Susan Rice Article

As this story rapidly begins to unwind, I have to wonder about poor Susan Rice. For the first time in her life she gets the opportunity to address a national forum and elevate her creds and national visibility in order to move to her next career milestone.

I wonder if she ever asked herself, “Why is Hilary not doing this?” Was she so caught up in the moment that her ego prevented any cogitation? Did she really believe that her ‘friends’ in the #ObamaNation were recognizing her abilities and finally giving her, her just desserts? Did she believe that she was finally getting her payoff for years of blind support and obedience to the cause?

The real question I have is, was Susan just used as a fool or was she a co-conspirator in this attempted fraud? No longer the subject of conjecture, even the main stream media has seen their blood pressure raises a few points over this one and begin to ask the critical questions peeling back the layers exposing the depth of the fraud. Clearly this was a political calculation.  While some seem to want to infer the blame rests with Hillary in an attempt to preserve a presidential run it the future.  That also belies common sense and style. Hillary  Rodam has a much more deft touch than this ham handed machination. I think Axelrod should be called to the Congressional hot seat as this has his fingerprints all over it.

This is not Watergate, it is doesn’t even rise to the level of some of the affronts to truth that came out of Tammany Hall back in the day. Yet it is disturbing, or it should be, to us as Americans, that our government would so bend the facts for no other reason than political gain.

We are a gracious and understanding people. We will allow fact bending for national security, we will even allow fact bending for our own peace of mind but we do not tolerate fact bending for individual or group gain. Regardless of Ms. Rice’s role in this, as fool or conspirator, she no longer should have any shot at a position of national trust. In the end this is sad, as despite her apparent ego and self adulation she appeared to be a dedicated and intelligent woman.

Perhaps in the future she will choose her friends a little more carefully!

Click to access the Original Article by John Gonzales

John M. Gonzales reporting for the California Healthcare Foundation Center for Health Reporting wrote a must read article called, How the U.S. tax code will drive Obamacare implementation, starting April 15. I strongly suggest all read it.

The negative effects of Obamacare on costs and care were immediate, and the ongoing negative effects are just starting to be disclosed and to build. Yesterday, I participated at a Health Care Summit put on by the Business Times. Panelists were the top healthcare professionals in CA and included; Bernard Tyson (incoming Chairman and CEO of Kaiser Permanente), Lloyd Dean (CEO Dignity Health), Darryl Cardoza (CEO of Hill Physicians Medical Group), Janet Widmann (EVP of Blue Shield of Ca), and Paul Fearer (Board Member of Covered California)–California’s new Health Exchange.

I will be writing an in depth article about the summit and the various areas discussed, in the next few days on my blog. This posting is to act as a summary. Each of these professionals agreed on the perceived benefits and mostly on the worries over implementation. One of the main theses was the need for collaboration in healthcare.

Overall my impression of the meeting was, while the panelists did a good job of describing some of the superficial issues of healthcare and the concerns they have about the approach Obamacare takes to solve them, they still are still working within the myths of the existing so-called healthcare system and not addressing the fundamental problems of the non-system we have today, nor did they discuss how Obamacare does not address one of the fundamental problems in the current non-system. Indirectly at least one of the panelists did allude to the issues in the existing structure when he said that if they were working from a clean slate this is not the system they would design.

One surprising revelation for me was that many of the quotes of historical context were simply wrong. They were repeats of many of the mythical justifications used during the debate. The discussion of the cost of care was noted but with no context applied. One panelist attributed the rise of Employer Sponsored Insurance from a change in tax code in 1943. This is not correct the rise in ESI came from a company founded by the same founder of a company chaired by another participant of the panel, Henry J. Kaiser—Kaiser Industries. IF not for the National Recovery Act Henry Kaiser would likely not have employed the idea he pioneered when building the Grand Cooley Dam. It was Henry J. Kaiser and his strong relationship with F.D.R. that led to the change in the tax code in the first place. While this may seem like a minor nit, it is the context of these changes that lead to many of the myths in the systems we have today. This is one brief example there were many more.

One participate mentioned that the cost to build a 500 bed hospital was in excess of $2 Billion. That equates to a cost of $2 million per bed. Assuming 100 percent fill of that bed over the 20 year initial life of the new hospital would equate to a payment on principal of $273.00 per day just for the construction and equipment. This does not include interest, personnel, licenses, insurance, utilities, maintenance, etc. To repay the cost of the bed over the 20 year life of the bed, the hospital will need to generate about $341,250.00 in services per year per bed. So every time we build beds we need to stimulate much more in services to pay for them and we wonder why the cost curve is not going down.

While another panelist did mention that Healthcare costs were equating to 20% of the Gross Domestic Product (GDP) and this was a rising problem. But once again the fundamental of the point was left aside. If you visualize healthcare costs/utilizations on one side of a teeter-totter, and our economy/business competitiveness on the other. You have an inverse relationship. As we stimulate more care, or better put as we stimulate the expectation for more free employer care on the one side, our ability to sell goods and services to other nations drop correspondingly. In fact our ability to sell the same goods and services to our own people drop just as precipitously without subsidies—which have the same effect. The more care we expect and are provided the less competitive we are, the bigger our international trade deficit grows, the less we can afford to buy, etc…

Most of the participants noted the concern over lack of available providers to deal with the influx of new covered patients, but they did not address the issues over Medicaid and Medicare reimbursements that are driving the current providers to stop seeing these patients. They did briefly note the issues of cost shifting as one reason why premiums are going up. Remember the Presidents new budget is counting on another $250 billion in Medicare savings. This is to come from reductions in reimbursements. This does not sound like much in the vacuum that is the healthcare debate in America. We need to recall that there is a $750 billion so called Medicare reduction that was once again postponed during the fiscal cliff fix. This is now a $1 trillion reduction in reimbursements if we are serious about the savings we count on to reduce the fiscal deficit. And do anyone believe that providers will shoulder a $1 trillion reduction and see these patients? It is a zero sum game here.

