Category Archives: Politics

Freedom vs. Health Care Reform

In the United States, we believe in individual rights, some of which are enumerated in the U. S. Constitution. The right to health care is not one of these. As our country prospers or declines, we may amend our Constitution to ensure more rights or take them away. The question, now, is can we afford health care for all? At this moment, I believe we cannot. Other countries have attempted to provide health care for all of its citizens but are facing economic troubles in spite of 70% tax rates (Clark & Dilnot, 2002). I believe that high tax rates are dangerous to the economy because the people and the government compete in mobilizing the economy; whereas with lower tax rates, the small businesses can drive the economy (U.S. Small Business Administration, Office of Advocacy, 2006).

It is my experience that those who overutilize health care are those who are under-insured (e.g. Medicare and Medicaid) and uneducated about the health care system. Further, it seems that the underpayment of costs by the Medicare and Medicaid programs are driving up the recoverable costs to other payors (Brennan & Mello, 2009). This is why I believe that our health care system is as expensive and inefficient as it is. “The U.S. health care system also spends more on administrative or overhead costs related to health care,” says Garber and Skinner (2008, p. 32), but they attribute this to administrative waste where I conclude that the over-administration is needed to meet the demands of an over-regulated and inefficient payment system.

In conclusion, our health care system is linked to our economy, and improving the economy is the only way to ensure that our health care system improves. By adding entitlements, we are forcing the American people to minimize their financial growth and, thereby, their financial freedom to choose affordable health care.


Brennan, T. A. & Mello, M. M. (2009). Incremental health care reform. Journal of the American Medical Association, 301(17), 1814-1816. doi:10.1001/jama.2009.610

Clark, T. & Dilnot, A. (2002). Long-term trends in British taxation and spending (IFS Briefing Note No. 25). London, UK: The Institute for Fiscal Studies. Retrieved from

Garber, A. M. & Skinner, J. (2008). Is American health care uniquely inefficient? Journal of Economic Perspective, 22(4), 27–50. doi:10.1257/jep.22.4.27.

U.S. Small Business Administration, Office of Advocacy. (2006, September 28). Small business drives the U.S. economy — represent 99.7 percent of all businesses, employ 57.4 million (SBA No. 06-17 ADVO). Retrieved from

Pay-for-performance in EMS?

There has been much discussion regarding reimbursement models for health services, and two main themes have emerged, the historical fee-for-service model and a quality-driven pay-for-performance model (Institute of Medicine, Committee on Redesigning Health Insurance Performance Measures, Payments and Performance Improvements Staff, 2007). While many providers argue that the reimbursement level is currently too low to sustain operations (Institute of Medicine, Committee on Redesigning Health Insurance Performance Measures, Payments and Performance Improvements Staff, 2007), patient advocates cite an overwhelming number of medical mistakes allowing providers to benefit from poorer outcomes leading to increased needs of critical care services which lengthen hospital stays dramatically (Committee on Quality of Health Care in America & Institute of Medicine Staff, 2001; Institute of Medicine, Committee on Redesigning Health Insurance Performance Measures, Payments and Performance Improvements Staff, 2007). While considering more effective designs within our health care system, treatment efficacy, reimbursement paradigms, and patient safety could possibly be used as a foundation upon which to rebuild our health care infrastructure. The Committee on Quality of Health Care in American and the Institute of Medicine Staff (2001) offer “six aims [safe, effective, patient-centered, timely, efficient, and equitable] for improvement that can raise the quality of care to unprecedented levels” (p. 5).

Fee-for-service models, the traditional norm in health care reimbursement, seek to itemize care expenditures based on particular procedures or services rendered to the patient. Though fee-for-service models reward providers for timely, and possibly effective and efficient, delivery of care, it does little to address safe, patient-centered, and equitable considerations.

