By: David Peyton
The gay marriage debate is heating up and fuming steam in two opposite directions. On the one side, gay rights activists are calling for full marriage rights for same sex couples while religious conservatives maintain strict opposition. At a recent Brookings Institution event, guest scholar Jonathan Rauch warned that we are headed toward a “scorched earth” debate in which both sides fight for all-or-nothing positions, similar to the abortion debate.
As America becomes increasingly polarized, is there a way to avoid an intractable and divisive debate about gay marriage? Yes, according to Rauch, who has found an unlikely ally in the gay rights discussion, David Blankenhorn, president of the Institute for American Values and author of The Future of Marriage. Both scholars take very different stances on gay marriage but have devised a compromise that they argue will give America the necessary space for a courteous and healthy public debate about the topic.
The Blankenhorn-Rauch proposal would grant civil unions to same sex couples in exchange for guaranteeing the right of religious groups’ to opt-out of recognizing them. This means that same sex couples would receive the same federal entitlements conferred on straight couples – Social Security survivor benefits, tax-free inheritance, hospital visitation rights, etc. In turn, religious groups would receive federal protections if they refused to recognize same sex unions. Religious houses of worship would not be obligated to participate in commitment ceremonies for same sex couples and could refuse to participate in any activities involving same sex couples that they find objectionable. In the hypothetical, if a photographer objected on religious grounds to taking pictures at a same sex commitment ceremony, he/she could refuse to offer photography services without being sued for discrimination.
The proposal is modeled in part after the federal exemption offered to doctors who object on religious grounds to performing abortions. According to Blankenhorn and Rauch, “If religious exemptions can be made to work for as vexed a moral issue as abortion, same-sex marriage should be manageable, once reasonable people of good will put their heads together.”
Both Blankenhorn and Rauch admit that their proposal is not perfect, but think it nonetheless creates the necessary policy space for a constructive discussion. “In the case of gay marriage, a scorched-earth debate, pitting what some regard as nonnegotiable religious freedom against what others regard as a nonnegotiable human right, would do great harm to our civil society.”
They did not design their compromise to solve the issue, but to buy America time to thoughtfully and cordially make tough decisions about marriage and same sex relationships. While it leaves neither side completely satisfied, it may be an important step in decreasing the chasm that has emerged between Americans on opposite sides of the debate.
Friday, March 20, 2009
Tuesday, March 17, 2009
Do Entrepreneurs Need College?
Federal Reserve Chairman Ben Bernanke made a minor case that the two help each other in his closing remarks on CBS's 60 Minutes on Sunday. Seeking to reassure Americans that our economy will recover, he focused on America's long-term economic advantages. Bernanke said:
We have the best technologies. We have-- great universities. We have entrepreneurs. I just have every confidence that as we get through this crisis, that our economy will begin to grow again, and it will remain-- the most powerful and dynamic economy in the world.
Bernanke's comments don't equate universities with entrepreneurialism directly but I cannot help but think that he mentioned the two together without any reason. Yet colleges may not be the best mechanism for training entrepreneurs.
Entrepreneur magazine, provides yearly rankings of the top fifty colleges for undergraduate and graduate programs for aspiring entrepreneurs. I've provided the top ten undergraduate schools below
Undergraduate
1. University of Houston
2. Babson College
3. Drexel University
4. University of Dayton
5. University of Arizona
6. Temple University
7. DePaul University
8. University of Oklahoma
9. University of Southern California
10. Chapman University
Some of those programs like Drexel, DePaul, and Temple have broad undergraduate audiences. Babson College , a small college in Massachusetts, adversities itself as a place for entrepreneurs.
There is a long tradition of American entrepreneurs , like Walt Disney and Henry Ford, who succeeded without attending college (in fact Disney) was a high school dropout. More recently technology leaders like Michael Dell and Bill Gates both began but dropped out of college to pursue successful business ventures.
None of this is to say that entrepreneurs don't benefit from college. Some of the early research on the subject (see Merrill Douglass, "Relating Education to Entrepreneurial Success", Business Horizons, 1976--sorry firewalled), indicates that while entrepreneurs are often more highly educated than the general population, their level of education did don contribute to their business success. This included finding that MBA students, who are trained to run businesses, are not consistently more successful entrepreneurs.
The benefits of college for aspiring entrepreneurs may rest more in gaining access to other bright young people willing to take business risks, through social networks and college groups aimed at entrepreneurs rather than benefits from the classroom experience.
We have the best technologies. We have-- great universities. We have entrepreneurs. I just have every confidence that as we get through this crisis, that our economy will begin to grow again, and it will remain-- the most powerful and dynamic economy in the world.