None addressed the problem with the current health care spend as to how the dollars are being used. Notably, they did not talk about the waste in the areas of fraud and abuse, and unnecessary or duplicated services or what was being done to address these issues. The discussion of collaboration could have been interpreted to alluding to how to deal with the 60 cents on the dollar wasted issue, and there was some discussion about the ACO model helping but I do not think the panel either addressed the fundamental problem nor any solution overall. It may be good to note that numerous studies both governmental and non-governmental all show that for every health care dollar spent, approximately 60 cents is lost to fraud and abuse and duplicated services, caused by defensive medicine on the one hand, and lack of real patient centered coordination of care and benefits across all providers on the other. The studies disagree on how it breaks down but that is irrelevant as a requirement for full coordination of care and benefits across all providers and payers would go a long way to eliminating a large part of both issues. The side benefit is it will not just eliminate cost but will free resources to see this large influx of newly covered patients.

Finally, the Member of the Board for Covered California unfortunately disturbed me the most. Much of his dialogue seemed to me to be way off the mark and filled with ideological myths as opposed to pragmatic reality. He spent a good bit of time reducing expectations as to how many people will be covered initially and perhaps at all. Some of his answers seemed misinformed as to how the ACA works but to be fair there was not an in depth discussion. One statement made was that Covered California would reduce the roles of the uninsured by 10%. This is a paltry realization of the goal as defined in the ACA.

According to the ACA we have between 35 and 50 million uninsured in the US today. California has a significant portion of them. The percentage of the population that is uninsured is between 10 and 12%. To reduce the 10% by 10% yields a 1% reduction in uninsured. We are spending north of $3 trillion for this? And remember the 35 to 50 million uninsured will soon become 50 to 75 million uninsured if what is being discussed in Immigration reform actually happens. Of course this is assuming that the population of undocumented aliens is not already getting the care (A big assumption despite the rhetoric.)

One participant said more than once that the current system is not the system we would design if we started from scratch. I wanted to yell, “Why the hell aren’t you designing from scratch?” as we do not have a system in the first place. This is exactly what is necessary for the industry to do, and they better begin it quickly. By 2015 the horse will be out of the barn and the industry will have no say in its own system under Obamacare. But due to the problems the government is having today with implementation of this disjointed, conflicting and agenda driven legislation there is a window for a real alternative. The industry still has a brief opportunity to redesign itself and get ahead of the train wreck that is coming.

But then I am not a conspiracy theorist.  But I can see how people jump to that conclusion.  There are no less than 10 articles today with basically the same headline that Microsoft and Windows 8 is a flop because it did not stop the erosion of PC sales and PC and Laptop sales are slowing as mobile devices like phones and tablets, convertibles or hybrids, take over the space.  Usually, the article goes on to quote all the supporting data to show that PCs are not selling as well and that people are moving from PCs.  The intimation is this is all Microsoft’s fault and that Windows 8 therefore is a flop because it has not reinvigorated the PC. They could just as easily blame Microsoft for not singlehandedly fixed healthcare and the economy at the same time.  But the basic premise is false in the first place.

There is an old journalistic technique, I use journalist loosely here, that says you can hammer someone to show them you’re the boss by setting up a failing premise and then tying the failure to an unrelated but conveniently associate-able event.

This is the case with Microsoft and Windows 8.  The premise that Windows 8 was made to somehow have PCs stave off Mobile devices is ludicrous in the extreme.  Windows 8 was built to bring a new, faster, and smaller footprint system that strongly incorporated touch to gain share in this emerging market from iPads, iPhones and other android devices.  It by happenstance provides and improved, faster and more efficient system for PCs as well, but you won’t hear that from the pundits.

The migration from PCs to mobile devices has been in process for a while. What has limited the trend is that mobile devices still did not offer the features, functions and required benefits that laptops and PCs had. But, in concert with Moore’s Law, they have reached that point. One of the last hurdles was ubiquity of access and usability. I had a PC, iPhone and iPad, and for the life of me I was not able to edit spreadsheets, documents and PowerPoint very easily and have the available easily on each device. I have good friends with Macs and they have reported the same issue. For me, Windows 8 has been the first system that really has done this.

These same pundits will tell you how Win 8 is not Win 7 or Win XP.  Of course it’s not.  For years some of the same pundits have been begging MS to move from that legacy restricted platform to a new system.  Now that that is happening, and I guess because Microsoft did not kiss their rings and get their blessings beforehand, their big complaint is it’s not the legacy system.

While some critics will tell you that the adoption rate is horrible, and no one likes it.  They have tens of millions of users of the new OS in a few months and most of the people I know that are learning it and using it are very happy with it.  Even some of the initial pundits who trashed it have now come back and said, well I said it sucked at this but… now that I know how to use it I like it better.

So why do many of these publications have a hard case for Microsoft?  Why are they trying to hurt Microsoft?  Well it likely goes back a long time.  Microsoft has not played the same game as Apple and Google and some others and spent a lot of money to ”support” these publications in all their many event based money making schemes.  Yes Microsoft does sponsor events but over the past years they have likely found that it doesn’t really bring as good a return.

Also this media, like all the rest of the media, has its own form of liberal bias.  It shows in the treatment of closed systems and open systems, in cool systems vs. utilitarian, in companies with liberal agendas and those with more conservative roots.  I often think Microsoft is now the tech GOP, Apple is the tech DNC and Google wants to be seen as a tech Libertarian in public, but behind the scenes wants to be a harsh capitalist.

If you read the number of articles I do each day on Windows you find a lot of people hammering how Win 8 is a flop, sux, is buggy, slow, won’t work on a PC, and doesn’t have a start button and much more.  You will also read about all these features that Windows 8 does not have.  But if you read the few, unbiased articles you will see the exact opposite.  Also if you buy it, take a week to learn the interface and the key commands, you will find that it is a very good next generation OS.

Finally the last thing I find fascinating, is I read an article today about Facebook’s Home system, released today.  The reviewer says its a good first attempt and that while its missing some things Facebook will be diligently updating and adding features quickly so it’s a good idea in process.  Yet when it came to Windows 8, it was weak, missing all these so called necessary functions, and Microsoft was going to have to update it often and it was such a poor showing from Microsoft to release such an inferior product and push users to have to rely on updates to gain what anyone would see as the minimum required functionality.