Financial barriers embodied in current payment methods can create significant obstacles to higher-quality health care. Even among health professionals motivated to provide the best care possible, the structure of payment incentives may not facilitate the actions needed to systematically improve the quality of care, and may even prevent such actions.
(Committee on Quality of Health Care in America et al., 2001, p. 181)

As a paramedic, I am bound to a Medicare reimbursement model that focuses solely on the transportation of the patient and not on the care rendered. For a patient experiencing cardiac chest pain, merely placing them on a continuous ECG monitor and providing transportation to the hospital allows my employer to be paid the same as if I initiated an intravenous line, administered oxygen, aspirin, nitroglycerin, and morphine, and performed serial diagnostic 15-lead ECG readings during the transport. In any case, though, payment is withheld if the patient is not transported. I have to assume that this inequitable reimbursement scheme is replicated across the health care spectrum.

Pay-for-performance models, however, seek to reward the provider for improving the quality of care delivered and “represents an attempt to align incentives in the payment system so that rewards are given to providers who foster the six quality aims set forth in the Quality Chasm report” (Institute of Medicine, Committee on Redesigning Health Insurance Performance Measures, Payments and Performance Improvements Staff, 2007, p. 36; Committee on Quality of Health Care in America et al., 2001). Some detractors of pay-for-performance worry that providers serving poor and ethnic communities that have typically poor health and preventative compliance will not benefit from such performance measures. The worry is that the numbers of providers will be lacking in these communities, worsening the communities health outcomes (Nafziger, 2010). Though, “pay for performance is not simply a mechanism to reward those who perform well; rather, its purpose is to encourage redesign and transformation of the health care system to ensure high-quality care for all” (Institute of Medicine, Committee on Redesigning Health Insurance Performance Measures, Payments and Performance Improvements Staff, 2007, p. 44). Pay-for-performance focuses on safety, and a search of the literature does not reveal any complicating risk to patients under a pay-for-performance system so long as the system is patient-centric, taking into account the patient population serviced by each provider.

For instance, regarding a certain type of heart attack called a “STEMI”, or ST-segment elevation myocardial infarction, it is beneficial for the paramedic ambulance to bypass the local community hospital and transport the patient to a primary coronary intervention (PCI) facility for a cardiac catheterization. In this instance, the local community hospital is losing potential revenue. Perhaps if the reimbursement model reflected this evidence-based and patient-centered decision and provided a small monetary reward to the local community hospital for allowing the directed care at the PCI center, then mortality and morbidity from STEMI in the community would be reduced and the local hospital would be rewarded for their involvement in the process even if they did not provide any direct care. This is just one instance in the realm of emergency care where pay-for-performance can help to ensure safe, effective, patient-centered, timely, efficient, and equitable delivery of care to the patient.

As both a health care provider and consumer, I would prefer the pay-for-performance model of reimbursement. As a provider, I am a patient advocate, and as a patient, I will, of course, advocate for myself. Pay-for-performance enables provider growth, evidence-based practice, better patient safety mechanisms, and an overall efficient and a more complete and holistic delivery of care.


Committee on Quality of Health Care in America (Author), & Institute of Medicine Staff (Author). (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.

Institute of Medicine, Committee on Redesigning Health Insurance Performance Measures, Payments and Performance Improvements Staff (Author). (2007). Rewarding provider performance: Aligning incentives in Medicare. Washington, DC: National Academies Press.

Nafziger, B. (2010, May 6). Pay for performance could hurt docs who serve poor, blacks and hispanics. DOTMed News. Retrieved from

Health Care Costs, Quality, and Access

It is the general consensus that the structure and organization of the U.S. health care system is fractured and disorderly. For many health care consumers, especially those who rely on governmental health assistance, there is no motivation to seek appropriate care responsibly. Many of these consumers rely on the local hospital’s emergency department and municipal emergency services for their primary medical needs. The Committee on the Future of Emergency Care in the United States Health System (2006) states “[Emergency Departments] are an impressive public health success story in terms of access to care” (p. xiv), and continues to describe how the emergency departments have “become the ‘safety net of the safety net’, providing primary care services to millions of Americans who are uninsured or otherwise lack access to other community services” (p. xv). With health care comprising one sixth of the nation’s economy, doubling in the last 30 years, the focus should be to create a model of efficient and effective delivery of care so that we, as a nation, may be able to care for our sick and injured without becoming bankrupt (Kovner, Knickman, & Jonas, 2008; Mushkin et al., 1978).

