Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: Extremist

An advocate gets busy while every politician and “talking head” takes credit for healthcare model ideas published long ago.

Reconciling data in my six health portals

Reconciling data in my six health portals

I watched Barbara Starfield again last night. She passed away in 2011 but it seamed as though she was sitting in my living room telling me everything will be alright but many of us will never get our way. Barbara spent several decades studying the characteristics of health systems all over the world. Her final conclusions were simple and easy to implement as long as social agreements were made between consumers of healthcare services and their providers. The contract (sort of) is that my primary care doctor will be available when needed if I promise to contact his or her office before going to the ER for an earache or other non-emergent condition; my doctor also agrees to follow my care as I transition through life stages and address all mental and physical health conditions as they arise by assuring I connect with the correct specialist if required. The specialists in return are in constant contact with my primary care doctor so the primary care clinic is coordinating continuous and comprehensive care and reviewing all interactions between myself and other medical environments. Like I said earlier this week. Someone to watch over me. I first learned of Dr. Starfield in 2001 and followed her publications. Funny, she was never accepted to sit on any best-practice boards but the scientific community considered her work to be spectacular in terms of statistical approach and quality. In other words, she looked for the null hypothesis also.

Again…concerns over repeal and replace.

Some more diatribe with hope at sarcastic humor is written for you below. Please follow through to the end as I pasted a really cool graphic pointing you to a new society of consumers and professionals that might fix the system over the long run.

The conversation doesn’t stop at my dinner table, on my phone, through IM or Facebook. It seems as though my popularity index took a healthy bump after November 8th, 2016. I wish I could be happy about the reasons for the traffic.
“Jeff, you are on Medicare are you concerned?”