I have reviewed Windows 8 on the MS Surface RT (panned by the pundits), Windows 8 Phone (panned by the pundits) and my PC, Laptop and Workstation (again panned by the pundits).  And I have found every single one of them superior to the Windows that went before, feature rich, efficient, stable, and functional and a pleasure to use.  I also have found it is the first truly integrated platform that works across all my devices in the same way so I can create or edit a document, spreadsheet or PowerPoint doc on any one of the devices and access it seamlessly from any one any time if I use the built in SkyDrive storage.  I have one device that is ultimately the most portable (Windows 8 Phone), one that is highly productive with 12 to 14 hours of constant battery life (MS Surface RT,) and one that gives me the horsepower for animations, 3D graphics, System Development, photography, music whatever (Workstation or PC.) The testament is that I have not used my laptop since 1 week after I have Windows 8 on my Surface RT. While overall I like the new systems there are some things that could be better…  Wait a minute… Hold the phone… I guess I need to change my whole opinion and…

In pundit speak, say Windows 8 sux! (For those that don’t always follow that was tongue in cheek!)

Recently I have been wondering how we have arrived at the point where our desire for unfettered, and unlimited access to health care is rapidly outstripping our ability to pay for the care we desire. Our understanding of our supposed healthcare system is so specious that the myths of our expectations far outweigh the reality of the system we think we have to deliver it. In fact, we have built an entire culture of props and supports around patently false beliefs that underscore everything we expect and require from healthcare. To a great extent we are obsessed in ever increasing ways with youth, good health, quality of life, and other personal life experience based desires. In addition to healthcare, we have huge consumer industries, neutraceuticals, vitamins, fitness and nutrition, focused on the promise of fulfilling unrealistic expectations of what we think we can expect if we just spend more. And despite all of our own personal experience we continue to believe some miracle cure is out there if we just spend enough.

Less than a century ago this was not the case. People did not have such expectations from healthcare. Today we believe with proper care we can live long lives. In fact, if asked many believe that technically they should “soon” be able to live almost forever. I mean why not? After all everyone deserves to live as long as they want don’t they? Our grandparents and great grandparents didn’t think so it turns out. As you move back in time, people expected to live shorter and shorter periods—mostly because they died much earlier. In the early 1790s the average life span was late 20s to early 30s. By the 1820s, the average life span had increased to about 48 years old. But by the 1850s again the average life span had once again declined to 29 years old—due in large part to the industrial revolution. By the 1970s we were at about 73 years old average life span, and today we are at about 83 years old. And as we have added these years to our collective lives, so too we have added costs. Not just the cost of food, housing and survival, but the cost of the things we need to continue to not get killed by our own life experience adds up as well. Today 85% of what we can expect to spend in our entire life on healthcare will be spent in the last five years of our lives. Some estimates suggest that 50% will be spent in the last five days alone.

Just a half century ago few people did not expect to live that long. They worked, they saved for a day when something bad would happen to them in order to protect their family. They expected to die. Their best hope was that it would not be a violent death or long lingering death. In those days, long lingering deaths were not as common place, as many people died from diseases more rapidly and often earlier in their lives. If they had not died by their mid-20s they likely were going to die suddenly from accident, fire or catastrophic illness. For those that did end up with a debilitating disease, often the cure was what killed them long before the disease had much of a chance to.

People, were intimately familiar with death. People saw death on a regular basis, often up close and personal. It was as much a part of life to them as birth. Birth and death were the bookends of a life well lived. When people died they were missed. Death was mythical, and life was reality. To better understand the context of death, people were closer to their god(s). Religions tend to be a key nexus for the ritualization of death to bring closure, rationalization and explanation. Unexplained or not, death then was more easily accepted. It was part of the perceived natural order. Mourning was more about the person than the event of death. Death was feared, but so too were many other things regularly seen in day to day existence. Things we take for granted today, caused significant fear. Fire, storms, lunar and solar eclipses, birth defects, diseases, and strange events like static electricity, instilled fear. The fear of death was in good company. Life itself was a string of unexplainable, irrational, fearful events.

That brings me to today? I see a much different picture of death. In fact, I think for many it is a much more horrifying concept—one that is almost irreconcilable for many people. We no longer actually see much death and we long to explain and understand it. Many of my friends have never seen a dead body. And the few that have, have seen them in the most defined and ritualized form in funeral homes, in repose in caskets posed as if in perpetual sleep. For those with religious affiliations they deal with death in context of their own religious rituals. Some religions find death as a celebration; others as a time of sorrow and mourning. For those with no belief in a higher order, death is either a big unknown unable to be reconciled or nothing more than a biological process leading to some assimilation of the body’s energies and life forces back to nature. Most people today that I know are significantly afraid of death.

I do not know if it is fortunate or not, but I have seen death a number of times. I have been there when some have died and I have also worked in the funeral business, dealing with the un-pleasantries of the process of death in both its peaceful and violent forms. For me, this has brought an understanding of the naturalness of death and dying and a realization that the abstraction of the mode of death, whether violent or peaceful, while significantly coloring how we perceive a specific death is unchained from death itself. I also have developed an appreciation for the role of religion and ritual in helping ease the fear of death and the loss of loved ones. For me I believe this has been a very good thing, as I don’t believe that I fear death. In fact, I would say I am curious as to where death’s path leads, if anywhere. However, I must admit that I do hope that the existentialist, Jean Paul Sartre, is not correct. If he is, I also understand that I will likely never know!

In writing The History and Evolution of Healthcare in America, I spent a lot of time thinking about the myths that we have developed regarding, what medicine can deliver, what technology can deliver and how far we are willing to go to disconnect cost from the equations. We now do this very well, all the while rationalizing why someone deserves some thing when it comes to healthcare. Most of the things we believe about our healthcare system are crap. And, the biggest problem is that the people that tell these things to us, mostly, know they are crap but they have convinced themselves that they are necessary to tell—important for us to believe in order for us to continue to live in blissful ignorance and preserve the status quo. It’s almost as if they believe that if they were tell the truth, then the myths will fall apart and we will all recognize that no matter what we are going to die! Oh my, woe is us, we are all going to die!

