I wrote this initially to publish in the local press. I now believe that the veiws expressed would be contoversial enough that I should proceed with caution. I would welcome your thoughts.

 

A Right to Health Care?

  As part of the Democrat push for healthcare reform, there is much talk about the “right” of citizens to access “Affordable Health Care”. Some seek to infer this “right” as an offshoot of the “Life, Liberty and the pursuit of Happiness” phrase of the Declaration of Independence. It sounds, at first blush, like a sensible policy, something an advanced society like ours ought to embrace.

 However, the enumerated “rights” thus far, have one thing in common. They mandate government non-interference in our lives and require no one’s direct labor (acknowledging our armed service for their defense of our liberty).

   I would propose however that health care is not a right, but a service, a commodity, provided by individuals and organizations to other individuals for a fee. If caregivers are treated reasonably by society, then they have absolute moral and civic duty to help the less fortunate. Their labors should not be mandated however, for that would equate to theft of services.

  Why should health care be a right? We have many more proximate needs than healthcare.

We need water.

We need nourishment.

We need clothing

We need shelter.

Yet we don’t treat these essentials as a “right” Water is absolutely essential to human life on a day by day basis. Other than drinking out of a public fountain, you have to pay for it, either in the form of a water utility, or bottled water.

 Food certainly isn’t free, and no one talks about a “right” to food. The government does pay for certain food essentials through food stamps though at the merchant’s price.

   If you are struggling, you can buy our clothes at thrift store, or wear hand me downs. No one is forced to give you clothing. Charities may hand clothing out to the truly needy.

   Housing is subsidized. Certain landlords choose to provide housing for that purpose. They are not compelled to.

So why should healthcare be a right? Part of it has to do with a perception, right or wrong, those healthcare organizations and providers, particularly physicians,  should be more altruistic than other professions and services. I do think we are. Many of us see as our duty the care of people who are struggling. But this has to have limits.

  Medical practices have overhead, just like your plumber, or your electrician, or any other service business. They are no more immune to the laws of economics than any other. And overhead costs of medical practices is rising rapidly, due to government and insurance company mandates, not to mention the cost of malpractice insurance.

   If for instance, your heat goes out in the middle of a winter storm, it a crisis of equal seriousness to that of many health care emergencies. You are forced to call your heating contractor.  Yet society doesn’t consider their services a “right”. Society realizes that a contractor has expenses such as fuel, supplies, and insurance, not to mention likely a family to support. . Even subject to market forces, they tend to be paid very well for their services. Importantly, it will be the contractor’s choice, if upon seeing the modest circumstances of your family, that he decides to discount his services as an act of charity (as I’m sure happens more often than we know).

    Once you make health care a “right”, then you say that everyone has a “right” to the labor of those who work in healthcare. If a person cannot afford to pay what physician or other caregiver determines to be a fair fee, based on their education, experience, time and overhead, then it  is likely either  he or she will be compelled give away all, or a part of  the value  their services, and/ or someone else will be forced to pay for them. That “someone” will probably be the taxpayers.

    Medicare has been appropriating the labor of physicians for a long time. It originally wooed the skeptical medical community in the 1960’s by first paying physicians largely what they billed. There was a tangible increase in the standard of living of doctors in those years.

Since the 1980’s, when I started into practice, Medicare has gradually at first and now more abruptly, begun to cutback on what physicians are paid. For instance, this year, Medicare dropped by roughly 30%, the basic fee specialists can charge to see a new patient. No reason was given for this. Now they threaten an overall 21% cut in all Medicare reimbursement. Remember, when Medicare gets away with cutting reimbursement, private insurers will follow.  

    In many regions of the country, practices have looked at the new payment schedule, and decided that it’s too far below the value of their time and their burgeoning overhead. They react predictably (sadly for patients) by refusing to participate. This has the secondary effect of reminding private insurers in their market that there is a floor below which rates cannot fall

    In this region, it is very difficult for physicians to drop Medicare given the high percentage of patients with this coverage. Docs around here will be very slow to quit, both out of financial necessity and I think, concern for the welfare of their patients. However, when we as physicians allow these cutbacks without a reaction, the private insurers notice. Geisinger Health Plan has already mimicked the specialists pay cut. If Medicare reimbursements are dropped by the proposed 21% however, even here physicians would have to soberly consider their options. Those would include leaving the region, or retiring.

   You may say, “Listen to that rich doctor whine about his income”. Except that an electrician would probably charge more for a one hour service call to my home, than I am currently paid by Medicare for a one hour visit of a patient in the hospital.

