still went out to run a few errands and a couple of shopkeepers were open to take advantage of th situation. At tremendous risk though, since the bandh initiators could have easily called them out and made trouble for the long run. The scary thing was my parents were driving in that day from New Delhi (which suffered its own bandh a week later) and buses, trains, roadways and such were the first to be blocked off by the boycotters. They got lucky and ended up cruising the empty streets, shaving an hour off their trip.

Robb describes the impact the best:

In short, it is pure global guerrilla. For example:

It exacts “taxes” on local businesses and individuals.

It promotes and participates in a thriving black market (which is made even more important due to suppression of “legitimate activity”).

It can rent the Bandh to politicians and businessmen for their own purposes. Competitive Bandhs from labor and politicians (aka non-violent strikes), are disrupted and can often turn violent when the Naxalites enforce their monopoly.

The last point – especially in essentially corrupt political environments such as in the East – is the scariest. Politicians renting out the black market and disguising it as a mercenary force gives little control to a “democratic” populace. When everyone agrees the wrong thing is OK, change management is nothing but showmanship.

I sometimes wonder whether this question deserves thinking time or whether it takes time away from actually doing things. Considering the sinusoidal nature of life, if there’s a question worth thinking about in the down periods, this takes priority. And DailyOM (the inspiring catalyst) provides the recipe for thinking about it. Read the whole thing, but the last sentence is my favorite part.

“Who am I?” is a timeless mantra, a Zen koan ultimately designed to lead us home, into the part of our minds that finally lets go of questions and answers and finds instead the ability to simply be.

November 13th, 2009
The Heart of Unknowing
Who am I?
At some point in our lives, or perhaps at many points in our lives, we ask the question, “Who am I?” At times like these, we are looking beyond the obvious, beyond our names and the names of the cities and states we came from, into the layers beneath our surface identities. We may feel the need for a deeper sense of purpose in our lives, or we may be ready to accommodate a more complex understanding of the situation in which we find ourselves. Whatever the case, the question of who we are is a seed that can bear much fruit.

It can send us on an exploration of our ancestry, or the past lives of our soul. It can call us to take up journaling in order to discover that voice deep within us that seems to know the answers to a multitude of questions. It can draw our attention so deeply inward that we find the spark of spirit that connects us to every living thing in the universe. One Hindu tradition counsels its practitioners to ask the question over and over, using it as a mantra to lead them inevitably into the heart of the divine.

While there are people who seem to come into the world knowing who they are and why they are here, for the most part the human journey appears to be very much about asking this question and allowing its answers to guide us on our paths. So when we find ourselves in the heart of unknowing, we can have faith that we are in a very human place, as well as a very divine one. “Who am I?” is a timeless mantra, a Zen koan ultimately designed to lead us home, into the part of our minds that finally lets go of questions and answers and finds instead the ability to simply be.

Why don’t you take a good look at yourself and describe what you see, and baby, baby, baby, do you like it?
There you sit, sitting spare like a book on a shelf rustin’,
ah, not trying to fight it.
You really don’t care if they’re comin’; oh, oh,
I know that it’s all a state of mind.

- Led Zeppelin from Misty Mountain Hop

It breaks old habits. Especially those learned in stress, during times you couldn’t control and reacted to instead.

Personally, I’ve made great strides stopping myself from biting my nails and cracking my knee. These simple but annoying habits were a natural part of my day and signaled various emotional states; nervousness, hunger, exhaustion, so on. The sabbatical has eliminated the cause – the root stressors – which in turn got rid of the effect – the bad habit.

Will they reemerge? Most likely. Yet I have a deeper understanding of how relative a state of mind really is. It’s a matter of time and place. Your context affecting your self. Change your setting and you change how you react, how you feel. I’m counting on this to make a difference.

The Dartmouth Atlas, relatively unknown to the general public, has been whispered about for decades in health care circles. It sees the light of day now:

A provision in the House health care bill, included over the objections of hospitals from New York and other cities, would order a neutral group, the Institute of Medicine, to conduct a two-year study of regional variations in Medicare spending. The bill requires the institute to recommend changes that would reward “quality and value,” and those changes would take effect automatically unless Congress objected by May 31, 2012.

This is certainly controversial and attacks have begun on the validity of the data showing major differences in costs across all regions of the U.S. for similar procedures. This is an effort to reign in those costs in high-spending hospitals.