I guess, this is the key point. Nothing, not one bloody thing is ever going to stop us from dying! If we get shot, and are transported rapidly to emergency care, and the EMTs and the Surgeons all pull off miracles and we live a bit longer, you know what? We are still going to die. And that, as they say, is that! The best thing we can hope for is to find something that will delay the immediate cause at hand for a bit more time. We have become quite good at this over the past 1oo years or so. We can delay the date of death, over, and over, and over throughout our lives. I likely would have died a half dozen times already not that many years ago if it was not for these advances. Having my neck ripped open by a dog when I was 6, kidney stones, an infection here and there, an allergic reaction to penicillin, and then another to sulfa-mycin. I have been in a bad car accident with a major concussion, had a few bouts of other illnesses and take cholesterol lowering drugs, that I am led to believe without I may have croaked by now. I have had two sons both with major medical issues both of whom are now alive and kicking and effectively can reproduce the species if they are so inclined.

The questions none of us want to ever ask is, at what cost? At every step of the way someone has paid for these things. Early on in my life my father had old fashioned indemnity insurance. Some of the catastrophic stuff, like the dog bite was covered, but much came out of his own pocket, or from whatever savings he had socked away for just that unexpected need. I know that the reaction to both penicillin and sulfa were covered by someone else, but do not know who. Later, these things were covered by either HMO, or PPO based coverage mostly through employer plans. But still they cost a lot of money. My second son was born premature and believe me his care cost a whole lot of money. And while insurance did cover part, it by no means covered all. I was not making great money in those days but I paid as much as I could, and providers worked to forgive quite a bit as well. In the end we survived to life another day and perhaps reproduce the species.

But money is not the only cost. Another uncomfortable question we need to ask is, what cost to the human species? Evidence is now overwhelming that we are getting weaker as a species. People that would have died in their early years from infections, metabolic deficiencies and other problems now easily grow to adulthood and have children. They can then reproduce the species, and these children are now more likely than not to have the same problem and pass that susceptibility on to their offspring, in other words to the human genome. And in the end, it is clear that this is not good for the species. We are becoming more dependent on artificial means to survive and reproduce. There is a rising incidence of infertility, potentially deadly infections, obesity, chronic disease and other problems, yet we are able to continue to delay our date with death, find a mate and have children.

It simply costs us much more to live the longer that we choose to live. And, we have so acclimated ourselves to the belief that we are deserving, or entitled, to whatever care we want for whatever standard of care or quality of life that we want, we do not even acknowledge or notice the cost. But, it is the cost that will kill the current system. There is simply no way we can sustain the path of indeterminate and unattainable expectations regardless of systemic cost to us all. We simply cannot get everything for nothing anymore and expect that somehow our collective economy will support it all.

But what do we do about it? How do we systemically address it? Do we put the onus for survival back on the individual or to we collectivize survival and place the cost on the whole system? Do we continue on the path we are on, knowing that we are building a weaker species, more and more dependent on artificial costly methods to continue to reproduce and survive or do we begin to make decisions that are for the good of the species? Do we continue to make decisions based on our heart, like not allowing genetic based manipulations as a form of treatment that would be inheritable and improve species viability because we are afraid of the development of a master race or some economic inequity that will drive species survival?

Long ago we began the process of removing ourselves from natural selection! I guess in the end, the question is who will win? Us or Mother Nature? Has our prowess over natural selection really been only a temporary stay of execution? Are the rising incidences of deadly diseases only evidence of some interspecies checks and balances? There has been some research over the years that the rise in certain behaviors, like increases in same sex attraction may also be natural forms of population control. In the end, it matters little. Because in the end, we are meant to die! It will be the bookends of life that are immutable. In the end there will be a determination of the appropriate period of time that we get to be counted among the living. Whether it is determined by some natural collection of checks and balances, our own determination or some divine intervention is irrelevant as it will fall where it must.

Steven Wright once observed that, “you can’t have everything, where would you put it?” The same thing can be asked of our perpetual desire for longer life!

Great Article in TruthDig by Ellen Brown

When my good friend Ellen Brown speaks I listen!  You should also.  I do not often reference others works as it is so easy to rely on the efforts of others to build a blog.  I believe that one should do their own thinking and work.  But sometimes, there are articles, like this one by Ellen, that say it all so well and elegantly, that to add to it is neither necessary nor appropriate.  This is one of those articles.  Please read Ellen’s Article on TruthDig titled, The Confiscation Scheme Planned for U.S. and U.K. Depositors.

About Ellen Brown

Ellen Hodgson Brown

Ellen Brown developed her research skills as an attorney practicing civil litigation  in Los Angeles. In Web of Debt, her latest book, she turns those skills to an analysis of the Federal Reserve and “the money  trust.” She shows how this private cartel has usurped the power to create money from the people themselves, and how we the people  can get it back.  Brown developed an interest in the developing world and its problems while living abroad for eleven years in  Kenya, Honduras, Guatemala and Nicaragua.  She returned to practicing law when she was asked to join the legal team of a popular  Tijuana healer with an innovative cancer therapy, who was targeted by the chemotherapy industry in the 1990s.  That experience  produced her book Forbidden Medicine, which traces the suppression of natural health treatments to the same corrupting  influences that have captured the money system.  Brown’s eleven books include the bestselling Nature’s Pharmacy, co-authored with  Dr. Lynne Walker, which has sold 285,000 copies.

I believe that the book that I recommend most to friends who want to understand the economy is Ellen’s Book Web of Debt.

Web of Debt
by Ellen Hodgson Brown
Third Millenium Press, 2007
Paperback; list price $24.95
www.webofdebt.com

My second most recommended book on the economy is Eric Janszen’s Post Catastrophe Economy.