Well yes; you see, as we become older the likelihood of needing assistance from case managers, specialists, short stays in skilled nursing or rehabilitation facilities increases. Same with home health services which is always the preferred place to recover from the self-inflicted fractured hip that occurred while my masculine ego informed me of my capacity to clean out my gutters.
One of the most important changes to the clinical language coming from Obamacare is the right for all patients cared for by primary care doctors with Medicare contracts to receive “Coordinated, Comprehensive Care”. Lately you might have heard the terms: “Patient Centered Care” or “Medical Home”. You probably heard President Elect Trump mention “Patient Centered” or a new commercial by Humana presented by a handsome young doctor stating that Humana’s system of Patient Centered Care is superior because of their capacity to coordinate your care within their “medical community”. Then you will watch a local conservative pundit state: “those stupid narrow networks tried through Obamacare didn’t work: here is a toast to repeal and replace.
This stuff cracks me up for the same proponents of patient centered care realize that closely collaborating narrow networks can provide you with clinical personnel that understand your needs better than anyone else! In fact, they have the same attributes of a Patient Centered Care Team using a single medical record and plan of care to increase safety and minimize mistakes. Yet you will hear no one (perhaps save me and a few of us that are tired of scraping the poop off our boots) tell you that the words Patient Centered, Narrow Network, Accountable Outcomes, Value Added Payment, Medical Homes, and all other terms implying a tightly coordinated, error free clinical team surrounding all patients are not original concepts. In fact, they are in place in many of our successful neighbor nations who provide universal enrollment and have always demonstrated lower reliance on emergency room services for basic medicine, better health outcomes and no difference in treatment effectiveness for cancer, diabetes, cardiovascular disease and other leading causes of premature mortality. Our own CMS (The Centers for Medicare and Medicaid Services) have published the policy here July 2016:
So all of a sudden the administration of 2017 will be using terminology invented by others to describe care models that work after years of academic surveillance by healthcare policy analysists and already written into The Patient Protection Affordable Care Act or what the opponents call “Obama-Care”.
My prediction is we will keep the new payment systems for coordinated care and chronic disease care management. However, the credit for the success will fall under a new Trump label. My fears is that the same three insurance companies comprising the oligopoly of payers for American Healthcare will recoup their lost profits of mandated care without premium inflation for the chronically ill by shifting the premiums higher for those with pre-existing conditions. So here is another question from the week:
“Jeff, what will I do now I couldn’t get covered because of my history of cancer before the ACA?” “What if “Trump-care” requires coverage for pre-existing illnesses but allows insurance companies to include the illness in the premium pricing model? “ My response to this question was “not sure, my cost in the NC High Risk Insurance Pool for my diabetes prior to Obamacare was $1200.00 per month not including co-pays. Today it is $350.00.
More on Patient Centered Care AKA Medical Homes AKA Integrated Care AKA Chronic Illness Care.
I discussed the integrated care model and its payment adjustments to my Men’s group on Thursday night as they requested a primer on planning for their last ten years of life. Their hope was that our system of care had evolved and they would not have to lose their homes to cover the long-term care charges. Many of the guys in my group neglected to buy long term care insurance when they were young and healthy, had since suffered a chronic disease diagnosis and episode of treatment and no longer qualified for long term care insurance. They could however place $10 K per month into an account to pre-pay up to one year of long term care. This is what my father did: In 2006 he entered into a contract with a transitional care organization. He paid them $350,000 for full access to assisted living and long term care until his death. They also allowed him to live in the attached apartment complex for independent seniors for an additional rent of $3200 per month including one meal per day. Not a bad deal eh? Oh yeah…one more oversight: My friends ; all retired upper middle class professionals had no idea that Medicare didn’t pay for long term custodial care either in home or inpatient facility.
Now, like I said the other day, I am a bit tired of shouting the truth to those who were unfortunate enough to buy into the following promise: “Oh we will have the most wonderful healthcare system in the world” and “We promise to repeal the expensive policies and replace with something better.
We were on our way folks: The biggest mistake, President Obama’s team was denied the necessary Medicaid expansion for ALL not SOME States by our supreme courts. If you don’t understand the math I will be pleased to describe it in another column. Basically when the folks that would have had access to Medicaid don’t receive the insurance they still consume services. The loss of revenue winds up on the balance sheets of hospitals and providers and they respond by increasing their cost per service. The insurance companies pay more and your premiums increase. So… my neighbors policy (55 year old male) in NC costs $11,000 per year. The very same policy in New Hampshire where they expanded Medicaid costs $5,500 per year. As Mr. Obama leaves keep in mind that the rate of increase in health costs since the inception of Obama Care is the lowest it has been in 40 years.
Somehow, someway; we need to cover everybody. If we do not we cannot cover the losses incurred in the private sector without the Magical Thinking that has been sold you for so many decade. Hide the losses, get others to pay for the losses through modest increases in cost of living and blame the doctors, and hospitals who give away more free care than you could ever imagine.
What would happen if our incredible consumer driven internet harnessed the decision support technology that we use daily on Amazon and instantly brings the right service to you when needed should you or a loved one become ill? What if we harnessed IBM Watson to make the diagnosis thereby reducing error rates and reducing unnecessary utilization of expensive diagnostic procedures?
What if we didn’t need insurance companies any more to assess population risk and perform preauthorization services while we waited for our new medication?
Since we have all of the data connecting lifestyle, culture, nutrition, infection and the human genome can anyone appreciate where we are headed with our capacity to discover the cause of disease and effect of treatment? This is not decades from now my friends; it is within the reach of our children’s lifetime. I have wonderful friends with incredible scientific minds that are creating open source technologies to accomplish human collaboration like humankind has never witnessed. The only barrier to their success is a loss of priority to cure disease, increase well-being and expand the functional-years of human life.
Or…we can keep these technologies secret, forget those we have developed through the natural sequestration of competing private enterprise and traditional silo thinking. If this is where we are headed then the best investment to assure a painless end of life if you are not surrounded by humanitarian friends is my undying support for the second amendment. If you catch my drift.

Check out Right Care Folks!

Right Care Now

Right Care Now

From the front lines in North Carolina’s debate over human equality

I am so sad to see the level of intentional prejudice in this State.

