Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for July, 2021

Sunday musings…7/25/2021

1 Frustum. Part of a pyramid or a cone remaining after the top has been cut off. No reason. Just a cool sounding word randomly encountered while reading about a new building in Chicago.

Built by stacking Frustums.

2 Volunteer. Random plant growing in an otherwise homogenous crop field. Often useful, like an cornstalk. Pretty sure I’ve mentioned this one (from my mother-in-law) previously.

Just too cool not to mention again after passing a few to and from the barn.

3 Invitations. My daughter once said of the “snobby pops”, the cool girls in high school, that they never really graduate, they just move. What she meant, of course, is that many of them never again reach the heights they perceive that they have reached in high school, and so they never really grow beyond what it was that made them popular in the first place.

They just move to a new “school” and play the same tiny games until it’s time to move again.

4 Costs. No matter how you shake it, obtaining healthcare in the U.S. costs a lot of money. Popular perception has it that doctors, and what doctors are paid, represents the lion’s share of those costs. Interestingly, no matter where I look, the highest percentage of healthcare costs associated with care by doctors (office visits, etc) is 22%. The lowest is usually somewhere around 15%. These are % of costs, not doctor salaries; one must remember that the fee you pay for your office visit does not translate directly into your doctor’s salary. Overhead expenses such as rent, staff salaries and the like come out of that fee, too.

Still, 22% of $2.5 Trillion is a lot of money. If you get in an accident, or you are diagnosed with cancer, your doctor bills are the least of your worries. Health “Insurance” was designed to cover these big ticket events. By and large, it does, if you have health insurance. Most of us won’t need this part of our policies. What those policies do is pre-pay for what is largely health maintenance, with the occasional modest trip to the repair shop (for example, cataract surgery). In these cases, even if you have a very high deductible (the amount of money you pay out of pocket before your insurance company starts to pay your bills) and you write a check for the entire amount in your bill (for example $1496 for standard cataract surgery), your insurance company has negotiated that bill way down from the “list price” (again, cataract surgery, ~$8000).

Here’s (part of) the rub: if you don’t have any health insurance, nothing from your employer or the government like Medicare, the largest healthcare organizations typically demand full price for your care. This is particularly true of our most famous non-profit medical institutions like Yale, Harvard-Pilgrim (Partners) Health, and our local behemoth the Cleveland Clinic Foundation. These institutions have taxes forgiven that are on the order of 10 times the amount of discounted care they provide to the community, even when that care is computed using their outrageous list prices.

This treatment of cash-pay, uninsured individuals by large, powerful for-profit and non-profit institutions is unconscionable.

In my reading I came across a very interesting idea. The Wall Street Journal did yet another exposé on this, once again focusing on Yale (they don’t seem to learn). A follow-up letter to the editor from Paul Horvitz, a professor at the University of Houston, offers an elegant solution: allow health insurance companies to sell products with an infinite deductible, or one that is so high that it only covers true disaster care (e.g. cardiac bypass).

Most of your insurance premium isn’t buying you real insurance; as noted above you are simply pre-paying for your healthcare services. Some of the remainder of that premium covers the processing of your claim. Neither of these expenses would be borne by the insurance company if you are going to pay for your care out of pocket. What they would be doing, though, is selling you the right to pay for your care using the rates that they, the huge insurance company, have negotiated.

Like $1496 rather than $8000 for cataract surgery.

There are certainly details that would need a bit of working out before something like this was ready for prime time. Imagine, for a moment, if this “negotiation for hire” plan was coupled with a more robust Health Savings Account, for instance. I think I’ll chew on this a bit and then revisit it when I’ve worked through some of the likely objections. It’s interesting though, and Dr. Horvitz is to be congratulated for the idea.

5 Three Rules. It’s always a huge compliment when something I’ve written or shared is passed along to another generation. Even better when the passing along is in a setting that is similar, or identical, to the original. So it is that I harken back to the days of my residency at NYU and world famous Bellevue hospital, transported by a note from my friend and colleague (and former junior resident) Dave, who has taught ophthalmology residents for 30+ years now.

Dave was a year behind me at NYU. He was (and is) brilliant in every respect, except for one, at least at that time: he was categorically incapable of holding his tongue when he was right. Mind you, Dave was (and is) right nearly all of the time. His meteoric rise in academia and the myriad alphabet organizations that run our world is testament to the fact that he has acquired this skill, acquired the ability to gauge when it will be most effective to share his thoughts and hold them until such time is nigh.