Post Catastrophe Economy
by Eric Janszen
Portfolio/Penguin, 2010
Hardback; list price $24.95
http://postcatastrophe.blogspot.com/

About Eric Janszen

The Frontiers Of Medical Privacy – Forbes www.forbes.com

Every time I think the lunacy that is becoming pervasive in America has gone as far as it can, I am again astounded by another extension of instability of thought.

This article attempts to conflate the effort of researchers to use cellular material harvested from an African America woman during a cancer treatment procedure, with involuntary sterilizations that were done through bigotry and ignorance earlier in history. I’m sick of people just playing the race card for everything.

To what end? To justify that her heirs are in some way due compensation for the gains that these cells have brought? A number of different people’s cells were used to ultimately develop the standard cellular culture lines used in gaining a deeper understanding of the mechanisms of cancer by those who sought a cure.

Tissues excised during these procedures was mostly discarded. For some reason, the people trying to cure Mrs. Lack’s found her cells viable in culture and used them to further their research. Somehow this author believes this was akin to forced involuntary sterilization? The author fails to state that Mrs. Lacks was not the only woman who’s cells went on to become the basis for cell culture standard lines. Many races did so.

We now live in a world where, among a number of lunacies, people have come to a belief that individual cells, harvested from an individual, that are then manipulated and then grown as pure cultures of the same individual cells in a Petrie Dish for research are still the personal property of the person who donated them?

The second, and frankly even more absurd argument, is that the genome in the cell somehow is analogous to a personal diary of private information. Somehow having a line of cells that shares her genome would impart personal and private information that her family may not want to impart. Of course the questions as to what potential harm is left unanswered. Something else that the author does not say is that most of the original cell strains, started at the beginning of the cell culture revolution, are no longer viable. They have found that in general cell cultures have a limited life span because as the cells reproduce they also age. After so many replications their viability dies out. This finding led to the current understanding of the role of parts of the genetic structure located at the end of the strand, called telomeres, that acts as a kind of cellular time clock. Each time a cell replicates part of the telomere is lost. Eventually the telomeres are gone and the cell no longer can reproduce.

Finally, while these cultures started as pure cultures of specific cells, they themselves have shown mutations over the generations and may no longer be so genetically pure.

As I said at the outset, I am continually astounded at who far we have come from any form of common sense in the search for things to complain about either for money or simply to seek some higher order of political correctness!

U.S. Senate Approves Proposed Internet Sales Tax | TechCrunch – techcrunch.com

No amount, or scope, of taxes are ever enough for progressives, in the current historical context Democrats but like could have been said for Republicans once upon a time. In this vote some Republicans also joined in to vote yea.

A national sales tax has been the holy grail of taxation for many years in progressive circles. This internet tax represents their best chance to capture more “revenue” for the government to give back to us in the form of subsidies and programs that will do little other than raise costs in businesses, making them less competitive on the world market–we already hold the bottom position–and provide false pricing letting us believe that we actually can afford the products in the first place. Thus, this is simply continuing the false sense of entitlement endemic in our current society.

All of this serves only one purpose, enhancing and extending the viability of the professional political class we have allowed to develop in the once “land of the free and home of the brave.”

CDC: 105 children died during flu season in US –www.foxnews.com

The overall evidence on flu vaccinations is a statistical mess. While there is convincing evidence that flu vaccines work, like most of healthcare data, it is not near 100% that really sees benefits from these vaccines and some actually see negative outcomes from vaccinations.

We mythically believe that healthcare and medicines are universally effective, meaning that they work for everyone, but this never has been the case. Historically the average benefit from medications are seen in only 65% of the population. In the rest, they find no benefit or negative outcomes.

I attended a conference in Palm Springs about 10 years ago called the BioAgenda Conference. At that conference the red flag was raised as a warning that there would be no more blockbuster drugs because the low hanging fruit was picked and the new drugs would have declining effectiveness and increasing side effects. 10 years later this is exactly what we are seeing.

This study indicates that about 100 children in the US died from the flu this season. This is typical. The article continues to make the statement that 90% of the children that died were not vaccinated. Yet it does not say what percentage of the population was vaccinated in the first place. You cannot draw the conclusion that the non-vaccinated were at any higher risk if much of the population did not get vaccinated in the first place, as an example. With the exception of epidemic years, about 100 have died each year, and we know that the vaccination rates have dropped off in the past few years for a variety of reasons, side effects of the vaccine being just one of them.

The efficacy rate of flu vaccines has varied widely. In some years it is a bit higher and in some years quite low. This is because the vaccine is prepared in advance, betting on what strains will be the main ones in the following year and also betting that the strain has not significantly mutated and will remain susceptible, both often problematic assumptions.

Underlying all of this is one of the biggest problems we have in our healthcare system. We believe that these are all highly effective cures. And in creasing numbers their effectiveness is failing and the unintended consequences growing.

Introductory Note:

First let me apologize for the personal tone of this article. I typically try to focus on issues and solutions and not on my own personal reflections. This past week, among other things, I have been working with a group of parents from the school where our 8^th grade children are about to graduate. We are working to create a video that captures the 8^th grade class’ experience from kindergarten to graduation. In essence, to marvel at the growth and maturation of these modern examples of humans as they move from cute cuddly yet blissfully ignorant small animals, into wonderful, intelligent motivated, caring examples of the best of humanity. And, to wonder at this progression as it prepares them for the next steps of their own lives and time on the planet and builds them to be the shepherds of America’s ideals and dreams. To assemble this video the committee have collected from each parent pictures of their children from birth through each stage of their Catholic life at the school. Many have provided pictures of birth, baptism, kindergarten, first through eighth grade, first communion, confirmation and number of other life pictures. As I have begun to edit this video and reviewed the pictures of each of these kids from birth through the 8^th grade it has both inspired me and raised questions as to what they will have to face as they take over responsibility for America sometime in the next 20 years.