    Like it or not however, the hope of a solid income is a big part of what incentivizes people to spend 12 to 20 years of their working life after high school, not to mention an enormous tuition expense, to become a physician.

   Imagine that you are being examined by a cardiothoracic surgeon who is proposing to reach into your chest to sew in a vein to bypass the blocked left main coronary artery that threatens to wipe out the majority of your heart muscle. Deep down inside, and regardless of your animosity toward physician incomes, you are probably glad, that as a very competitive college student, he saw a career in medicine as a potentially gratifying and lucrative option for his future.

   And as he places the last tiny suture in what was formerly your saphenous vein, now conducting blood to your myocardium, you’re grateful that he worked incredibly long hours during his surgical residency, competing for a fellowship in cardiothoracic surgery, which was for him, a big jump in prestige, and potential income.

   When he succeeds, you will be at some level grateful that he’s happy, and well incentivized to deliver your care. After all, that is what draws talented people to the field. This latter fact is very important for the upcoming 20-30 years, as baby boomers come into an age where they will require increasing amounts of healthcare resources.

   Imagine: it is sometime in the near future. Your cardiothoracic surgeon has a daughter. She is extremely bright and physically talented, in a manner reminiscent of her father. She is also thoughtful. She is aware that after of flurry of democrat-sponsored legislation that healthcare is a now a right, guaranteed to all Americans. She has discussed the ramifications of this with father, who decided to retire young.

As she fills out the acceptance papers to Princeton she reaches the section where she is forced to choose a major. She thinks of her father, as the pen hovers over the “pre med” check box. She sighs, and checks “pre law” instead.

 I told you she was bright.

Medicine is unique as a profession. Our services to patients are uniquely intimate; part of the oath we take at graduation involves helping to protect the welfare of patients. I am proud to fulfill this oath. But if society claims a “right” to my or any other profession’s service, then it has begun to conspire to steal them.

 

 

 

 

I reside, as I have mentioned before, in a fairly rural part of eastern Pennsylvania.

As a landscape photographer, I am naturally drawn to certain scenes more than others.  I think like many people, when I drive around on country roads, in my case looking for fresh subjects for my work, my eyes are naturally drawn to farm infrastructure, and most especially, to barns.

  People seem to like barns. Images that contain them tend to be well received in gallery exhibitions, and importantly, they tend to sell.

They seem to evoke pleasant thoughts in viewers. Perhaps it involves a harkening to some imagined ancestral past, a back-to-the-earth sort yearning for the mythical farming life, free of the stresses of the modern workplace. This is absolutely mythical, because farming of any kind is far from stress-free.

   Perhaps it is something about their permanence. Most barns you see tend to be rather old. It‘s easy to imagine them being used by multiple generations of the same family. This is pleasant concept in our increasingly transient lifestyle.

  Often they show off their age. Commonly a barn will, over the years, drift far out of plumb. I will often encounter structures that lean precipitously, yet are still in use.

When they do begin to fail structurally, as often as not, they are allowed to die without intervention. I watched for years, a barn near my home with a pronounced saddle on the main roof line. Over time, and seemingly unnoticed by the farmers, it proceeded to fall in on itself. It was finally finished off by a wet November snowstorm, the wood structure collapsing completely into the stone foundation where it remains to this day.

   It seems to me that barns are all about function rather than esthetics. Gambrel roofs aren’t there to be pretty; they allow a farmer to store more hay in the loft than in a barn with a simple pitch. Cupolas aren’t for decoration, they’re for ventilation.

 Need a new wing to the structure? Build what you can, paint it with whatever pigment you have stored in the loft somewhere. What’s most important is that the new building will serve as a shelter for whatever new equipment or livestock you need to be housed.

I think it is this pragmatic approach to construction that makes barns visually interesting to non-farming folk.

Now all of this having been said, I sometimes feel that photographing barns is somehow cheating. It’s fairly easy to create a pleasant image with a barn as an anchor. Not uncommonly, as I round a bend on a country road and find yet another bucolic barn-containing rural scene, I pause and think. Do I really need this image? Will it add anything to the vast archive of similar bucolic barn-containing rural scenes already residing on my external hard drives? Shouldn’t I be looking for more novel and challenging subjects?

  Oh, but what the hell, it’s just another file for the hard drive.

I’m a little “fuzzy” on this Friday morning. I freely admit that I overindulged last night.

You see, once I get started, I find it hard to stop. I have the first one, then see another and want that also.

