Changing our Focus after the Election

 The 2020 election is over. We’ve made our choice for the top of the ticket and any number of other down ballot races. It may be we still don’t know the outcome of the presidential election when this column is printed. Regardless – hear me now! – life must goes on. 

By life, I mean in areas like work, family, worship, and commerce, of course, but also volunteerism and philanthropy. All of these are people-driven, relationship-driven activities, or in the case of our service to others, neighbor-driven. We are learning that we can be COVID-careful and still be caring. We cannot let fear paralyze us into ignoring the needs of those around us. 

Unfortunately, the recent end-of-the-world rhetoric from both sides of the aisle leading up to this election has been way over-the-top scary. One of the last Gallup polls prior to the election showed that nearly two-thirds of voters are afraid of what will happen if their candidate loses. At the same time, both parties are underwater when it comes to favorability. If the Gallup poll is correct, most of us have been not merely concerned, but downright it’s-going-to-be-the-end-of-the-world-if-we-lose afraid; yet, we don’t trust either party to be the solution. 

It is time to take our gaze off the White House and look around our neighborhoods and at ourselves. We must be the solution we want to see in Angelina County. How about supporting the wonderful businesses and non-profits that serve and minister in our community? Don’t just give money (but do that, please). Volunteer! 

There is no question that our ability to volunteer in person has been hampered during the pandemic. Even so, more than 200 First Baptist Church members, organized by Minister of Missions Walker McWilliams, worked throughout the community last Sunday – socially distanced and masked – in their fourth annual Love Lufkin day.

Folks, hunger hasn’t abated. In fact, during the pandemic food insecurity has gotten much worse according to those on the hunger front lines like Captains Cavon and Jenifer Phillips with the Salvation Army. Prior to COVID-19, they fed on average 100 people a day. Since the pandemic began, they are feeding 350-400 people a day, and at one point it was up to 600 a day. In addition, they have seen an exponential increase in rental assistance requests. These two saints do phenomenal work and would love to have your volunteer help and financial support. You can donate online at https://www.salvationarmytexas.org/lufkin/ or sign up to ring a bell during their Red Kettle Campaign at www.registertoring.com. 

Another local saint that can use all the help she can get is Yulonda Richard at the Christian Information and Service Center (CISC). Prior to the pandemic, CISC was seeing an average of 17,000 people per month. Since March, her mostly elderly volunteer base has had to stay home for their own safety. CISC is only able to be open three days a week now. They are still helping around 7,400 people a month and making deliveries as far away as Zavalla to those who have no other way to get food. And they continue their back-pack buddy program which provides weekend rations for school children all over the district. Yulonda told me, “It takes a village to raise a child but it truly takes the love and kindness of Angelina County to help our neighbors in their hour of need.” Thank her by mailing a check to CISC at 501 S. Angelina St, Lufkin, Texas, 75904.

With Thanksgiving just around the corner, let’s not forget the wonderful legacy of the late Rev. Bettie Kennedy and the Community Food Drive, so ably run each year by Bruce Love. In years past, they have distributed 2,000 Thanksgiving meal boxes to families in need. Even with COVID-19 affecting volunteer participation opportunities and logistics, Bruce still plans to distribute 1,000 Thanksgiving meal boxes this year. Send Bruce a Thanksgiving-sized check to Community Food Drive, 1508 S. First St, Lufkin, Texas, 75901.

I still remember as a child reading Corrie ten Boom’s biography, The Hiding Place. Her family’s story of sacrificing their safety (and for some, their lives) to hide Jews during the Nazi invasion of the Netherlands was profoundly inspiring. At great risk and despite constant fear, they practiced love. 

Still afraid of what the election results may bring? Let’s stop wringing our own hands and start holding the hands of those around us. The peace that comes with helping others can heal any troubled soul. That is a choice we can all vote for!

Reflections From the May 5th Election

On May 5, 2018, the citizens of Angelina County had the opportunity to participate in what is arguably the bedrock activity of our democracy: a free and fair election. This election was not, some might argue, as significant as one involving state or national representatives. And voter turnout was certainly less than would be expected for those elections. However, approving a $70 million bond issue and electing leaders of multiple educational institutions – with combined budgets of well over $100M and employing nearly 3,000 people – is not insignificant.

The various independent school districts in Angelina County are quite used to running elections. Angelina College, on the other hand, had not had a contested election for 22 years. They pulled it off admirably. But let’s be honest. This set of elections was not perfect. There are things we can do better next time.