Thoughts:

Faced every day with the continual revelations and problems coming to light, as President Obama’s administrations strives to expand the national “Givernment’s” perpetual generosity of OPM (other people’s money), I have had a hard time trying to select a topic to write about. This difficulty has not been a result of a dearth of vital problems, a recent lack of political duplicitousness, or the realization that all of the sudden the American economy is now well and functioning. On the contrary there is not a dearth but a plethora of issues that are rising to the surface like the fetid, curdled and infected cream our parents and grandparents may have found on their front stoop when the milk man left their daily delivery shortly after everyone went to work on a hot summer day. The issue at the moment is too much information.

We are inundated with media stimulus relating to Obamacare and the negative impacts we are seeing as a result of this legislation. The continual news on Obamacare is so decidedly negative that the main stream media, so long spinning to the benefits of the law, is beginning to now readily report these negative issues. It seems they have grown so tired of reporting the positive spin, in the face of the overwhelming evidence, that even the more ideologically motivated reporters have decided it’s not in their own self-interest to keep hauling the president’s polluted water. Sure there is still a spin machine in the press, but it’s no longer doing the unfettered bidding of this president’s administration. The MSM has gotten so bad at keeping the desired message for the president flowing, he has had to convert his old campaign machine into an organization, called Organizing for America (OFA)—or as I think it should be named Obama For Federal Administered Liberalism (OFFAL)—to continue the incipient spread of what the now departed Stormin’ Norman Schwarzkopf referred to as “Bovine Scatology!”

Ad Hominum Ad Nauseum

Enter Paul Ryan and his attempt at a balanced budget. Now once again there is a personal target and the latest “Ad Hominum Ad Nauseum” program of personal media attacks can begin. Once again the argument shifts from the fiscal issues on which budgets are based, to how Ryan, and his ilk, wants to starve Grandma. That is, if he can’t figure out how to hasten her earlier demise by eliminating access to free healthcare. If you want reform to any entitlements based on fiscal concern, you’re either a racist, a bigot or, an unfeeling greedy pawn of the even more unfeeling and greedy super-rich in America. The alternative to admission of the problem and seeking a solution, is to deny the problem and, of course in that role we have the President and none other than Nancy Pelosi. Ms. Pelosi, I am convinced, is really the result of an Obama time travel experiment gone wrong, where the genetically modified spawn of Neville Chamberlin was transplanted frozen from the loins of Eva Braun, just before her bad experience in the bunker, to Baltimore, MD where her in utero programming proceeded to override her Catholic education and gave us what we have today. This in conjunction with the fact that there appears to be a recorded series of ridiculous platitudes that were implanted in her brain and have now become stuck on a random loop. I am sure that at first, the President felt this technological triumph of time-traveling, transcriptase transmutations was nothing less than his missing link, but perhaps now as the MSM starts to get a clue he may live to regret her biogenic support.

Not Sustainable

Continually lost in the media and the debate are the underlying issues that were the reason that Ryan created this budget in the first place. For some on the right they are angry that Ryan has included in this budget the call for the repeal of Obamacare as it once again has invited the personal vilifications, and I think they believe is a fruitless pursuit. Whether or not the entire law is repeal-able, or whether certain parts of the law should be repealed is really no longer even the issue. Realistically, while I was looking at the pictures of these 8^th graders I came to realize that the extent of the systemic issues I have been seeing in healthcare are perhaps even more problematic than I have understood. The opinion expressed by the president, Ms. Pelosi and a few others aside, most, on both sides the aisle, agree that our economy is not sustainable. None of the entitlement programs are sustainable. The revenue sources are not sustainable. The continuation of the monetary policy of the past 70 years is not sustainable. The path of real GDP growth is not sustainable. Our educational system is not sustainable, nor contributing well to the nation’s sustainability. The continual increase in the expectation from healthcare to provide us a life experience where we do not suffer any loss of the same quality of life we had as 18-20 year olds, even as we push our average lifespans from the mid-50s, to early 60s years of age, we had in the 1960s, on towards the middle 80s years of age we have today is not sustainable. And as I looked at the magical growth of these kids I realized this list of where most agree on the items that are not sustainable goes on and on. Yet we are doing nothing to fix the problems. We are doing almost anything to focus our efforts and energy on anything other than the problems themselves, often focused on demands for more things that we expect others should give to us or do for us.

If one reads the news carefully you will see numerous reports, like the one from Charles Blahaus, a Medicare Trustee, advising that the promises by the Federal government are simply not sustainable and that the money will just not be there. The president brought together a blue ribbon panel a few years ago to study these problems and they came back with a bleak report of non-sustainability. The report was so far from what the president wanted to hear that he shut down the commission, ignored the report and their recommendations and continued to push in the opposite direction. One is left to ask, why? Perhaps it’s simply that the findings of the commission are so anathema to the inbred ideological framework that they simply cannot fathom any world needing to exist under these conditions.

Self-Delusion

Perhaps, it is our own expectations and attitudes that are also not sustainable! Maybe we need to rethink who we are and what our own roles and responsibilities are for ourselves or we will face a much bigger demise than we realize. I used to think self-delusion was not endemic in society, that it was more of an individual, infrequent and relatively benign occurrence. As I have gotten older, and as I have focused so much time trying to understand the problems of our healthcare system, I have become more convinced it is self-delusion that is the primary cause for most of what we are facing. Reviewing our history, and its application to Healthcare’s evolution, has truly shed light on how the temporary decisions made many years ago—then made permanent, often for narrow or self-serving reasons, have continued to endure, causing more convoluted temporary decisions to be made to fix ever more complicated issues, that again have found political benefits causing these new temporary fixes to become permanent. This process seems to have repeated ad infinitum.

O’ Columbia

Our history impacts our current systems in often conflicting and unseen ways. Decisions made in the 1800s, in many areas unrelated to healthcare, continue to have major negative influences in the healthcare system we think we have today. And, our historical decisions do not just affect our healthcare system in this manner, they affect every part of what America is. Today, it is clear that America is no longer the shining city on the hill. The lyrics of a song popular during the Civil War, and considered a pseudo national anthem of the day, offers insight into what our ancestors felt was the promise of America.