As emergency medical services are considered as the health care gateway for many, allowing the emergency medical services to refer patients into appropriate pathways (e.g. primary care providers, urgent care clinics, psychiatric services) for their conditions would allow for more directed care for the patient with shorter wait times and shorter care times overall. Unfortunately, insurance providers, including Medicare and Medicaid, do not allow remuneration for such services, requiring the transportation component to trigger payment; therefore, the only option left is to transport these patients to the emergency departments. This promotes the inefficient use of such services and continues the current paradigm of inefficiency throughout the system. Though this change would increase insurance payments to emergency medical providers, increasing the initial cost of seeking health care, this would allow the provision of selecting more efficient pathways leading to more cost-effective care. Hopefully, this paradigm would result in an overall net savings.

This is only one example of modifying a current system to be more effective and help to promote efficiency throughout the health care experience. We need to consider where we can shift roles and responsibilities within the health care system in order to promote a more usable system, one that promotes integrity, efficiency, responsibility, and efficacy by both providers and consumers. Once we realize the opportunities that efficient use of current services will offer, we can realign the services to better fulfill the needs of the population where it comes to health and wellness.


Committee on the Future of Emergency Care in the United States Health System. (2006). Emergency medical services: At the crossroads. Washington, DC: National Academies Press. Retrieved from

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Mushkin, S., Smelker, M., Wyss, D., Vehorn, C. L., Wagner, D. P., Berk, A., … Louria, M. (1978, October). Cost of disease and illness in the United States in the year 2000. Public Health Reports, 93(5), 493–588. Retrieved from

Reducing our Health Care Expenditures

With the recent signing into law of the Patient Protection and Affordable Care Act (2010), more affectionately known as ‘Obama Care’, much of the health care discussion has turned from deciding what we should do to how we should do it. Many us acknowledge that the current state of our health care needs reformation; the only problem seems to be choosing the best approach. As a licensed out-of-hospital provider, I am in a unique position to observe patients entering our health care system, being treated by our health care system, and exiting (for good or bad) our health care system. I can see that our health care needs are not being met, and I can see both how patients approach their care and how practitioners approach their patients — inefficiently and ineffectively. We need to resolve these issues.

Canada is a fairly close approximation to the United States in locale, geography, economy, and political ideology (Doran, ca. 2000; “GNI per capita”, 2010). It might make sense for us to look towards Canada to see if they have adopted a plan that we could either emulate, or, in the very least, research for a sense of best practices. Kovner, Knickman, and Jonas (2008) describe Canada as having a national health insurance (NHI) system of health care, in that the system is provisioned by a mix of both public and private contributions. Two benefits of Canada’s health care system include a high life expectancy (77.4 for males at birth) and a low cost ($3,165 per capita, or 9.9% of GDP; Kovner et al., 2008, Table 6.2, p. 165). In comparison, Kovner et al. shows that the life expectancy for males in the United States is 74.8 under a system that costs $6,102 per capita (or, 15.3% of GDP). These numbers are significant because we need to understand what we can expect from our investments, and I feel that the average life expectancy is a great benchmark of a health care system as a whole. One worry that I would have, though, is if we were to adopt the same pharmaceutical cost controls, research and development in the industry may suffer, as well as any other technology burdened by cost-cutting measures. I have to assume that the free market would effectively drive these areas, however.

In order to adopt such sweeping changes of our health care system, both liberals and conservatives would have to negotiate their ideals. I am a fairly conservative citizen who believes in smaller government and spending constraints. If reducing our health care expenditures by realigning the modes and methods of health care delivery was realistic, I could be in favor of such a reform. Political agendas aside, Canada’s health care system is certainly one that we should further consider.


Doran, H. (ca. 2000). Politics and political parties in Canada. Internet sources for journalists and broadcasters. Retrieved on April 22, 2010, from

“GNI per capita, Atlas method (current US$)”. (2010). Data catalog. The World Bank Group. Retrieved on April 22, 2010, from

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Patient Protection and Affordable Care Act of 2010, H.R. 3590, 111th Cong. (2010).

