Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: Obama

A Diabetic in Puerto Rico calls out for insulin : Shame on us…

Normal Retina                                                        Severe Diabetic Retinopathy



I am angry.

Listening to a diabetic in Puerto Rico plead for an insulin delivery this week brought back remembrance of the body pain, insatiable thirst and intractable nausea I experienced when I was broke in 1974 and had to borrow money for medication as I hitch hiked to California to live with my brother Bruce. Feeling helpless I received a $75.00 wire transfer in the nick of time. Fortunately I had a loving brother and Western Express. Thank G-d for a wonderful primary care Doc that taught me to reverse DKA on my own when I was only 13 years old. I can’t describe the misery of Diabetic ketoacidosis with sufficient magnitude. Imagine dying of thirst.

I do not understand where our Army is. It seems we have infinite resources to drop special forces into any part of the world where there is a threat to The American Way. Yet in the time of Trump, and in the Time if Bush I heard the call of The Great Oz.. “We are doing a fabulous job”  or  “Great job Brownie”. Here lies evidence of my claim that we are own our own in this great country: The Country that used to promise opportunity and someone to watch over us when we fall upon hard times. Go ahead, call me a snow-flake…Then walk a mike in my shoes and tell me again “to suck it up”.

Today I am ashamed of the indifferent , arrogant attitude of Donald J Trump and want our Global Friends to know that we know how to care for our own, we have the resources to care for our own and that the Real America is currently on the mat in a twelve round championship fight against Master Blaster. Let me be clear; Master Blaster doesn’t run this part of town!

The retinal photo above right is an actual photo of a person with diabetes who has not had access to primary care. She lived in a rural area of North Carolina, had no insurance and died one year after this photo was taken. She was in her thirties. Medication, a treatment plan and adequate nutrition go a long way.

Hey DJT, stop worrying about what people think of you and send some helicopters in with the supplies that are piled up a few miles of the shores of Puerto Rico.

Awe Nuts! I am really pissed.

Obama Phones: We continue to justify our prejudice through cerebral intercourse – tidbit on health-care cost


I recently was involved in a discussion with a beloved friend. We were both upset about what we thought were inappropriate entitlements and the forthcoming ‘fiscal cliff’. The topic of choice was cell-phone entitlement programs and my friend stated that Obama had expanded a program for free cell-phones for the indigent; calling them ‘Obama-Phones’.

I said in our conversation, “people do scam these programs and it aggravates me as well but I need to look into it.” “I am aware of and FCC ‘life-line’ program that benefits many people like myself who have diabetes, asthma, heart disease and so on, so I cannot throw out the legislation without a careful review.” I further discussed antiquated FCC protection regulations for rural areas and how these original ‘anti-trust’ laws gave rise to local monopolies allowing community entrepreneurs to monopolize the telecom industry across multiple adjacent counties in NC. This is a real case that requires thorough investigation as it drives out competition from more efficient providers like Time Warner subsequently costing a former Health Center client of mine to spend $8000 per month in ISP fees. I could have purchased better technology for 50% of the fee if my client relocated 50 miles North. The legislation traces back to the Ma Bell days and like all population based protection and entitlement programs now requires review and appropriate action based on the current environment. ‘Zillions’ of influencing variables exist that drive up our cost and inefficiencies!

What troubles me is that the Web is being used to post video and text which propagates ignorance and judgment. Everyone is now an expert in tax-reform, the fiscal cliff, health-care and so on. The truth is: most Americans have no idea how these programs work; especially our elected officials who do not recognize the natural escalation of entitlement programs that are bound to public health standards yet provided by a self-defining ‘free-market’.

In my career I have seen organization CEOs sell company’s for $Millions$ that provided decision guidelines for denying insurance coverage. I have seen these guidelines be put to use to deny hospice coverage. I hope you get my point: In this case I was reviewing a denial on a dead-man.

The factors inflating healthcare and entitlement program costs over time relate to a natural human tendency to place self-interest above all else: After all didn’t Adam Smith use this as the fundamental driver for capitalism?

Of course we have a Fiscal Cliff! I suggest it is time we place the black and white (no-pun intended but interesting end-point) definitions of liberal and conservative  politics in the hopper. The extremists among us are using our ignorance and fear to further split our country in two. I welcome all to leave out names, political affiliations and institutions out of their commentary and begin speaking to the issues as human beings. Let me model a comment for you that brings an issue into the spotlight.

On free cell phones:
“I was informed recently that our free cell phone program is expanding and people are getting these that do not need them. I have also been told that these are old rules which expanded under the present administration. I do not believe America can afford this program. I fear the fiscal cliff may end our way of life. I hope someone can explain the details to me.”

You will note that I:

1) described ‘overheard’ data

2) made a judgment

3)pointed to a financial fear

4)asked for help.

Here is the best answer I could find on the Web:
Snopes Obama-Phones

Here’s to a collaborative future!

