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wisteria-lodge · 3 years

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lion primary (bird model) + slightly burnt lion secondary

Hi there! I’m a fan of your sorting posts, and of your kind and insightful way of supporting people in finding out more about themselves. So naturally I’d be very interested in your take about my own sorting, if you’re game! :)

I won’t talk much about my Secondary, because now that I’m starting to unburn my Lion seems very clear to me, even when my explosion-prone Badger model still tries to get in the way of that clarity sometimes. The more interesting riddle is my Primary. So far I’m operating under the working theory that I am a Lion with a very strong Bird model - or is it the other way ‘round?

The supposed dichotomy between “thinking” and “feeling” in many of the more binary personality models has always bugged me, so it’s no wonder this is the area where whenever I feel like I’ve decided on who I am (for now) a new question mark pops up (so much fun!).

If ‘thinking’ and ‘feeling’ doesn’t work for you as terminology, it might help to think of Lion as leading with subconscious reasoning, and Bird as leading with conscious reasoning.

Instead of trying to formulate a cohesive text, which would have gotten even longer, I’m putting together an associative list of thoughts and stories that kept turning up while I was trying to figure out my Primary.

A very Lion primary way to solve a problem, not gonna lie ;)

- I think I got my Bird model from my father, who made quite an effort to teach me to look at things from all angles. As a child, whenever I got in a fight with this friend I had, he would sit me down and ask me to put myself in my friend’s shoes. It was hard, because a lot of the time my friend was being unfair to me and I actually could have used some support, someone to tell me that it was not okay to treat me this way. But I’m still immeasurably grateful for my father’s lessons, through which I’ve learned to understand peoples’ motivations and gained an understanding for the complexities of every conflict. He also taught me to doubt, to look closer, to not just believe the first thing I see, or want to see. To this day I still consider my ability to pin down the relevant factors of a situation before I make judgments one of my strengths.

That definitely sounds like a very strong, beloved Bird model.

- Whenever I had to write an essay at school or uni, I first had to come up with some aspect about the subject that I really cared about, even could be passionate about. (I am passionate about many things, so it was usually possible to find some connection to that.) Then I would use the essay to discuss this aspect in great detail, ending with a polemic flourish. I had the time of my life doing that; meanwhile the text would structure itself magically in relation to the issue I had chosen to focus on. Whenever I tried to write without such a focus, I’d get bored, stressed and the text would be of a much lower quality.

- Something similar happened in oral exams at uni: Only when I got the opportunity to bring a discussion paper (a few pointed statements regarding the exam topic) which I could then debate, I was able to recollect all the important details I needed for that. If I just had to report on the topic or answer questions, I often got confused, to the point of drawing a complete blank.

Linking things to emotion and passion - thinking with emotion and passion, basically - is a Lion primary thing. Especially if doing that makes you feel safe & comfortable & effective & happy.

- Even as a teenager I was very interested in philosophy, ethics and moral decision making.

I love teaching philosophy to teenagers. It’s the perfect time for it, they are so into it, and if it were up to me I would absolutely make it a required class.

I picked up certain philosophical ideas and concepts that I liked and integrated them in my belief system (yes, I know how very Bird that sounds).

I had my mind blown by Genealogy of Morals in high school, and I still won’t shut about Eichmann in Jerusalem. But what was so staggering to me in high school was… here are these ways of thinking that are possible and allowed. The fact that here they are in words in front of me made me a great deal more expansive.

Now that I think about it — I don’t remember adjusting my beliefs as in any way traumatic back then. The shift from a belief in the Christian God to Mother Goddess to my very own brand of agnostic paganism was smooth, natural.

Now that I think about it… I would describe myself as a mythic relativist (which is a term I just made up.) Systems of belief are metaphors, and they’re metaphors trying to describe and say something large and beautiful about what it means to be human, and what it means to live a good life. And since we are all human, they are all attempting to describe the same central, indescribable thing in different ways.

I feel this very deeply, but it took me a long while to be able to articulate it.

I constantly reevaluate, and I adapt.

You stop reevaluating and adapting, might as well be dead.

Still, there are some basics I’ve kept with me that just make too much sense to me to give up, and some that perhaps I keep because I just really like them and I’m kind of attached to them.

… somebody’s thinking with Pathos :)

- I’m a constructivist at heart, so that makes it much easier to tweak the content of my beliefs while staying true to the principle that we (socially) construct our reality, and (my take on this): that I choose what kind of world I want to live in, and according to that I make choices which are the most likely to create that world.

- At uni I attended a seminar about the development of moral judgment and action. What I remember most clearly about it is how much it bugged me that the other students didn’t seem to understand that morality always depends on the perspective. Even though I had definite moral convictions that I was ready to fight for, at the same time it seemed obvious to me that theoretically there could be a justification for every kind of moral guideline; it depended on your principles and the world you wanted to live in.

A human after my own heart.

I wanted to understand these different perspectives, not talk about empty categories like “right and wrong” or “good and evil” that meant nothing to me. I still feel that way.

Absolutely. I don’t use alignments when I DM Dungeons & Dragons. I mean, I can list evil *things* but that’s not the same thing as defining *being evil.* I want to know WHY these people did these evil things.

It just seems so impractical and complicated to base a conversation on those broad categories that don’t have any definition people can agree on instead of referring either to defined principles (in order to explain what good/ bad is *for you*) or consequences of certain actions, and whether you want them/ accept them/ don’t want them.

Oh that’s a fun discussion. Asking a highschooler to define “evil.”

(and then they have to figure out what moral systems Jigsaw, Pinhead, the Joker, and Bane all subscribe to.)

- Between “the Revolutionary” and “the Grail Knight”, I would love to be the former, but I’m clearly the latter. I’m someone who questions, not someone who knows.

Take my archetypes with a grain of salt, they are supposed to describe characters. (Who are different from people - but still useful, because they are attempts to describe us.) I actually want to write more about the differences I see between the way fictional secondaries are written and the way real-life secondaries work.

And just “knowing”... is dangerous. That’s how Exploded Lions happen.

There are a lot of causes I find worthy to fight for, but I haven’t committed to any one, which so far I’ve attributed to my Burned Secondary (How do I do things?).

Sounds about right.

If I’m honest, though, it feels a bit strange to really, really fight for anything. I’d rather contribute to the cause by keeping an eye on whether we stay aligned to our values on every level of the fight, not by storming sightlessly in front of some army. (I got polemic again, didn’t I? ;))

So after all this Bird talk, why do I think that I’m a Lion?

… that was the Bird segment?

- I trust my intuition. It has never steered me wrong, with one exception: My Primary burned for a time when I first understood the concept of privilege and internalized bias, which was coincidentally at a time when I also went through a lot of changes in my personal life. Like many people unaware of their own privilege, I had thought of myself as “one of the good ones”. I learned that even with the best intentions I could cause great harm without even noticing it. This then also happened to me in a relationship, when I was already confused, hurt and more than a bit burned. It seemed like I couldn’t trust my intuition anymore, but I also couldn’t figure out intellectually what to believe, because I felt mentally overwhelmed by all those new concepts, all of which put my previous convictions into question. Which Primary burned then?

Been there, done that, it’s brutal. It sounds to me like a Lion dramatically changing direction - that’s what I mean when I say that it *hurts* when a Lion changes their mind. Birds see their past selves that thought wrong as almost different people. “I wasn’t aware of my privilege then, now I am, and can take steps doing forward.” But if you’re a lion it’s like… I *should* have been aware, and the fact that I wasn’t says something terrible about my moral/emotional calibration, and THAT has to be put right.

- I felt like everything I had learned about the world and myself didn’t count anymore. My concepts and my strategies didn’t serve me anymore. So I started to rebuild everything from scratch, this time with less pride and more practicality.

Yeah. That’s some Lion recalibration. With a Bird Model, to help.

- Anyway, I trust my intuition. It contains my experiences, instinct and all my accumulated unconscious observations of the situation, and it’s very reliable. Usually I use it as an important source of information which I try to back up with data/ understanding, but when push came to shove and the apparent facts would contradict what my intuition told me, I would be unable to set my gut feeling aside. I wouldn’t follow it blindly, of course. But I would never just go against it either. If the voices of my unconscious and conscious mind don’t align, I keep poking at the issue until they do. If I absolutely cannot come to a satisfying conclusion, I go with my gut. Since I know it usually knows what it’s doing, I’ll find out the reasons for my feelings later. (Weird, says my inner bird who is busy compiling these examples.)

I’LL FIND THE REASON FOR MY FEELINGS LATER. What a perfect way of articulating what is perhaps the central experience of being a Lion primary.

- Probably I’m just both, you know. Some interesting lion/bird-chimaera. I like it.

I read you as a pretty clear Lion Primary, Bird primary model. But as always, the decision is very personal.

- I have a weird way of processing information: I read/ hear it, work to understand it, work to connect it to existing knowledge in my mind, then my beliefs, my existing knowledge and my feelings about it all wind around each other, grow into each other, some dissolve together, becoming a swamp which then nourishes the plants of new ideas and connections that grow from it.

You grok it. And that’s not weird.

I often can’t remember where certain knowledge came from. I can’t take it out of a memory shelf and tell you about it. I usually remember that I’ve read a certain book and whether I liked it / it influenced me, but I won’t exactly remember what was in it, even if it was important to me. Because all that information is already processed/ digested/ transformed into something new. It’s much easier to access my memory swamp intuitively than consciously.

and you seriously had like… any doubt that you were a Lion.

In intellectual discussions I tend to get stuck because I just can’t remember enough of the details (for my satisfaction), just my conclusions about the topic and how I feel about it.

I’m inclined to think that not accessing the details is either a secondary thing, or an entirely unrelated processing thing.

What do you make of all this? I’m very curious!