Disregarding the Second Amendment

The Socio-political Consequences and a Libertarian Solution

Americans, as citizens of the republic, have rights that transcend any government. These rights ensure the continuing operation and stability of the republic. Our founding fathers outlined these rights conspicuously after thoughtfully debating the specific wording that should be used. Though times change, these freedoms should not. Most Americans accept that with these freedoms come social responsibility, and I will delineate how this relationship can be maintained without the use of specific anti-gun legislation. The current opinions surrounding gun control range from desires to ban all privately owned firearms to disallowing any government (Federal, State, County, or municipal) from placing any controls on the citizens’ ability to own, possess, carry, control, and use firearms. On the other hand, some people are willing to accept a compromise of terms. There are socio-political consequences for each of the various levels of proposed gun control in the United States, including impacts on the U.S. Constitution and the Constitutions of the fifty States.

The anti-gun coalitions dispute the claims that crime rates soar when gun bans are put in effect, and admittedly, the correlation does nothing to prove causation, yet, a sober analysis of the matter reveals confirmation that the claim is, in fact, valid. Following the 1997 gun ban (Firearms Act, 1997), Great Britain suffered the highest crime rates in Europe, specifically domestic burglary, the forceful entering of residential premises. A Home Office report shows that violent crimes increased steadily by 26% over the next 5 years (2004). Johnston reports, “Britain has one of the worst crime rates in Europe…. It is the most burgled country in Europe, has the highest level of assaults and above average rates of car theft, robbery and pickpocketing” (2007, para. 1). In fact, the violent crime rate continues to grow 77% through 2006. Japanese crime rates increase dramatically 128% during the years 1997 to 2001, after adopting similar firearms legislation. The same phenomena was seen in Australia with robberies increasing 44% after a similar gun ban. Interestingly, the authorities in New Zealand found it difficult and cumbersome to enforce the Australian ban and they abandoned the effort. The crime rates in New Zealand decreased dramatically (robbery: 18% decrease, domestic burglary: 27% decrease). Unfortunately, after a rejuvenation of the gun ban in 2000, the report reflects an 8% overall increase in violent crimes (Home Office, 2004). Unfortunately, the research is still lacking.

Another component of the gun control debate in the United States is the consideration that the Second Amendment of the U.S. Constitution refers not to individuals, but to State and Federal sponsored militias. Though the U.S. Supreme Court (District of Columbia v. Heller, 2007) has recently ruled that the Amendment proscribes an individual right, this is not a new opinion. A search through documentation of the Constitutional Conventions (Elliot, 1836; Ford, 1888) and previous Supreme Court decisions (United States v. Cruikshank, 1876; United States v. Miller, 1939) shows a consistent viewpoint, the Second Amendment refers to an individual right to bear arms. There certainly has been some confusion regarding the interpretation of this Amendment (Miller v. Texas, 1894; United States v. Cruikshank, 1876), but most of the experts now concede the individual rights interpretation.

Proponents of gun control have also sought to ban weapons described as assault weapons. The position of The Brady Campaign to Prevent Gun Violence ( on assault weapons:

The Brady Campaign supports banning military-style semi-automatic assault weapons along with high-capacity ammunition magazines. These dangerous weapons have no sporting or civilian use. Their combat features are appropriate to military, not civilian, contexts. (n.d., Position section)

Here many gun control advocates erroneously cite United States v. Miller (1939) as limiting the civilian ownership of military-style weapons. Justice McReynolds, in his opinion, states, “Certainly it is not within judicial notice that this weapon is any part of the ordinary military equipment, or that its use could contribute to the common defense” (p. 6). This ruling is problematic. Miller and his co-defendant were not represented by counsel, and before the proceedings took place, Miller was murdered (Aultice, 1990). With these issues in mind, the opinion was based on a lack of evidence that a sawed-off shotgun could be used as ordinary military equipment. An argument could have been made that might have impacted Justice McReynolds’ opinion. During the Civil War, Confederate cavalrymen regularly employed the sawed-off shotgun against the Union cavalry, and during World War I, American soldiers in Europe used short-barreled shotguns regularly to clear trenches (, n.d.). Had this argument been offered, perhaps the opinion would have been different. As Aultice (1990) writes, “by default it is acceptable to own weapons with a ‘reasonable relationship’ to the preservation of the militia, and nothing so fits the description as those creatures of their own distorted imagination, the so-called ‘assault weapons’!” (Viewpoint section, para. 1). During debates, the proponents of gun control find themselves requiring a different argument in the face of this.