One criticism that was leveled at both the LISD bond and Angelina College elections was a lack of transparency. I suppose this allegation is leveled during every election, especially the national ones. Whether or not voters have not only adequate information but honest information about the issues (or people) involved is always in question. With the LISD bond vote, some voiced there was not enough lead time between the announcement of the bond proposition and the actual vote, and not enough information about how that overall decision-making process came about. However, I strongly feel the LISD board, administration, and others did a great job of educating the voters about the needs. You couldn’t live in Lufkin and not be aware that the bond issue was on the ballot. And you certainly couldn’t have had a child at the Middle School in the last 20 years and not been aware of the critical state of that campus.

The transparency criticism of Angelina College was more vague. I did hear it rumored that Angelina College wanted to become a 4-year university (and the implication was that by doing so the needs of the local population would be ignored). Nothing could be further from the truth! Angelina College has amazingly broad educational offerings for students from all walks of life. That is not about to change. But where rumors exist, there is an opportunity for education. 

One recent example may serve as a model for the future. Angelina College welcomed a number of people who came to one of our board meetings (which are always open to the public) when the board toured the Technology Workforce Building. Board members and visitors alike were very impressed with the quality and number of programs offered. This type of “open house” may be a good way to showcase periodically what Angelina College has to offer to our community. 

Another idea brought up during the election during a town hall meeting in North Lufkin was to have town hall-type meetings from time to time as a way to gather community input and to keep the community informed about what is happening at Angelina College. That is not a bad idea.

Angelina College President Dr. Michael Simon has become well known and quite visible in the community and has made inroads and contacts throughout the county. This visibility and approachability – not just of the AC President, but also of the Board – is key to maintaining strong community relationships as well as a vital way to address questions about the direction of the college.

By far, however, the biggest complaint about the election process this year was about lack of publicity, whether TV or newspaper, especially in the days leading up to the election. It seems everyone was looking for last minute information about where to vote. Examples abound of people who voted early in one election but still needed to vote in another, and where do they go? To the LISD Administration building? Slack? Angelina College? To another school district altogether? And early voting in two different locations with different hours of operation was confusing as well. Voters were counting on the local news media to make sense of a very confusing, complicated election. The news media largely failed. 

Yes, this newspaper provided some voter education about the candidates several weeks prior to the election, but the mechanics of the election itself were largely ignored. One article on Tuesday, April 24, 2018 mentioned that early voting was underway, and discussed where early voting for various races was taking place. Beyond that, and especially close to the election, there was nothing. Television coverage was conspicuously absent as well.

That being said, the number of voters participating – nearly 3,000 voted in the LISD bond election and nearly 2,100 in the Angelina College election – shows that off-year, local elections are important to the citizens of Angelina County. Compare that to the Nacogdoches ISD board election, where one candidate won by a vote of 246 to 104.

Going forward, we must not take our democracy for granted, even in the “less significant” or off-year elections. The voters of Angelina County have every right to expect that a free press in a democracy will beat the drum of voter education and voter turnout as loudly as they can. When the next off-year election happens, the news media must step up to their role to educate the public about the complexity and details of multiple different and simultaneous polling locations. Our democracy is too precious to ignore.

What I Would Like to See in Healthcare Reform (Part 1)

I often tell people that if all I had to do was take care of patients, life would be grand. It is the countless hours of dealing with the administrative aspects of healthcare that have practically ruined the practice of medicine for many physicians. You should care; it takes away from our time with you.

TheHill.com, noted that physicians and their staff spent over 15 hours per week complying with quality reporting requirements and that for every hour a physician spends with patients, an additional two hours are consumed completing administrative tasks related to the visit. This meaningless (to physicians, anyway) work has costs in both time and money, leads to burnout, and is increasingly mentioned as the reason for early retirement. I, for one, found myself daydreaming in a committee meeting the other day and I calculated that it was 3361 days until my 65th birthday. That's 9 years, 2 months, and 15 days. No, am not planning to retire early, but sometimes I sure wish I could. Healthcare needs reform.

The average person thought Obamacare WAS healthcare reform. In reality, Obamacare did nothing to actually improve the healthcare system; it simply added more people to the rolls. Don't get me wrong. Having more people insured is not a bad thing. But we need more than just additional enrollees in a broken system.

