“Stress” interviews: hiring by humiliation

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Job interviews are rarely a pleasant experience but the one Olivia Bland recently endured appears to have been particularly hideous. The 22-year-old graduate says she was left in tears at the bus stop after a two-hour grilling by Craig Dean, the boss of a tech company in Oldham where she had hoped to become a communications assistant. In a letter to the company turning down a job offer, which she posted on Twitter, Bland complained that Dean had called her an “underachiever”, torn apart her written application, asked personal questions and even criticised her music taste as he scrolled through her Spotify account. The interview, she wrote, felt like “being sat in a room” with her “abusive ex”.

One point of view:  Interviews are meant to be “robust and challenging”, to reveal the best candidates. Bland deserves credit for bravely speaking out, but her response will have reinforced the view of many that “the default position for privileged middle-class millennials is to paint themselves as victims who would rather turn to social media than wake up to a real world that’s often stressful and unfair”.

Another point of view:  Experts are divided about the effectiveness of the “stress interview” concept.  Some believe that deliberately unsettling candidates can reap useful insights into how individuals cope with pressure and approach problems. “But virtually all agree that using any level of derision and humiliation is unacceptable and outdated.”    (drawn from:  Peter Rubinsten, BBC News; James Moore, The Independent; Amanda Platell, Daily Mail; and The Week 13 Feb 2018).

My reaction:  At one time I had 120 employees.  Half of running a business is motivating the employees; the other half is keeping the customers.  Neither can be done by bullying, because the above account is just that- bullying.  An interviewee comes before you nervous to start with.  Upset them and you yourself have blown the interview.  Aside from that you want the new staff member to look forward to joining, and setting to with enthusiasm.  No, the Epicurean employer treats his/her staff with respect.  Making a success is a team effort.

Medicare for All?

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The current, hugely expensive American health system absorbs 18% of U.S. GDP and leaves nearly 30 million people uninsured and another 40 million underinsured with large deductibles and copays.

A surprising study by the Koch brothers- funded Mercatus Center shows how, under Medicare for All, every single resident of the U.S. can be guaranteed good-quality health care at an overall cost that is nearly 10% less than our current system — savings that can translate into lower health-care costs for both households and businesses.  Average businesses that cover their workers will lower their costs by 8%. Middle-class households who now buy insurance on their own will see a savings of 14% of their income. That is, their net income will rise by 14% through Medicare for All.

On top of these cost savings, no American will ever again be uninsured or have to fight with an insurance company for coverage or worry about having to cover co-pays or deductibles while living on a tight budget;  or live in fear of a family member getting sick and facing bankruptcy as a result.

The study also considers in depth how to provide a Just Transition to people now employed in the private health insurance industry–providing them with retraining, relocation, job placement, as well as direct financial support as the country moves away from our existing private health insurance system.

The study reflects the reality of every other similar economy in the world: guaranteed healthcare for all with no barriers to care. This saves lives and costs less.   However, I also have to  report a figure $32 trillion of extra Federal government expenditure  over 10 years  under the Sanders bill as currently written.  This has caused the debate to get roiled in arguments about government expenditure rather than benefit to the economy and to general health and medical cost reduction.

The study was peer-reviewed by a group of eminent experts on the subject. One of the reviewers, Professor Jeffrey Sachs of Columbia University, concluded that, “This study is the most comprehensive, detailed, authoritative study ever undertaken of Medicare for All, and it points powerfully and unassailably in support of MFA.”.      (The Costs of a National Single-Payer Healthcare System” by Charles Blahous,  Mercatus Center,  George Mason University).

My comment: a government dedicated to shrivelling the role of government is never going to let Medicare for All become reality.   There is no benefit to the rich in extending tbis idea to the poor, just higher taxes. Already the knives are out .  In todays New York Times there is an article by the very moderate David Brooks entitled  “The Impossible Medicare for All”.  Watch while a positive idea about helping ordinary people, struggling with health costs, is savaged and disposed of.