Here is todays local television coverage of the closure of a critical access hospital (CAH). CAH’s are placed in rural areas throughout the USA and exist strictly to provide life saving healthcare to sparsely populated areas (usually agricultural).

This event is blamed on a corporation “Vidant Health”

In reality, it is not the fault of a corporation; or the pharmaceutical industry, or publicly funded healthcare, or the insurance industry; or the doctors; or your dog.

This is a collapse of civilization. In NC, we have decided to stop caring for those in the lower socioeconomic classes. We have proven this through our elected officials. So the fault lies with us and every life that is lost in transit to hospitals 45 minutes away is our responsibility.

You see:

The Affordable Care Act found the money to expand Medicaid and provide coverage for those with incomes less than 200% of Federal Poverty Level (about $28,000). In doing this, the cost of insurance polices through exchanges decreases. This has been proven in States that accepted Medicaid expansion funding. North Carolina did not.

The money for expanding Medicaid is partially funded by eliminating the large disproportionate share payments to critical access hospitals. You see, they would now bill Medicaid.

Well, NC did not accept the money as a “Statement of our conservative believe in small government”.

Now the hospitals are closing.

Here are my comments to our State Health News today, and more will come of this situation as you watch it play out on the national front. You will note that the good people are here. They are just under-represented.

  1. Very sad indeed. Within the last week the following has occurred in my personal world of chronic disease management: 1) the endocrinology group that fills the diabetes management subspecialty role for many Medicaid diabetics in the RTP area has stopped taking these patients and (according to my personal MD) they plan to discontinue services for existing patients on Medicaid. 2) The behavioral health group that treats many of the same diabetics for depression has dropped away from their care-team roll as they too are no longer accepting payment from Medicaid.

    Meanwhile, back in the grass roots of Johnston County we have been blessed by three Raleigh Retina Specialists who are willing to continue treating Medicaid patients. This includes visits, laser procedures, vitreal injections for macular edema etc. I begged them not to drop the Diabetes Eyesight Preservation program at Taylor Retina Center and their response was clear: Are you kidding Jeff, we will turn no-one away, this is a serious disease and far too many preventable vision related disability cases are missed.
    A Heart-Felt Hooray for the Good Guys.

    I wish the NC voters could understand the magnitude of dishonesty between legislators and their constituents. I have worked directly with past external review actuaries including Mercer when determining the return or loss associated with NC Managed Care through their CCNC program. The level of detail, down to the adjustment for illness burden and months of enrollment in Medicaid proved to me the sincerity and accuracy of the folks charged with program evaluation. Later (2006-2010) the program and its outcome data were modeled in many States around the country.

    Yet when attending a Medicaid public forum I witnessed a NC employee from the budget office explain away all cost efficiencies by pointing to differences in the percentage of the NC population that are children in contrast with other States. Such an illinformed if not ignorant piece of information to share with the GA. This comment was made as I sat next to a former legislator who is a surgeon. I described the inaccuracy to him and said they may want to get some help with interpreting the data reported on Medicaid estimates. After a few more minutes discussing evaluation methodologies he looked at me and admitted ” We really do not know what questions to ask”.
    I testify to the truth of this statement further acknowledge that it is mine alone.

New Comment On Self-Management Responsibility

A snapshot of my PHR s data-store homepage MS HealthVault

Jeffrey Harris • Sandy, I enjoyed your comment and want to tease out a couple of points:
If best healthcare is measured by vital measures such as infant mortality, number of quality adjusted life years between age 65 and death and social perception we really don’t provide the best healthcare. For existence: I have a brother-in-law who has been hospitalized for syncope and loss of bladder-bowel function in addition to anxiety and right-sided hemiparesis three times in the last eight weeks. Discharges are always premature with an inconclusive diagnosis while all symptoms and signs point to micro vascular injury to his brain. He has fallen at home and been taken to ER a total of six times. The hospitals treating him are two well-known academic medical centers who keep avoiding the commitment of concluding his dx. I argued for IP rehab but Blue Cross denied the admission due to his inability to participate in three hours of therapy each day. At this point he is living at home alone with his son who has significant developmental disability.