What Dave shared with a young resident in whom he sees the seeds of leadership (and perhaps greatness) were my three rules for surviving, and perhaps thriving, in an organization or institution: Knowledge is power. Perception is more important than reality. Evolution is better than revolution. Like any set of rules mine has caveats and exceptions, and it has evolved over the years. But as a strategic building block upon which you can construct your tactical responses, this list is as good as any others I have encountered. It has served me, and Dave, very well over the years.

I used to say the the more knowledge you had, the more likely you were to succeed in any organizational structure. As the years have gone by I find that the power inherent in knowledge, or more precisely information or intel, is dependent more on the quality of the information than the quantity. Being in possession of nearly all of the information necessary to make a proper decision or foray, but not holding that key bit of knowledge that forms the crux of the issue, is akin to not having any knowledge at all. Since we do not even possess the information crunching ability of our phones, Power comes from having the right knowledge. The actionable knowledge. Still, what hasn’t changed is the absolute absence of power you face when you are not read in to all of the information necessary to make the decision that is most right for you.

Once you have enough knowledge it is time to learn what everyone around you perceives. How do they see the situation? To lead one must understand not only the cold, bare reality of what is on the ground before you, but also what and how those around you THINK is the reality. I’ve admitted in the past that this, too, may fall under the “knowledge” axiom, but separating it out emphasizes its outsized importance. It’s awfully hard to lead from spot #1 to spot #2 if your group is convinced that they are presently sitting on “M”.

Finally, in general, evolution is a better route to effective and lasting change (hopefully improvement) than revolution. There are certainly circumstances where revolution cannot be avoided; I’ll leave it to you to reflect on some historical note or another that proves the exception. But there is so much damage, much of it collateral damage among “non-combatants” in revolution, that it has to be an awfully big deal bad thing you are hoping to change to lead the revolution. In our case back in the Bellevue days Dave was almost certainly trying to solve for a chronic administrative barrier to providing care or receiving an education, or both.

Once again let me emphasize that Dave was almost always right. In the end, by acquiring the proper knowledge he saw where the power to make the change lay. Seeing the issue through the eyes of everyone else involved allowed him to avoid the obstacles erected along the straightest path to success. By biting off small pieces of the problem, each small step leading inexorably to the proper change event, whatever it was that Dave sought to change was achieved in such a way that it came to be seen as the only plausible outcome possible.

While I admit a bit of “discoverer’s bias” these three rules work in almost every group setting. Work, family, your Sunday softball league…doesn’t matter. They’ve worked well enough for me, and for Dave, that they are still being passed on to the next generation of young people who will lead us all through the next evolutions.

I’ll see you next week, a week made better by the evolutionary changes you have brought about through obtaining the key knowledge necessary, and seeing the problem not only as you see it, but as others around you see it…

“Expiration Date”: Sunday musings…7/11/2021

1 7/11. Heh. Always makes me laugh when I come across these numbers together.

Can’t remember the last time I was in one, but still.

2 Huber. Getting a lift from one of those ubiquitous golf carts cruising around at a horse show. Horse Uber. Right? Right?

Should be a word.

3 Aren’t you? It always tickles me when someone recognizes me. Not that it’s a very common occurrence, at least not any more. Maybe once or twice a year at a conference, especially if I’ve done a couple of professional videos around the same time. In the CrossFit world, back in the day, it would happen pretty much any time I showed up at an event. I was always tickled when it happened.

Walking around the show grounds with Beth and her trainers it was cool to see them recognized by folks from all around the horse world. The twist, though, was having their HORSES recognized. Again, pretty cool, but totally foreign to any of my experiences anywhere, ever.

Still a rookie at this game.

4 Expiration. As in expiration date. For whatever reason I’ve come in contact with several people who have received dire medical diagnoses with a terrible prognosis. Really, nothing short of being presented with your own expiration date. A couple us who’ve been more fortunate got to chatting about this on the way to dinner after yesterday’s show sessions. You know how it went, of course:

What would you do? How would you structure the rest of your life if you pretty much knew what “the rest of your life” was going to look like from the calendar’s point of view?

There’s nothing really very new or unique about this question, of course, and it’s quite likely that when I’m done writing this morning I won’t have covered any untrod ground or come upon any revelations or epiphanies. But still, the question is out there and it’s rather interesting that it has come to rest in the “Restless Mind” while I’ve been doing mental gymnastics around the issue of finding new ways to occupy myself when/if I hang up my professional spurs. What would your days look like, how would you paint the final canvasses or pen the final chapter if you pretty much knew when the show was going to close?