Jeffrey Harris aka ‘Halbstein’



IOM Panel finds $750B wasted per year in US Healthcare


I love the Institute of Medicine. Much time this week trying to explain the multiple factors contributing to high-cost, ineffective healthcare. Well the IOM published a wonderful paper yesterday describing the issues and contrasting them to other industries. One cleat take-home is the need to preserve the Affordable Care Act and step up as patients this voting season. The answer is not vouchers folks. The answer is adaptive engineering as many have been saying for…well fifteen years at least.











How to save $750B per year without cutting Medicare.

Finding payment assistance when you are not insured

Okay……. I just had a cold realization that I needed to write something quick so folks do not automatically believe that they are not insurable. This comes after a friend who was employed as a master’s level case worker called me for help. She was disabled last year and is now on Social Security Disability Income. She was not assisted with enrollment in one of the numerous options available.

Medicaid, CHIPS etc.

First off: If you are receiving Social Security Disability you should either have Medicare or Medicaid or both. In some instances you may have a policy from your former employer. You can call your county DSS for this.

If you fall below a State determined percentage of Federal Poverty Level Guidelines you might qualify if you are a female with children or pregnant. In addition if you have children they may qualify for a program called CHIPS Children s Health Insurance Program. Once again your County’s Department of Social Security will assist you. 

If you are poor and over 65 years of age you may qualify for Medicaid assistance for the elderly.

If you are blind you will qualify for Medicaid as well.

Here is the Federal Poverty Guideline Table:


If you have chronic illness and are not disabled, not female with children, not over 65 years of age, not blind and not financially exhausted:

Medicaid is financed through State and Federal resources. I believe States this year pay 35% with 65%b coming from Federal Govt. If your State elected to use the Federal expansion money for Medicaid you may qualify for one of the new eligibility category’s in 2014. For example; until health reform I would not qualify for Medicaid until I became completely disabled from my Diabetes, even if I made poverty level income and did not have enough money for my insulin and other medications. Today, if North Carolina decides to add the new category’s I will. All of the money for the category that includes me will come from the Federal government and then gradually decrease to 90%

Non-Medicaid High Risk Pools

If you are high risk like me e.g. have a chronic disease and have been excluded previously  you will qualify in many states for a high risk, low-cost insurance pool which is partially funded through other Federal and State resources. For an example check out Inclusive Health of NC which is my wonderful State’s offering. My policy was decreased by 50% after the affordable care act was created. In 2009 it was $1140/mo. for me alone. Today it would be around $450/mo. for me alone.  

Inclusive Health the NC High Risk Insurance Product









Finally since this is a short post: Use the new US Government Insurance Finder

US Government Insurance Finder









 My list is by NO MEANS COMPREHENSIVE!  You have many choices and you should never get stuck as an UNINSURED SELF PAY on any service provider’s patient accounting system. If you do, you will pay a multiple of the charge anyone else pays. For example: My stress test with an echocardiogram last week  had a total charge amount of $3000 for combined technical and physician services. However after applying the adjustments through Blue Cross the hospital and provider were paid $642.00 and my co-pay was $64.20. If I had no insurance I would have been responsible for the total amount! By the way, this too is an obstacle that goes away through the Affordable Care Act!!!!!! PLEASE, PLEASE, PLEASE… do not let yourself become bankrupt due to a lack of knowledge as to how to make this crazy system work for you!! You have choices. If for some reason you remain uninsured: BE SURE TO BARGAIN WITH ALL PROVIDERS FOR A DISCOUNT THAT IS ROUGHLY EQUAL TO THE CONTRACT AMOUNT THEY RECEIVE FROM THEIR LARGEST INSURANCE PLAN! After all if you were at Jiffy Lube and everyone that came in through the door paid a different price for the standard oil change you would question the business manager ‘wouldn’t you’?

e-Patient Jeff Harris



PS: if I can help in any way respond with a question or write me at jeffharris@untangledhealthcare.come


Getting Involved In YOUR DATA and HOW IT IS USED













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


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

New comment added to Forbes tonight on “Direct Primary Care”


I suppose it’s worth the risk here as it appears many in the healthcare sector are insulted by logic. My colleagues and I have been saying for years that to make this high cost scenario simple for the common voter we simply need to use the “too many hands in the pie” use case. Jiffy lube works well. What would you do if you suddenly realized that the $24.95 you were paying for an oil-change was completely inconstant with your neighbors who worked at the John Deer plant down the road: Their cost; only $14.95, and your mothers cost: Well that’s a new ball game as hers is free.

So now we have Direct Primary Care. When I first started in this business we had Primary Care Gatekeepers, then we had Primary Care Case Management and now of course; the Medical Home. The best we have done is to bonus physicians on process indicators and…finally we are talking about clinical outcomes.

When I first arrived in NC in 2001 I went to work for the evolving Community Care Medicaid population and disease management folks. They “according to their data” have managed to carve significant costs out of the Medicaid budget through a model that includes a pmpm component for the PCP and additional pmpm components for what you might call Accountable Care Organizations who offer case management, poly-pharmacy review and an administrative infrastructure to make an attempt at transparency.