Medicare in America

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The top 1% of Medicare patients account for 20% of the total cost of Medicare. The top 5% account for 50% .  This is the greatest threat to the US government finances, scarcely discussed, after the profligate funding of futile foreign wars.  And now the huge Baby Boomer population is starting to have a threatening effect on the cost of Medicare, potentially blowing the budget, just as Republicans are planning to reduce taxes!

The high costs, to be fair, are caused by a moving population of people with serious conditions, who cost a lot for a few months , then revert to “normal”, that is, if they don’t die in hospital.  But there are some patients with chronic conditions of multiple co-occurring conditions who are treated for months.  The doctors dare not end the treatment for fear of legal challenges, and relatives won’t let the sick person go.  The taxpayer is stuck with the bill.

It will come as no surprise to learn that the very people who advocate spending less on the poor through Medicaid, are the biggest consumers of publically funded Medicare, ready to call a lawyer at a moment’s notice, and eager to fund research into ever longer lives for themselves – as long as they don’t have to pay for it out of their own pockets.

Surprisingly, under Republican rule,  seniors will have to pay a larger share in 2018 for Medicare the richer they are ( as defined by their 2016 Federal tax returns).  Higher premiums will be paid for both Medicare Part B and Part D for individuals with modified adjusted gross income which exceeds
$85,000.00, and married couples with joint incomes above $170,000.00.  (I have tried to understand the Medicare website setting out the new arrangements, but it is written by an illiterate and, to me, it is incomprehensible.  I will not try to list the new rules because you won’t probably understand them either).

The point is that there is a segment of the (well-off) population for whom no amount of public money is enough to keep them alive.  Rationing is anathema for them, but reducing even basic healtthcare for the poor is apparently fine by them. It is one thing to help someone recover from acute injury, but long-term cognitive impairment should be a matter for intelligent discussion between doctors and family.  Keeping alheimers patients alive at all costs is cruel to everyone ( I have personal experience).  End-of-life is end- of-life.  If relatives want to extend it, they should make a major contribution towards the cost, not expect the taxpayer to pay out with no end in sight.

And yet…and yet…. Americans are under the illusion that American medical care is the best in the world, even though US life expectancy is lower than  all the other OECD countries.

Tomorrow: Medicare for all?

A passage worthy of Epicurus and appropriate for our roiled-up times

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“There are among us still those who would deny to others the right to hold a different understanding of the fundamental issues of our time.  Thus, if we look around us , we see dogma still in conflict with rival dogma; we see people of one culture or belief at odds with their human neighbours who are of a different culture or belief; and we see many who are prepared to act upon this difference to the extent of denying the humanity of those with whom they differ.  They are prepared to kill them, and other innocents, in the process, in order to strike at those whom the perceive to be their enemies, even if these so-called enemies are, like them, simple human beings, with families that love them, and with hopes and fears about their own individual futures.

( A long-dead person returning to visit us) “would recognise those self-same conflicts and sorrows which marred his own world and made it such a dangerous place….He would, I suspect, say that much has remained the same; that even if we have put some of the agents of division and intolerance to flight, there is still much evidence of their work among us.

………..” Let us remind ourselves of the possibility of combating, in whatever small way we can, those divisions that come between man and man , between woman and woman, so that we may recognise in each other that vulnerable humanity that informs our lives, and makes life so precious; so that each may find happiness in his or her life, and in the lives of others.  For what else is there for us to hope for? What else, I ask you, what else?”

( An excerpt from Alexander McCall Smith’s book “At the Villa of Reduced Circumstances”, pages 56 and 57.   McCall Smith is the author of the wonderful series  “The No.1 Ladies’ Detective Agency” .)

 

Physician- assisted suicide: the attitudes of doctors are changing, slowly.

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Polls show that many Americans think doctors should be allowed to help terminally ill patients end their lives.

