Life and Death Decisions

One of the concerns that people express about reforming health care is that the government will be making end-of-life decisions.

First of all, for the majority of people facing these issues, the government is already involved through Medicare.

But for those facing these issues before they reach senior citizenship, consider the following:

(o) Most medical protocols require the involvement of medical ethicists in making these decisions, as well as others. So ethical guidance is usually provided.

(o) Private insurers are already making these decisions, and they’re not always in favor of the patient. Consider the case a couple of years ago, in which Aetna (it might have been Cigna) refused a liver transplant to a young woman, claiming it was experimental. Their former Director of Communications later admitted it was merely a cost-saving effort. Although public pressure forced the insurer to reverse its stand, such a situation was exceptional.

(o) Doctors make these decisions on-the-fly in emergency rooms all the time, often without consulting either the insurer or the patient, because of a lack of time.

All of that said, all of the proposals on the table for health care reform preserve the right to private insurance, if the patient so wishes. What it does, however, is ensure that the patient has coverage for pre-existing coverage, and won’t lose it should a serious condition continue.

On the witness stand before Congress, the leaders of the major insurance companies could not promise that they would do that without being forced to by law.

In other words, for those of you worried about preserving your options, just remember—under the current system, your options can be dropped the moment some number cruncher in the insurance company decides you’re too expensive to insure.

As David Brooks wrote in his Friday column in the New York Times, it's time to overhaul the system.

Worried about Health Care Reform

I am very worried that health care will not pass. When you've known people who had their insurance dropped immediately after a cancer diagnosis, gone bankrupt as a result of health care bills, or gone without care because of the cost, it's heart breaking.

I am similarly worried about the mis-information about the Canadian health care system that's been portrayed in the US. Although it's not perfect, it costs a lot less than health care in the US and people live longer. That might be because of the cold weather, but it might also be because health care isn't that ineffective.

Check out this backgrounder on how one national health care system works:
http://economix.blogs.nytimes.com/2009/07/07/how-does-canadas-health-system-actually-work/#more-20175

And contrary to popular belief, research by some of the best health care policy researchers in the US has found that Canadians are NOT crossing the border in large numbers to use the US system.

http://content.healthaffairs.org/cgi/content/full/21/3/19

And paying the hospital and emergency costs of the uninsured drives up costs for everyone.

The Online Learning Component of the Obama's Community College Proposal

One key component of the Obama proposal for community colleges is online education.

Here's the paragraph from the proposal:

· New Community College Bill Includes Significant Online Education Component: Create a New Online Skills Laboratory: Online educational software has the potential to help students learn more in less time than they would with traditional classroom instruction alone. Interactive software can tailor instruction to individual students like human tutors do, while simulations and multimedia software offer experiential learning. Online instruction can also be a powerful tool for extending learning opportunities to rural areas or working adults who need to fit their coursework around families and jobs. New open online courses will create new routes for students to gain knowledge, skills and credentials. They will be developed by teams of experts in content knowledge, pedagogy, and technology and made available for modification, adaptation and sharing. The Departments of Defense, Education, and Labor will work together to make the courses freely available through one or more community colleges and the Defense Department’s distributed learning network, explore ways to award academic credit based upon achievement rather than class hours, and rigorously evaluate the results.


If I read this correctly, the courses will come from a centralized source--meaning that each college won't develop its own courses but, rather, will access them from a central source.

And if my understanding of that is correct, that has the potential for a significant centralization of learning content which, of course, has other implications.

To see the entire White House proposal, visit
http://www.whitehouse.gov/the_press_office/Excerpts-of-the-Presidents-remarks-in-Warren-Michigan-and-fact-sheet-on-the-American-Graduation-Initiative/

Community Colleges Get Some Much Needed Attention

While everyone was watching the Sotomayor hearings, worrying about the secret reveal in the season finale of "The Bachelorette?" or just enjoying summer vacation, the White House announced a plan to significantly increase aid to community colleges.