What has happened in my opinion is the staffs of each facility see a 375lb man with 100 pack year history of smoking and wash their hands of going the extra mile. I understand this and have been there myself until my ‘higher self’ shook the judgments out of me.

I worked in PM&R for ten years and would have no problem creating a treatment plan that would occupy three hours per day of my brother’s time using the neuro-rehab team. But… here I sit in the great State of North Carolina with three medical schools within 25 miles of my home and I am powerless over people’s judgmental bigotry obscuring their human empathy. Our healthcare system is sick on many levels. Yes we need policy, procedure, payment mechanisms and total inclusion but a thoughtful look at our internal judgments and motivation wouldn’t hurt either.

I like the idea on penalizing people for poor compliance. I also like the idea of rewarding people who exercise good self-management. I have had diabetes type 1 for 45 years, hepatitis c for 30 years and neuropathic pain syndrome for two years which has required I reduce my schedule to part-time. What I can tell you is that I and many others find chronic disease a lot of work and certainly wouldn’t mind a seven hour work day if we agreed to attend the corporate aerobics class for the remaining hour. This may seem as if I am whining but we see it as being given the supports necessary to take care of our human bodies; for without them we have no contribution for the society that constantly complains about the cost of our care.

Thanks for your thoughts, I believe I mirrored what your ideas are but perhaps introduced some thoughts through the consumer’s lens.
Jeff
UntangledHealthcare.com

 

Getting Involved In YOUR DATA and HOW IT IS USED

 

 

Blessings

 

 

 

 

 

 

 

 

 

As you know, I am all about client rights to equal, skilled and contemporary care. This includes care to the ‘whole of you’ meaning your body, your mind and emotions and right to work in any field in which you can demonstrate the employers required skill set.

If you know anything about advertising and marketing you are clear on how data are collected on large populations of people who represent the matching demographic for which the product is designed to satiate.

It shouldn’t surprise you then that medicine is no different from any other industry. Data are collected and assessed to find new occurences of unknown illnesses, the success of various treatment regime to reduce symptoms of an illness or cure it all together and Data are used to compare, contrast and show superiority over one’s competition.

For many years now, the good data: Meaning the files that contain a complete set of important things we need to know about you that contain a proof of the data quality are more valuable than just about any possession you can imagine. Because of this value: the organizations that own the data (lets say how bad your seasonal allergies were before you started on a new medicine) have tremendous power and influence. These data have not typically been available to the general public but could be purchased for a price. To stay legal the data are stripped of your personal identifying information so no-one can determine where you live or how much you owe Bank of America.

Recently the Commission on Vital Statistics under the US Department of Health and Human Services has started a web service for both the professional and common public. Great stuff! I applaud the effort as it opens the capacity for us citizens to begin deciphering what the heck all this ruckus is about and even find health care facilities and physicians based on the quality of their service.

As I move on with my life you will see me attempting to educate the public further on these topics as they truly will help when it comes to making wise choices regarding your healthcare. I can not express the magnitude of importance for your learning how to interpret healthcare information as I am willing to stand nude (ugly picture) in front or the Washington monument and point out to the majority of our legislative branch just how ignorant they are when they buy into the last lobbyist discussion on heath-scam LTD over their three martini lunch.

To that end I am sharing a posting that I wrote tonight to the DHHS Healthdata.gov team. Essentially I am pleading for your rights to participate and beyond that shutting another door in my career. I will let you know how it all works out. Know for now that many in Federal Government are working hard to provide you with the transparency into the business of healthcare that you deserve. Depending on the outcome of our election you may only have this access for a very short time. So please read on and feel free to ask questions. The language used is common to folks that work in epidemiology but not others so please don’t skip through the material…ask questions…always ask questions my friends.

