Wednesday, September 24, 2014

Nurses put the care in health care -- Sept. 25, 2014 column


Something very important has been missing from our national debate about health care.

The debate focuses endlessly on big numbers, like the millions of aging boomers who will strain the Medicare rolls and the millions receiving care under the Affordable Care Act, a.k.a. Obamacare, and Medicaid.  And the millions still left behind without insurance coverage.

We focus on big-picture politics, like which party is winning or losing. Will Republicans gain control of Senate and keep the House so Congress will move to repeal the health law? What then?

And we fixate on big money. Why does health care cost so much and how can we rein in costs?

These are all worthy theoretical topics for a national discussion, but there’s really only one number that matters in health care, and that’s one.

When a beloved family member or friend is sick, that one patient’s experience is everything.
Like many journalists, I’ve written for years about big-picture health care from a distance, as an interested observer. Very recently, though, I had the sad, bewildering experience of watching a loved one die.

So today, I want to bring health care back to the personal and individual. I want to say thank you to nurses – to certified nursing assistants, licensed practical nurses, registered nurses, nurse practitioners, and others.

You put the care in health care. 
My 92-year-old mother died Monday in a hospital in Richmond, Va. The care she received from the team in the Coronary Care Unit the last three and a half days of her long life was exemplary.  Thank you, Michelle, Chris, Geeta, Dan, Justin, and Kay in Hospice and the rest whose names I’m forgetting. You were wonderful.

For most of her life, Jennie Jennings DeGenaro was exceptionally active and healthy. She ate right and exercised and was proud that she’d been in the hospital only once, when she gave birth to me. Then, close to 90, she fell, broke her pelvis and was hospitalized. Her long decline began.  

I’ve learned over the last couple of years, as my mother came to rely more on nursing assistance at home for daily tasks, that health care is all about what happens between people. It’s the relationship of trust between the patient and family members and a universe of medical professionals. Nowhere is the relationship more vital than between patient and nurse.

Nurses are the front line of care. Doctors parachute into our world and we into theirs, but nurses stay on the ground from crucial moment to moment. It’s meaningful that the word for nurse derives from the Latin word meaning to nourish.

At the hospital, the nurses anticipated my mother’s needs and my dad’s and mine. They listened, helped us understand what was happening and involved us in decisions. They were very busy, but they didn’t show it. They took the time needed to do their work. They were compassionate, efficient, cheerful and very kind. Thank you.

At such sad times and at joyous occasions as well, like the birth of a baby, each family judges our nation’s health care system on what happens to the people in one room.  Our national health care debate must remember that whether our system is thought a success depends on those individual  experiences.    

I know we can’t generalize from one case, but I feel pretty sure that my family didn’t just happen on a fluke of nursing greatness. We’re fortunate in this country to have men and women who want to work 12-hour shifts relieving pain and helping people heal. We all should be grateful for nurses – and encourage more young people to enter the field. We face a growing shortage of nurses.

It’s also time to support nurses as they seek expanded roles in providing medical care. We’re undergoing profound changes in the way medicine is practiced, and nurses have the ability and desire to do more. They are a most valuable resource and we should use their talents. 

To those who say health care in America doesn’t stack up with that other countries, I say, baloney. Thank goodness for nurses.

©2014 Marsha Mercer. All rights reserved.


Thursday, September 18, 2014

On Ken Burns, a noisy vacuum cleaner and the Roosevelts -- Sept. 18, 2014 column


When filmmaker Ken Burns’s second daughter, Lily, was a little girl, she was terrified of the vacuum cleaner.

“Whenever it was roaring, she had to be out of the room or asleep or out of the house,” he said. But then one day, when Lily was 1-and-a-half or 2 years old, she “walked into the room where the monster was roaring and walked over and sat down on it.

“And in our family, sitting on the vacuum cleaner is our idea of what you do in life. You move forward, and you face the thing that worries you the most,” Burns said.