Bernanke's comments don't equate universities with entrepreneurialism directly but I cannot help but think that he mentioned the two together without any reason. Yet colleges may not be the best mechanism for training entrepreneurs.
Entrepreneur magazine, provides yearly rankings of the top fifty colleges for undergraduate and graduate programs for aspiring entrepreneurs. I've provided the top ten undergraduate schools below
Undergraduate
1. University of Houston
2. Babson College
3. Drexel University
4. University of Dayton
5. University of Arizona
6. Temple University
7. DePaul University
8. University of Oklahoma
9. University of Southern California
10. Chapman University
Some of those programs like Drexel, DePaul, and Temple have broad undergraduate audiences. Babson College , a small college in Massachusetts, adversities itself as a place for entrepreneurs.
There is a long tradition of American entrepreneurs , like Walt Disney and Henry Ford, who succeeded without attending college (in fact Disney) was a high school dropout. More recently technology leaders like Michael Dell and Bill Gates both began but dropped out of college to pursue successful business ventures.
None of this is to say that entrepreneurs don't benefit from college. Some of the early research on the subject (see Merrill Douglass, "Relating Education to Entrepreneurial Success", Business Horizons, 1976--sorry firewalled), indicates that while entrepreneurs are often more highly educated than the general population, their level of education did don contribute to their business success. This included finding that MBA students, who are trained to run businesses, are not consistently more successful entrepreneurs.
The benefits of college for aspiring entrepreneurs may rest more in gaining access to other bright young people willing to take business risks, through social networks and college groups aimed at entrepreneurs rather than benefits from the classroom experience.
Monday, March 16, 2009
Who pays for the EMR system?
By: Dominic Bodoh
During the past several months, there has been an increase emphasis and discussion upon health information technology. The most noticeable discussions regarding Health IT are those revolving around the implementation of electronic medical record (EMR) systems. These are systems that capture and share electronic information related to a medical patient between hospitals or doctors. With more than $20 billion of the stimulus package earmarked for this specific purpose, the media has been awash with outlining the benefits of these systems, and there a several.
EMR systems are being pursued because they will provide a means for doctors to share information regarding a patient without risk of confusion due to poor penmanship, short hand, miscommunication, etc. The information will be captured and distributed in a format that will reduce the possibility that two or more doctors will prescribe conflicting treatment or drugs. This is a very important benefit. How many people would like the assurance of knowing that the drugs they are taking will not have a detrimental side effect when combined? For the patients’ sake, this is the most important reason hospitals and doctors should pursue an EMR system.
While EMR systems may be a new item of discussion for the media, they have been in existence for a number of years. The reason these systems have not received traction within medical community is due to the cost required to implement and support them. The average cost of the software usually runs between $20,000 and $50,000 per physician within the adopting practice. And this price does not include consulting, implementation, training, or hardware costs. It is not unheard of to hear that an EMR implementation required nearly $1million investment.
Thankfully, the recently passed stimulus package provides approximately $20 billion to address some of these implementation and technology costs. However, it does not address the post deployment costs required to maintain and support these systems. Practices or hospitals adopting an EMR system will have to continue paying an annual licensing cost per physician as well as maintain a technology staff or contractor capable of supporting the hardware. These costs can range dramatically from practice to practice based upon the EMR product selected as well as the IT infrastructure of the practice. But these are not the greatest cost incurred by the adoption of an EMR system.
An EMR system can be implemented into one of two business processes. The first involves and administrative employee deciphering a doctors hand-written notes and charts and inputting the data into an EMR system. The process is similar to the processes utilized in most hospitals or practices today. The second process involves the introduction of a computer into the exam room. The process requires the doctor to be responsible to inputting the information. Both of these processes have their weaknesses and increased costs.
If a practice continues to have an administrative employee input the physicians’ notes into an EMR system, the practice is sacrificing some of the key benefits available to the doctors. Namely, the physician would not be notified in real-time that two prescribed drugs may have negative side effects when taken together. Additionally, this process does not remove the possibility that the doctor’s notes may be misunderstood or transcribed incorrectly. Some practices have recognized these effects and chosen to counter act them by having a doctor transcribe his or her own notes and charts. However, this approach leads to the physicians seeing fewer patients and requires practices to increase their medical staff to meet their need. This also requires a proportional increase in the investment of an EMR system.
The alternative approach would be to introduce a computer to the exam room. This would allow physicians to input their notes, prescriptions, and diagnosis’ directly into the EMR system without having to increase the medical support staff. But what does this do to patient care? As any individual who uses a computer knows, computers have a tendency to act up on occasion, and usually at the most inopportune moments. How many patients would appreciate it if the doctor had to pause or stop an exam so that a technician could come fix the computer? The other concern would be who the doctor more focused upon: the computer or the patient? Would the doctor be more concerned about navigating and completing the correct fields on the screen or listening to the patient describe symptoms? Most patients would prefer a physician that is focused upon them.