To: The Healthdata.gov Team

Healthdata@hhs.gov

Subject: data sets cost and availability to common citizens

We have been working on assembling a data model that represents a consumers ‘heath status’ on a   longitudinal basis from birth to death since 1997. Our rudimentary model was patented in 2001 as US   6,282,531 BI: System for managing applied knowledge and workflow in multiple dimensions and   contexts. The patent creators: John Haughton MD. Robert Merenyi PhD, Alexander Sherman and myself   Jeffrey Harris sold the IP to Active Health Management who later sold their company as a bundled   service and product vendor to Aetna in 2004.   The data model described a variety of object classes that could be used to create geographic, resource,   culture, behavioral health and physical medicine based triage and referral guidelines as they emerged as   best practices in human medicine.   The notion was that an ever-changing plan of treatment determined by disease, impairment, disability   and handicap would address both single  disease episodes of care as well as complex co-morbid bio- psycho-social events with indeterminate end-points. A great example are the issues we deal with relating to care transitions today.  

Those of us working on this project had the following characteristics: We were all diagnosed at some   point in our life with a severe life-threatening chronic illness; we were all clinicians with varying degrees   of training (therapist – MD) ; we had a significant understanding of the economic drivers in all forms of   medical therapy including: hospital, skilled nursing, rehabilitation ;  ambulatory care and the processes used to assess illness severity, assemble and deliver treatment using plans of care in each venue.

At the time there were no unifying forces to build applications which would leverage decision support   and community resources to drive the patient routing and monitoring yet today we are falling into   alignment with much gratitude for the Affordable Care Act.

My observations over these 15 years have led me to conclude that the weakest links in our healthcare   system are the mechanisms for funding research; the development of payment models as a failure to include the common public in the determination of definitions for health, wellness, and   what we should expect from our systems of care.

The result is a recurrent, perseverance analysis of the  size of our problem (trillions of dollars) and the ongoing attempt to isolate a scapegoat on which to place our blame.   Amazing for a dysfunctional social system that has been over one hundred years in the making.

Having worked in both public and private sectors, for classical conservatives and classic liberals we are still trapped by our own egos and a system of finance that demands a return on share-holder equity.   I am pleased that our government is unveiling the data for us to use for creative attempts at   understanding the nature of various issues in healthcare as well as meta-analysis of the entire system.

I have a request:  Since I can account for a nurse’s assistant preventing numerous instances of nosocomial infection in my workplace between 1989 and 1997 I can attest to the value including  professionals and lay-people from all walks of life in deriving the solutions and pilot studies that might arise from the sea of   data you have brought the fore-front.

My fear is that those of us who work on the outskirts of the system for a variety of reasons including  misperception of our goals will not have access to the data due to cost barriers. I have witnessed this   many times with at least one of the data-sources you give reference to in your web-marketing.

Another concern is how we –as a society will determine effectiveness and the weight of various   interventions since the lay-public do not possess the ‘non-biased’ academic resources required.   I ask that you consider the following so we can set-forth on a journey of redesigning our healthcare   system:

Derive a general consensus and understanding of health, wellness and quality adjusted life years that  can be understood and adopted by the citizens of the United States.

Make all data affordable to all requesting parties as long as it is stripped of PHI.

If this is not possible,   create a grant mechanism allowing communities and county governments to receive funding to have access to these data and information.

As opposed to the existing regional representatives that US DHHS has who’s job is to create awareness of   the governments success and direction in healthcare. Create a class of personnel that are used for the same function yet are equipped with the skills necessary to explain the data, issues with data reliability, validity and sensitivity to change therefore arousing an interest in the general public in health care systems. Currently, the public relates to healthcare as minor episodes   of sickness or catastrophic orphan diseases. Unless we truly achieve a 12th grade level of critical thinking   we will never have parity or agreement.