The anecdote is lovely and evocative on its own, but Burns, the master story-teller, wove it into a speech to illustrate Eleanor Roosevelt’s steely resolve.

“Eleanor Roosevelt sat on a vacuum cleaner every single day of her life,” Burns told a National Press Club audience Monday. 

In learning to translate her own fears into action, she became “the most consequential first lady in American history,” tackling the problems of women, poverty, children and immigrants that we still struggle with today. Her uncle Theodore and husband Franklin also had to face their fears to become great leaders.

It was classic Ken Burns. Since he burst on the scene in 1982 with a documentary on PBS about the Brooklyn Bridge, which was nominated for an Academy Award, Burns has been surprising, educating and inspiring television viewers to explore what they want for their country and their own lives.

His two dozen-plus documentaries have explored such diverse topics as baseball, painter Thomas Hart Benton, the Civil War, Thomas Jefferson, the National Parks and the Central Park Five. 

His latest, “The Roosevelts: An Intimate History,” is a seven-part, 14-hour series that PBS is streaming on its website free through Sept. 28. 

On the media circuit to promote “The Roosevelts,” Burns was an amiable scold about our superficial media culture.

"We have lots of information and almost no understanding,” he said at the press club, where he’s an honorary member.

The Roosevelts were the most prominent and influential family in American politics, Burns believes. We benefit from their legacy in LaGuardia Airport, the Lincoln Tunnel, Skyline Drive, electric lights in the Tennessee Valley, thousands of bridges and miles of roads, the GI bill, minimum wage, work hours and child labor protections, among other things.

The documentary naturally prompted a myriad of laments that we don’t have heroes anymore, but,  Burns insists, that is the fault of our media culture.

“We are expecting in the superficiality of our media culture today…perfection in our leaders, and when we find they aren’t perfect we turn away,” he said.

The Greeks, who gave us the word for hero, did not envision perfection. They saw heroism as a complex negotiation, even a war, between a person’s very obvious strengths and weaknesses, he said.  Today, we see one flaw in a politician and become disillusioned.

Even the Roosevelts couldn’t get elected in our time, Burns maintains. Theodore was too hot for the cool medium of TV and would have flamed out in Iowa with “10 Howard Dean moments a day.” The Vermont governor’s emotional rallying cry to supporters after losing the Iowa Democratic caucuses in 2004 became known as “the scream” and doomed his presidential chances.

Franklin’s paralysis from polio would have raised too many questions about his strength to handle the crises of the Depression, Second World War, and Eleanor wasn’t sufficiently photogenic.

Listening to Burns, 61, one can’t help but marvel at his energy and productivity. He currently has five films in development and several others in his head.  

“The Emperor of Maladies,” a three-part, six-hour series about the history of cancer, is scheduled to be released next spring.

A 10-part, 18-hour history of the Vietnam War is coming out in 2017. A two-part biography of Jackie Robinson is in the works. Shooting has just begun on a “massive” history of country music and on a biography of Ernest Hemingway. 

“If we were given a thousand years to live, we would not run out of topics in American history,” Burns said.

What’s most appealing about his work is that Burns shows us how our country has struggled to become what it is and reminds us that we’ve always had vacuum cleaners to confront. 

(c)2014 Marsha Mercer. All rights reserved.