According to Time's Laura Fitzpatrick, "President Barack Obama made a historic announcement on July 14 -. . . but you'd never know it from the crickets in medialand. CNN and Fox devoted no live airtime to the speech, which Obama delivered at Michigan's Macomb Community College, while MSNBC cut back to the Sotomayor confirmation hearings partway through. "

The New York Times' David Brooks lauded the bill, commenting both on the low status of community colleges, and the unsung, workhorse role they play, all the same, in the larger educational system. Among their many benefits is their potential to have significant impact on graduates' salaries.

But that's only if students at community colleges graduate, which the majority don't. So that's one of the problems that Obama proposal addresses. One solution: online education (which I'll tackle in the next post).

Nearly all of the press is noting the Rodney Dangerfield ("I Don't Get Any Respect") characteristic to community colleges. But for so many students, they make a lot more sense than university. As significantly, many university students who graduate with degrees in fields where they cannot find employment end up going to community colleges to learn practical skills that leads to a paying job.

Whether the proposal will be passed is another story. According to the news reports, funding will come from savings in a revamp of the larger student loan program. But that revamp has the government cutting out middle people who make a lot of profit on student loans, and who are fighting the proposal. If the student loan restructuring fails, then the community college proposal is in danger.

To see the entire White House proposal, visit http://www.whitehouse.gov/the_press_office/Excerpts-of-the-Presidents-remarks-in-Warren-Michigan-and-fact-sheet-on-the-American-Graduation-Initiative/.

To see Laura Fitzpatrick's column in Time, visit http://news.yahoo.com/s/time/20090715/us_time/08599191047200.

To see David Brooks' column, visit http://www.nytimes.com/2009/07/17/opinion/17brooks.html?ref=opinion.

Understanding the Other Point of View

In his column in the New York Times July 12, 2009 this week, Frank Rich writes about Sarah Palin’s base constituency. Demographics might be working against them, but they’re loyal, angry, and loud and, as a result, efforts to lampoon her just might backfire.

Read the full column at http://www.nytimes.com/2009/07/12/opinion/12rich.html?ref=opinion

Moving onto the Next Thing

Although some of us are still waiting to Google to make its all-in-one voice-e-mail box available in Canada (a huge boon for those of us who have several many voice and e-mail accounts but just one set of eyes and ears), the press has moved onto Google’s latest project, an attempt to build an operating system.

For example, in the July 12, 2009 New York Times, Miguel Helft writes about the new project, as well as its role in building, and implications to, cloud computing. (Read the entire article at at http://www.nytimes.com/2009/07/12/weekinreview/12helft.html?ref=weekinreview.)

The operating system sounds good enough for the majority, but the product really only works with Net-connected PCs. What about people in remote areas or who have limited web access in other areas (not just for issues of coverage, but also of cost)?

Maybe Something Is Broken

In “Survey Shows Gap Between Scientists and the Public,” published in the new York Times, July 9, 2009, Cornelia Dean describes a recent Pew Research Center study showing a wide gap between what scientists and the public believe about global warming and evolution.

For example, although nearly all scientific evidence supports the role of humans in global warming, a large part of the public is still skeptical of that, and some members of the public don’t even believe a global warming problem exists. The study reports similar differences on evolution.

This gap between the research community and the general public isn’t news to anyone who has been following it. For example, Rynes, Colbert, and Brown report a similar gap between the evidence unearthed by researchers and the beliefs of practicing professionals in their 2002 article in the journal, Human Resource Management, HR Professionals' Beliefs about Effective Human Resource Practices: Correspondence between Research and Practice.

In that article, they also raise the concern that editors of professional magazines in the field are similarly uninformed of the research, and have gone on to publish articles whose central theses are contradicted by the research evidence.

Part of the problem might come from differing interests. For example, in their 2007 article in Human Resource Management Review, An Examination of the Research–Practice Gap in HR: Comparing Topics of Interest to HR Academics and HR Professionals, Deadrick and Gibson compared the topics covered in academic journals and professional magazines on human resource management and found little overlap among the two.

But their conclusion, paraphrased, simply suggested that practicing professionals should pay more attention to research.

