US Healthcare

I’ve been in Europe for a couple of weeks now and I keep getting asked about US Healthcare. It’s in the news every day and everyone seems to have an opinion. Here’s a fact that I think many of us need to accept.

If you are gainfully employed and enjoying the benefits of a solid PPO insurance plan, it is unlikely that you can maintain your current quality of care and level of access to care as the nation moves to a better solution for everyone. If you are unwilling to budge on this, then you are part of a problem that cannot be solved. (Yes, my family enjoys PPO coverage and yes, I am willing to downgrade our care to meet the uninsured in the middle.)

Please note that I am very similar to some of you imaginary readers in many regards. I support free markets, I favor small government, and I do not wish to create public support programs that encourage a lazy life of free loading. However, we need to get the overall costs of healthcare under control and when about a third of our citizens cannot seek care for emerging problems, we have no choice but to treat them when they arrive at an expensive, emergency state of poor health. If we can get everyone access to earlier, routine care, then we can control costs and work toward improving standards going forward.

If that is Socialism then I guess I am a socialist when it comes to healthcare.

Just to finish that point. I am a capitalist in general and I agree with the old adage “capitalism is the worst form of economic structure except for all the others that have been tried”. Nonetheless, I don’t think that a pure free market yields good care for all. In fact, a free market is only designed to yield spoils to the winners; only the successful get BMW’s, the adequate get Honda’s, and the losers join the lazy and the unlucky on foot.

For automobile’s, this works fine and everyone gets where they are going eventually. For healthcare, the consequences of “poor performance” in the market can be both dire and immutable; a bit of structure is required to keep the population at its healthiest and most productive. That is best for all of us.

WWDS Rreaders on US Healthcare

Now that the comments have died down on this one, I am summarizing here what I think were the prevalent themes voiced by the readership:

1. The biggest problems are "lack or personal responsibility" and "overall costs" with the former driving the latter in many ways.

2. Personal responsibility ain't gonna happen. But education might move some in the right direction.

3. Another driver of costs is the fact that they are unconstrained by usual market forces because neither the consumers nor the prescribers of US healthcare are paying for it.

4. Requiring everyone to buy insurance (i.e. contribute to the overall pot of funds covering the nation's care) may be a solid step in the right direction. The impoverished will need subsidies.

Note: of the 45 million uninsured, about 15 million can easily afford coverage but choose to save the money and rely on emergency room care as needed and about 15 million more are eligible for Medicare or Medicaid and simply have not signed up. The real problem is the final 15 million (about 5% of the population).

5. While there is no requirement for employers to offer health plans, it seems to be a reasonably effective tactic for attracting talent and can also keep a workforce healthy and productive. However, any suggestion that employers be "required" to offer medical coverage seems out of place.

6. Thomas Jefferson, a democrat, apparently wrote the mantra for today's republican's. I totally agree with Jefferson's philosophy but I do think healthcare, like infrastructure, must be organized on a mass scale.

7. Some whipper-snapper out there thinks I'm old and another whipper-snapper has no rental insurance.

The Art of Concision...

"I didn't have time to write a short letter, so I wrote a long one instead."  - Mark Twain

"Everything should be made as simple as possible, but no simpler."         - Albert Einstein 

I am stuck between Twain's "too long" and Einstein's "too simple".          - Too Much Den

Next month, I will begin my 19^th year as the President of a cognitive analytics company. It’s a job that has challenged the full extent of my creativity, my problem solving acumen, my sub-par diplomatic skills, and my general tendency to persevere through challenge. On the whole, I think I have earned passing grades, with one possible exception.

I am not exaggerating when I say that, on the majority of the nearly 7,000 days that I have held this job, I have devoted some portion of my day pondering how best to tell the story of what our company does. Now, I think I have at least average communication skills, and I have devoted immense effort to this problem, but somehow, I’ve not yet constructed a satisfying version of our story that is both lucid and concise.

The long version, that makes our commercial proposition clear and compelling, is too detailed and too boring for most audiences. The short version leaves most wondering what it is that we actually do. I’ve never found the middle ground that balances the two approaches.

Part of the problem is that our story is not simple. To appreciate it, one must have a smidge more than a cursory grasp of the US healthcare system, of inferential statistics, and of human cognition. However, squeezing together even a single sentence about each of these diverse and complicated topics makes for a necessarily complex plot.

I am writing this blog entry while preparing for an investor presentation and wrestling with this very problem. I am hopeful that a momentary diversion, a brief interlude with my imaginary readers, might finally shake into place the right series of thoughts, the precise words and statements that explain why our business is valuable and important.