After Trump was elected, there was an initial, overly optimistic assumption that Obamacare was on its last leg. Recent infighting among policy makers suggests Obamacare may be more like the proverbial cat with nine lives. I only hope true reform is part of whatever "replacement" or "repair" Congress and the President come up with.

In particular, let's hope some of that reform will significantly scale back a bloated, paranoid bureaucracy that sucks hundreds of billions of dollars out of healthcare that could go to those who actually care for patients. And, perhaps, some could go back into the taxpayers' pockets.

Back in 2012, Berkshire Hathaway CEO Warren Buffett called healthcare "the tapeworm of the American economy". To be more accurate, the federal government is healthcare's tapeworm. In an online article in Medical Economics last year, Ryan Gamlin, who studies what drives inefficiency, waste, and harm in U.S. healthcare, found that "as countries spend a larger percentage of their healthcare dollars on administration (as opposed to public health, or providing patient care, for example), things get worse for patients and healthcare providers. High administrative expenditures seem to be associated with negative experiences of providing and receiving healthcare." That is a nice way of saying there's a ton of money wasted going to paper pushers.

Helen Adamopoulos, writing in Becker's Hospital Review in 2014, noted that US hospital administrative costs account for more than 25% of hospital spending, more than double that of Canada, for example, where hospitals receive global, lump-sum budgets. In contrast, US hospitals must bill per patient or DRG (diagnosis-related group), requiring additional clerical and management workers and specialized IT systems. They also have to negotiate payment rates with multiple payers with differing billing procedures and documentation requirements, driving up administrative spending. Not to mention all the personnel, time, and IT required to satisfy CMS’s (the Centers for Medicare & Medicaid Services) monstrous appetite for "quality" and "safety" data, with the ever-present threat of fraud and abuse hanging over every unintentional misstep.

What should be a simple process of billing for services provided is a minefield. And anyone who has ever tried to understand a hospital bill knows it is an impossible task. Aliya Jiwani, writing in BMC Health Services Research, notes that billing and insurance-related (BIR) administrative costs in 2012 were estimated to be $471 billion and that fully 80% of this spending, which provides little to no added value to the healthcare system, could be saved with a simplified financing system. Jiwani predicted that greater use of deductibles under Obamacare will likely further increase administrative costs, stating, "Empirical evidence from similar reform in Massachusetts is not encouraging: exchanges added 4% to health plan costs, and the reform sharply increased administrative staffing compared with other states."

A CNBC report of a Health Affairs study tagged the extra administrative costs of Obamacare at more than a quarter of a trillion dollars, an average of $1,375 per newly insured person, per year, from 2012 through 2022. The Health Affairs blog authors reported, " The overhead cost equals a whopping 22.5 percent of the total estimated $2.76 trillion in all federal government spending for the Affordable Care Act programs during that time."

What do I wish we could be different in our healthcare system? In March, I will discuss some specific changes that would reduce the administrative burden on healthcare providers and, in many ways, return us to a simpler, more direct, and frankly better transaction of healthcare.

Let's Not Get Trumped

I am ashamed. I wrote that phrase recently on a Facebook post of two Finnish friends who are looking across the ocean with a combination of disgust and disbelief at the Trump phenomenon. Consider my vow to avoid public political commentary this year broken.

The first president I ever voted for was Ronald Reagan in 1980. I have voted Republican ever since. But I will not vote for Trump if he is the Republican nominee. Don’t worry… I’m not voting Bernie Sanders, either. The socialist movement in the Democratic Party is just as disaffected and radical as the Trump wing of the Republican Party… and just as dangerous to our American way of life. We are not Finland. But with Sanders, you know what you get. With Trump, all bets are off.

Trump's campaign speeches are bullying and belittling, full of empty rhetoric and supportive of (indeed, encouraging) violence. I don't care how angry you are at the “establishment”; there is no place in American politics for Trump’s inflammatory, derogatory speech. Yes, he has a right to say those things. But shame on each and every American who jumps into the pig sty with him, eggs him on, and actually votes for him! Regrettably, all of us on the sidelines have been stained by Trump’s mud.

To my fellow Christians in particular, Trump – in his campaign rhetoric, at least – displays no evidence of being a Christian, which he claims to be. There, I said it. Forgive me if you think I am being judgmental, but I simply don’t see the fruit. This is not about waffling on various social issues on which well-meaning Christians can and do disagree. Consistently, his public demeanor is far from “Love God”, much less “Love thy neighbor as thyself.” If Trump loved anything as much as himself, we’d all be better off.