Neither of the business processes related to the use of an EMR system appear to have the patient’s best interest in mind. The first approach requires additional costs in staff which requires an increase in healthcare costs. And the second approach requires a reduction in the interaction between the physician and the patient. Until these concerns can be addressed, the implementation of EMR systems may be premature.
Healthcare is a service industry and as such the focus should be upon doing what is best for the patient. With a large number of Americans lacking the means to pay for it, raising the costs of healthcare is not an option that should be considered. For this reason, the push to implementation EMR systems should be slowed until the development of best practices can be established. The technology is nearly there, now it is time to reorganize the business. Until such practices can be identified, the patient is the one paying the greatest cost for the EMR system.
During the past several months, there has been an increase emphasis and discussion upon health information technology. The most noticeable discussions regarding Health IT are those revolving around the implementation of electronic medical record (EMR) systems. These are systems that capture and share electronic information related to a medical patient between hospitals or doctors. With more than $20 billion of the stimulus package earmarked for this specific purpose, the media has been awash with outlining the benefits of these systems, and there a several.
EMR systems are being pursued because they will provide a means for doctors to share information regarding a patient without risk of confusion due to poor penmanship, short hand, miscommunication, etc. The information will be captured and distributed in a format that will reduce the possibility that two or more doctors will prescribe conflicting treatment or drugs. This is a very important benefit. How many people would like the assurance of knowing that the drugs they are taking will not have a detrimental side effect when combined? For the patients’ sake, this is the most important reason hospitals and doctors should pursue an EMR system.
While EMR systems may be a new item of discussion for the media, they have been in existence for a number of years. The reason these systems have not received traction within medical community is due to the cost required to implement and support them. The average cost of the software usually runs between $20,000 and $50,000 per physician within the adopting practice. And this price does not include consulting, implementation, training, or hardware costs. It is not unheard of to hear that an EMR implementation required nearly $1million investment.
Thankfully, the recently passed stimulus package provides approximately $20 billion to address some of these implementation and technology costs. However, it does not address the post deployment costs required to maintain and support these systems. Practices or hospitals adopting an EMR system will have to continue paying an annual licensing cost per physician as well as maintain a technology staff or contractor capable of supporting the hardware. These costs can range dramatically from practice to practice based upon the EMR product selected as well as the IT infrastructure of the practice. But these are not the greatest cost incurred by the adoption of an EMR system.
An EMR system can be implemented into one of two business processes. The first involves and administrative employee deciphering a doctors hand-written notes and charts and inputting the data into an EMR system. The process is similar to the processes utilized in most hospitals or practices today. The second process involves the introduction of a computer into the exam room. The process requires the doctor to be responsible to inputting the information. Both of these processes have their weaknesses and increased costs.
If a practice continues to have an administrative employee input the physicians’ notes into an EMR system, the practice is sacrificing some of the key benefits available to the doctors. Namely, the physician would not be notified in real-time that two prescribed drugs may have negative side effects when taken together. Additionally, this process does not remove the possibility that the doctor’s notes may be misunderstood or transcribed incorrectly. Some practices have recognized these effects and chosen to counter act them by having a doctor transcribe his or her own notes and charts. However, this approach leads to the physicians seeing fewer patients and requires practices to increase their medical staff to meet their need. This also requires a proportional increase in the investment of an EMR system.
The alternative approach would be to introduce a computer to the exam room. This would allow physicians to input their notes, prescriptions, and diagnosis’ directly into the EMR system without having to increase the medical support staff. But what does this do to patient care? As any individual who uses a computer knows, computers have a tendency to act up on occasion, and usually at the most inopportune moments. How many patients would appreciate it if the doctor had to pause or stop an exam so that a technician could come fix the computer? The other concern would be who the doctor more focused upon: the computer or the patient? Would the doctor be more concerned about navigating and completing the correct fields on the screen or listening to the patient describe symptoms? Most patients would prefer a physician that is focused upon them.
Neither of the business processes related to the use of an EMR system appear to have the patient’s best interest in mind. The first approach requires additional costs in staff which requires an increase in healthcare costs. And the second approach requires a reduction in the interaction between the physician and the patient. Until these concerns can be addressed, the implementation of EMR systems may be premature.
Healthcare is a service industry and as such the focus should be upon doing what is best for the patient. With a large number of Americans lacking the means to pay for it, raising the costs of healthcare is not an option that should be considered. For this reason, the push to implementation EMR systems should be slowed until the development of best practices can be established. The technology is nearly there, now it is time to reorganize the business. Until such practices can be identified, the patient is the one paying the greatest cost for the EMR system.
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