Mark Twain implied that “time” was the key ingredient for brevity in composition, but after 18 years of trying, I’m not so sure.

    

Putting the BS in BCS

Contributed by Auggie
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I was once asked by a foreigner, “why do American colleges have sports teams - isn’t the purpose of college to get an education?” This is a good question, and as I searched for an answer I simultaneously tried to discern their objective for asking. Was this an honest attempt to understand American culture, or a sarcastically delivered rhetorical question meant to imply it’s an idiotic tradition? I believe the language barrier scrambled the normal cues and I never did discern the questioner’s true objective. I answered it anyway. I tried sounding educational but smattered in a defensive tone just to cover the sarcastic scenario if that was indeed their angle. I rattled off something about college being an opportunity to experience many aspects of life and grow in different ways, and when sporting was becoming popular college was an ideal environment for young men and women to compete with people of similar interests, ages and skill level, and how it has evolved over the years to where it is now. Blah blah blah.

I still don’t know why the person asked, and I still don’t know the answer, but this much I do know: College football has become far too important to far too many people. I need only to look at the last two weeks for examples to explain my view.

Exhibit A: According to recent reports Congress was set to review and vote on a bill that could potentially end the current BCS (Bowl Championship Series) method of determining a college football national champion and force a playoff system instead. That would be the U.S. congress in case you are wondering. This boggles my mind - if one member of congress wastes 10 seconds on this issue its 10 seconds too much. Just to clarify - its college football!!! I don’t mind paying my fair share of taxes but I was kind of hoping our representatives would focus on other key issues of the day like the ongoing wars, the state of our economy, healthcare, energy etc. - and stop worrying about college football!!! (Italics mean I’m yelling).

Exhibit B: Alabama has cancelled classes for three days because its team will compete in BCS championship game against Texas on January 7th. The message: football is more important than academics. Apologies to the students paying top dollar because they want an education – there will be no refund for the lost days.

Exhibit C: Brian Kelly, the head coach for Cincinnati this past season just accepted the position as Notre Dame’s new head coach. [Quick background: Kelly just coached the Cincinnati Bearcats to an undefeated regular season and they are now preparing to play Florida in the Sugar Bowl. If Texas had not defeated Nebraska last week with a last second field goal – after the referees added one second to the clock at the end of the game - it would be the Bearcats playing the Alabama Class Cancellers – I mean Crimson Tide, for the national title]. So my first thought when I read the news about Kelly was “how will this affect his preparation for the Sugar Bowl?” Silly me, I now understand it will have no effect at all because he left Cincinnati so fast the door didn’t even graze his butt. I realize this example doesn’t exactly fit with the two above; after all, any of us are free to switch jobs whenever we want and employers are free to unceremoniously dump us in similar fashion. We all make decisions that are in our own best interest. But whatever happened to the old 2-weeks-notice rule? You know, common decency. Kelly’s announcement left some of his former players in tears, and why wouldn’t it? They worked hard all year to go undefeated and earn the right to play in one of the biggest bowl games in school history, and he can’t be bothered to hang around a couple more weeks and help finish the deal. Why? Because college football is soooooooo important that he must immediately get to Notre Dame and start laying to groundwork for returning that school to its rightful elite status. In football I mean.

Look, I’m a huge sports fan and usually find myself defending the sports world against naysayers, but college football just needs to simmer down. Of course, I could be wrong.

On 50 Trips Around the Sun...

This is a list of 50 reflections from my particular 50-years of life, which may or may not overlap much with anyone else's particular experiences. For imaginary readers in a hurry, it more or less sums up into this 5-word philosophy that seems to work for me: Work Hard. Be Kind. Repeat.

On Social Structure

1. Every kid grows up in a world significantly changed from the one in which their parents grew up. This is the source of an inevitable, cultural, age gap.

2. People tend to live at the very peak of their economic means, with every penny committed and no room for disruption. This creates great stress, but few are able to resist the habit.

3. Now I see people living at the top of their logistical means, with every spare moment committed and no room for disruption. I think this is equally, if not more stressful.

4. I think I understand the evolutionary benefits of “tribe-loyalty” that led to modern fan loyalty to sports teams. However, given how the players move from team to team, I don’t understand why it persists.

5. Travelling the world is a great way to develop perspective. So is staying in your hometown and cultivating life-long relationships. These two paths may result in different sensibilities, but one is not superior to the other.