Perhaps the research community is ignoring the problem that’s staring us in the face; that our models of communication are broken. Advance online publication, like that described in a Scientific American editorial in 2006 (and reported by Geoff Hart in the newsletter of the Special Interest Group on Scientific Communication of the Society for Technical Communication) is a start, but we need to find a way to (a) help the public better understand the role of evidence in scientific communication, (b) distinguish strong from weak evidence, (c) take an interest in keeping informed about developments in science, and (d) bring along the popular and professional press for the ride.

No small order.

Read the complete New York Times article at http://www.nytimes.com/2009/07/10/science/10survey.html?_r=1&src=linkedin

(And by the way, watch for an upcoming article of research that I led that explores the extent to which training and development professionals read research literature in the Canadian Journal of Learning and Technology. The article is ready for publication; just waiting for it to appear on the website. (http://www.cjlt.ca/index.php/cjlt)).

Opportunities in Writing How-to Videos

I saw this article about how-to videos in the New York Times this week. Although the article focuses on howcast.com, the article notes that several sites feature how-to videos, including (a quick Google search turned up several, including wonderhowto.com, expertvillage.com, videos.about.com, and monkeysee.com).

As a technical writer and instructional designer by training, it’s nice that people are finally seeing the value in this type of material.

And for you future producers of how-to videos, the article suggests or implies several interesting teaching points:

(1) Interest in instructional content in everyday life is strong. A belief exists that users are interested. Businesses definitely are interested.

And for you guys—some of these companies are willing to pay a little bit up-front for content, as well as a share of future ad revenues should the clip become a hit.

Downside in terms of content: subject matter can be a bit on the trivial side and attention span for these informal videos is probably short, 3 to 5 minutes.

(2) Cost issues: Web-based videos are cheaper to produce than traditional ones. It’s not just that the cameras are much cheaper; video production can now occur on a typical computer (instead of souped0up ones) and can produce acceptable, commercial quality. Implications: lower prices for instructional videos (which were already at the lower end of the market to begin with).

(3) Ethical issues: when a company produces online educational content, how far do they go to promote their brand? In some cases, it’s essential (see discussion of Nescafe Gold, which also suggests that “intuitive” products aren’t always intuitive, and that intuition has a cultural dimension.) In some cases, brand promotion needs to be minimized.

Read the full article at http://www.nytimes.com/2009/07/12/business/12howcast.html?_r=1&hpw=&pagewanted=all

Updating the Traditional Conference

In, Twice the Work, Half the Pay, Martha C. White describes the impact that the sharp drop-off of the conference market has had on conference planners, who earn their income from commissions on the meals, hotel rooms, and other services sold at these events. (Tasks that meeting planners handle include ordering the catering and making sure everyone is served; reserving meeting rooms, specifying how those rooms should be set up, and ordering the audiovisual equipment--and making sure that everything is set up and running properly; and coordinating registration and signage at the event.) With orders down by 50 percent and more, commissions are drying up. Read the story at http://www.nytimes.com/2009/07/07/business/07meetings.html?em.

This loss of opportunity in face-to-face conferences creates opportunity for online programming. Consultant Mitch Joel describes how organizations are trying to integrate online connections into their programming. His article can be viewed at http://www.montrealgazette.com/business/Real+virtual+conventions+together/1725270/story.html.

To be honest, however, many organizations in the field of training have been experimenting with online formats for years. For example, ASTD (www.astd.org)has been offering regular webinars for at least 7 years. The publishers of TRAINING magazine (www.trainingmag.com) have offered online certificate programs since 2004. The e-Learning Guild (www.elearningguild.com) has been running online symposia since the same time, and began offering webcasts before that.
in 2007, Tony Karrer (working with others) launched a week-long online "fest" that was preceded and followed by online discussions, included a number of live events during the "fest" week, and included lots of social networking. Jay Cross was among those in leading the followup event in 2008.

In my opinion, one of the things that's important about what's going on with training conferences is that people are experimenting a lot with them. What's sad is that, for the most part, people are not publishing what they're learning through these experiences, so there's little chance to share the lessons learned.

Does Job Re-Training Work?

I saw an admittedly disheartening article about the poor results of job retraining programs in the New York Times. People are attending retraining programs, but the majority aren’t finding jobs in their new fields (and if they are, they’re not staying in those jobs for a long time).