Thank you so much for your efforts and service. We will now set forth on determining the ease of use of   the systems you mention. For example: One year ago I attempted to assist a homeless dual eligible   person with Medicare and came to the realization that the Blue Button data set I was extracting did not   have diagnostic codes which I was planning on using to trigger conditions in Health Vault in my effort to   create a permanent PHR for this individual.

I offer this feedback with respect and as an experiment to see if one American Citizen still has an   opportunity to be heard by large government enterprise that invests countless tax revenues to create and market a service for our benefit. In other words, the intent is good but the chasm of understanding is infinite.

 

Jeffrey Halbstein-Harris

Untangled Healthcare

Assisting communities to monitor and improve healthcare

919 627-5038

Cell 919-779-7368

Office Fax 888 783-6178

(Jeffrey Harris) email: JeffHarris@untangledhealthcare.com

Linkedin: http://www.linkedin.com/in/untangledhealth

Forbes: http://blogs.forbes.com/people/jeffreyharris2/

Blog: http://www.untangledhealth.com/

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Slideshare: http://www.slideshare.net/untangledhealth

“Go to the people, live with them, learn from them…. Start with what they know, build with what they have….” Lao Tzu

Patient Advocates! New tools to step up and remotely monitor emotional components of chronic disease along with standard physical indicators

As you all know: Disease or Dis…Ease… is comprised of four components to be addressed by patients and their care-giving support groups. These domains include: Disease, Impairment, Disability ad Handicap. For example: A blind diabetic presents as follows:

  1. Disease: Diabetic Retinopathy
  2. Impairment: Vision
  3. Disability: Blindness
  4. Handicap: Cannot read LCD screen on insulin pump.

If all are not considered as part of a treatment plan we tend to place our head in the sand and lose the patient to depression induced suicide while being fixated on BMI and A1C. Well here is something exciting!!!!!

 

The convergence of psychosocial data (adjustment scales, depression index, mood, pain etc.) with other digitized remote biometric data e.g. interstitial glucose will add great value to examining the correlation of emotional/behavioral patterns and glycemic control for diabetics as well as give insight into correlations in many other diseases.  This is a big deal for me as a diabetic and even bigger as I consider the research we could do. In the 1990s our team introduced patient-family group visits to our ambulatory COPD management program and reduced hospital in-patient days by 70% (N=300). In the virtual world we have a way to accomplish the same objective (Care, Share and Never be alone and afraid).

I have been reviewing various tools for self-management and secure communication for diabetes, heart failure, COPD, Addiction and so on as success in managing these conditions relates to social support and data vigilance. I am also trying to get large pharmacy providers off their feet and please consider adding a remote retinal camera and Apple I Phone to their diabetes management programs as a pilot. In NC I have a group of physicians willing to read the retinal photos if I can get a camera ($10K) and head out into the woods where our indigent are losing vision and functional capacity early in life due to lack of linkage to primary care. Imagine what could be done with bio-psycho-social monitoring. Of course we will need funding for interventions but we can drive off that bridge when we get to it.

So please take a look at this project THE GINGER IO COLLABORATIVE  http://ginger.io/the-platform/

 

 

 

Jeff Harris

Untangled HealthCare LLC

Donald Berwick | The Health Care Blog

We are dropped from the universe into loving hands (unfortunately not for all though)

 

 

 

 

 

Donald Berwick | The Health Care Blog.