Gun control advocates ask a fairly simple, though outlandish, question: Where does it end? The gun control advocates are simply asking if there is a boundary to the militaristic weaponry that a civilian should be able to possess. I have to agree that this is an excellent question to ask. When exercising our rights, it is important to understand the social responsibility that must be exercised. I, and most firearms enthusiasts, concede that it would be troublesome for the citizenry to possess weapons of mass destruction. Where is the line? Libertarian principles dictate that no law should preempt freedom so long as the exercise of that freedom does not interfere with the rights of a third-party. Block and Block (2000) developed a theory based on geography and spatial relationships. They describe a constant where, as long as the weapon can be used defensively and the effect of the weapon can be isolated to the user and the target, the spatial relationship must fall between two extremes: (a) proportionally using the entire universe and (b) proportionally in a crowded phone booth. These are obviously not realistic situations, but the theory must transcend the boundaries of reality in order to prove all-encompassing. In the case that a population is spread over the entire universe, it would be acceptable for each person to have nuclear weapons for defensive use. On the other hand, in the latter scenario, perhaps only a small knife would be acceptable. To draw this theory back into the realm of reality, consider the spatial population differences between a highly populated city where a handgun would be acceptable, but a high-powered rifle may not be safe. Also, consider the population density of the many rural areas in the United States. In these areas, it might be plausible to own and use a tank, bazooka, and machine gun without fear of infringing on the rights of some third-party. This theory creates a direct relationship with the destructive power of the weapon and the likelihood of impacting an innocent person. Perhaps, this is the commonsense gun control that the gun control advocates are searching for. It appears that gun control advocates would like to remove the rights of the people instead of holding the individual responsible for committing crimes. As I believe, the right is certainly an individual right, and the responsibilities are also individual responsibilities. Using this theory as the predominant philosophy of responsible gun ownership would limit the need of any further legislation, as we already have laws enacted which seek to protect the public from endangerment; punishing the criminal, not the victim.

Is this theory realistic? What are the chances of its actually being considered? Ultimately, what is at stake here is the continuation of our government as we know it. Our founding fathers developed the U.S. Constitution in such a specific way as to protect ourselves from ourselves. Politicians with Socialistic views, though motivated with good intentions, could certainly lay a legislative foundation enabling future politicians to create a totalitarian regime, controlling the populace in the future with no fear of a reprisal by an armed citizenry (Savelsberg, 2002). We must keep this possibility in the front of our minds as we discuss and debate the focus and depth of the Second Amendment. Admittedly, there is a public safety component to the debate (Winkler, 2007, p. 727). On the one hand, it appears that large urban areas are fraught with gun violence. On the other hand, as Rand’s (1994) report shows, handguns are used in 17% of violent crimes in the U.S., and defending one’s self with a firearm reduces the likelihood of victim injury by more than 40%. Rand continues to show that guns are used in defense against violent crimes over 60,000 times annually. Firearm ownership is an absolute fiber in the fabric of American society, for the defense of self, State, and Country. We should approach this topic with care and knowledge. Although firearm issues may seem of concern to only a small group of Americans, it should, in fact, concern anyone who cares about the Constitution of the United States and the American way of life.


Aultice, P. L. (1990). United States vs Miller Court Opinion and Documents. Retrieved from

Block, W. & Block, M. (2000, October). Toward a universal libertarian theory of gun (weapon) control: a spatial and geographical analysis. Ethics, Place & Environment, 3(3), 289-298.

The Brady Campaign to Prevent Gun Violence. (n.d.). Military-style assault weapons. Retrieved from

District of Columbia v. Heller, 554 U.S. 290 (2007).