The problems seem to stem from a few issues. First, these programs don’t address some of the challenges that arise when a person who has had a lifetime of employment in one industry try to work in a different one (a problem not only for the worker but of convincing hiring managers that the worker is worth hiring). Second, the data on which workers base their decisions about which fields to study is not completely reliable. Last, a weak and unpredictable economy has not produced any jobs in many fields; opportunity will not open up until the economy does.

Although looking at the issue from a different perspective, the findings in this article are similar to those of a study I read about in the mid-1990s, in which researchers compared the employment prospects of low-skilled workers who went to a several-month-long training program with those who merely went to a one- or two-hour resume writing workshop. Researchers found little difference in results among the two groups.

On the one hand, I work in the education industry, so on an instinctive level, I believe in the value of an education. Furthermore, I work in career-related education, so I believe in that, too. On the other hand, I do not have a blind faith. An education in a professional field alone does not guarantee someone a job. The job has to be there and, if it is, employers need to be willing to hire the candidate.

Much of the problem described in the New York Times article, however, results from the failure to properly identify what job skills will be in demand. Given the unpredictability of the economy, not sure how to fix that one.

Read the entire article at http://www.nytimes.com/2009/07/06/us/06retrain.html?_r=2&hp.

Culture Wars?

If the recession can be responsible for anything positive, perhaps it’s the quieting down of the culture wars. In a recent Week in Review piece for the New York Times, Sam Tanenhaus provides evidence of this quieting down.

No real reasons are given, though many can be proposed, including the currently visible favorites like the implosion of the Republican party to the well-documented differences of priorities of younger voters.

But perhaps the recession is the reason. With many people out of work and wondering how they will meet expenses, perhaps attention is being focused on more fundamental issues.

Read the entire article at http://www.nytimes.com/2009/06/28/weekinreview/28tanenhaus.html?ref=weekinreview.

Big Businesses Mentors Small Ones

In a recent article in the New York Times, reporter Elizabeth Olson described a unique program in which large companies mentor small ones in reaching a level of stability and health. One of the ways that prospective protégés come to the attention of the mentors is when they unsuccessfully bid on contracts for the large companies.

On the one hand, I have always expressed concern in a blanket belief in the power of mentoring. In many ways, it’s like dating and the success rate of formally arranged mentor / protégé relationships, especially ones with no other structure and preparation provided, matches that of blind dates.

On the other hand, I have also always believed in the power of mentoring when all of the stars are aligned, as they seem to have been in the cases described in the article.

Read the entire article at http://www.nytimes.com/2009/07/02/business/smallbusiness/02sbiz.html.

Could Michael Jackson Be Michael Jackson Today?

An opinion piece in last week’s New York Times suggests why Michael Jackson, the pop culture phenomenon, is a product of his times and, in today’s media market, could not repeat itself.

At first, I agreed. But the more I think about it, it seems that the most successful celebrities today have found several pathways to their audiences. Think of Beyonce, who—in addition to her singing—dances, acts, models, and even has a fashion line. What the current media landscape means, however, is that attaining celebrity requires more work for less attention.

Read the entire article at http://www.nytimes.com/2009/06/28/weekinreview/28segal.html?ref=weekinreview.

How the Canadian Healthcare System Actually Works

And for those of you who are interested in how Canada’s health care system works, check out this recent posting at the New York Times online.

(What is not explained here, however, is why do I have to read an American newspaper to find out how my Canadian healthcare system works?)

For the full description, visit: http://economix.blogs.nytimes.com/2009/07/07/how-does-canadas-health-system-actually-work/#more-20175

A Canadian Perspective on Canadian Healthcare

As Americans debate a new system to pay for health care, you’re hearing a lot about the Canadian system.

So I thought you might be interested in this editorial from the Montreal Gazette, “Americans being misled about our health care.”

Admittedly, the Canadian system isn’t perfect. But neither is the American system. And the bottom line is indisputable: In terms of Gross Domestic Product (GDP), Americans pay much more for their healthcare than Canadians, and Canadians live longer.

For the complete article, visit http://www.montrealgazette.com/opinion/Americans+being+misled+about+health+care/1754554/story.html