Memories from the San Joaquin Valley

A bit of background: On December 7, 1988, I reported to my first U.S. Navy fleet duty station: Attack Squadron 22 (VA-22), “The Fighting Redcocks,”  based at Naval Air Station (NAS) Lemoore, California. The squadron has since been redesignated as Strike Fighter Squadron 22 (VFA-22), but the Fighting Redcocks remain based at NAS Lemoore, the Navy’s west coast premier air station and home to Strike Fighter Wing (formerly Light Attack Wing) – Pacific. The Naval Air Station is located on California Hwy 198, a few miles west of the town of Lemoore in Kings County. It is approximately a 30-minute drive to Fresno, in the heart of California’s central valley. Each winter (at that time) a thick blanket of fog would settle into the valley, probably due to a reaction between the relatively mild winter temperatures and the colder air blowing in from the Pacific: San Francisco on an enormous scale.

At that time, almost all of the squadrons at NAS Lemoore flew the same type of aircraft: the A-7E Corsair II, a carrier-based light bomber. Although the A-7E was capable of flying missions in all weather, the extremely poor visibility at Lemoore was deemed an unnecessary risk for training flights. As a result, we spent 4 or 5 months out of the year playing cards. As I had arrived near the beginning of a particularly long foggy season, I literally did not know what my base looked like for the first 6 months I was there. I could not see a person standing three feet away from me. A shuttle bus ran between the administrative area of the base, where our barracks was located, to the more restricted operations area a few miles away. My new shipmates helped me by making sure I knew which direction the bus stop was and how many paces as I walked out of the barracks. They did the same for the enlisted club, the operations mess hall, and the brightly-lit, but still invisible, McDonald’s directly across the street from Barracks 12, which our squadron called home. I could get to work, food, and alcohol. The necessities having been taken care of, the rest would have to wait for spring.

I have always loved the beauty of the outdoors. The following is a post about some of my memories (caveat: from 21 years ago, but still as vivid as yesterday) about my first spring after the fog finally lifted. It was previously posted on my Facebook page, and it meant enough to me that I wanted to preserve it. It has been edited slightly from the original post for contextual reasons.

I still remember working nights, and the sun coming up directly in my eyes on the way home as it rose over the Sierra Nevada around 9am, an hour or more after “sunrise” and the first time I ever saw the peaks of the area of Sequoia and King’s Canyon National Parks from Visalia. I had arrived at Lemoore in the middle of the fog, and after it finally lifted, I just assumed they were clouds for weeks afterwards. Nothing east of the Mississippi is that high in the sky except clouds or aircraft vapor trails.One day something made me just stand there and watch them – always in the same place and never drifting.

That’s one of the (few) things I loved about NAS Lemoore in summer – I could see from the peaks of the Sierra Nevada, over the Coalinga Hills to the Coast Ranges. That and the friggin jackrabbits. We used to have to hop into trucks and chase the jackrabbits and coyotes off the runways and taxiways so that we could conduct flight ops. You’d think a big, loud A-7 or F/A-18 coming toward them would have been as much of a clue as a grey truck. Of course WE had 54mm flare guns. I don’t advocate setting coyotes on fire with red flares, but this was the Cold War, and as exhilarating as it was to be the tip of the spear, we knew who the adversary was, and he had a spear, too. Although if we were “on the beach,” we were training, rather than in an operational role, but we took our jobs no less seriously than those who maintained and flew the B-52s with the white undersides or the Air Force Strategic Air Command tankers that supported them. If you’ve lived long enough to remember the Berlin Wall, hopefully you can understand that there was no such thing as a “just practicing” mentality at that point in the history or our Armed Forces. Nor should there ever be.

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More Thoughts on Healthcare

The current state of healthcare isn’t literally about healthcare at all. It is about the enormous and continuing rise in the cost of healthcare due to the separation of healthcare consumer/patient and the entity that pays for the care, typically an HMO or the government. To give an example of “HMO-driven inflation,” before transferring my care to the Veterans Health Administration (VA), more than one of my providers had a “standard” rate at which they billed HMOs and presumably Medicare, and a second, significantly lower rate that they charged to individuals without health insurance or other third-party payer. I was shocked to find an example even within the VA. Under certain circumstances, such as lack of available bed or inability to provide a service in within a mandated time limit, the VA contracts with private healthcare providers to handle their overflow (at no cost to the veteran – the cost is billed directly to the VA). I had occasion to be treated by a private provider on behalf of the VA, and I came to learn that my care was billed to the VA at a rate that was TWENTY-FIVE PERCENT above the standard rate that was billed to HMOs or other payers. As shocking as that is, I suspect it’s more of an example of the government ironically being price-gouged because its needs are frequently immutable, rather than being a major contributor to “HMO inflation.”

The problem and its causes are no great mysteries. More important are solutions that avoid a massive new Federal government entitlement (when some major current programs are of questionable sustainability) and pricing healthcare out of reach of more Americans, straining non-profit hospitals by further turning the ER into a primary care clinic. I don’t advocate the abolition of HMOs, but I do propose doing away with absurdities like the “sky’s the limit” surgery in exchange for a $20 copay.  We need to look at reviving features of “traditional” 80/20 insurance (which has never gone away for small businesses or the self-employed), such as DEDUCTIBLES and a reasonable, realistic (for patient and provider) percentage match. Nothing onerous that would prevent a person from obtaining needed care, an amount sufficient, if only symbolically, to restore the patient/consumer’s awareness that increased consumption of medical resources costs proportionately more, a basic lesson of economics that seems to function normally until someone with a lab coat and stethoscope enters the picture.