6. The selfless soccer mom seems, on the surface, to sacrifice everything for her family. In my view, many of them selfishly undermine their own communities in their efforts to gain personal advantages. More thoughts on soccer moms here.

7. As the saying goes, “Capitalism is the worst economic system in the world, except for all the others that have been tried”. That quote is a veiled endorsement for the American way, but capitalism has some serious flaws and promotes inequality.

8. Disparity in wealth is the world's most pressing issue, and is the number one source of unhappiness and conflict.

9. If I had been born on the other side of the border, I would cross it illegally to get better education and healthcare for my children. As I've written about Mexico, it boggles my mind that not all parents agree, but then again, point 25 might explain this.

10. Division of labor gave society a great leap forward. But it came with a price. Now, self-sufficiency is not possible.

11. Work is the constant in the structure of our social lives. Even if you have enough resources to eschew full time employment, the best course might be to stay employed. Winning the lottery has wrecked many otherwise fulfilling lives.

On Attitude and Perspective

12. Life is not fair. If you want it be fair, then start by treating others fairly. It will still be unfair, but at least you did your part to help, and did not contribute to the inherent unfairness at large.

13. I suspect that some people go long stretches in their lives without thinking much about how well their actions reflect their values. I think it is probably worthwhile to reflect often, maybe even continuously.

14. You cannot save time, you can only spend it. If you don’t think very carefully about what is important to you, you may not spend your time wisely.

15. A majority of great accomplishments come from those who are singularly focused. Such unbalanced people have been important in history. But I think I’d rather be balanced.

16. If you don’t like someone, you may not know him or her well enough. It is relatively easy to accept someone’s offending behavior once you understand the personal experience that has shaped it.

17. You should take some calculated risks in your life, but don’t be reckless with other people's hearts.

18. Every body thinks they are good at reading people. In fact, one of the traits that makes us human is an astounding ability to perform mental accounting, consider another person’s actions, and draw conclusions about their motives. We’re all good at it.

19. Almost nobody is as good at reading people as they think they are. And few are really any better then everyone else. Adults commonly under-estimate the complexity and nuance of the people they know.

20. There are no dumb people. Not everyone is smart in the same ways but everyone has their strengths. Not all strengths are equally valued in every society, but they’re still intellectual strengths.

21. Carrying a grudge is a burden you choose. Letting it go is probably a better choice.

On Human Nature

22. I hate the way people seek confirming evidence, and ignore contradictory evidence, with regards to the things they want to believe. Not sure why humans cling to favored ideas at the expense of understanding the truth.

23. When traveling abroad, it is easy to notice the cultural differences from country to country. I have always been more struck by the glaring similarities among people the world over.

24. I think people are too uptight about privacy. We should all protect our identities and credit cards, but worry less about a supermarket tracking our purchases and a web-browser tracking our online movements.  More on privacy here.

25. We all have things in common, but everybody is different. You just need to accept it. YOUR logic, even if impeccable, is not likely to change THEIR nature.

26. Truism: What doesn’t kill you makes you stronger. You really do need to struggle and be challenged if you want to learn and grow. Confidence never comes to the over-protected, nor does conviction.

On the Cycle of Life

27. Heroic end of life care doesn't make sense to me, especially if the quality of the remaining life will be poor. Why extend poor quality of life?

28. I think we should honor and cherish old people much more than we do. If we did, old age would be a more inviting destination.

29. The constant battle against aging is a futile effort and might not be waged so vigorously if we could all see the tremendous value of perspective that only aging can bring.

30. If we could more consciously appreciate the brevity of a single lifetime, accept the aging process, and embrace our own inevitable mortality, life perspective would improve. We would have less angst as we age, and less sorrow/regret when we lose our elders.

31. Species appear on earth, thrive or struggle, and then disappear. This terminal track record for all life forms has been clear and unblemished. Humans will also become extinct one day. Our time on earth is brief in the scope of ecological time.

On Religion

32. To the extent that organized religion fosters community and promotes kindness, I am all for it. Not sure why it always gets tangled up in the concepts of creation and the afterlife.

33. Faith can be a great positive force and I am happy for all that have it. But I’m not sure we should brainwash our children to believe; probably best if they come to believe on their own.

34. If there is a god, and if he’s all-powerful, then he’s not benevolent. All-powerful means you can teach lessons without tragedy and suffering.

35. “God works in mysterious ways” translates into, “I want to believe so badly that I am willing to ignore all the suffering”.

Random Reflections

36. Reading fiction is very educational. The stories may be specifically untrue, but good writing can efficiently fill your brain with new perspectives.