[On an unrelated note, I’d like to specify the compliment I made at the beginning of this post. I’m really impressed with your ability to pick up on what people need, not just what they say they want. As a counselor this is a skill I try to hone, so I know how difficult it is to not get too distracted by the story people tell and miss the more subtle cues. You have a powerful combination of perceptiveness, insight and so much kindness, which you use to effectively support people who have questions, are in distress or confused. You don’t generalize. You don’t judge. You see the people who talk to you. I love that you’re a teacher, because I can see you’re using the influence that gives you in a way that contributes to making the world a better place. Fellow Idealist, I’d like to give you a High Five for that, if I may. :)))]

I’m not sure I’ve ever been given a better compliment. Thank you.

#submission #sortinghatchats #lion primary #lionpri #bird primary vs lion primary #philosophy stuff

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ineffable-endearments · 4 years

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Waking up in July

(Rating: G. Approx. 1917 words.)

July 1, 2020.

On reaching for the snooze, Crowley discovers an envelope he definitely didn’t leave on top of his phone. (Mail doesn’t usually get delivered to his bedside, of course, but given the handwriting on the front, Crowley has the impression divine intervention was involved this time.)

Dear Crowley,

I am writing to you in frustration. Not with you, you must understand, but with myself. There are a few things I do believe need clarifying.

Given everything that’s happened, I feel strongly that I ought to be behaving in solidarity with the guidelines the people of London have set for themselves. I must admit, it was a surprise to hear you express the same sentiment. I’ve always known you aren’t cruel enough to want to see innocent people fall ill (don’t you roll your eyes at this letter; you said it yourself), but I thought surely you would have your own ways of getting around the lockdown, carrying on outside the rules and indulging in mischief as you always do. Were this the case, it would only be responsible to invite you over here, to decrease your bad influence.

And yet, this was not the case. Still, after declining your offer when we spoke, I felt somehow unsatisfied, or perhaps at loose ends. It would have been very nice to share my baking with someone who is not attempting to steal my cashbox.

If you read this letter before July, do know you’re encouraged to reach out. We could at least speak telephonically. And if you don’t read this before July, know I will be immensely happy to meet with you again as soon as you awaken.

(There’s a long gap between the end of the paragraph and the end of the letter itself.)

Crowley...I suppose the truth is I miss you very much.

Yours, always,

Aziraphale

“Sentimental old sap,” Crowley says out loud. How else is he going to dislodge the painfully fond lump in his throat? “Right. Time to see what’s going on, then.”

Continue below or read the rest on AO3

One rushed mobile search and five minutes later, Crowley has an approximate idea of where the humans stand. They haven’t done the greatest job of getting the virus under control, but they seem to have made...progress? Arguably? Ugh, they could have done better. At any rate, if he and Aziraphale want to see each other, they’re going to have to form a...a “support bubble.”

The notion of asking Aziraphale out loud if he would like to be in something called a “support bubble” together almost makes Crowley want to turn around and go back to sleep.

On second thought, the angel would probably get a kick out of it, and the awful naming scheme would give Crowley something to gripe about, so all’s well that ends well, really.

The bookshop phone barely rings before Aziraphale’s voice is on the line. “Hello. I’m afraid we’re closing early--”

“Good,” Crowley says. “I’m not calling you to buy books.”

“Crowley!”

Oh, that’s a familiar delight in his voice. That’s rescuing-from-the-Bastille, cleaning-paint-off-his-coat, showing-up-for-Armageddon-in-a-flaming-car delight.

“Good morning, angel.”

“So very much has happened. I’d like to fill you in, but oh, I don’t even know where to begin...”

Crowley frowns at his phone, worried. “A lot has happened? What, at the shop?”

“No, no, I mean in the world.”

“All right. Well. Just start in...I dunno, start off from our last conversation, I fell asleep pretty much right away--”

“Come to the shop,” Aziraphale blurts. “You have to wear a mask, and-- and don’t go anywhere else, but it’s allowed. It...it’s okay now.”

“I’ll be there in five,” Crowley says, grinning, ready to ignore any admonishments about speed limits.

“Wait! Crowley?”

“Hmm?”

“Actually. If you come see me before July 4, we...we have to be in, ah. A support bubble.” There it is. “Have you heard about that yet?”

“Sure I have.” Crowley does his best to sound gruff and unaffected.

“You couldn’t be in anyone’s place but mine, you know. And even after the fourth, you couldn’t...get closer than two metres to anyone but me, even though you could visit--”

“Aside from the fact that all this is totally for show anyway, stop worrying, it’s fine,” Crowley insists. He miracles himself the least-ugly mask he can contemplate and bustles out the door, hurrying irritatedly back a minute later to grab the “something drinkable” he forgot.

They don’t even sit down right away, much less get within the 2 metres of each other. Aziraphale does, however, give Crowley a long, pleasantly intense look (it appears to be a proper drinking-in) when he enters the shop.

“Did you, ah,” Aziraphale clasps his hands together. “Did you get my letter?”

“I did,” Crowley says. “Got a bit bored, did you?”

Aziraphale sighs, impatient. “I suppose you could put it that way.”

“I’d have come over, you know,” Crowley says softly, just loud enough for Aziraphale to hear. “You could have called. Had my phone right by the bed.”

“I know,” Aziraphale responds, not any louder. He looks away to the table next to him, makes a show of studying a book that wouldn’t have moved from the shelf since 1949 if it weren’t for Adam’s reorganization. “But if you’d...stayed here, wouldn’t you have been bored?”

Crowley shrugs. “Maybe. I’m sure being bored here wouldn’t be worse than being bored at home.”

“If you were here, hunkering down as you put it, we might have got in each other’s way. I’m sure it would have been lovely for a while, but what about after a day or two? Or after a week? A month?”

“You have always liked being left alone with your work,” Crowley muses. “I could have gone to sleep here, too, though. I know you’ve got that little flat with the single bed you haven’t used since 1993 upstairs.”

At this, something in Aziraphale’s face loosens, and he looks almost as if he might smile. “Oh, now what kind of host banishes his guest upstairs for bedtime?”

“You absolutely would. Or I could just come visit and leave. Rules only apply to us if we decide they should, right?”

“Well, that’s the thing,” Aziraphale says. “I was stuck. It seems silly, I know, I know, but it’s such a strange time, everyone out there struggling - I would have felt terrible for choosing not to align with the humans’ rules myself. I was hoping…”

“That I’d help you get around them,” Crowley finishes.

“As you always have,” Aziraphale admits. That confession alone pushes the air out of Crowley’s lungs, a surprising sensation even considering his breath is optional.

“Those were...stupid rules. Dangerous for an angel to break. I felt like I was sort of doing you favors while also being a proper demon when I did that. This isn’t quite the same.”

Aziraphale nods. “No. Perhaps it’s not.”

“Aziraphale,” Crowley says, urgently needing eye contact. Aziraphale cooperates, drifting even a little closer as he does. Not quite 2 metres away now. “This is our side.” Crowley gestures vaguely at Aziraphale and everything around them. “I can sneak around other people’s rules all you want, but I’m not gonna force my way around yours.”

“I don’t know what’s right,” Aziraphale says, plaintive. “People aren’t supposed to be seeing each other, so if we’re going to live here, neither should we. I missed you every day, though, Crowley. Isn’t that strange? We don’t even meet every day under normal circumstances, but something about being forced to stay apart reminded me so much of old times - bad old times…”

The angel is getting himself worked up. “No point worrying about it now,” Crowley interjects. “We’re a...we’re a ‘bubble,’ aren’t we? We’re following the rules just fine and I’m even allowed to come and go. Problems solved.”

Aziraphale purses his lips. “For now,” he agrees, smiling in earnest this time. “It did get me thinking about an awful lot of things, though.”

“And none of them have to be resolved this second,” Crowley reassures. “Would you like to talk over wine? I’ve been thinking about this bottle since April.”

“Certainly, yes.” Aziraphale waves his hand. “One more thing before we do, though. You know, it’s alright for people in a bubble to get close to each other.”

“You sure?” Crowley asks, not because he doesn’t know the rule, but because he doesn’t know what Aziraphale’s rule is going to be.

“Yes. I was actually hoping you might - and you can refuse, Crowley, really, it’s a bizarre request - but I was hoping you might allow me to hug you.”

Crowley feels a big, undignified grin breaking out on his face. He schools it into the best semblance of a smirk he can manage, but he’s definitely not going to fool Aziraphale. That’s fine. “All right,” he says. “If it makes you happy.”

There is a different sort of delight on Aziraphale’s face as he sidles nervously up to Crowley. It’s not as blatant as what he’d sounded like on the phone. It’s quieter, but deeper. It’s rescued-books-after-a-fallen-bomb delight.

“Come here,” Crowley murmurs, pulling his very favorite fusspot into a hug. Upon resting his head on Aziraphale’s shoulder, breathing in that cologne and the scent of various baking experiments, soaking in Aziraphale’s warmth like a...well, like a serpent in the sun, Crowley realizes this is as much for him as it is for Aziraphale.

And he doesn’t want to stop. Sod the wine; let this take hours.

“Do you still get the feeling we’re not supposed to be doing this, no matter how safe it is?” Aziraphale asks, voice muffled. He’s sort of talking into Crowley’s jacket.

“Not really the same for me,” Crowley says. “My lot weren’t big on guilt. Fear, more like. Terror, yes. Not guilt.” He lifts his head so he can rest his cheek against the angel’s ridiculous fluffy hair.

“Oh. Yes, that makes sense. Sorry.” Aziraphale presses his head into Crowley’s shoulder.

Crowley rolls his eyes, knowing Aziraphale won’t see it, more attempting to reassure himself that he hasn’t gone completely, entirely soft. “Let’s take it one moral crisis at a time,” he whispers, stroking Aziraphale’s back. Aziraphale shifts and breathes out, snorting very lightly (although he’d never, ever allow it to be called a ‘snort’ out loud) in a way that indicates he’s trying not to giggle.

“You know,” Aziraphale says, apparently regaining his composure, “they might tighten restrictions again.”

“It’s possible. It might be the smartest option,” Crowley agrees.