O Columbia! the gem of the ocean,

The home of the brave and the free,

The shrine of each patriot’s devotion,

A world offers homage to thee;

Thy mandates make heroes assemble,

When Liberty’s form stands in view;

Thy banners make tyranny tremble,

When borne by the red, white, and blue,

When borne by the red, white, and blue,

When borne by the red, white, and blue,

Thy banners make tyranny tremble,

When borne by the red, white and blue.

When war wing’d its wide desolation,

And threaten’d the land to deform,

The ark then of freedom’s foundation,

Columbia rode safe thro’ the storm;

With her garlands of vict’ry around her,

When so proudly she bore her brave crew;

With her flag proudly waving before her,

The boast of the red, white and blue,

The boast of the red, white and blue,

The boast of the red, white, and blue,

With her flag proudly floating before her,

The boast of the red, white and blue.

The Union, the Union forever,

Our glorious nation’s sweet hymn,

May the wreaths it has won never wither,

Nor the stars of its glory grow dim,

May the service united ne’er sever,

But they to their colors prove true.

The Army and Navy forever,

Three cheers for the red, white, and blue,

Three cheers for the red, white, and blue,

Three cheers for the red, white, and blue,

The Army and Navy for ever,

Three cheers for the red, white and blue.

(There was also a slightly different third verse)

The star spangled banner bring hither,

O’er Columbia’s true sons let it wave;

May the wreaths they have won never wither,

Nor its stars cease to shine on the brave.

May thy service united ne’er sever,

But hold to the colors so true;

The Army and Navy forever,

Three cheers for the red, white, and blue!

Three cheers for the red, white, and blue!

Three cheers for the red, white, and blue!

The Army and Navy forever,

Three cheers for the red, white, and blue

It is times like these that I ask myself, “How can we get back to this belief in our nation that was endemic of that age?” I wonder how we, as a people, have become so jaded and self-absorbed that we no longer see the good that our nation does and can do. I wonder why it is that many Americans instead now see our own nation as an evil influence. How did we once have such a positive and patriotic fervent belief in America as an extension of ourselves through our own creativity, self-reliance, productivity and our generosity to others and the world; and today, arrive at the belief that America is merely someone, or something, who is there to provide whatever we desire to us, wherever we want, for free? How is it we once envisioned America’s government as the shining star leading the battle for personal freedoms and opposing tyranny only to see our own government become the main oppressor of America’s personal freedoms and liberties. How have we arrived at a place where one side of the media can argue that the Second Amendment must be subject to modern interpretations and restrictions and therefore must be limited while at the same time they argue the First Amendment cannot? I ask these questions and I can find few answers. The historical context of the decisions in healthcare give me guideposts to the mechanisms that have brought us to this place, but the complexities and the depth that these systemic infections have invaded our American body are so deep and intertwined I can find no simple and rapid path to health. I worry for these 8^th Graders and I suspect that the task will fall to their children, and their children’s children to rebuild a failed nation once again.

Sadly, for me this is truly worrisome. At times like this I don’t often know where to start.

Charles Blahous, Medicaid Trustee warns state to NOT expand Medicaid (image by Charles Blahous)

In an excellent article, Charles Blahous, one of Medicare’s Trustees, warns states of the dangers of the expansion of Medicaid.  He makes many of the same arguments that I have been making for quite a while, his warning, as a Medicare Trustee, may finally cut through the background noise and get some people to actually pay attention.  You can read the full Report by Mr. Blahous here: http://mercatus.org/sites/default/files/Blahous_MedicaidExpansion_v1.pdf

Mr. Blahous reminds me of Wilbur Mills who was the recognized congressional expert on Social Security during the administration of President Lyndon Johnson in 1964.  Mills initially strongly opposed the expansion of Social Security proposed by Johnson and warned that the cost estimates were not wildly optimistic and in the long run such programs would bankrupt Social Security, a program he also felt was not sustainable.

Mills soon bowed to political pressure. As the Chairman of the powerful Ways and Means Committee Mills eventually delivered the bills expanding Social Security to include Medicare and Medicaid to Johnson.  In a recorded call to President Johnson, Mills, House Speaker – Carl Albert, and Wilbur Cohen – architect of much of Social Security and Medicare legislation, said,

“…I think we’ve got you something that we won’t only run on in ’66, but we’ll run on from hereafter.”

Mill’s continued to warn about the risks to the economy of the program but in the end he rationalized as it was good for the Democratic Party. He argued that social security itself was not sustainable and that the expansions would bankrupt the country.  Mills was correct in his analysis although his time frame was optimistic.  He projected that Social Security, Medicare and Medicaid would cost only $12 billion by 1979.  By 1979 the total federal cost of the Social Security Acts (including Medicare and Medicaid) topped $1 trillion (in 2010 dollars). And it is important to note that Medicaid is both a federal and state program and federal costs represent only about one-half of the actual spend.

The rest as they say is history!

(If you want to hear the Johnson tapes, they are available online at, http://www.lbjlib.utexas.edu/johnson/archives.hom/dictabelt.hom/content.asp You can easily search the archives.  They are a fascinating glimpse into the backroom deals, pressure tactics and outright intimidation that can be wielded by any presidential administration.)

Microsoft’s little-screen, big-screen interactive future

Big and little screens interacting. That’s Microsoft’s vision of a collaborative future nirvana.

A new world revealed!

20 years ago, when most of us were still dumb kids despite our relative ages, I was at a meeting with Bill Gates of Microsoft. He gave a presentation on the future of computing as he saw it. He predicted how we would interact with the things around us. He spoke of three devices; a personal interactive device, a portable interactive device and a social interactive device.  He explained how all three of these devices would deliver the same content in roughly the same manner from any point on the globe. He predicted that the underlying system would be ubiquitous and the information could come via wire, or through the air in a variety of forms.  The most interesting thing to me at the time was that we would get the data through the same underlying system.  Few today likely remember that, the internet at this time was mostly a dream unrealized, that to get information from a floppy had one type of interface and system, to get data from a hard disk another system, and from a network still another system.  Today we have hardly noticed that the view of the files, and the method to get the information is largely the same.  Many in the room at the San Francisco Airport Marriott Hotel, were skeptical to say the least and some in proximity to me and my business partner Ken Waters, were actually chuckling.