Whoa… it not what you think. I’m fuzzy this morning after getting only about 5 hours sleep. It’s that damn YouTube.

One of the core beliefs in my life, is that that much of what serves as entertainment these days, pales in comparison to that which was available routinely on television to those of us who grew up in the 60’s and 70’s.  Entertainers such as such as the so-called “Rat Pack” of Sinatra,  Dean Martin, Sammy Davis Jr. Bing Crosby, along with others such as Judy Garland, Andy Williams, Peggy Lee, Louis Armstrong and even Ella Fitzgerald, were seen by many in my generation as embarrassingly unhip, in a world where John was as big as Jesus, and Paul was dead. They were my parent’s favorites, which alone cause them to be totally uninteresting. As I have now reached middle age and survey the offal that is served up on prime time television, I dearly miss the past.

   One thing missing from television modern television schedules is the variety show.

There have been a few recent attempts to revive the genre, none have been successful.

The beauty of these shows was that it seemed that no one in entertainment was “too big’ to be a guest. Most big performers have hosted shows, either as once a year events or as a series. This set the stage for some incredible combinations of now legendary performers in there prime years. Would you like to have seen Babra Streisand appear with Judy Garland? It happened several times. How about a young Sammy Davis, with Nat King Cole? Ditto.

As I discovered several months ago, it’s all on You Tube.

   Last night, it was Julie Andrews that sucked me in.  Her name appeared in the Google window as an offering, as I searched for something else (I was actually new car shopping). I clicked on it and ended up on You Tube watching the most amazing duet of Andrews with, believe it or not, Carol Burnet. It was early sixties and both were young, up-and-coming Broadway stars (Andrews I think was playing Guinevere in Camelot, Burnett was starring to rave reviews in Once upon a Mattress).

I was bowled over by this. Julie is her usual extraordinary self here, her voice bell-like and elegant, yet flexible enough to handle the up-tempo parts.  Carol Burnett that surprised me. As a young woman, perhaps her career as a “comedienne” was not yet established. Perhaps she was keeping her options open by singing in a more polished way than she did later in her career. When I hear this video, I wonder if Burnett sandbagged a bit, in duets on her show , perhaps to keep the singers whom often guested  from being upstaged by a mere “comic”.

Well, once done with that video, there will be a title on the right side of the page that seems interesting, and off you go. Andrews and Tony Bennet, then Bennett with Vic Damone and Bobby Darin, Darren doing “Mack”…it goes on an on. It’s an astounding resource.

   And before you know it; its quarter to three.  And wouldn’t you know that in a window to the right of the screen, there’s a link to a live version of Frank doing “One for my Baby”.

Oh well, just one more…

 

 

Daffodil and Motorcycle

  As I have mentioned before in this space, the camera bodies that I utilize include the Nikon F-Mount system cameras. I have always preferred the ergonomics of the Nikon based cameras to their Canon counterparts. For me, these digital bodies, in particular, the professional level models have the best user interfaces on the market.

    This is all personal preference: Canon, Pentax, Sony, and Olympus all make systems with compelling features and good quality imaging chips, and I have used many of them in the past.

  Among the cameras made with the Nikon F-Mount, were cameras made by Fujifilm. I have always thought that there is something special about imagers designed by film manufacturers (Kodak makes imagers also, now used in high-end digital backs). The Fuji that I use is an S5,  a modified Nikon D200, with Fuji firmware and a unique sensor that gives it a wide dynamic range.

   Originally designed for the wedding industry to capture the bright whites, and dark tones in the attire of a typical bride and groom, it work very well for landscape situations where the light range is broad, or the color is particularly intense. The sensor has two sizes of photodiodes for a total of 12 million pixels arranged as a honeycomb.

   There are 6 million larger pixels that are responsible for most of the imaging duties. The addition 6 million small pixels are utilized to allow the camera to record very bright whites. They are set at a lower gain than the large pixels and thus don’t burn out with very bright scenes. The sensor layout increases the apparent resolution of the camera from the expected 6 Mp to more like 8-10 MP still lower than the resolution of many current DSLRs. Even so, I have printed images from my S5 as large as 20”x 30” which were happily accepted by professional art buyers without complaint.

  The camera has a small but dedicated following, who believe as do, I that the images produced by the Fuji have a unique tonality, and film-like quality, unlike other competitive products, in large part because of the unique sensor design.

   Fujifilm has not announced a successor to this camera. The dream of Fuji aficionados would be a true 12 MP (12 million small pixels, 12 million large pixels) full frame body built on the D-700 chassis. In the mean time, I’ll keep using the S5.