“We should consider what we’re going to do if that happens.” Aziraphale has not removed himself from Crowley’s grip. “If you’re really sure you wouldn’t mind…”

Crowley finds himself chuckling, progressing to a full-throated laugh. “What, sleeping upstairs?”

“Well, no--”

“We’ll cross that bridge if we get to it, but if there’s one thing I can guarantee, it’s that I wouldn’t want to sit around and chatter 24/7. You’d have your reading time.”

Aziraphale sighs. “And wouldn’t you miss your things?”

“Sure, possibly. Not like I was using them when I was sleeping the months away, though, was I?”

“All right.” Aziraphale pulls away enough to gesture toward the sofa, leaving Crowley wanting more. Days. Days more. Aziraphale is beaming, though, and Crowley might be, too, and Aziraphale doesn’t end the hold entirely because now their hands are clasped. “Now, bring the wine over here and let’s go sample the desserts. I’m especially interested to hear what you think of the devil’s food cake.”

#good omens #ineffable partners #good omens lockdown #ineffable husbands #ineffable spouses #covid19 cw #coronavirus cw #alcohol cw

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speakingwhentheworldsleeps · 5 years

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Some various beliefs I was taught as a Christian:

The Bible is infallible, and everything it states is absolutely true and 100% happened exactly as stated, no lies or inaccuracies. Also the places where it seems like it contradicts is because two people can witness the same event and remember it differently.

The Bible is our moral guideline, but when the Bible doesn't address or even seems to accept immoral behavior that we absolutely know is immoral, those places are just descriptive.

God is transcendent, the creator of reality itself, he can do anything he wants but everything he did had to happen exactly like that because it’ in God’s nature and God cannot control, change, or defy his own nature.

God gave moral guidelines for immoral things in the Bible as a concession to their sin, something that will never happen now because it is against that same unchangeable nature for God to accept our immorality and work within it.

And evil exists because God cannot interfere with freewill, except for that accident, that sickness, that natural disaster, or that tragedy, or even that time you prayed for a parking spot, where he totally treated other people like they were his puppets in order to align things to his will.

And God is not the author of confusion, of course, but context context context context context, because the plain words of scripture don’t actually mean what they say, except when they do, and then you obviously want to rebel against the very clear words in the Bible just to excuse your own sin.

And you must believe all of this, simultaneously, and also know which contexts applies to which situation, without mixing up what scriptures apply to what beliefs. Because you would know all of this, of course, and understand how very accurate and consistent it is, and what beautiful, loving, wonderful picture of God this all expresses, if you were really saved.

#evangelical christianity #deconversion #ex-fundy

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tomasorban · 5 years

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THE ZODIAC: VIRGO THE VIRGIN

Date of Rulership: 23rd August-22nd September; Polarity: Negative, female; Quality: Mutable; Ruling planet: Mercury; Element: Earth; Body part: Solar plexus and bowels; Colour: Dark brown, green; Gemstone:Sardonyx; Metal: Mercury or nickel.

Up until now, the formative forces expressed by the zodiac under the signs of Aries, Taurus, Gemini, Cancer, and Leo have been orientated towards the inner realm of self-expression and self-actualization, and particular an expression that doesn’t wish to be hindered by external influences or contingencies. This all changes with Virgo, a sign whose potency derives from the ethereal element of earth and mutability. Virgos are quite like a combination of metal oxides, minerals, and organic matter otherwise known as clay. They adapt quickly to the pulling, pushing, thrashing, twisting, folding, and overturning caused by the protean elements of the environment through sharpened faculties of common sense and level-headed thinking. If Virgo were a cosmic process, it would be an accelerated version of natural selection; if it were an animal, it would be a rainforest chameleon; and if it were a person, it would more than likely be a molecular biologist. The three just mentioned things partake of the same methodology when it comes to encountering reality and the world: they all start by apportioning a state, condition, or situation into its respective subcomponents; then studying the composition of each piece, its practical purpose, its relation to the other parts, and all possible forms of interaction; and finally pondering all possible outcomes and consequences should any unforeseen mechanistic failure or breakdown in communication between the parts ensue. Moreover, the mutable energies of Virgo are meticulously practical and conscientious; they will measure, demarcate, and map out their worldview before ruffling through to weed out items of information that are superfluous, insignificant, of no intellectual or creative interest, or of no practicable use. Virgo is a focused sign and sees no value in going off on wild goose chases or intellectual tangents that are merely products of curiosity rather than data aligned into a chronological tree of final causes.

Thus Virgo is the “analyst” of the zodiac, the sentient filter that gathers, stores, retrieves, analyses and prioritizes information in a mental filing system designed to sharpen the conscious will and force the ego along its chosen path and trajectory of evolution. To arrive at this state of being, Virgo had to sift through an array of primary characteristics from preceding signs and single out the ones it wanted: from Taurus it borrowed willpower, diligence, and focus; and from Cancer it acquired the desire to mother and nurture others, especially those beings that seem helpless and in need of protection or attention. Virgo’s innate tendency towards analysis, its sedate disposition, and its agenda rendered the traits of the other three signs–Aries, Gemini, and Leo–both undesirable and incompatible, and hence it bypassed the lot without a second thought.

“You know guys and girls, I’m a bit like extra virgin olive oil,” says Virgo. “I am well aware of my own composition, texture, colour, and taste. I know my own essence, what I mix well with, and what I don’t mix with at all. I can also tell you without the slightest doubt that I’m good for you, and that I probably know what’s best for you better than you do. The endeavour that we call life is best approached from an angle that involves formulating plans and putting them into action. Throw in a bit of salt and pepper in the form of self-discipline and hard work and you have a recipe for instant success and satisfaction. It’s as simple as that. Those of you who say or do otherwise are either naïve, ill-informed, delusional, or plain stupid, and you can be certain that I’ll be giving you the “I-told-you-so” lecture somewhere down the track for taking detours onto dirt roads which lead to oblivion. We never, ever let our hearts usurp the position held by our heads–this sentiment extends to all areas of life, including family, love, sex and relationships, profession and career, finance, and so forth.

In any case, if you’re not quite sure as to how the mechanics of this little secret works I’d be more than happy to forfeit some my own time and give you a demonstration. There’s nothing more satisfying than giving to a fellow projection of the conscious universe, a brother or sister, and you can be more than certain that God, salvation, and peace are to be found in such moral, selfless, and loving acts. I do have some insight into my own psychic makeup, and understand that my love of perfectionism, my sense of righteousness, and my “know-it-all” approach can intimidate, irritate, and anger others. This has nothing to do with conceit or being up myself but rather a love for the world and my devotion to it. Why can’t people wake up and realise what’s good for them I say? Why do they make the same mistakes, over and over, without learning from them? How can the most intellectual of earthly creatures be so incompetent and inefficient sometimes? We need to listen before we speak, prepare before we do battle, and look before we jump. If people adhered to these very simple guidelines, there’d be a hell of a lot less grief in the world!”

From what we can see, Virgo is obviously a reflective sign that places a colossal emphasis on education and learning. And what Virgo aptly sees in this temporal and sometimes chaotic world of change and evolution quicker than any other sign is that self-preservation is dependent upon doing things in moderation. When physical, mental or emotional energies are utilized to extremes for prolonged periods of time, the individual will manifest wear and tear that inevitably leads to burnout. The best way to avoid hitting a wall, according to Virgo, is to engage in periodic exercise, eat a nutritious diet high in protein, complex carbohydrates, fibre and coloured vegetables, and cordon off a few hours each day for solitary endeavours intended to cultivate the soul. Learning new skills and refining natural talent is way more important and meaningful to a Virgo than being a social magnet or an energy vampire. From this perspective it’s easy to see why the Virgo man or woman admires, respects and holds in the highest esteem individuals who are intellectually and academically inclined.

In neural physiology, we might align Virgo with the rational, mechanistic, and dominant scientist that lives in the left hemisphere of our brains. Like the latter, Virgo is only interested in knowledge pertaining to reality that is collected by the sense faculties and categorized through deductive reasoning. Unlike the latter though, Virgo discriminates between knowledge collected on the basis of its usefulness. If theory or knowledge cannot be applied in some concrete way to improve the present conditions of life, then there’s no point in even knowing about it. As far as Virgo is concerned, anything abstract and speculative or anything that evades human comprehension and classification is simply not worth any vested time or effort.

There are two symbols associated with Virgo the Virgin. The first is a reclining woman, an obvious allusion to the Great Mother Goddess in all her guises (i.e. the virgin, the crone, the good mother, the temptress or seductress, the whore, and so forth). She is the stellar goddess of innumerable names: for the ancient Babylonians and Assyrians she was Ishtar, the all-encompassing deity of love, war, fertility and sex; for the ancient Egyptians she found expression through the feminine triad of Nut-Hathor-Isis; for the ancient Greeks she was a triune spirit encompassing the Olympian deities Artemis, Athena, and Hestia; and for the Imperial Romans she was Ceres, the maternal goddess of agriculture, grain crops and fertility who was always depicted holding a sheaf of corn. One would have to say that the most recognized religious iconography associated with this zodiacal sign is that of the Christian Mary, the Immaculate Virgin and Queen of Heaven who brought forth the incarnation of God the Father in Jesus Christ the Son.

In classical mythology, the stellar constellation of Virgo was inextricably linked with Astraea, the goddess of justice and innocence. According to the Hellenes, there was a time when the immortals were thriving alongside the mortals on Earth. Back then the world was largely devoid of diseases, plagues, burdens, and other conditions detrimental to general health, wellbeing and contentment. This was to change with the curiosity of Pandora, who made the tragic mistake of opening a cursed box gifted to her by the immortals themselves for the sake of testing her willpower in consort with her ability to toe the line and follow simple instructions. Save for being the source of all misfortunes for mankind, Pandora also became the reason for the gods and goddesses to desert their corporeal posts. Even Astraea, the most tolerant and patient amongst them, surrendered all hope of a swift redemption for mankind and fled to the mount of heaven when she saw that the ravages of war had escalated to a degree of barbarity that left expired mercenaries without dignity. It is said that Astraea will descend from her celestial throne to Earth again when the human psyche returns to its former Adamic state of spiritualization.

