Raining again in Durham. After the drought of 07, I steel myself not to complain as the waters fall. And we’re 3x the usual for this time of year. My form of lemonade for this circumstance would be snow, which is a stretch for Central Carolina in late Fall. Healthcare and the associated reform movement perplex me. Participated recently in a well-managed discussions within this topic. Duke’s Fuqua School hosted a day-long series of panel discussions on how we, the nation and its array of providers, payers and patients, might find a way to get most of the healthcare that we pay for. By now, it is common knowledge that the USA pays the most per capita without being close to the top in quality of care received. Tangentially, we’re applying the same thinking to the war in Afghanistan, i.e. we must do the right thing even if it is neither affordable nor is victory, however measured, likely with this continued investment of resources. “Turn him to any cause of policy,
The Gordian Knot of it he will unloose, Familiar as his garter” (Shakespeare, Henry V, Act 1 Scene 1. 45–47)

Back to Fuqua. The participating senior members of the government, the sincere consultants, the MDs turned economists and the very bright business school students (Fuqua competes with Wharton for the top spot in HMS (Health Management Systems- the program once known as Masters of Hospital Administration)- were thwarted by the complexity and interconnection of the elements of our problem. If we solve one part, we penalize an important constituency; if we resolve that part, we anger this other important constituency. The hovering bomb, of course, is the unfunded liability, now estimated to be $59 trillion dollars, for Social Security, Medicare and Medicaid obligations. Occurred to me that the sole and probable solution, unless we want to continuously spend 20%+ of the GDP on healthcare, is to prepare for the collapse of the system. Some hope remains if the likes of this MBAs attack the root causes of this mess. With enough time and authority, they will make an important difference. If they venture into healthcare front as a second option to employment on Wall Street, then it’s welcome to HCA – HealthCareAfghanistan.

By the way, some argue that the Push-Up is the best indicator of physical fitness.

Time marches and sprints at frequent intervals so three passed since my last entry.

At this Friday’s USNA Alumni Luncheon, our two guests will be a former Army Captain who graduated from West Point in 2002 and a USNA grad also of class year 2002. The Captain became an engineer and found himself in Iraq in 2003 digging-up IEDs (improvised explosive devices), including 155mm artillery shells hidden in the carcass of a dead dog. The Navy lieutenant, a pilot, faced better equipped bombers when he arrived in 2005. Luckily, he had more sophisticated detection euipment along with more experienced support on the ground.

From our USNA Chapter Secretary:
USNAAA NC Triangle Chapter VP Chris Perrien has suggested that some helpful background reading for Friday’s meeting can be found in the dispatches of journalist/blogger Michael Yon, particularly his dispatches from Iraq in 2007 and the first half of 2008 (though his posts from Afghanistan since August 2008 are equally compelling).

Before going to Yon’s site, you might wish to familiarize yourself with him and his work through his Wikipedia entry.

This recommendation does not constitute a blanket endorsement of any of Yon’s statements about either the Iraq or Afghan wars (which are complex and difficult to classify)–it’s just a pointer to an up-close-and-personal account of what the war looks like from the soldier’s point of view.

Recommend the film, Hurt Locker. Was it shot in Iraq? live? Gritty texture of film and the silly-serious bravado of the main character is captivating, regardless of your politics. Why do people do these things?! How do they do these things?! And Michael Yon appears to be one of them. Who got us into this policeman’s nightmare of Iraq? How did anyone think that we could make a democracy of such people in such cultures in such a climate and environment. What would they do to us if they could?!