I don’t get how so many people – Christians in particular – are following like lemmings in the wake of a reality show Pied Piper – one who plays an enticing (but fundamentally deadly) tune. It is ironic that Jerry Springer, who long ago helped set the nasty reality TV tone that is emblematic of Trump’s campaign, can’t believe we would elect Trump as president.

I get that Trump is tapping into popular themes like immigration and "making America great again" – whatever that means – but the reality TV emperor has no policy clothes. In effect, Trump supporters are saying they want an angry president who doesn't know what he is doing. That is both startling and dangerous. Anger does not lead to sound foreign policy.

Trump's narcissism, lack of a verbal editor and foul speech suggest a personality disorder at a minimum. More worrisome, they expose a disturbing lack of compassion and respect for the innate value of other human beings. Add in a questionable moral compass and I truly fear the international fallout with his impulsive finger on the nuclear trigger. He’s just plain scary.

Ultimately, this column is not really about Trump. It is about me. By what ethic do I live my life and cast my vote? Do I believe that might makes right? Does the end justify the means? God forbid!

What about you?

If the Republican Party implodes (or if the Democrat Party nominates a Socialist), I do not blame the "establishment". I blame voters on both sides of the aisle who can't tell the difference between a slot machine and a voting booth. They just blindly pull the red or blue lever hoping for a jackpot. If only they could see, with that approach we are all going to lose.

Giving Thanks!

Thanksgiving is just around the corner, but why wait! I want to send a big thank you to Debbie Jackson, my hardworking co-chair for local enrollment for the American Cancer Society’s CPS-3 study, and to all of the CPS-3 Champions who helped get 423 people enrolled in this amazing cancer prevention study. Our enrollment sites – Memorial Health System of East Texas, Power of Pink!, Lufkin Industries, First Assembly, and the C. L. Simon Recreation Center in Nacogdoches – were fantastic.

Thank you to Becca Chance (along with her powerhouse committee), whose leadership and grace under pressure – and under thunder and lightning! – resulted in another successful Cattle Barons Gala. Thank you to Yana Ogletree and Lindsey Mott with Memorial Health System of East Texas, who hosted an amazing 21^st annual Power of Pink! luncheon. Since 1990, breast cancer deaths in the U.S. have decreased by 27%. Much of that is due to education about mammograms and the importance of screening and early detection.

Today is Election Day. I’m thankful for the right to vote! The most important issue on the ballot today is a constitutional amendment on funding the state's water plan. Voter turnout is expected to be light — below 10 percent of all registered voters — because we just don’t get too excited when actual people aren’t on the ballot. But you need to go vote for Proposition 6. The proposed amendment would authorize the Legislature to withdraw $2 billion from the Rainy Day Fund to begin funding the state’s 50-year water plan. The benefits from a long range planning and economic prosperity standpoint far outweigh and possible downside. And frankly, I think it is poetically appropriate to use a rainy day fund for water planning anyway. Be thankful you can vote, and vote YES on Prop 6.

Thursday is Salute to Healthcare, the Lufkin/Angelina County Chamber of Commerce’s awards banquet to recognize and thank outstanding leaders throughout the healthcare sector for making Lufkin and Angelina County a better place to live and work. As a physician, I have considered it my highest honor to serve as Chairman of the Chamber board this year. The healthcare sector is now one-fifth of our local economy and drives more jobs and more shopping, retail, and dining dollars than any other industry. Our community can show their support for the healthcare sector not only by coming to the banquet Thursday night, but also by “voting with your feet” when you choose where to go for healthcare. The reimbursement changes that are being implemented at a national level could easily kill what we have here locally if you don’t make the conscious decision to stay here for your healthcare needs. Like anything else, if you don’t use it, you lose it. I applaud the Chamber for starting this event several years ago and for thanking our physicians, nurses, and so many others who help care for us.

Finally, as a cancer doctor, I deal daily with the highs and lows of cancer – celebration and victory for many, but bad news and eventual death for others. I’m thankful I can “be there” for my patients, walking alongside them, no matter which path they are on. You can, too. Comfort is one of my favorite words. Its Latin roots paint a picture of coming along side with strength. Each of us needs to be a source of strength during the holiday season for those around us who are hurting, needy, and hungry. Join in helping others with Community Food Drive, Angel Tree, or other efforts with your church or in the community. And be thankful!