The second symbol, an astrological shorthand for the zodiacal sign, looks like the small letter ‘m’ with a curved projection linking the top and bottom parts of the third leg. As a sygil, it bears a great many resemblances to two subsequent signs, Libra and Scorpio, both of which are intensely concerned with the collective social and psychospiritual evolution of humanity. On a great many occasions we find that the uroboric loop formed by the final leg is represented as a fish, the Piscean totem. Therefore we can infer that the glyph is denoting an ethereal condition where spirit or vital essence is in the process of incarnating in the dense, lower world of physical forms.

Both symbols together recall characteristics central to the Virgo archetype–discrimination, intelligence, refinement, serenity, self-control, dedication, assiduousness, orderliness, and self-discipline. Over and above the positive connotations linked to them, these qualities are typical by-products of highly evolved and spiritual states of consciousness mediated by Virgo’s formative energies. We can be certain that both signs place immense emphasis on ascension and specifically the ascension of the human soul because the totemic figure is often shown with a pair of angel wings. The position of Virgo on the great cosmic wheel also reveals that both signs have to make do with maternity and fertility, as well as the condition of having fulfilled all prerequisites leading up to any undertakings meant to test physical, psychological, or spiritual parameters.

#zodiac #astrology #astrotheology #astropsychology #psychology #consciousness

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audiblogologist · 3 years

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Anchors and Compasses

We are living in extraordinary times. There are public policies that shift based on evidence, at the exclusion of other contradicting evidence, there seems to be groupthink run rampant and divisiveness in culture not seen by humanity for quite some time. We seem to be at the abandon of policy makers and there's talk of agendas from the goodwill to the draconian end of the spectrum. What then is our anchor?

Let’s consider the nature of what an anchor is. It is released to hold the ship in place generally and ideally before the storm hits so that the vessel can be generally stationary despite many natural forces that are out of control including wind, current, waves, and rain. It seems so simple. The anchor is not the compass although equally important. The compass got us there, and will be used when the journey continues. But sometimes you just have to pause the journey and use the anchor.

What can be our anchor? First, we need to determine if we should pause or push on during the crisis. If we move on, then the compass takes over and we find our direction. Either way, whether held in place or surging ahead, we need our ethics and morality to guide us and that needs a basis.

Professionally, this means being in line with one’s professional code of conduct and ethics statements, and on a higher level it means having one’s morality, character and mind in the right place, whether aligned to a spiritual belief, moral code or general consensus of common sense. In our extraordinary times, we are losing that. Our pluralism has resulted in shifting standards of morality. But there are some things that cannot change. Things like the Golden Rule. Such as kindness and doing good to others and not withholding help or knowledge one is capable of giving that would benefit another human being regardless of all the divisive barriers we have come to know in this new normal.

If a doctor sees a patient who needs a specialist but that specialist is not available for 12 months, and the doctor can provide care to help the patient through that period until they can see a specialist with a band-aid solution and clearly identifies it as that, and does that pro bono although it is not common practice, not outlined in a professional code of conduct or ethics document, is the doctor out of line? We have such stringent and unbending adherence to such guidelines that such a doctor is accused of malpractice. No harm was done to the patient, good was done to the patient, no costs were incurred for the patient, but it didn’t fall into the rigid guidelines of the profession. So the doctor is at fault.

How do we reconcile such a rigid interpretation of care with the need to go the extra mile in an already hurting health care system for the practicing practitioner who fears for his license and will inevitably do less not more for future patients even if his or her knowledge, resources and ability can remedy a situation as a bandaid solution pending specialist diagnosis and treatment?

These certainly are extraordinary times. The good do well and are restricted, those who don’t do enough are reprimanded, our pluralistic unanchored society as a whole is becoming more rigid in its definitions of right and wrong and old fashioned common sense of doing right to help someone when it is in one’s means to do so is deemed wrong.

As for me, there are no easy answers on when to use a compass or an anchor, but either way, both should be run by the same standard and that’s a human code of conduct: always do well, help others with one’s knowledge, ability and resources, especially as a professional, even if that means going above and beyond at one’s own cost to do right, even when that “right” is not spelled out by any professional codes or standards. Always have a clear conscience that one has done everything in one’s power to do good and no harm. If that, as in so many things these days, is offensive, because it does not follow the status quo, or fit into the rigidity of dated guidelines, then the doctor should be willing to be found at fault by the rules that do not consider conscience. I challenge our world to find its conscience and ask whether the current day trends of divisiveness, rigidity, or exclusion are conscionable.

As for me, I stand by the doctor that does what is right even if it offends, challenges status quo or provides a partial solution until more applicable help is obtained, and the outcomes for the patient are measurably beneficial. I think we need to not only have a conscience but also a conviction for what is right even if the world does not spell that out for us anymore.

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beesandbooks1 · 4 years

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D&D Series #3: A Character Example

Introduction

It’s Thursday book bees, and you know what that means? Another installment of my Dungeons and Dragons series! Following my previous posts about creating characters and the importance of their backstories, I thought it might be smart to give an example of a character created and played for those that learn by example. Okay, so this is also an exercise in self indulgence that lets me talk about one of my favorite D&D characters. Nevertheless, I do think examples are helpful when diving into the world of Dungeons and Dragons roleplay.

So let me introduce you to my character of choice: Annamaria Riverend. I built Annamaria for my husband’s first campaign as a DM, so her background is based in a homebrew world. This means that locations and social norms, among other factors, conform to the rules of his world rather than the worlds of official D&D canon that inform the character build guidelines. This largely only effects the racial part of her backstory, meaning that as a half-elf she does not feel the divide between elven and human worlds the way the description of the half-elf in the Player’s Handbook recommends.

Backstory

Annamaria was born to a human father and an elven mother. Her father, a bit of a playboy, had wandered the Empire of his birth for a while, interacting with many different people. This left a few half-siblings roaming about in the world before Annamaria’s family took form. Annamaria didn’t live with her full family for long, though. Her younger brother tragically died of illness and the family broke apart, her father going off to wander some more and her mother jumping straight into a second, more stable marriage. Stability could only last so long, though, and another sibling tragically died. Her mother disappeared and was unable to be contacted, leaving her stepfather to watch over Annamaria and her older sister, as well as his own child and her half sister. The area they lived in deemed that her stepfather had insufficient funds to care for three children and chose Annamaria to be rehomed. She was adopted by a couple, both elves, who worked as a jeweler and a liason to a local farming community where she was raised with three other adopted siblings.

Annamaria was emotionally stunted by the turmoil in her early life and rather rebellious. She was also left with an unusual gift: she could see spirits. Her adoptive mothers sent her to a local druid commune in hopes that they would be able to guide her to the right path as well as help her with her strange gift, but things didn’t turn out how they expected. Annamaria, irritated with the hippy nature of the commune, stole some underutilized treasure and used it to fund a new identity. She forged paperwork, bought a wig and a new wardrobe, and posed as a long lost member of a diminished noble family, making friends with some wealthy folk and spending half her year with them as a down on her luck noble girl. The other half of the year she spent working at various jobs to fund her extravagant second life.

At the time that the campaign began, Annamaria had unwillingly acquired a druidic mentor. Appearing only as a mysterious shadow with a distorted voice, her mentor was trapped in a bronze orb she’d stolen from the druids and been unable to sell off. The shadowy mentor showed her druidic magic and attempted to guide her to a more straight and narrow path in life, largely unsuccessful until the campaign took off and Annamaria had to set aside her second life in order to adventure.

Development of Character

In the course of the campaign a lot of fun stuff happened to help me grow my character. Of course, we had a lot going on outside of the campaign that affected things, namely a lot of players rotating in and out so that by the end our party composition was small and much changed from how we began. I was the only person who started and ended the campaign only missing one session while I was away for my master’s research. As a result, I think Annamaria received the most character growth and resolution by the end of things. Granted, we didn’t really get to establish how our characters ended the campaign due to time constraints but we jokingly said that she retired to one of her properties in the North and married someone that was a consistent love interest for her.

At the beginning of the campaign, Annamaria was a Chaotic Neutral alignment. This means that she was largely looking out for herself, and did so in whatever manner made most sense at the time despite what chaos or harm that might cause. She made decisions such as refusing to partake in battles that didn’t seem to concern her, and making slightly less strategic choices in battle. By the end of the campaign she was Chaotic Good due to her loyalty, her altruism, and her choices to put others first and save people even when she was told she wouldn’t be able to.

Throughout the campaign, I got to explore a morally grey character with a tiny desire to see good and change the world. Annamaria went from being unwilling to put herself into a fight to protecting her friends, and from wanting wealth and riches to giving things away to those in need. She found her new family and healed from the trauma of losing her first one piece by piece. By forming bonds with the other members of her party, Annamaria grew as a person and found her moral center.

The Practical Stuff

Beyond the backstory and character development, Annamaria was a Circle of the Shepherd Druid. Her background was Charlatan, and she primarily utilized her Wild Shape and conjuration magic during combat. The Druid class is a magic casting class that focuses on natural and animism spells, and comes with the ability to shapeshift a limited amount of times into animal forms that yourself and your DM work out. At various times, my DM presented me with new animal shapes with custom stats that were outside the traditional stats within the DMG and PHB. As a Druid, players select a Druidic Circle that determines a bit more of a specialty. The Circle of the Shepherd is featured in Xanathar’s Guide to Everything as an expanded option for Druids. This Circle focuses on spells regarding the spirits of animals which played on her ability to see spirits.