I am losing hope. Dr. Donald Berwick has been an individual that I have followed since 1996 when I lived in Boston. He is foremost a dedicated servant to efforts involving improving the quality of healthcare in our country. I am not using the term quality as a market strategy here but from the perspective of a person with diabetes who would trust this man with his life. Dr. Berwick IS Dr. Safety. He is the founder of the Institute for Healthcare Improvement where many of us policy and quality wonks spend our time learning new strategies to decrease medical error rates and prevent morbidity and mortality in hospitals. Dr. Berwick launched the save 100,000 lives campaign that focused on the National Institute of Medicine report from 2000 titled Crossing the Quality Chasm. In it they cited hospital acquired preventable infection, and many other issues as being unacceptable. We learned to quickly diffuse treatment guidelines for the prevention of ventilator acquired pneumonia and empowered fast response teams all over the country in demonstration hospitals. The fast response protocol allows any observant (family member, housekeeping staff etc. to hit a panic button if they sense a patient is in danger). Trust me folks, thousands of people have died who could have been saved if the patient’s family or nursing assistant who know the patient better than the attending physicians and charge nurses were allowed to activate a multidisciplinary rapid clinical evaluation.  I have experienced this as a clinician and personally when my niece Marianna passed away from  an asthma exacerbation that was observed hours earlier and reported by a respiratory therapist whose request to call for an emergency evaluation was disregarded by the local hospital’s charge nurse. She was 32 years old and NO ONE should die from asthma these days.

So Dr. Berwick was appointed to direct the Centers for Medicare and Medicaid Services in 2009 due to his international respect and knowledge of our healthcare system. According to NPR he was asked to step down this week as congress would not re-confirm his appointment. Why? Because he had made a positive comment about the UK National Health Service.

Once again we have a completely biased and uninformed group of bureaucrats drawing conclusions that we are commie, pinko socialists using antiquated references and experiences from the cold war: branding individuals with outdated labels, selling their fear to the ignorant voter who by no means is stupid but simply uninformed as to the corruption and shell games that drive health care practice in our country.

I am having flashbacks from Archie Bunker in the All in the Family series from the 1970s.

Meanwhile, we have republicans and democrats (all of whom you and I elected) being exposed for their million dollar hypocritical business deals and appear to not care as we re-elect, re-elect and re-elect. So we are headed to slaughter.

I am not giving up: I have been screaming for consumer rights as a patient, provider and program manager for thirty years. I have evidence of direct commentary from State officials demanding a termination of my contract with one of my customers three years after I left the State’s employ. The information presented was false, I confronted the issue with proof which discredited the spurious information by my personal patents and documentation; received a tearful apology and had no recourse since the NC law has a one year statute of limitations on defamation of character. By the way, my client whose board member instructed her to beware of me immediately informed me of the conversation and kept me on to perform my strategic contract which they were quite pleased with.

The issues that we have here refer back to the discussion on finding the gold that we all have to offer as opposed to presumptive guilt of our industrial colleagues. I am disgusted at our species and sometimes wonder if we shouldn’t hit the reset button.

So, we have fired one of the most dedicated professionals in our clinical world who has given thousands of free lifetime hours during his most productive time in life as a simple act of service.  He was the wrong brand… for those who continue to believe that 2011 is no different from 1776 and use such arguments to convince you my friends that they actually know what they are doing.

I am begging you to take your country back in a peaceful manner by understanding where the shadow people are, following the dollar and asking yourself if it is working for you. I ask that you not blame a single party, institution or person but own the responsibility yourself and find strength in your numbers.

As history usually points out I imagine that nothing will change, the occupy wall street and tea party movements will become nothing more than marketing tools for democrats and republicans next year and all will be diluted when we experience some form of economic recovery and we continue to not engage the homeless “eye to eye”.

Are you familiar with the behavior of Tasmanian Devils AND have you seen the movie 13.

With love and respect to my readers:

Jeffrey Harris   Communitarian Republicrat with fiscal conservative beliefs.

So you all know: every one of my wealthy and successful friends who agree with my opinions keep telling me to shut up as they are frightened for my career. You see I presently have no job and they want me to keep a low profile. My defect of character here is that I can’t as to do so would be to abandon my hope for eliminating disparities in health outcomes.

Dr. Berwick, I apologize for every vote I cast save for the President in 2008. I have hope and will continue to follow you in your efforts to teach us all that we actually have a heart. Perhaps quick 2D echos on every citizen to help them identify with that piece of themselves that miraculously works itself to death to maintain each persons life.

No Humor For Today a message from the 99%

The photo is enough:  Excerpted from Facebook