Elliott, J. (1836). The debates in the several State Conventions on the adoption of the Federal Constitution: June 14, 1788. Elliot’s Debates, 3, 365-410. Retrieved from

Firearms (Amendment) Act 1997, c. 5 et seq. (1997).

Ford, P. L. (1888). An examination into the leading principles of the Federal Constitution proposed by the late Convention held at Philadelphia. With answers to the principal objections that have been raised against the system. By a citizen of America. Pamphlets on the Constitution of the United States, published during its discussion by the people, 1787-1788, 25-65. Brooklyn, NY. Retrieved from (n.d.). Shotguns. Retrieved from /systems/ground/shotgun.htm

Johnston, P. (2007, February 6). Britain tops European crime league. The Telegraph. Retrieved from

Home Office, Research, Development, and Statistics Directorate. (2004, October 24). International comparisons of criminal justice statistics 2001. Retrieved from

Miller v. Texas, 153 U.S. 535 (1894).

Rand, M. R. (1994, April). Bureau of Justice Statistics crime data brief: Guns and crime: Handgun victimization, firearm self-defense, and firearm theft (NCJ-147003 Rev. 2002, September 24). U.S. Department of Justice: Office of Justice Programs, Bureau of Justice Statistics. Retrieved from

Savelsberg, J. J. (2002). Socialist Legal Traditions. Encyclopedia of Crime and Punishment. Retrieved from

United States v. Cruikshank, 92 U.S. 542 (1876).

United States v. Miller, 307 U.S. 174 (1939).

Winkler, A. (2007, February). Scrutinizing the Second Amendment. Michigan Law Review, 105(4), 683-733. Retrieved from

Revisiting My Goals

When I applied to Walden University, there were some choices that I needed make in regards to which program I would enroll in. I relied on my past experience and some of my current goals to direct me to the Bachelor of Science degree in Computer Information Systems (BSCIS) with a concentration in Information Systems Security (ISS), a process which truly motivates me. Revisiting my goals and lending them power to help navigate the world of academia, I needed to ensure that these goals still held true. The first assignment in the Introduction to Information Systems class afforded me the opportunity to do just that, while this assignment will allow me to review my goals once again.

My affinity towards positive social change (Schadone, 2009) is unwaivering, as is my desire to achieve a position in the field of disaster management. I do feel, however, that my chosen degree program is ill-prescribed to prepare me for such ambitions. Though there has been a great incentive to involve the engineering sciences into public policy administration (Connolly, 2009), my experience with the BSCIS degree, even with the ISS concentration, leads me to believe that the curriculum does not satisfy my current needs or goals. I do believe that a career in Information Systems Security would provide an opportunity to reach many of my goals, but other academic directions would provide a more solid foundation for me to build upon.

As of this writing, I have decided to research other avenues of academia which might be better suited to providing the core educational opportunities that would benefit me the most. I have decided that the B.S. in Health Studies with a concentration in Health Administration would be a better fit at this time. I hope to use this degree to propel me forward into an opportunity to earn an MPH with a concentration in Emergency Management and, ultimately, a Ph. D. in the same.

As the H1N1 influenza virus reminds us all about the 1918 “Spanish Flu,” there is an undertone of personal responsibility and preparedness in the event of a pandemic (Bornstein & Trapp, 2009), of which conditions are favorable. I plan to take personal responsibility in this and other potential disasters to position myself as an expert in the field helping to promote plans and policies to mitigate and respond effectively to such incidences. Though, I am versed in the computer sciences, I feel that my position as a health official would be better utilized in these times of crisis. Perhaps one day in the future I will return my focus on computing, but until then, my social conscience and sense of community seem to be my only defining factors.


Bornstein, J., & Trapp, J. (2009, June). Pandemic Preparedness: Ensuring Our Best Are Ready to Respond. IAEM Bulletin, 26(6), pp. 6, 14. Retrieved August 22, 2009, from

Connolly, J. (2008, September). Bridging the gap between engineering and public policy: A closer look at the WISE program. Mechanical Advantage, 19. Retrieved August 22, 2009, from

Schadone, M. F. (2009). Information Systems and Me: My Professional and Career Goals. Minneapolis, MN: Walden University.