Thursday, September 11, 2014

Portraits on taxpayers' dime -- Why? -- Sept. 11, 2014 column

A perk of being a Washington bigwig is to be immortalized the old-fashioned way -- in an oil painting paid for by taxpayers.     
The official portrait of former CIA Director Leon E. Panetta was unveiled Sept. 5 at the CIA, where a Directors Gallery honors every chief since the first in 1946.
What made Panetta’s painting different from his predecessors’ and most, if not all, the hundreds of official portraits on walls around Washington was his decision to be painted with his dog, Bravo.
Panetta, who served as CIA director from February 2009 to June 2011, has said his golden retriever was in the room during some of his toughest moments, such as planning the operation to kill Osama bin Laden in May 2011.
In the portrait, a smiling Panetta has both hands on his pet, making him look more like a genial professor than the spook who took out Public Enemy No. 1. The picture elicits appreciative “awws” from pet lovers, but it also raises a question:
Is an official portrait – even of a distinguished public servant like Panetta -- a good use of your tax dollars?
Taxpayers spent $300,000 last year alone on oil portraits of senior officials, reports “Wastebook 2013,” the annual compendium of wasteful federal spending published by Sen. Tom Coburn, R-Okla.
The price tag of the CIA’s portrait of Panetta wasn’t disclosed. But if one picture is worth the cost, whatever it is, how about two? Of the same person?  
Panetta served eight terms in Congress and was President Bill Clinton’s chief of staff. After his stint at the CIA, he was secretary of defense from July 2011 to February 2013. So, naturally, the Defense Department commissioned a Panetta portrait last year for its Pentagon Collection.
I say naturally because over the last decade the Defense Department has ordered 25 of at least 69 official portraits purchased by government agencies, according to “Wastebook.”
The Defense Department contracted to spend $31,200 on its Panetta painting, which hasn’t been unveiled yet. The sum is infinitesimal in the Defense budget, but it’s real money to many Americans who have no say how their taxes are spent.
Don’t get me wrong. I love portraits, especially those that give us a glimpse of the subject’s personality. Generations of school children might have no idea what George Washington looked like were it not for artist Gilbert Stuart. There’s still a place for portraiture in the 21st century.
But as often is the case, the government is being free with other people’s (our) money. An official portrait shouldn’t be the default honor for a departing agency head.
In October 2012, then-Defense Secretary Panetta presided over the ceremonial unveiling of the official portrait of former Defense Secretary Robert M. Gates. Speaking that day, Gates mentioned that the same artist had painted the official portrait of “a certain CIA director” two decades earlier.
“It didn’t seem all that different, a few pounds lighter, maybe a couple of inches taller. The hair a more useful shade of white,” Gates said, drawing laughter. He was CIA director from 1991 to 1993.
“A sure sign you’ve been in Washington too long,” Gates said, is when the portraitist has “more than one crack at your portrait a generation apart.”
You can argue Gates and Panetta deserve the honor. But people whose careers are not nearly as distinguished sit for artists on the taxpayer’s dime.
The Department of Housing and Urban Development ordered a $20,000 portrait of former Sec. Steve Preston, who was in the job all of seven months. “Wastebook” also reports taxpayers forked over $20,000 for former Energy Secretary Steven Chu, $23,000 for former NASA deputy administrator Lori B. Gardner and $30,000 each for the first and second Homeland Security secretaries, Tom Ridge and Michael Chertoff.
Enough already.
“Taxpayers shouldn’t pick up the tab for a portrait that costs more than many hardworking taxpayers make in a year,” said Sen. Jeanne Shaheen, D-N.H., who is leading a bipartisan effort to rein in spending on portraits.
The proposed Responsible Use of Taxpayer Dollars for Portraits Act would prohibit federal funds for portraits of members of Congress and most agency heads and set a cap of $20,000 per painting of those in the line of succession to the presidency.  
Congress should stop spending taxpayers’ money on official portraits – even for bigwigs who have good dogs.
©2014 Marsha Mercer. All rights reserved.