37. Multi-tasking is about the most over-rated “skill” I can imagine. In fact, there is no such thing as multi-tasking, there is only a continuum of distraction that one might tolerate while performing a single task.

38. For many of us, the sound of birds has been a common source of background noise for all of our lives, and tuning it out is natural. But it is free music for the soul if you pause to listen.

39. I really hate waste born of laziness. It is a despicable, and all too common, human trait. More thoughts on waste here.

40. Achieving a world-changing accomplishment in one lifetime is difficult and unlikely. If you want to impact the world, your best bet is to raise confident, conscientious children who are well grounded and who care about others. Your kids are your final report card.

41. The pen is absolutely mightier than the sword. Violent defeat by the sword will not change the attitudes that initially led, and will lead again, to conflict. Shaping underlying attitudes with the pen, through dialogue, is the path toward lasting change. More on why speeches matter here.

42. If you can only be known for one thing, be known for being kind. Show your kindness to those least able to repay you.

43. Don’t underestimate the power of punctuality. When you show up late, you basically signal that you don’t respect other people’s time. That’s usually a bad thing to signal.

44. You should know what you stand for, and you should stand for it consistently. Even if it is in a small, subtle manner that no one else notices. You will know.

45. Driving courteously is a great stress reliever. This works for you and for the recipients of your courtesy. But, as written here, over-courteousness can be a problem.

46. Don’t be afraid to do something for nothing. This is one of my father’s sayings that took me many years to appreciate. If you don’t appreciate it yet, keep trying.

47. Rereading a book you enjoyed the first time is almost always a surprising delight. You only have one chance to read a good book for the second time.

48. Having alternative personal choices is better than having no personal choices. But in terms of ultimate happiness, having only a few choices is best. Decisions become burdensome when too many alternatives are at hand. Earlier I wrote about the angst of high-schoolers with too many choices.

49. Even though we all know how boring it is to hear someone brag about his or her kids, you should brag about yours anyway.

50. Despite all the reasons why it makes sense, I don’t like the philosophy of living in the present. Your present is most appreciated in the context of the past, and hopefully, it is a product of the plans you made when it was your future. I prefer to spend some time in all three time zones.

A Sad Comment on Humanity

You can probably guess from the title what this post is about. That's right... Home Owners Associations.

I know this topic may not resonate with all imaginary readers, especially those in rural areas where the specter of these repulsive Associations is less pronounced. But this blog is for me to spew my opinions, and I happen to have one about the human shortcomings that lead to the existence of HOA's.

I find it odd that the human species evolved to thrive using social strategies, such as community agriculture, healthcare and education, yet individuals cannot live near one another without paying a full-time board of referees to resolve their disputes. And I use the term "dispute" lightly because, in this case, it includes grave matters like agreeing on what types of plants each neighbor can have in their yards, what color they can paint their front doors, and whether or not they can build a deck in their back yard. Thorny topics indeed.

There's an economic principle at the heart of the matter; the idea is that your home is more of an investment than it is a place to live, and you cannot risk the value of said investment without having some reassuring authority regulate the appearance of the neighborhood. Clearly, if Clarence down the street does not cut his grass on a regular basis, his unkempt yard could negatively affect the curb appeal of every nearby home. Possibly true, definitely absurd.

I did a quick search and learned (see for yourself: HOA statistics) that about a quarter of all Americans (including me) now live under the iron fist of an HOA. Sadly, we collectively pay nearly $100 billion per year in dues for this oversight. The average family among us pays between $200 and $300/month for the privilege of an Association that writes down how all disputes should get resolved and then steps in when anyone questions the rules.

Now, I'm no math major but I know this. The UN estimates that we could end world hunger with $116 billion (makes me wonder why we haven't done that yet, but I'll save the topic for a blog on another day). According to my calculations, we could take HOA fees for less than 14 months and completely cover the world hunger bill. Sure, if we stopped funding the HOA's, someone in your neighborhood might paint their front door a "property-value-reducing" shade of purple, but that seems like a reasonable trade-off for ending world hunger.

The unequal distribution of wealth in the world is a major problem, probably humanity's biggest current challenge. However, as I suggested in my post about relative wealth, we don't really seem very focused on reversing it. In fact, we seem much more focused on accelerating the disparity. HOA's are a visible symbol of people with a fair degree of wealth, going to great lengths, to ensure that no other person negatively affects their ongoing accumulation of even greater wealth.

The whole concept is a sad comment on humanity.