My learning from all of this: Transparency to one is not Transparency to another; so be sure you set your outcomes definitions before agreeing on a P4P model. Still, I like the physician-patient direct notion the best.

Now, here are some considerations which arise from my 30 years in population medicine and 45 years as a diabetic with complications.

Figure out the illness burden component if it is a bone of contention that will be used in the future by practitioners that don’t like statistics.

Create an all-inclusive global capitation rate that includes fee for service, pay for process (EBG) and pay for clinical outcomes which include improved quality adjusted life years. Also consider how to test for and measure non-compliance (see my blog on medication adherence today at www.untangledhealth.com).

For God’s sake get some buy-in from your specialty brothers and sisters and the facilities where you park your patients for procedures and care from time to time.

Let’s use me as a model: 55 year old male executive with diabetes X 45 years, non-smoker, non-drinker but other comorbidities including hepatitis C, arthritis, neuropathy and retinopathy. Kidneys are good but I am on an ACE.

So number of drugs =six; an insulin pump with continuous glucose monitoring due to lack of awareness of hypoglycemia. My co-pays and deductibles alone are $5000 per year and the insurance plan cost in the NC High Risk Pool is around $7000 per year at last glance.

I have lots of ideas about keeping me compliant (again check out the blog above). Step on up my doctor friends it is time you take your power back and re-assign wasted dollars to true health-care not new positions created to help patients “navigate” their way through this haunted house. Cripes, you can have an MA do that in your office if you provide some special training and get rid of all of the insurance business rules. GO FOR IT.

New Cartoon Describing Cost Shifting – Cost Sharing…Enjoy


The British Primary Care System and Its Lessons for America | The Health Care Blog

The British Primary Care System and Its Lessons for America | The Health Care Blog.


Great post today on UK system. Makes a nice follow up to my complaints yesterday.

This is my reply to MD as Hell who was noting many issues with attorneys.

YAHOO!!! Yes, a confirmation of what my dear friends from UK have told me for years: And of course if we look at Barbara Starfield’s work for the Maryland Commission on PCMH measures she concluded a need for universal enrollment, a single payer AND these clinical functions. The results, better health outcomes. More visits to GP, fewer to specialty, less cost, increased quality adjusted life years.


Her comments in 2008

At the clinical level

–the critical structural features are Accessibility, mechanisms of Continuity/Information Systems, and Range of Services available in primary care.

–the critical process features are Problem Recognition on the part of practitioners (both for initial problems and for reassessment) and Utilization of primary care services, both over time and for new problems as they arise.


Together, these features achieve the evidence-based FUNCTIONS of primary care: First contact, Person-Focused (not disease focused) care over time, Comprehensiveness, and Coordination.


MD as Hell, my good friend Steve is a board certified ER doc who busts his butt for fairly reasonable life. One Friday evening a well-known malpractice attorney was in a car accident and presented in Steve’s ER with enough trauma to require lots of volume replacement, head tongs etc. Steve told me the next day that it took everything he had to not bend down and tell the attorney that he would save his life if is surrendered 33% of his future income. We both had a good laugh at that. Of course Steve didn’t say that, the guy lived and this was 30 years ago.


So what do we do: Well here is what I am observing:

Physicians 50 and over are retiring all around me.

Physicians 35-50 are wishing they would get paid the amount that they projected for their sub-specialties’ procedure of choice: Stent, joint replacement, IOL etc. The physicians that are 35 to 50 (far too few) that are engaged in PCMH work are pleased with the new outcomes based incentive systems, those who are not are living in wealthy areas as concierge docs. The kids that I have worked with the last two years in FQHC’s actually enjoy what they do and are learning to lead teams.


Me, I am a program manager IT guy who started as a CV technologist so I never got used to huge incomes and have always enjoyed each craft I learned.


As a diabetic for the last 45 years I can honestly say that my feet were infrequently checked until the last few years when EBG training occurred in the primary care setting. Since I have a good buddy who is an ophthalmologist (see my blog on Dr. Jeffrey Taylor at www.untangledhealth.com) I have been closely observed and received the   best laser, scleral buckles and IOLs at an affordable price since he wrote of extensively high co-pays.


I figure I have 15 years left and do not want to throw in the towel but teach folks about the history of medicine, insurance and technology in our nation of addicts so they can make more informed decisions at the voting booth. Another guy, John Harrison on this blog is doing the same thing.


So I am asking you physicians to stay with us, be angry, sacrifice something important as we all need to do for re-engineering and build a new system for the future.


The docs, the nurses, the hospitals, the technicians, the pharmaceutical companies, the manufacturers of large magnets and ionizing radiation collectors have all had a pretty good run. But it is over; we can walk away, stick around and complain with no suggestions or create something that works for everyone.



Jeff Harris

Untangled Health




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