Tuesday, September 9, 2014

Think Cooperative Extension is all tomato clubs and tractors? Think again -- on

Cooperative Extension Reinvents Itself for the 21st Century

man checks bags of wool© AP
Corey Childs, with the Virginia Cooperative Extension, checks 200-pound bags of wool at the Clarke County Ruritan Fairgrounds in Berryville, Virginia. State cooperative extensions are transforming themselves in an effort to remain relevant. (AP)
For most of the last 15 years, Seth Wilner was the go-to guy for any and all questions about growing plants and animals in Sullivan County, New Hampshire.
“Used to be, someone in my county called up and said, `I have a llama and two goats, can you come out and look at my pasture?’” Wilner said of his former role as an educator with University of New Hampshire Cooperative Extension, his state’s version of a century-old, national effort to spread the latest livestock and agriculture knowledge from universities to farmers.
But after New Hampshire legislators slashed the extension’s budget by 23 percent in 2011, UNH revamped it.
Today, Wilner works out of an office in Sullivan County, but he travels all around the state advising farmers on the business of farming. He and the other field specialists still drive to farms to build relationships, but they also rely on technology like Google Chat and Skype and offer online tutorials and webinars. 
Similar transformations are happening across the country as state cooperative extensions work to stay relevant in an era of smaller budgets, fewer farmers, a more diverse population and modern technology. 
President Woodrow Wilson signed the law creating the Cooperative Extension Service in 1914. The goal of the unusual county-state-federal partnership was to share land-grant university research on agriculture, home economics and rural energy.  Back then, more than half the U.S. population lived in rural areas, and 30 percent of the workforce farmed.  
Today, however, less than 2 percent of Americans farm for a living, and only 17 percent live in rural areas.  The extension service remains active in nearly all of the nation’s 3,000 counties, but the shift has prompted major changes in how it does business.
With fewer full-time employees—the size of the full-time workforce dropped 22 percent from 1980 to 2010, from 17,009 to 13,294 full-time workers—the extension service now relies heavily on nearly 3 million trained volunteers and its web site to disseminate information. 
Extension still shares scientific research aimed at making farms and ranches more profitable. But it also works to protect the environment, ensure a safe food supply, respond to natural disasters, foster greater energy independence, help youth and adults be healthier and enhance workforce skills.
“How we remain relevant and well-connected is by focusing on the problems people have in our states,” said Daryl Buchholz, associate director of extension at Kansas State University. K-State Extension set five “grand challenges,” including raising food to feed the world and growing future leaders through 4-H, extension’s youth development program.

Agriculture Still the Backbone

For many states, agriculture remains the backbone of extension. Oregon extension, for example, brings together vineyard managers, winemakers and students for classes in person and online. As a result, wine grapes have catapulted to the 17thmost important crop among 220 commodities in the state, according to A. Scott Reed, vice provost at Oregon State University and extension director. 
Virginia Cooperative Extension has helped train more than 300 farmers in Virginia, the Carolinas and Kentucky get a head start on expected federal food safety regulations – and, in the meantime, expand their markets.
“I didn’t understand what it took to sell to the big box stores,” says Mike Calhoun of Churchville, Virginia, who spent 39 years in construction before buying three greenhouses three years ago. With help from county extension agent Amber Vallotton, he was able to get certified as having Good Agricultural Practices by the U.S. Department of Agriculture. More retailers are requiring growers to have GAP certification.
Vallotton spent about 25 to 30 hours at Calhoun’s farm without charge, helping him to write a food safety plan with worker sanitation, water quality, harvesting and packaging practices and prepare for an audit of his system. Farms are inspected annually to ensure compliance.
“If it hadn’t been for her, I don’t know if we’d ever have gotten it,” Calhoun said. “She’s been a godsend to most everybody around here.”

New Territory

In many states, extension is expanding its mission. For example, in southwest Kansas, which has a large immigrant population working in beef feeding and processing plants, extension has started bilingual 4-H clubs for immigrant children and their parents.
The idea came from Steve Irsik, owner of Royal Farms Dairy in Garden City, whose 60 workers are from Central and South America. In 2012, Irsik, a former 4-H member who serves on the state’s 4-H Foundation board, was brainstorming how to combat a decline in 4-H membership when he hit on serving the Latino community. The goal was to create one bilingual club of up to 30 youths and their parents, but soon there were four clubs with 90 youth and hundreds more on the waiting list.
“These people come here because they want to work and get ahead in life,” said Irsik. “If we don’t help them, we’re holding them back.”
Last year, after the Affordable Care Act insurance exchanges went live, the Delaware and Maryland extensions developed the Smart Choice training program to help consumers choose the right health insurance plan. The program has spread to 30 states, said Michelle Rodgers, director of University of Delaware Extension.
Extension services have worked for years on helping individuals fight obesity and improve health, but future efforts will engage the community on improving the environment for health, such as school lunch and restaurant menus, said Rodgers, who chairs extension’s task force on health.
The 4-H Food Smart Families program is helping 2,500 children and their families make good food choices in pilot projects in Delaware, Idaho, Illinois, Nebraska and Washington, thanks to a $2 million grant from ConAgra Foods Foundation.