As a result, Annamaria’s magic talents largely lied in conjuring large amounts of fey creatures that could provide assistance in combat. Generally in a long enough session of combat, I played Annamaria as utilizing her magic more than her Wild Shape since I often used Wild Shape forms to do other important things such as sneaking into prisons, eavesdropping, and other tasks that required stealth. Generally using her Circle of the Shepherd features, Annamaria could provide strength and healing to the party in an area of the combat, while also using long distance spells and close up attacks to beat back combatants. If the party was smaller (missing players or just out numbered) she could summon up an amount of animals to act as a buffer zone and attack the enemies.

Conclusion

So yes, there you have an example of a character played from beginning to end with character development and changes to motivation. Ultimately, you don’t want to find yourself playing the exact same character at the end of a D&D campaign. You want your character to grow, mature, and change just like a real person. It takes a talented DM, commitment from yourself as a player, and a pleasant and comfortable group of fellow players to achieve character growth though. Sometimes, your group just doesn’t have the time or energy to follow through with a complex campaign and so the changes to your character may be small, only really resolving facts from their backstories rather than pushing forward new character growth. But still, as long as you feel that your character’s development was rewarding, that’s the important thing!

#bookblr #book blog #Dungeons and Dragons

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whimsyandwonderings · 5 years

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I did a huge quiz thing to begin exploring my corse values the results were:

"Your Core Values are: Spirituality Health Happiness Growth Integrity."

I'm fairly happy with this.

Spirituality is something that I have always thought of as important. I am not particularly religious, as I don't hold myself to a set of specified rules or guidelines, rather I pick and chose what seems appropriate for me from various religions. In that way I consider myself an eclectic witch with mainly norse and celtic influences. My spirituality has taken a back seat this year as I filter tgrough my shit but it's good to think about and perhaps a call to get back into it. It would probably help my mental health.

Health is something that ai have always struggled with. Both my physical and mental health have never been quite right. Depression, anxiety and post traumatic stress play a large role in my mental health but I am trying to overcome this. Journaling on here, writing out my story in novel form, talking to people honestly and making appointments with support services even though there is a five to six month waiting period. I'll kesp trying until I get there and I have made progress, I'm less neurotic now and I don't want to die anymore. I'm just hurting all the time and angry because of it. Physical health has always been a battle for me to, my relationship with food is horrendous and strongly linked to my mental health. I tend to either over eat or even binge eat when I get upset or stressed or I go the complete opposite direction and stop eating. I'm still trying to figure out how to find a balance there. I got a beautiful vegan cook book from one of my students as an end of year gift and have been looking through it. After christmas I'm going to try some of the recipes. I have found a workout plan that seems good for me, so I'm going to print and laminate thst today and give it a go. It's 3 days cardio, 2 days strength and 2 days rest, seems like a good starting point at least. My partner may be joing my gym too which will give me more motivation to go. I'm realising that comfort has been a priority for me for a long time, which has made me lazy and unwilling to put myself in uncomfortable situations. I'm chosing to let go of this now and make my health both physically and mentally a priority.

Happiness is something that I have always wanted and never felt like I have achieved. I don't know if I have ever really experienced happiness. I have has moments of happy affect but never really a positive mood. I am quite pessimistic but I have hope too, things just never seem to go quite right. I don't mean little trivial things either. On a large scale there has almost always been something completely fucked up going on. My upbringing, childhood and family have been a huge part of this ongoing drama as well as my choice in romantic partners but I am working on this. I'm attempting to set boundaries, to say no to people and not feel shit about it and to not do thing just because I feel bloody obliged to. I'm finally allowing myself to actually be angry at the people who deserve it rather than being angry at the world. Small steps but maybe oneday I will have my own version of happiness.

Growth has always been important to me. I hate being stagnant and even in my depression I feel as though I am consistently striving to become better or as Mark Manson says "less wrong." Sometimes this is slow but I am always critically analysing my behaviour, sometimes too much. I enjoy learning and think I will probably study for a large portion of my life even as I work full time. I am currently studying psychology part time online while working full time as a teacher. Learning is something that I really value, it brings opportunity and really ai just enjoy it.

Integrity is something that I have always valued highly. I hold myself to a string set of morals and standard, I have fucked this up in the past but I learn from those experiences. I endeavour to act with integrity at all times and if I do fuck up, because of being human, I hold myself accountable, apologise, fix things where I can and learn from it. I think the biggest issue I have around integrity is that I expect the same level of behaviour from others and have been consistently let down because of this. I am trying to accept thatvI can only control my own behaviour and there is nothing that I can do about the choices and behaviour of others. It just infurates me at times. I can't understand how people, other humas beings, can treat each other like shit and not be torn apart by their conscience. I guess it has to do with their values and I'm finding that if people's values don't align with mine I can accept it for the most part, I can still love people with extremely different values however I have realised that certain values have no place in my life and the presence of them effects my mental health so if people aren't treating me with respect or are being dishonest I have no more time to waste on them. I have given my partner a final chance to show me that he is prepared to value our relationship more that sleeping around but am also prepared to break it off completely should he breach my trust again. Loving people is hard but this value of integrity is a major component of me as a person and I will not allow it to be compromised anymore.

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kristinsimmons · 6 years

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Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue?

By KHURRAM NASIR MD, MPH, MSc

In the industrialized world and especially in United States, health care expenditures per capita has has significantly outgrown per capita income in the last few decades. The projected national expenditures growth at 6.2%/year from 2015 onwards with an estimated in 20% of entire national spending in 2022 on healthcare, has resulted in passionate deliberation on the enormous consequences in US political and policy circles. In US, the ongoing public healthcare reform discussions have gained traction especially with the recent efforts by the Senate to repeal national government intervention with Affordable Care Act (ACA).

In this never ending debate the role of government interventions has been vehemently opposed by conservative stakeholders who strongly favor the neoclassical economic tradition of allowing “invisible hands” of the free market without minimal (or any) government regulations to achieve the desired economic efficiency (Pareto optimality).

A central tenet of this argument is that perfect competition will weed out inefficiency by permitting only competent producers to survive in the market as well as benefit consumer to gain more “value for their money” through lower prices and wider choices.

Restrained by limited societal resources, in US to make our health market ‘efficient’ we need to aim for enhancing production of health services provision at optimal per unit cost that can match consumers maximum utility (satisfaction) given income/budget restraints.

Keeping asides the discussion on whether a competitive market solution for healthcare is even desirable as adversely impact the policy objective of ‘equity”, however from a pure ‘efficiency’ perspective it is worthwhile to focus on the core issue whether conditions in healthcare market align with the prototypical, traditional competitive model for efficient allocation of resources.

To simply put it, one needs to ponder

1) can efficiency with no waste in production and consumption be achieved in an unregulated healthcare market conditions?

and 2) where does the health market stand on the spectrum from almost perfect to imperfect market without government regulations.

While discussing healthcare, among many others, I will focus on deviations from the following four major perfect market assumptions which has significantly contributed to inefficiencies noted in US healthcare delivery system

1. Homogenous products with buyers being fully informed about a) what, when and how much they wish to consume, b) price, quality and production methods of services provided, as well as c) of available alternate choices. On this basis, consumers should be being fully informed are capable of making rational decisions to realize maximum utility (Information symmetry)

2. Transactions are impersonal with sellers unable to considerably influence consumer’s choices, especially in situations where engaged as ‘perfect’ agents.

3. Many buyers and sellers (firms) exist to influence market prices, so they are all price- takers

4. Firms (sellers) can freely enter and exit of entry the market freely without significant restriction such as from rigid regulations or entry barriers

First, considering the random nature of timing illness with uncertainty of financial implications of these episodes, there is a significant element of uncertainty involved. This eventually creates demand for insurance (mostly private in US), which unfortunately further brings in new sets of challenges hampering equitable as well as efficient distribution of healthcare. In ideal situations of perfect information of risk, in a free market fair (actuarial) premiums can be charged for each individual catering to individual gains in utilities. However in the real world, sicker individuals superior knowledge of their medical conditions who can anticipate greater downstream healthcare expenditures are more willing to seek insurance and naturally incentivized for lower premiums by signaling false information. To address the challenges faced with incorrect risk signaling and adverse selection, private health insurers screen customers and offer a) varying levels of contracts with deductible and or co-insurance further inducing self-selection and/or b) increase overall premiums to cover the expected losses with these higher risk patients. In these situations high-risk buyers likely prefer complete coverage with lower risk participants preferring cheaper contracts with high deductibles or leace the insurance market, further compounding the problem of adverse selection.

Second, an additional challenge inherent to any form of insurance coverage to overuse or maximally use services beyond the point of deriving maximum utility or benefit (moral hazard), leading to inefficient use of resources, which in turn has lead to gatekeeper mechanisms as well with disincentives such as copayments/deductibles. These insufficiencies threatened due to adverse selection created by US private insurance markets contribute to higher absolute transaction costs, large inequality in access to healthcare and large segment of the population being uninsured and can potentially be rectified by a universal public compulsory coverage to pool population heterogeneous risk as well resolve inequitable access to healthcare, a subject heatedly debated in our current election cycle.

Third, a major reason for healthcare market insufficiencies in IS healthcare market can be attributed to the complex interplay of asymmetrical (unequal) information in the context of patient- physician agency relationship. It is an established fact the patients (consumers) have inherent inability to completely comprehend the quantity and quality of health services needed to maximize their individual utility; more pronounced in situations of acute illness. This inherent limitation of being relatively uninformed to for rational choices in these complex situations, has led to the delegation of physician responsibility for decisions as an informed agent (agency relationship). A central challenge in this situation how best interest among contracted parties do not diverge and the inherent impact of agent’s conflict of interest interfering with consumers interest.

Fourth, there is an old saying, “if you build it they will come,” equally is true in our medical profession. One can argue that the supplier-induced demand (excess healthcare demand beyond what would have occurred in market in which patients make rational decisions based on being fully informed) can be linked with the how the financial incentives are structured in the US healthcare market. Under the predominant fee for service format of healthcare delivery in US, its not uncommon for providers (firms/physicians) to promote consumer demand for services, especially when consumers are likely face no additional costs. A classical example that is frequently cited in this case is a study by Gruber and Owings elegantly demonstrated that 13.5% fall in fertility over the 1970-1982 time period likely attributed to obstetricians/gynecologists to substitute normal childbirth with a more highly reimbursed alternative, i.e cesarean delivery. This is a clear example of physicians inducing excess substitute demand when facing reduction in revenue generation with older paradigms.