There’s a very poignant song, I think it’s by Graham Nash but it could be David Crosby, titled “Encore”. It’s about leaving the stage behind but carrying on with the rest of your life. More like #2 up above, “aren’t you?” or “didn’t you used to be?” than “clock’s ticking”, and more in line with a healthy retirement. I thought I’d address that until I met another soon to be released soul, and to be honest I think the “expiration date” is bringing a welcome clarity to my “Encore” internal dialogue.

Like everything else there are poles to the question. Extremes, if you will, on either side. The person I’ve been with this weekend is simply ramping up the intensity of what you and I would see from the outside as their “regular life”. They go to work, although maybe not quite as often or for quite as many hours each day. There’s been no effort to check off any bucket list items. No fantastic or fanciful travel. Dinners mostly at home and only on the road if the destination is family. To be sure there are no sacrifices being made, financially or otherwise; if there is something there to be had in the moment that will make that moment a bit more special or memorable, whatever it is gets “had”. No fools are suffered, although what little I know of this person leads me to believe that they’ve not suffered fools any time anyway.

On the other end of the spectrum, I went to college with someone who was presented with a diagnosis that had a high likelihood of causing a calamitous end to the journey at any moment. No medicine or surgery exists that can change the odds. This person could do literally anything they wished; the risk of disaster seems to be the same no matter what they do after they make their bed in the morning. Their choice was quite different: they retired when most of us were just barely getting going with our careers and our families, and they have been off on a lifetime of the kinds of adventures that the rest of us will put off until we are too old to even think of them, let alone pull them off. They suffer fools and pharaohs equally; it’s all a part of the journey when you can literally expire in minutes, any minute.

So what would it be for me, then? You may remember my friend who passed some years ago from cancer. The one with whom my friendship deepened in the brief 22 months between his diagnosis and the day he died. It’s a shame that it has taken another dire diagnosis to see that my friend Ken gifted me with the answer to the question of an “expiration date”, as well as the answer to my interminable quest for some kind of meaning if or when I retire.

If I were to get stamped with my own expiration date I know now that I would simply live each day with the joys of being with Beth, our family, and our friends. Where I am or what I might be doing doesn’t seem like it would matter all that much. Heck, I’m sitting in an empty stall at a horse show, listening to an auction for young horses in Europe and picking straw out of my shoes. Not my personal groove at all, ya know? And yet, I am happy. Content. What I am is content in a place and around an activity that is not me or mine because I am around people who dream of being here and doing this. These people are mine, and I, theirs. I am literally basking in their happiness.

Why would I want to be anywhere else, or doing anything else, no matter when?

Silly, this, to find myself with this answer as if I needed to be looking for it, since I come around to this “answer” so often, here and elsewhere. We all have an expiration date, after all. It’s just that most of us don’t know when it is. Blessedly, myself included. If we do, certainly if I do, I just can’t find anything other than my people to think about. Like Ken did. Be with my people doing the things we do that make us think of each other as “our people”.

I’m flattered and happy to have spent this weekend in the company of a person who has received their “stamp” and chose to include me in what time they have left. It made me smile to think of my college buddy, doubtlessly off on an adventure that will make us all a tiny bit jealous if not for the price of their “stamp”. In both of their honors, and in honor of Ken, it’s been a privilege to remember that it’s not really a very difficult question for me to answer if it ever comes my way.

Looking ahead I’ve already got everything I need to be happy with whatever time I have left, and looking back I’ve had everything I’ve needed to be content with the time I’ve had.

I’ll see you next week…

Fourth of July musings 2021…

There’s Something about the Fourth of July. Such a complex day around Casa Blanco, at least the part of Casa Blanco that lives between my ears. Many years ago the first two weeks of July meant a family vacation. We lived in a one-company town; American Optical shut down for the first two weeks of July and the town pretty much did, too. Little League games went on hiatus. Everyone who could left town.

When I was super young my maternal grandparents would scoop me up and take me to their Jersey shore beach house for a week or two in June. My folks would then come in on the first and we would have a cottage in the town next door for the two week holiday. Funny, but I just now realized that we almost never saw my grandparents during those weeks even though they were just one town over. I have no memory of fireworks there, either with my little family or my grandparents.

We spent every day on the beach. It must have been funny watching our little caravan of kids carrying chairs and an umbrella. Mom or Dad pulled a wagon with a classic styrofoam cooler containing tuna sandwiches and store brand soda. Full on sugared soda. There was an outing to the boardwalk carnival and miniature golf. I remember a Saturday dinner at Esposito’s near the beach in one of the other of the towns. The kids would fill up on the bread and my Dad would be furious when we ate maybe a bite apiece of dinner. Happened every year, our own little Groundhog Day at the beach.