Published in: on 2009 08 16 at 01:25:12  Leave a Comment  
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Near-Death Experience of the Day – Cheating Natural Selection

For reasons that aren’t really important to anyone who doesn’t know me personally, I take MS-Contin for chronic pain. I have since late 2007. Since that time, I have simply accepted the fact that I could no longer drink alcohol. The extreme danger of mixing central nervous system depressants such as alcohol and opiates is probably the one thing I retained from a high school drug-awareness course more than two decades ago. Today was an extraordinary day. I had an opportunity to reconnect with an old friend from my high school days, and it appeared that that would coincide with a chance to relive some long-dormant Rocky Horror Picture Show fun. In my excitement, two critical things happened: I forgot to take my MS-Contin this morning, and I allowed myself to forget for a few moments that I could no longer drink alcohol. While waiting for my friend to arrive at the small theatre she runs, I sought shelter from the heat in the pizzeria next door to the theatre and had a beer. Or rather, I had less than half a beer, followed by panic as I began having difficulty breathing and realized that, unusually, I was not carrying an epinephrine autoinjector (drug allergy). I clutched my cell phone, tried to hide my distress as I asked the waitress to bring me a soft drink, and waited it out. Ten minutes later, I was fine, but only because, by sheer luck, I had not taken the MS-Contin that should have been near peak plasma level at about that time,

Published in: on 2009 08 16 at 00:50:21  Leave a Comment  

Some Thoughts on Healthcare

As a brief preface, this post was precipitated by the current disagreement within the United States about President Obama’s healthcare proposal. As with any writing on a political “current events” subject, it is doomed to eventual irrelevance. I must confess at the outset that I have not read President Obama’s proposed bill, in part for reasons based on MY source of healthcare.

I am a disabled Navy veteran. For two years now, I have received all of my medical care from the Veterans Administration (VA) at a VA Medical Center in a major city. I interact with my healthcare providers far more than the average person (merely intuitive assumption) and have for over a decade, and I feel as though my more frequent interactions with a broad spectrum of providers gives me a bit more insight than the average bear on at least a comparison between HMO care and VA care. There are a few things that are the same: one will not always agree with one’s doctor, specialist appointments take longer to get than primary care appointments, and PCPs are the gatekeepers for specialists. There are also some differences: though both can change doctors, the VA has a smaller pool than an HMO in all but the most rural areas, specialist appointments are generally much faster in the VA, all of my VA providers, as well as the pharmacy, work from and contribute back to a master electronic medical record, which contains documents as well as all labs and diagnostic imagery I have ever had, the VA is quicker to adopt evidence-based procedures and standards of care, and if I am dissatisfied with a situation and cannot resolve it with my doctor or his/her clinical supervisor, I can go beyond them to a patient advocate who can navigate the bureaucracy much better than an outsider such as a patient.

In general, I am more satisfied with VA care, though I miss several of my former providers personally. I have heard it suggested that a solution for Medicare might be to give Medicare patients access to VA facilities. I don’t support that particular idea, though some of my reasons are purely personal, such as the sense of cameraderie with other patients, and some VA staff, as fellow veterans.

I think that requiring those hospitals that are significantly subsidized by federal funds be brought to VA standards would vastly improve the care experience, and outcomes, for patients who, perhaps due to “falling through the cracks” between heath insurance and Medicare eligibility, use the county hospital-of-last-resort as their primary source of care. Mandating that hospitals use VA-style electronic medical record and prescription system would improve care/outcomes and reduce errors.

Having said all that, I DO NOT support required government healthcare (or being able to decline it only at your disadvantage or peril). My VA care is a benefit of a specific contract between me and the federal government, basically “Workers’ Compensation” for the Armed Forces. It is a valuable benefit to me, but I am still free to seek care anywhere, from anyone. If the government required me to surrender that liberty in order to avail myself of VA care, the VA wouldn’t know I exist.

If one wants to improve healthcare, don’t start by thinking about what liberties you must take away from the American people. I do not believe, however, that the free market will fix this as long as the current HMO system exists, where people pay their premium, then feel entitled to consume all the medical resources they want for a $20 copay. The economics of paying, say, a $40 copay for a medication that costs $900 just don’t work. There is no free lunch. So the choices appear to be status quo, government regulation, or quite a bit of temporary pain if we want the free market to shift the system of medical payment to something closer to reality. Even the status quo is, I think, merely delaying deciding between the other two.

Green Energy from The Southern Company

Are you a customer of an electric utility operated by The Southern Company? I buy my electricity from Georgia Power, a unit of The Southern Company. I can’t be sure that my experiences hold true for other states served by The Southern Company or by EMCs that operate in some parts of those states. If you spot an error, don’t hesitate to let me know.

Georgia Power offers a program called Green Energy, where customers can elect to purchase power generated from renewable sources for a monthly premium of $3.50 (for wind, water, and biomass. $4.50 per month for solar) per 100 kWh each month in addition to the normal charge for the electricity consumed. That’s less than a cup of gourmet coffee per month to have 10% or more of the average home’s electricity produced from renewable sources! In starting my own experiment in a new (to me) house, I started off with a single block of solar energy. At this moment, I could add 45.00 to my electric bill, and ALL of my energy would come from solar. NO coal. NO nuclear power plants. And I can do it NOW, without saving up or taking out a loan to pay thousands of dollars for a home solar installation.

I have not lived in this house to have a year-round baselineof its energy consumption. That’s my first priority, followed by maximizing opportunities to conserve energy – the cheapest option is not to consume the energy at all! After that, I’m planning to set up budget-billing and and purchase ONLY solar power for my home. This is a powerful alternative within reach of every Southern Company customer. Even buying a single block of Green Energy – $3.50 – will reduce by about 10% the amount of coal or nuclear power, and the resulting pollution, that must be generated for your needs.

Where else can you make a difference for such a tiny investment?

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