Moreover in US many health systems continue to physician groups owned with multiple studies suggesting excessive use of testing and procedures in these facilities. Furthermore, even to date many expensive procedures and tests, which remain lucrative from a supplier standpoint, are undertaken at a higher rate as buyers continue to have incomplete comprehension on their potential utility. For example, a recent survey among patients undergoing percutaneous coronary intervention for stable coronary artery disease, nearly 9 out of 10 believed it to reduce risk of mortality and heart attacks; while extensive evidence refute these perceived benefits. There are meaningful ongoing efforts targeting supplier induced demand by a) empowering patients via standardized evidence based decision aids, b) regulating treatment guidelines, c) reducing variations in practices via diligent performance measure assessment and incentivizing suppliers for quality vs. quantity, a theme becoming prominent in current US markets. However it is yet to be seen whether these emerging practices focusing on ‘value’ can triumph the incentives of the prevalent “free market” model.

Fifth, while considering the ‘many buyers and seller’ assumption of perfect market, with an aging population as well significant rise in chronic diseases due to western world lifestyle, there seem to be no shortage of consumers (buyers) for healthcare in US. On the other end, it may not be true with significant variation noted in sellers available in healthcare market. The passage of affordable care act has indirectly encouraged ongoing trend of consolidation with creation of oligopolies (few sellers) and monopolies (one seller) such as regional accountable care organizations (ACO’s) aiming to promote efficiency through economies of scales and pass the savings onto consumers.

However, the potential deviation from ideal competitive market conditions adversely creates milieu for price setting as well as a disincentive to efficiently allocate inputs for the desired health services outputs.

For example, a study by Robert Wood Johnson, hospital (firms) consolidation generally has enhanced bargaining power with payers, resulting in higher prices for health services6. More importantly, the price increases dramatically increase, often exceeding 20%, when these consolidations have occurred in concentrated markets. Capps et al estimate that following the US policy change in 1993 that deregulated healthcare providers mergers, have contributed to relative increase in health market inefficiencies, with nearly 0.4-0.5% (approximately $10-12 billion annually) higher current healthcare expenditures as a result of these hospital consolidation trends.

Many argue that although these consolidations result in higher services costs, but benefit consumers with potentially better quality and outcomes. However, a recent study by nonpartisan National Academy of Social Insurance (NASI) scrutinizing publicly available data on financial performance and quality measures suggests otherwise. The report confirmed that while per capita cost of care significantly increased with merging of hospital and physician groups (as also noted by RWJF report); these expansions did not improve clinical or financial efficiency and resulted in lowered marginal profits for these firms.

In a specific example, merger of the among the top two hospitals in the country (Massachusetts General Hospital and Brigham & Women Hospital) resulting in the state’s largest healthcare provider (Partners) market of more than a third of hospital patients in Boston city (state of Massachusetts). The Boston Globe reports that since 2000, a major local insurer (Blue Cross) increased pay rates for Partners services by 75%, whereas neighboring providers with comparable quality outcomes measures while treating a sicker population was able to command significantly less imbursements for similar services.

In fact, many insurers who initially balked at these increase rate hiked, gave away under enormous economic and political clout exerted by Partners. In spite of significant increase in prices for providing comparable services (that naturally should have maximize returns), its been reported that Partners operating profit has not exceeded 2 percent in this period and is much less compared with major teaching hospitals in other states, pointing towards the natural consequence of lack in production efficiencies noted with large consolidated oligopolies in other markets.

Sixth, adding insult to injury and to counter increasing bargaining power of consolidated health systems in US, for profit insurance (payers) companies have also followed suit to balance the negotiating power with the providers. For example, earlier last year Aetna announced $35 billion deal to buy rival Humana that would create the second largest health insurer in US (33 million members). This announcement came at the heels of Anthem $47 billion offer for rival insurer Cigna that can result in the largest health insurer in US (>50 million members). Although these deals did not follow through, however any similar efforts in future will limit choices will further grow economic/political powers of these large payers as they have already sought out 20-40% hikes in premium rates for 2016 in guise for anticipated loses. In fact, Dafly and colleagues from Northwestern University exploring relationship between premium growth and changes in market concentration using a large employer-sponsored health plans enrolling over 10 million Americans, conclusively pointed the merger of two large insurance companies (Aetna & Prudential HealthCare) in 1999 resulting in 7% higher overall insurance premiums.

Seventh, in contrary to view of ‘economies of scale’ from these consolidations benefiting favorable product prices to the consumers, we have actually observed the opposite unfavorable impact of these monopolized positions result in price setting for these services at a much higher cost than would be observed in true efficient (free) market. Barriers to free entry in the market further limiting healthy competition and consumer choices compound these challenges. Entry to the healthcare market from a supplier perspective entails significant capital needed to develop service lines, extensive training for specific provider (such as subspecialties) to practice, no compete provider contracts, significant state by state licensing regulation as well as individual system pervasive credential processes. The ongoing trajectory of healthcare consolidation in US and barriers to market entry, clearly deviates from basic principles of an ideal competitive market, resulting in demonstrable production inefficiencies, higher prices and no substantial improvement in quality of care.

The rapidly developing duo-monopolist market of healthcare providers and insurance has practically ensured loss of most (or all) consumer/societal welfare gain had they been able to purchase the valued services in a regulated and competitive prices. Many argue the ongoing raising costs (welfare loss) passed out to buyers secondary to the ongoing monopolistic consolidations of direct (firms) and indirect (insurances) sellers in the healthcare market can only be realistically countered by consolidating consumer negotiating influence .

A publicly operated insurance plan as initially proposed by President Obama, though never passed through legislation, appeared an attractive option that would have provided significant consumer welfare by allowing more benefit derived for the amount spend for healthcare by providing more choices would have ignited new competition and efficient suppliers to thrive as well as naturally weeding out incompetent market players.

These extensive insights from literature provide a sobering reminder that while realistically impossible to conform to the ideal assumptions of ‘perfect market model’, unfortunately healthcare markets, especially in US, can easily be singled out as almost completely imperfect. The continued unwavering support to avoid regulation in our political circles fueled by ideological fantasies have further exaggerated market failures, reduced economic efficiency and further deteriorating social welfare. Though we proudly boast of the most advanced and expensive health systems in the world, but witness considerable inefficiencies as indicated by suboptimal performance on almost all established health system performance metrics.

In summary, the current US healthcare system’s structure centered around the philosophy of ‘maximizing profit’ for service providers (health systems, insurers, pharmaceuticals) at the expense of significant welfare lose to those purchasing these services (government, employers and individuals). The unsustainable failures in current health market have rejuvenated extensive soul searching in US political circles on whether healthcare to be pursued as rights issue or continue to trade it as a commodity where the sole purpose is to maximize profit and personal utility? The road towards a single payer has merits, entails a difficult journey, a fight worth fighting for.

Khurram Nasir is an Associate Professor of Medicine at Yale University and the Director of Population Health & Health Systems at the Center for Outcomes Research & Evaluation at the Yale School of Medicine. This article originally appeared on LinkedIn here.

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue? published first on https://wittooth.tumblr.com/

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isaacscrawford · 6 years

Text

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue?

By KHURRAM NASIR MD, MPH, MSc

To simply put it, one needs to ponder

1) can efficiency with no waste in production and consumption be achieved in an unregulated healthcare market conditions?

and 2) where does the health market stand on the spectrum from almost perfect to imperfect market without government regulations.

2. Transactions are impersonal with sellers unable to considerably influence consumer’s choices, especially in situations where engaged as ‘perfect’ agents.

3. Many buyers and sellers (firms) exist to influence market prices, so they are all price- takers

4. Firms (sellers) can freely enter and exit of entry the market freely without significant restriction such as from rigid regulations or entry barriers

Article source:The Health Care Blog

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pastor-matt · 6 years

Text

Our Way, A Way

Welcome to week five of our series Future Family where we have been dealing with issues surrounding families. Today’s post is going to be a little bit different because I want to address some questions surrounding parenting and provide some insights about our comprehensive curriculum that we recently purchased as a result of our FOR Campaign. When it come to the topic of parenting I will admit that I am still learning so as we explore this topic we will pull from several sources that are more experienced than I am.

As we explore this topic today we must first understand that the approach to this topic will look different for everyone. Perhaps you are from a traditional family, blended family, single parent family, or maybe you don’t have children but regardless of your situation there will be things said for all of us that will help us because we should all desire to impact the next generation because someone once did that for us. For those who have children one insight that could be very beneficial might be to establish rules or family commandments. These could include things like “Thou shall not lie” and “Honor your mother.” When we establish guidelines like these it becomes the standard or a reflection of the ideal that we discussed the first couple of weeks of this series. In regards to the topic of lying, its important because if you lie you break the relationship. In families, if you honor others, you become a hero. In the church if you help parents/families win you become a hero. We have to model this for other people not simply talk about it to them. As a church this applies because one of the first things that children observe, is how the church treats their parents. If the church empowers their parents and helps them feel supported, the children are happy. But if the church devalues their parents, the children are likely to disengage and may never come back to the church.

Maybe you want to take this a step further and establish family objectives that are based in how your children behave. These could include things like: Have enjoyable adult relationships with your children. In other words, once our children are grown we want them to want to be with us. The goal here is not to be obedient or even good but to want to be with us. Another example would be children who feel accountable to God and who seek His will for their lives. We want our children to know that God has a plan for them and we don’t want them to miss it. We need to help our children understand the voice of God, be discerning about it, and move towards it. Finally, Don’t bail, let ‘em fail. This means that we don’t protect every skinned knee or hurt feelings but allow our children to learn life-lessons. When our children are young, they can learn life-lessons about friendship and authority, when the stakes are really low. When these situations arise, you can support them entirely and march down to the school to confront the individual that hurt your child or you can ask them how they think they should respond to the situation.