The CEO of Beth Israel rationally thinks through the issues, especially that of patient noncompliance, which everyone health care facility suffers regardless of region.

“I don’t dismiss the Dartmouth study out of hand,” said Stanley Brezenoff, chief executive of Continuum Health Partners, parent company for major New York hospitals like Beth Israel Medical Center and St. Luke’s-Roosevelt Hospitals. “What I’m saying is there may be explanations that go beyond the simple explanation of overutilization.”

“I now have my people poring over readmissions,” he said. “What we’re discovering are things like individuals don’t take their medications, and you ask yourself what it is that we as a hospital could do to deal with that.”

The New England Journal of Medicine’s perspective on payment reform:

Care management, with its cost-reducing potential, will not spread widely in the health care system without substantial changes in payment policy. If hospitals profit from unnecessary readmissions, they are unlikely to adopt effective hospital-to-home care-management programs. If primary care practices are not reimbursed for the work of a registered-nurse care manager, they will not hire one unless they share in the savings generated by reducing hospital admissions and emergency department visits. Other obstacles include nursing shortages and the paucity of training programs for nurses to become effective care managers.

Current financial incentives sometimes create less revenue for better care. In a fee-for-service (FFS) system, rework (i.e. unnecessary readmissions) can be profitable because providers are paid per visit, not a cumulative clinical episode.

The first line of the article cites a stat noted often that deserves reiteration:

In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications, frequent hospitalizations, and limitations on their ability to perform basic daily functions due to physical, mental, or psychosocial challenges.

Chronic disease, such as congestive heart failure, diabetes, and coronary artery disease commonly occur in the elderly (though in the case of diabetes that is quickly changing). This sector of the population is also growing faster than any other.

Cost reform must be strategic and piece by piece unravel the complex knot that now represents the US health care system.

John Robb writes about Entrepreneurship as Resilience:

One of the best ways you can prepare for the future is to train yourself to become an entrepreneur — essentially a person that makes their own economic opportunities. It’s going to become a major differentiator between those that succeed and those that fail in a harsh global system (this expertise has been deprecated by a system that prides itself on manufacturing salaried consumption bots).

He gives 10 survival tips. Here’s a great one:

Deconstruct any business you see. Estimate revenues. Evaluate competition and competitive advantage and marketing. Etc. Find out how they make money and how much.

Much thanks to Cameron Schaefer for sharing.

Commenting on Schaefer’s Blog today, I realized the dilemma that we face on a daily basis. Making inane choices that actually matter. In the aggregate.

MONEY

Currency is the most obvious. The cycle starts the moment we spend money. From our wallets to the cash register all the way up to the parent company as a credit. So whether it’s cigarettes or clothing or fast food, what you buy does make a difference. More personally, it expresses your support towards that business’ bottomline.

EFFORT

A more subtle example is the work we do. We don’t view work the same way as volunteering, even though work is even more of a demanding master. The tradeoff is MONEY. Our desire to be at work when we don’t want to be is directly tied to our bank account. Where we work also signifies allegiance to a greater cause. Engineering might be a calling, but it is also a tool. Apply it with discretion.

TIME

Often referred to as the most valuable currency, how we spend it tends to define us a little too much. On one hand, time utilized towards study or personal development is productive. On the other hand, it may be stressful. Playing video games or going out to party may be fun and relaxing. It may also be destructive to well-being. It’s VERY relative.

Understanding our individual relationship with each of the resources above can be extremely rewarding. The final – and possibly harshest – judge is you. The idea of “opportunity cost” is prevalent in our ROI-driven, American dreamy culture. But not so much in others. Judging what may be lost if we choose one thing over another may be useful for long-term planning, but will deplete one of the above in the short-term.

We all change our minds, so there’s little reason for regret. Choose as it suits you.

I’m really catching onto a certain style of blogging that’s not theme-based and reads like free streaming thought. Examples include Seth Godin, Ben Casnocha and Jay Parkinson.

I’ve decided to use this approach blogging here. Pulse of Care is my business site about health care, which for reasons I don’t even understand, has always been a strong passion of mine. I’m all over the place though and health care need only define me to the degree I let it. If you’re interested in what I have to say about health care, check out http://pulseofcare.com

I’m just going to be here.