The AMA’s Council on Ethical and Judicial Affairs spent two years reviewing resolutions, not so much on whether to support the practice but on whether to take a neutral stance. On 2018 the council recommended that the Code of Medical Ethics “not be amended” and continue to refer to “physician-assisted suicide,” saying that language still “describes the practice with the greatest precision.”

Doctors showed strong support for the status quo, a  position that is increasingly at odds with public opinion.  Polls show that many Americans think  doctors should be allowed to help terminally ill patients end their lives.

Among doctors some argue that physician-assisted death should be a choice for patients who are already dying and want to end their suffering on their own terms. Those on the opposing side contend that such assistance violates one of the core principles of their profession — do no harm — and could become a slippery slope to euthanasia. There’s even disagreement about how to characterize the practice. Opponents say terms such as “aid in dying” are euphemisms that obscure the harsh reality, while proponents see “doctor-assisted suicide” as stigmatizing patients who choose it.

“This is not just a medical issue,” said cardiologist Thomas Sullivan, an AMA delegate from Mkassachusetts who agrees with the recommendation for no change. “This is a social issue. This is a moral issue. This is something that many, many people are faced with from time to time, when your own parents or your own children or your brother or sister or you are faced with a terminal illness.”
Neurologist Lynn Parry, a delegate from Colorado, said she will vote to reject the ethics council’s stance and ask it to spend more time “looking at what protections for physicians, and particularly for patients, would need to be in place” for the AMA to amend its guidance.
“How we look at the universe is really driven by our personal belief system and, in large part, by our philosophies and religious beliefs, and that’s as it should be,” she said.
Her state is among those that allow physician-assisted death. Oregon led the way with a 1994 ballot measure, followed by Washington in 2008 and then Vermont, California, Colorado, the District and Hawaii. A court case established the legality of assisted death in Montana. (California’s 2015 law was overturned by a judge last month, a decision that is being appealed.)

John Radcliffe, right, who was diagnosed with cancer in 2014, watches as Hawaii Gov. David Ige signs a bill in April to legalize medically assisted suicide.  (Sophia Yan/AP)
The practice drew intense national attention in fall 2014 after a terminally ill woman named Brittany Maynard moved from her home in California to Portland so she could utilize Oregon’s Death with Dignity Act. The 29-year-old had been diagnosed with a Stage 4 brain tumor — glioblastoma, the same aggressive cancer that Sen. John McCain (R-Ariz.) is battling — and was told it would kill her within six months. She instead set her own timeline, taking a fatal dose of barbiturates that November.
Half a year later, a Gallup poll found nearly 7 out of 10 Americans surveyed said doctors should be allowed to assist terminally ill patients in ending their lives — a notable increase from 2014.
David Grube, a retired family physician from Oregon and national medical director for Compassion & Choices, calls the current AMA policy “antiquated.”
“ ‘Do no harm’ leads to a lot of harm in medicine,” he said, with “people on breathing machines for months and all kinds of things.” He considers the “enemy” to be terminal suffering, especially the cases where doctors can’t ease patients’ pain. Since his state passed its law, Grube said, “more people haven’t died, but fewer people have suffered.”
But doctors are still debating it.
“I just do not believe that in the medical profession, which at its core is about protecting the quality and quantity of life, we should become the agent by which we hand them a prescription so they can choose the exact time and moment of their death,” said M. Zuhdi Jasser, an internist and primary-care physician who serves as an AMA delegate from Arizona.
Jasser, who presented the resolution to maintain the term physician-assisted suicide, said he plans to vote for the association to hold firm.
“The big question that I think physicians are going to be dealing with over the next five, 10, 15 years as more of these states legalize it is: Are our ethical guidelines and core principles going to be determined by cultural shifts and by popular vote or populism,” he said, “or are they going to be things that we adhere to and hold on to regardless of the shifting winds of populists’ concerns?”. (Washington Post, June 10 Lindsey Bever?