Still, it’s funny that I am just now after more than 50 years realizing that the vacation was a single family affair. No grandparents, aunts or uncles, or other families. Just us.

Some time after my sister Kerstin arrived (5 years after Tracey) the beach trips ended in favor of Webster Lake in Massachusetts. Also known by its Native American name “Char gog agog man chog agog chabunga munga mog”, it was our summer vacation spot for 2 summers. Not many memories from those days to be honest. Our family was of very modest means in those days. What I remember is kinda like what I remember of the Jersey Shore–day after day of just hanging with my siblings and my parents near the water. Not many memorable outings. Well, no outings, really. Fireworks were a couple of Roman Candles my Dad fired into the lake.

Anyone who has read any of my stuff is familiar with what has come to be known as “Cape Week”. In truth what we call Cape Week is actually Cape Cod v2.0. In the waning years of our life in Mass and the first couple of Rhode Island years we spent the first two weeks of July on the Cape at a place called Radio City. As an aside my brother married a girl whose family had a home there right on the beach. Small world, eh? We crammed the whole fam damly into a two bedroom cottage (my folks slept on a fold out couch) with a classic beach community outdoor shower. My Dad cooked every meal on a grill he bought at a gas station on the way there. Fireworks? We sat in the dunes at the far end of the beach and watched as they burst over the public beach across the river.

Cape Week v1.0 was also pretty much just us. 4 kids, two parents. All of my Dad’s people summered just down the road, maybe 20 or 30 minutes away, in Buzzard’s Bay. Grampa White was there full time, and my Uncles Larry and Kenny had tiny cottages there, too (Larry would go on to retire there, and two of his daughters would spend at least part of their adult lives there as well). Did we visit them over vacations? No clue. I’m pretty sure they never came to Radio City, though. Just 2 weeks of alternating between beach and pool, basketball and tennis, each day bookended by Dad handling the kitchen duty.

Things changed once we all got to high school and started working during the summers. Kerstin is still bitter, or at least she feigns bitterness, that our “away” family vacations came to an end after one Radio City trip where I stayed behind to work. Leaving a teenager alone at home made Mom nervous, although we were all so afraid of my Dad that not a one of us would have dared to crack a beer at home, let alone throw a party. The 4th became just another working day for us, just another round of golf or day at the pool for my parents. We never did spend Independence Day on the Cape during Cape Week v2.0; the family that owned the cottage we rented kept that week for themselves.

Some things didn’t change though: Cape Week as we all know it was still just us, Mom and Dad and the four kids, our spouses and children. With rare exceptions visits from extended family really just didn’t happen.

There’s something about the 4th of July that resonates, isn’t there? Like we are all supposed to do something, SOMETHING, to mark the day. Preferably with some sort of family around. Several years ago I said I’d like the Fourth to be a “thing” at Casa Blanco. I really had no idea what that would mean, what it would look like, but I did the “Field of Dreams” thing, just sort of “built it”, and hoped family might come. How’s it going? Like I said up top, it’s complicated. Kinda like Cape Week all those years. Lots of moving parts, lives moving in and out of each other. There are no rules for my “thing”; Casa Blanco is Beth’s house after all, and “Dad’s 4th of July thing” is an open, casual, fluid invitation, not a command or call to action.

So how’d it go this year? I’m going with great. We saw all of my kids over the weekend. Megan flew in for the Fourth AGAIN! Dan arranged a “field trip” to a local winery where the wine was California good. My sister Tracey and Steve came with all three of their’s. Randy spent an afternoon playing all sorts of beach games with his cousins, just like Cape Week. The lake was calm and all the toys got wet. Fireworks? Compliments of the neighbors, thank you very much! It could have been any summer weekend at all, really, but it was the Fourth, and somehow that made it just a little more special.

And so I sit here with Beth, a cup of coffee in hand, and finish this version of “Sunday musings…” on a breezy Monday morning, happy to have had this Fourth. I close my eyes and the little waves on Lake Erie sound just like they did on the Jersey Shore and the Cape. I feel the sand between my toes on the beaches of my childhood. There are eggs scrambling in the bacon fat, and my Dad is burning the toast. Mom is reaching into the styrofoam cooler pulling out tuna sandwiches. Someone just got a hole-in-one at miniature golf. The wine was just a little bit better, the beer a little bit colder, the sun a little bit brighter. I open my eyes and I am here with Beth on the day after a Fourth of July weekend where just for a bit we had us all.

There’s something about the Fourth of July…

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