Fishing the Lehigh

 

 

In honor of the first day of the Trout Season for 2010, I offer this essay:

 

For the Pennsylvania angler, there are many forms of fishing to be experienced. From trolling the depths of Lake Erie for salmon, “still fishing” at night for catfish, jigging through a hole in the ice of a frozen lake, or riding a high-powered bass boat across a lake to a favorite weed bed, the choices are numerous. Without disparaging these pursuits however, fishing in Pennsylvania for me has always been about streams… and trout.

     The trout is a wonderful food-seeking engine. Whether brook, brown or rainbow, it is a sleek, torpedo, painted with precise and tasteful patterns of red, silver, brown and blue, aesthetic in a way unmatched by the pallid green of most other game fish.  For the most part, they exist in rivers and streams, searching for a variety of food sources including crayfish, minnows and most importantly, aquatic insects.

   Trout behavior is if nothing else, logical. They favor positions in the flow where they are protected from the current (and thus expend less energy), but have ready access to the main channel where the food is plentiful. Larger fish generally get the most favorable locations. Fishermen know this, they cast their lures into the relatively quiet water behind large rocks, or near to eddies and undercut banks.

    Pennsylvania is well known as a desirable trout fishing destination. It is our topography that determines this. With large regions of ridges and valleys; with mountains that are high enough, but not too high, our state is interlaced with excellent trout water. From the remote hemlock-shaded streams of the Allegheny National Forest, to the more open limestone creeks of the central state, to the upper Delaware River, the angling opportunities seem almost endless.

     Though there are many ways to fish for trout, fly-fishing is by far the most challenging. For most anglers, the goal of an outing is to catch multiple, preferably large, fish however you can.  Fly fishermen see it somewhat differently. Limiting themselves to the use of odd-looking wisps of feathers, hair, and thread as bait; they seek to present the quarry with unlikely replicas of the aquatic insects that on that month, day and hour, and in that particular creek, are the trout’s likely food source.

    To accomplish this with any consistency, one must not only understand trout and their behavior, but also the etymology of aquatic insects. Much of the fishing is “catch and release”, facilitated by the use of “barbless” hooks.  Thus in effect, the trout ceases to be a trophy, but becomes instead a judge, testing the accuracy of the fly tiers art, the gentleness of the cast, and the angler’s knowledge of stream biology.

     This is not to say that trophy fish are not pursued. Even in this gentle art, landing a huge, slack-jawed creature is an exiting and memorable event. The fish is handled gently, measured, and perhaps photographed, then as quickly as possible returned to the streams embrace.  A taxidermist may later immortalize it; working from the snapshots and dimensions to create a replica of that noble creature.

    As we later admire it, mounted perhaps on a den wall, it is fun to think that the magnificent spirit depicted there probably still exists. One can imagine it, grown slightly larger now, slipping quietly through the waters of that very same stream, waiting patiently for the next juicy morsel to float by.

 

Vernal Pond on the Hill Trail

 

 

One of the joyful moments of spring for me, is when on an early April walk through the woods near my home, I first pick up the trilling of spring peepers, the tiny wood frogs that seem to emerge earlier than their kin, in the Pennsylvania forest. Their existence in our woods depends on a hydrologic phenomenon that occurs with the end of winter.

  

In the spring, the rains of March and April combine with the water released in snowmelt, to pool in dependent areas in the landscape creating what is a temporary waterway. These ephemeral collections are referred to as vernal ponds. In the northeastern US, these can be found throughout wooded areas, in varying forms; from swampy wetlands, hundreds of yards wide, to the small pools that will form at the base of a root ball, upended by the force of the winter winds, or a summer storm. True vernal ponds last for weeks at a time, or in a wetter year, will last for many months, succumbing finally to the evaporative effects of the warm summer air, and perhaps also to the thirst of the surrounding oaks, maples and hemlocks. 

Their importance to the ecosystem is considerable, for they serve as the nursery for the woodlands amphibian species, which will travel over the forest floor for a considerable distance in the cool spring air, to deposit their eggs at a favorite pool. 

This is a gamble. If the water dries up before the amphibian tadpoles reach their terrestrial form, then a generation is lost. Hiking, perhaps in late May, I have often come upon the desiccated basin of such a pond, dried up prematurely, the tiny tadpoles mummifying in the chalky mud. 

The ephemeral ponds are but one reason that it is important to preserve relatively unbroken areas of forest. Significant disturbances, such as roads, clearings, expose the fragile amphibian populations while en route to lay eggs and breed.