Shifting gears a little bit, I want to turn our attention to the two biggest factors that shape our soul, which are rejection and acceptance. We are who we are today because of these two items and the dosage of them we have received. These two items are shaped at home by the words we use and the schedule that we choose. Perhaps there are words we used that even though they were true, conveyed a sense of rejection to our children. We probably can recall the words of our parents that fall into this category and the reality is that our children will remember this category of our words as well. To counteract this we must, decide what they need to hear and say it ten more times than you think they need to hear it. Next we need to look at our schedules and how we schedule our time. We need to examine how we spend our time and what we make a priority. Our days may feel long, but our years are so short and we need to be aware of this. We have to learn a key word in the English language that many of us are not good at saying, which is “no!”

Now let’s concentrate on the topic of discipline. There may come a time when your children do not like you or that you may be afraid of them. As you think about this topic you need to understand that later is longer. We want our children to like us later in their lives and later is longer than right now. This topic is challenging because maybe you are saying the right things and doing the right things but it seem like your child is just pushing themselves away from you. Whatever the case, I invite you to think about parenting in the following stages: The Discipline Years (Ages 1-5); The Training Years (Ages 5-12); The Coaching Years (Ages 12-18); and The Friendship Years (Ages 18+). It is important to move through these stages in order and not try to skip around to what is convenient.

As you think about the concept of discipline there are three main areas you can focus upon, disobedience, dishonesty, and disrespectful, otherwise you will wear yourself out. There is a Biblical context about discipline that I just want to point out quickly. We know that God is our Heavenly Father and He disciplines those He loves. As Christians we need to remember that God has sided with us against sin. When we sin, God is grieved because of the consequences we face and the scars we bear. However, due to the cross, we know that God has sided with us against sin. Discipline is all about reestablishing broken relationships.

One final area that I want to explore is the concept of Faith and Family. To understand this topic more fully we need to help our children understand the intersection between their faith and their decisions. As a church we are choosing to emphasize the concepts of faith and family through the utilization of the Orange Curriculum. This curriculum combines the light of the church (yellow) and the heart of the family (red) because two combined influences make a greater impact than just two influences. The two influences must work together because there are 8,760 hours in a year of which the average parent has 3,000 hours of influence and the church has 40 hours in a given year of influence.

To understand how we will accomplish this we need to integrate five central practices. First, we must Integrate the Strategy by aligning leaders and parents to lead with the same end in mind. A strategy is a plan of action with an end in mind. That means you have identified what you want something or someone to be, you use your creativity and intellect to devise a way to get there. Second, we must Refine the Message by crafting core truths into engaging, relevant, and memorable experiences. It’s not what you say, its how you say what you say. Say less more often so everyone will know what really matters. Third, we must Reactivate the Family, by enlisting parents to act as partners in the spiritual formation of their own children. Parents are looking for three simple things from the church: Give me a plan because they want a system of support, consistent influence, and a steady flow of relevant information. Second show me how it works because parents need influence just as much as children do, and they desire to be engaged in the process in a way that prompts them to take the next step. Third, Tell me what to do today. If we are going to to truly partner with parents we have to give them specific instructions or resources to use this week. Here is why this is so important: What happens at home is more important than what happens at church. Family shapes us, connects us, and influences our story. Who shaped your story? Fourth, we must Elevate Community by connecting everyone to a caring leader and a consistent group of peers. Everyone needs to be believed in by someone, and everyone needs to belong somewhere. Fifth, we must Leverage Influence by providing consistent opportunities that are created for others to experience ministry. The heart will gravitate toward whatever offers adventure and significance.

Orange thinking is just a different way of looking at everything you do. Orange thinking is not either/or but both/and. If you are thinking both/and, yo are synchronizing the efforts of the church and family around a master plan.

In regards to strategy, your key leaders are becoming both specialists and generalists who will break down silo thinking.

In regards to the message you are valuing truths that are core and evolving your style to connect with culture.

In regards to family, you are cultivating spiritual and moral leadership in parents who are inside and outside of your church.

In regards to community, you are tapping into the influence of the parent and recruiting other adults to build influence with kids and teenagers.

In regards to influence you are mobilizing volunteers to BE the church and they are mobilizing those they are influencing to the BE the church as well.

#OurWayAWay #FutureFamily #Sermon #LoveGodLoveOthers

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opalmothnightingale · 7 years

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No Moral to the Story

1- 19- 18 -

I think so much of life has no one moral for all the players. They each have their own sort of book, guide, lines, and each view is right, but none is the whole picture... And that is how I see it..

I am both fragile and strong, and I am both complicated and overly simplistic and rough around the edges...

One person’s ideas of being callous is another’s idea of a joke. One person’s idea of selfishness is another’s idea of getting their basic simple needs expressed and met. One person’s idea of harming others is another person’s idea of the essential competition for resources, not trying to take more than one’s fair share or trample people in the rush for the resources...

But,... yes, it just happens, and one reason it happens... Is because some people are so fragile, weak, slow, and what could happen?

Just like in nature, some are choked and weeded out. Fair or not, but so it might be.

And so... Yes, it’s true, if sad. I wish it was not true. But it’s true, that humans... humans, too... Yes we, too, are subject to nature and it’s laws, rude, mean, stupid, cruel, stopping for no one, ignorant, basic, driven by impulse, instinct, habit... So often...

And what can you say? It’s not objectively right or wrong, except if you see it’s really hurting someone and then their feelings are valid and need care... They need to care for their own feelings, though. We can’t always be so careful of each others’ feelings, or else there would be no clarity on what’s real, what matters, etc... Sometimes all we can do it get away, nurse our own hurt feelings, and realize that others just don’t feel in those regards, but instead it’s just as meaningless and empty and frivolous, flippant... Or maybe, reckless,... Or just, insensitive, not even registering... Not aware of how their actions or words cut people so deeply... And even if you were to try to point it out, to explain, chances are strong they would only laugh, scorn, not even begin to be understanding of the person whose feelings are hurt,... Much less change their behaviors. People in general are self-righteous and feel their way is better and everyone should act as they do and see it like they do... Forget sensitiviity to others’ ways of being and seeing things and feeling... Oh well... It only is just one more path of filtering out those who can get and respect and get along with me and my needs and my worldview,... From the many, many who cannot.

I know even though that many of my views and values are the very opposite, because I have learned not to care, not to take things seriously, not to take things personally, to see things as just nature, as just events, random or human nature, or just... like,... Life... Just... Life, and I wish that life didn’t lead us to act, see, feel insensitively but if we all live in bubbles and deny the diversity, challenges and different persepectives and experiences, that is not really a good thing, and we can’t thrive then in the array of life’s challenges, but are fragile as bubbles, waiting for it all to shatter us in the shudder of a slight wind if we can’t maintain our complicated set of conditions needed to keep our frail world safe.

Even so some people can’t help but be weak, and that is not a judgment... I am glad they can be safe in a bubble world, if they really do need it or even if they want and choose it, then maybe that is right or at least, their right... If it is not heavily borrowing what they should instead be giving... taking instead of giving... But in this life and this world of give and of take, who can say when and how we should give or take, because sometimes things aren’t as they seem. The inner world of thoughts and feelings might be hard at work, while the outer world looks to be taking, escapist... Therefore are there the spiritual ascetics who depend upon charity of others. There may be people who are like this, but aren’t officially spiritual ascetics, just doing their own deep wandering and soul searching in their own private lives, maybe that not another soul knows of... And that...

That’s what I feel I’ve been doing all along, so many years of my life, to a degree, sometimes totally swallowed for years, sometimes lost and misguided... But it felt more alive and right than to fall in line with the values and answers and paths that just felt wrong, empty and shallow and totally unmotivating, against my nature... Those paths others told me to walk, and that I even kind of believed, really tried to believe and follow, but something wasn’t flowing and I couldn’t bring myself to “live right”,.. And only now do I see that it was not right for me, and that is why I couldn’t “do right”. There is not a one size fits all moral path. We all have our own unique gifts and it’s like trying to make a wild animal bend it’s nature to fit some charitable cause... Our own human individual natures can be just as wild and unbendable, unbreakable, resistant and different from what society tries to demand from us... So I just follow intuition and feeling and passion and excitement, enthusiasm... these days,... and I feel that guides me to my true nature, much better...

Even though it has to include heart, not to much mind, and it has to include logic, not just impulsive feelings,... And it has to include convictions and not just pleasure and enjoyment... But as long as I maintain those ideas in action... And also, it has to include social giving and recieving and social stimuli... Not just solitary mental activity...

and, but as long as I maintain all those requirements and follow the need to rest when tired, do what brings me a feeling of joy, beauty or goodness, etc, no matter if others scoff or think me selfish, going as slowly as needed, taking as many breaks as needed... And, last but not least, depending on spirit guidance and alignment...

As long as I include that list of several requirements... Because, yes, I keep thinking of more.. And there might be more, still.. But that is a general idea, starting point, guidelines... Off the top of my head..

I need special conditions, to just keep from sinking and getting lost and it’s not some easy, pat answer like “follow your passion” as the sole guidance, like people like to hear and say, but I need many caveats to that statement.

Still it’s not THAT complicated, and I can do it, even on my sick days, and loneliness, overwhelm, disillusionment, confusion,... Etc... If I do remember all these requirements, I can make it pretty well, for me, most days... And this is my moral path and path to wellness...

It’s all starting to fall together, somewhat because the critical mass of it makes it like that what addresses one problem also addresses this other one, and this other one, and all these other problems, because with a holistic life and holistic complex healing that affects and is affected by many levels...

So it is. A huge, complex set of hurdles and issues to overcome and deal with and balance... But also,... A huge set of achievements, blessings, cures that are also the keys to thriving, joy, the answers to life’s meaning... Strange how that is... It’s still complicated and has sub-areas, not one single big “critical mass” that addresses it all, all at once, immediately... But just,... many things falling into place and rippling their affects across many areas of my life...