Changes in Funding

In another sign of changing times, the bilingual 4-H project was practically cost-free to the counties and Kansas State University. That’s because Irsik, the dairy owner, wrote a check for $30,000. Such personal generosity may be rare, but extension is turning increasingly to foundations and corporations to help pay the bills. 
“Extension back in the day was funded about one-third federal, one-third state and one-third county,” said Sonny Ramaswamy, director of the federal National Institute of Food and Agriculture. “That model has frayed quite a bit.”
Federal money for the extension service—about $300 million this year—flows to the states by formula, based on rural and farm population and other factors, and must be matched by the states. Each land-grant university makes up a budget through a mix of state and local funds as well as grants, gifts and fees.
Federal funds account for only about 10 percent of current extension budgets, with 45 percent coming from states (including grants and gifts) and 45 percent from counties and cities, said Jimmy Henning, director of Kentucky Cooperative Extension and chairman of the Extension Committee on Organization and Policy, extension’s national governing board. 
In most states, extension relies on the state legislature and county commissions for appropriations. In Kentucky, though, 108 of 120 counties have approved a designated extension tax. Almost all the revenue stays in the counties, Henning said.
“It’s a referendum on whether people value extension,” Henning said. “Without it, we would be half of where we are. We’d be back in the basements of courthouses” instead of in buildings that serve as community hubs, he said.
Many states also go after competitive federal grants and enter into partnerships with nonprofits and corporations. Texas, which lost 18 percent of state extension funding and 115 positions between 2009 and 2011, recently hired its first employee with shared funding from the Scott & White Healthcare company.
“Extension, as it looks to the next 100 years, has to find ways to make up the reductions in state and county funding,” said Douglas Steele, director of Texas A&M AgriLife Extension Service.
As grants become more common, however, some worry about the strings attached to outside funding.
“There’s a greater fear that the search for money may lead to funders who don’t share the mission of extension,” Henning said. “This is a serious issue. Foundations are not by definition as concerned about the community” as extension is.

‘Their Own Little Fiefdom’

Some critics, such as Chuck Caudill Jr. in Beattyville, Kentucky, say local extension money in eastern Kentucky would be better spent on economic development than on buildings.
“For nearly 100 years, the University of Kentucky Extension Service has annually taken hundreds of thousands in local property taxes from every county, set up district and local commissions, built countless buildings and provided programs on youth, family science, community and economic development. Yet Eastern Kentucky remains poverty-ridden, low achieving and very unhealthy,” Caudill wrote in April in an opinion article in the Lexington Herald-Leader.
Counties are allowed to run extension offices “like their own little fiefdom,” with too little oversight from the universities, he said in an interview.  
Caudill said he applied for a county extension job, but the position was eliminated.  He is running in the fall election as an independent for Lee County judge-executive, the fiscal officer who administers the extension and other special taxes.
“Extension is a great idea, a fabulous idea,” Caudill said. “But local politics have gotten so they trump the mission.”      
In New Hampshire, residents were initially skeptical about extension’s reorganization. But in time, people came around.  
“I have not heard any widespread or in-depth complaints,” said Lisa Townson, assistant director of New Hampshire Cooperative Extension. “People say programs are more focused and better quality,” although, she conceded, “It’s a challenge letting people know what we are doing.”