 

 I went with my daughter recently to visit Penn State, Main Campus where I am proud to say, she is accepted to the Schreyer’s Honors College.

 The people there put on a great show, we were treated exceedingly well. While Brigid was talking to some fellow prospects and current students, I wandered around, camera in hand.

It was the first in a promised run of summer-like weather in Pennsylvania. The campus lawns were as expected dotted with sheets, groups of students sitting in circles, girls in groups sunbathing, couples canoodling. My middle-aged parental mind-set was jolted back suddenly 32 (could it be?) years.

It was April of 1978. I was biology major in my junior year of college. Scranton had come through a particularly cold, snowy winter, which as a “townie” left me cold and miserable, slogging through the slush all winter after finding one of the few parking spots left, anywhere near the school, not blocked by moraines of plowed snow.

Also making me miserable were the twin scourges of the Biology curriculum,  Physics, and Physical Chemistry, two subject alien to my junk collecting, math averse, bio major brain. Unfortunately, these were important courses on a transcript that was soon to be in the hands of medical school admission committees. I had to study… and hard.

  So when as it often does in Pennsylvania, spring came with a rush and the first sunny 70 degree days began to string together,  I watched with envy from the library as my schoolmates lay blankets on the greening lawns of the Jesuit residence, and did what college kids have done on such days for the past 40 years.

 Balls and gloves and Frisbees were everywhere, the men clad only in shorts displaying their physical talents to  the assembled females on display after being shrouded all winter; their figures flattered by their swimwear, or tight tee shirts,  but still pallid from the cold grey winter.

I tried to cope by studying in a lawn chair in a secluded part of the property, with pleasant visits from my lovely, and more math adept girlfriend Cathy (who I married 3 years later). It was all too distracting. I retreated to the library, this time to the windowless basement, consoling myself with one thought:

 In less than a week, the exams will be over…and the women will be tanned.

Long ago, as a young man, I acquired my first SLR. It was a Fuji body with a 50mm f1.9 lens. Before this acquisition, I had only used “point and shoot cameras. The “fifty” was the standard lens for SLR bodies in those days, useful because 50mm for 35mm film, is a so-called “normal” lens; the field of view close to that of normal human visual perception. At the time, most zoom lenses were far inferior to their so-called single focal length “prime” lens. They also tended to be slow, with narrow apertures that limit subject isolation, and light gathering.

This lens/body combination had an extraordinary ability to recreate what I was actually seeing with my eyes to the film stock.

I remember the joy of discovery when my slides were developed. After many years of shooting compact cameras like the Olympus XA 2, I was able to capture the scene as I remembered it. The lens was razor sharp, and the format was liberating.  I was finally able to control the depth of field in an image. I was 18 years old, and I was hooked.

Later in life I became intrigued with digital imaging. The thought that I would be able to control the whole image path, from acquisition to print was irresistible.

 Affordable early digital cameras were modest devices. I was forced initially to abandon larger “sensor” photography for point and shoot digital cameras that were available before the millennial change (the few digital SLRs available were very expensive).  These cameras were rangefinder devices; it was hard to get a feel for how the final image would appear.

Many of us acquired digital SLRs in the early 2000s. These bodies, whether Canon or Nikon, had smaller than 35mm sensors, forcing a crop factor of 1.5 on the traditional system lenses. As a Nikon user, I began to collect F mount lenses including the Nikkor 50mm f1.8. On a DX format body, like my Fuji S5 or my Nikon D2x, this glass is a 75mm equivalent portrait lens, and I have used it to good effect in this role. I had a Nikkor 35mm f 2.0 that, with the crop factor, was close to a 50mm equivalent but I never felt as though I experienced the sense of immediacy that I experienced with my film SLR and a “normal” lens.

Last year, I purchased a Nikon D 700 which has a full size 35mm sensor (Nikon calls it the FX format) of extraordinary quality. Many of the zoom lenses I had collected were dedicated to the smaller DX format and were not useful. Happily I had begun to purchase a variety of prime lenses, suitable for the full 35mm sensors. I had also kept a lookout for pro level full frame zooms on EBay and have purchased several. These are also fine performers; technology has allowed zoom lenses to approach, and sometimes surpass the optics of earlier primes. Anyway, it is wonderful to use a lens at it traditional (for 35 mm) focal length again.

I keep coming back to that 50mm.  It’s small, discrete and pin sharp. The wide aperture allows me to shoot in low light, and creates a pleasant blur effect when desired, for shooting people. In short- it sees what I see.