Like diet, what foods address certain ailments often address other ailments, so addressing one health issue often starts to address others, if not totally address them... Like a puzzle all coming together, overlapping, building in from so many angles and even weaving in and out an emerging unexpectedly sudden big images you didn’t even know were going to be there... but are there, all the sudden, as you heal and do this and that to help your life problems,... But still it can fall apart, the pieces all precariously connected, easily scattered... Like perched children’s blocks, knocked easily down by carelessness and insensitivity...

So I just wish that I could make my world more safe, whole and together and keep the level of achievement to function on a half put together, work in progress kind of life and world.. But I’ll do the best I can,...

I feel I am getting closer day by day but the days might still number such a huge sum that it might feel absurd and like some trick of fate or trick of god on me.. I’m the joke. Thanks so much,... But that’s life for you. It’s not so personal and one on one, caring and saving you in time as you want and understand... not necessarily.. Not for me, so far, try however hard and well and whatever as I can, try to be good, try to be aligned, etc, but to no avail that I can see, yet... Still waiting for it all to fall together...

I guess.

So it’s good enough,... Because,...

because it has to be. Thank you for this day.

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jeromechill1 · 7 years

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Does Evidence-Based Medicine Imply Utilitarianism?

In this blog I want to explore the question of what moral values underpin or justify the practice of evidence-based medicine (EBM). For example, we might be interested in patient outcomes, patient choice, economic factors, public health, or a combination of these. It matters because this provides the standard for evaluating the success of EBM, and informs us about how we can make EBM better. In particular, I want to respond to a recent paper by Anjum and Mumford on ‘A philosophical argument against EBM’ [1], which argues that the values underpinning EBM inevitably collapse.

According to Anjum and Mumford, “the policy side of evidence-based medicine is basically a form of rule utilitarianism” (p1045)

Utilitarianism is the view that, when faced with a moral dilemma, we ought to act according to which of our options causes the greatest amount of overall wellbeing or happiness, and the least amount of suffering. Rule utilitarianism specifically looks at which rules, heuristics or policies are able to do this, rather than looking at each action individually [2]. In the context of medicine, this means we should aim to create healthcare policies which promote the best standard of health for the greatest number of patients.

An important aspect to this approach is that these policies do not always create the best possible benefit for the patient. In some cases, the guidelines will be ineffective. For example, a given treatment may be recommended in general cases of patients with an illness, but in the case of a particular patient we know it would be harmful. It’s just that having this policy in place for all patients is worthwhile overall. How we respond to such scenarios poses a problem for the rule utilitarian.

Here, we might still say that the treatment recommendation is a good guideline (because it maximises patient health) but in this case, it would seem unethical to prescribe the treatment in the knowledge that it will cause harm. We therefore probably want to say that even good evidence-based guidelines have exceptions. However, this risks compromising the whole point of rule utilitarianism – if we have a set of rules which determine how we should act, but we can contradict or find exception to these rules whenever we need to, what’s the point of having those rules at all? It seems we haven’t said anything that won’t dissolve back down into the more general utilitarian principle of maximising health, regardless of what rules/policies we create [3].

One response that Anjum and Mumford suggest is to look at EBM policies not so much as ‘rules’ for how to act, but rather ‘codes’ for how we can act [4]

This way, policies which are based on EBM can offer us guidance for how a practitioner should act, but nonetheless require a practitioner to use their own judgement and common sense in applying them.

I want to respond to this paper by contesting the authors’ initial premise that EBM implies a kind of rule utilitarianism. I would suggest that, if we seriously look at our medical policies, conventions and laws, the picture is in reality far more complicated than this.

To see why this is the case we need to bear in mind that utilitarianism is not the view that ‘consequences matter’. Everyone cares about what the outcomes of their actions are, and pretty much everyone agrees that it’s generally better to cause happiness rather than suffering. What makes utilitarianism unique is the view that only these consequences matter, meaning there are no values that should influence our actions other than the impact that the action will have on other peoples’ lives. For example, this suggests that there is nothing wrong with lying, coercion, torture or manipulation, except for the fact that they can have bad consequences.

Whether these non-utilitarian values should have any significance from a moral perspective is beyond the scope of this article.

What I do want to demonstrate, is that the practice and justification of many medical policies (including EBM ones) implies non-utilitarian values. Consider the following scenario…

An adult patient requires medication for a fatal illness that they are at significant risk of contracting. However, due to their religious beliefs they refuse to take this medication because it contains an ingredient derived from animals. This refusal is clearly bad for them – they have a high chance of dying if they don’t take the medication. A week after the patient saw her doctor and refused to take this medication, she has a small accident and is taken to hospital unconscious.

In a stroke of luck, the same doctor who saw her a week before is passing her ward. The doctor knows the patient’s medical history and knows there is no chance of the patient having an adverse reaction to the medication which she refused. The doctor (a utilitarian) decides to take the opportunity, while the patient is unconscious and while there are no other patients around, to administer the medication to her, without her consent. The doctor has done something good for the patient – she has potentially saved her life, and there is no chance of being found out.

I hope we would agree that in this case the doctor has done something unethical. She has clearly ignored the patient’s own wishes and values, violated her right to consent and openly deceived her. Of course, a rule utilitarian could always avoid stating the uncomfortable conclusion that the doctor was ethical by deferring to policies – it’s better for everyone if we have policies and regulations against doctors deceiving patients, for example. This conclusion seems pretty unsatisfactory however. This suggests that the only reason this doctor’s actions are unethical is because she has violated hospital regulations. There would be nothing wrong, in this view, with creating a law which allowed doctors to deceive patients if only it had desirable consequences for the overall health of patients.

The values of honesty and consent seem to run far deeper than merely pragmatic rules or regulations

What’s ultimately at issue here is the patient’s right to decide how to live her own life – according to her own values, judgements and preferences, which may not always align with a medical model of what a healthy patient looks like. The role of the doctor is not to decide on a set of desirable outcomes for the patient and enforce them on her; rather, it should be to help the patient to determine her own ends, insofar as her health affects this.

These non-utilitarian values also play a role in the literature on EBM specifically. For example, an article from the Evidence-Based Medicine Working Group in 1992 defends EBM on the grounds that it gives patients a clearer understanding of their prognosis, diagnosis and treatment/s [5]. According to their argument, deferring to clinical intuition or expertise, risks leaving patients “in a state of vague trepidation” about their health prospects and choices. By contrast, the openness about evidence which EBM encourages, offers the patient a more transparent picture of their expected outcomes and options. EBM in this way doesn’t just aim at increasing positive utilitarian outcomes, it can also have benefits from the perspective of the patients’ rights, autonomy, and choice.

References

[1] Anjum RL and Mumford SD. A philosophical argument against evidence-based policy: Philosophical argument against EBP. Journal of Evaluation in Clinical Practice. 2017,October;23(5): 1045–1050. doi:10.1111/jep.12578

[2] For an explanation of the difference between act and rule utilitarianism see: Utilitarianism, Act and Rule | Internet Encyclopedia of Philosophy

[3] This is a version of an argument by Smart. Smart JCC (1973) An outline of a system of utilitarian ethics. In Utilitarianism: For and Against (eds J. C. C. Smart & B. Williams), pp. 1–74. Cambridge: Cambridge University Press.

[4] Hooker B. (1995) Rule-consequentialism, incoherence and fairness. Proceedings of the Aristotelian Society;95:19–35.

[5] Guyatt G, Cairns J, Churchill D, et al. Evidence-Based Medicine A New Approach to Teaching the Practice of Medicine. JAMA. 1992 November;268(17):2420–2425. doi:10.1001/jama.1992.03490170092032

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kristinsimmons · 6 years

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Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue?

By KHURRAM NASIR MD, MPH, MSc

To simply put it, one needs to ponder

1) can efficiency with no waste in production and consumption be achieved in an unregulated healthcare market conditions?

and 2) where does the health market stand on the spectrum from almost perfect to imperfect market without government regulations.

2. Transactions are impersonal with sellers unable to considerably influence consumer’s choices, especially in situations where engaged as ‘perfect’ agents.

3. Many buyers and sellers (firms) exist to influence market prices, so they are all price- takers

4. Firms (sellers) can freely enter and exit of entry the market freely without significant restriction such as from rigid regulations or entry barriers

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue? published first on https://wittooth.tumblr.com/

0 notes

kristinsimmons · 6 years

Text

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue?

By KHURRAM NASIR MD, MPH, MSc

To simply put it, one needs to ponder

1) can efficiency with no waste in production and consumption be achieved in an unregulated healthcare market conditions?

and 2) where does the health market stand on the spectrum from almost perfect to imperfect market without government regulations.

2. Transactions are impersonal with sellers unable to considerably influence consumer’s choices, especially in situations where engaged as ‘perfect’ agents.

3. Many buyers and sellers (firms) exist to influence market prices, so they are all price- takers

4. Firms (sellers) can freely enter and exit of entry the market freely without significant restriction such as from rigid regulations or entry barriers

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue? published first on https://wittooth.tumblr.com/

0 notes

kristinsimmons · 6 years

Text

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue?

By KHURRAM NASIR MD, MPH, MSc

To simply put it, one needs to ponder

1) can efficiency with no waste in production and consumption be achieved in an unregulated healthcare market conditions?

and 2) where does the health market stand on the spectrum from almost perfect to imperfect market without government regulations.

2. Transactions are impersonal with sellers unable to considerably influence consumer’s choices, especially in situations where engaged as ‘perfect’ agents.

3. Many buyers and sellers (firms) exist to influence market prices, so they are all price- takers

4. Firms (sellers) can freely enter and exit of entry the market freely without significant restriction such as from rigid regulations or entry barriers

Failing Healthcare’s ‘Free Market’ Experiment in US: Single Payer to the Rescue? published first on https://wittooth.tumblr.com/

0 notes