Thursday, September 4, 2014

Bubba to the rescue? Bill Clinton deploys to save Democrats -- Sept. 4, 2014 column


Bubba is back.

Nearly 18 years after he ran his last campaign, former President Bill Clinton is on the campaign trail for beleaguered Democrats, and he hasn’t lost his touch.

When he stands before a cheering throng, bites his lip and says, “I love Maine”… Connecticut… Arkansas… (insert your state here), Clinton sounds like he means it, and Democrats love him back.

Bill Clinton is by far the most admired president of the last quarter century, polls show. Forty-two percent of registered voters say they admire him most among recent presidents.

Republicans have no comparable presidential star power. Only 17 percent said they admire former President George W. Bush the most, the NBC News-Wall Street Journal-Annenberg survey also reported in June. His father, George H. W. Bush, and Obama each edged out the younger Bush by just one point in the survey.

On the campaign trail, Clinton praises inclusiveness and cooperation, both of which are sorely lacking these days. But he, of course, isn’t on any ballot. Does his approval mean anything? Polls suggest it does.
Thirty-seven percent of voters said they were more likely to vote for a candidate endorsed by Bill Clinton while 27 percent said they were less likely to do so – for a 10 percent net positive, a Wall Street Journal poll in March found.  In contrast, Obama’s endorsement of a candidate meant a net negative of 20 percent, similar to a tea party endorsement.

The South could be pivotal in the battle for Senate control, and Clinton may be especially helpful in motivating African American voters. The former president is welcome in red-ish Southern states where Obama is not, including Georgia, Louisiana, North Carolina and Arkansas.
To win Senate control, Republicans need to pick up six seats. They hope to hold onto Georgia, where Republican Sen. Saxby Chambliss is retiring. Democrat Michelle Nunn, daughter of former Sen. Sam Nunn, is in a tight race with Republican businessman David Perdue. Clinton will be the political star power at a Sept. 13 fundraiser for Nunn at the home of singer-dancer Usher in Atlanta.
Clinton also is helping Sens. Mary Landrieu in Louisiana, Kay Hagan in North Carolina, and Mark Pryor in Arkansas, among others.  He has campaigned for Senate candidate Alison Lundergan Grimes in Kentucky, who’s hoping to topple Senate Minority Leader Mitch McConnell.

He’s even going to Florida to help the party-changing Charlie Crist, who is in a close gubernatorial contest against incumbent Republican Gov. Rick Scott. Times have changed since Crist, previously a Republican and independent, called for Clinton’s presidential resignation in 1998.

The last thing Republicans want is an election about the glory that was Bill Clinton. They want the midterms to be about Obama and what they see as his failed policies, including health care reform. 

Typically the party of an unpopular president suffers significant losses in midterm elections.  In 2006, Republicans lost 30 House seats and six Senate seats when George W. Bush’s job approval ratings were the same or slightly lower than Obama’s ratings are now. About 42 percent of people approve of the job Obama is doing.

In 2010, Obama’s first midterm election, Democrats lost 63 House seats, ceding control of the House to Republicans, and six Senate seats.

But the 1998 midterm, the last of Clinton’s presidency, played out under the shadow of the Monica Lewinsky affair and Republicans plans for impeachment, and yet Democrats managed to add five House seats and lose no Senate seats.

That’s a strong enough performance to gladden Democratic hearts and kindle hope that Clinton can yet save the Senate.

In 1998, though, Clinton and Democrats had the wind of a booming economy at their backs in an election where no single issue dominated.
This year, voters are disgruntled with the economy and the country’s direction, and there’s again talk of impeachment. Republicans are already planning their GOP Senate agenda for next year.
With Democrats’ backs to the wall, Clinton’s magic looks awfully good. And Clinton, whether to show his own vigor or to score points for Hillary in advance of 2016, is only happy to oblige.

There are nine weeks until Election Day. And Bubba is back.

©2014 Marsha Mercer. All rights reserved.