This article from CNET, by Brooke Crothers, shows Bill’s progress in making those predictions a reality. I had the good fortune to be there and to hear this presentation. It is gratifying to see his efforts have stayed true to his vision and that we are at the door step of this next step in our technological evolution. Perhaps it is my age and perhaps it is just my perspective but watching the migration of technology, and Windows, over much of the past 30 plus years, I guess I have gained a perspective that some others seem to lack.  For me I am grateful for it, because I see a grand design playing out and despite the complaints, arguments and plain biased attacks, I see a company marching forward to a real and distinct value-based proposition not the singular marketing prowess of some of their competitors.

Many modern pundits have decried, Windows 8’s changes for many ridiculous and superfluous reasons. Oh no it doesn’t have a start button! Oh my, it is designed for touch and won’t work with a mouse, Oh its… (fill in your own blanks) While I do not know if their motivations are due to other alliances or just to their youth and lack of historical context. Perhaps there is a bit of both. But for me Windows 8 is the beginning of the final step of delivering Bill’s vision. I, for one, am really glad to see it, and hope I live long enough to discover the benefits of its ubiquity.

Save the Nincompoops!

Have we finally arrived at the point where the idiotic spending and regulation of everything under the sun, real or contrived, has finally seen a stopping point? In the above article by Chris Stirewalt, whether you love him or hate him his point of view is shared by a significant portion of the country (about ½ give or take a few at any point in time)

I guess we can watch this story play out. Or perhaps we can help move the ball securely down this road. People say the pendulum swings both ways over time and perhaps we are at the beginning of the meridian of this arc. The inertia driving the swing is in this nations hands. It is in the hands of the people. While the country is marginally divided, as the miniscule effect of these cuts are realized, barring any grand-stand plays from the administration to focus the cuts on the worst possible things, perhaps we will find the national courage to continue to pare away the recently expanded role of the federal government and return responsibility to the individual. The Constitution says we have the right to do things, not, the guarantee someone will do them for us, nor does it say we have the obligation to do most of them(the obligation to spend money for the good of the economy, is the one coming frequently to mind for me these days). I see the release of large amounts of illegal immigrants into the streets blamed on sequestration cuts as little more than a tragic play to convince America how bad and cutting is — which reminds me of Castro emptying the Cuban prisons and boating the inmates to Florida as political refugees. Yet, in reality it shows to me that we should have spent more on securing our border and defense in the first place, and less on guaranteeing free stuff to anyone who happens to sleep within our borders.

Giving away everything to everybody just for being born, simply attracts more people to come here illegally to get the free stuff, and to take the jobs that we won’t do because we don’t have to do them because of the same free stuff. And the cost of the free stuff, not tied to individual output, creativity and diligence, puts our nation at an uncompetitive advantage to other nations where people work for basic survival. When a person in some other place will work for just $1.00 per day and can make 30 hand-painted coffee cups in a day, they cost about 3.3 cents a cup and we can buy them after shipping and sales and distribution costs for about 50 cents each. Yet in America where the average full cost per hour for most jobs, fully loaded with vacation, benefits, healthcare, taxes, and subsidies, comes in at $80.00 per hour the cost is quite different.

Assuming through automation the same worker can produce 300 “hand painted” cups per day, the cost to make them is $2.13 per cup and when you bring this through the supply chain to the retail store, we will pay about $11.95 per cup. To be at the same price as those who do not get our free stuff and all the benefits, the America worker has to make over 850 “hand-painted” cups each day. It was “technology” and automation that we felt gave us the opportunity to make more profit and eventually afford more free stuff and entitlements. But we were wrong as to the lasting effects of our advantages, wrong as to the extent of the actual cause of our prosperity, and wrong to continue to believe our own hype when solid evidence was contradictory.

“Time to cut costs in America, if we ever expect to regain our economy.”

The New Obamacare Insurance Is Looking More Like Medicaid

One of the biggest Issues I have with the ACA, Obamacare, is that it did nothing to fundamentally alter the bad self-predatory system that is one of the root causes of the issues we have in Healthcare today. This article, by Scott Gottlieb in Forbes Magazine, highlights why I feel this way. One of the effects of the law is for Hospitals to accept lower payments with the plan to carve the money back from other providers in the chain. This is the same cost shifting that has driven some hospitals to the brink of bankruptcy and also eliminated viability for a number of practicing physicians businesses. This is a very good read and something we all need to understand. These kinds of practice modifiers will either increase costs to consumers somewhere else in the chain or restrict services and choice.

What Happens When the Fed Really Does Run Out of Ammunition?

The above article in Time Magazine by Michael Sivy leads me to wonder how did we move from a nation of personal responsibility that saved our way out of war debt, to grow a robust economy and lead the world, to one that relies on money created out of thin air injected into the economy with the mantra to the middle class that they should borrow and spend more to “Stimulate the Economy.”

In speaking of these new bonds Bernanke says, “We can retire them (bonds we created and purchased with money created out of thin air) without selling them” What he is saying is, Yes we created the bonds, sold them mostly to our Federal Reserve Banks with money they printed just to buy them and then instead of retiring these bonds in to market my printing money out of thin air to pay the banks for the bonds we could just print the money and retire the bonds ourselves. Either way this is nothing but a vehicle to create more money not driven by productive value.

Someone famous once said!

“Beware the money changers!”

Vietnam Memorial

Names aren’t supposed to mean much. They’re simply a title that our minds link to an appearance to create recognition. Heroes on a history book page would still be heroes, no matter what you called them by. Who we are and what we do isn’t decided or defined by something that insignificant. It’s the kind of thing that’s just there, making no more difference than the decision of what umbrella to take with you on a rainy day. Sometimes, though, a name is all you have left.

Roughly 58,195 names fill the shining black marble wall of the Vietnam Memorial. There are no pictures, no lists of heroic acts for any one of them; nothing that draws your eye to one particular person, and yet it’s still powerful. Names aren’t especially meaningful, but people die, the sadness over it comes close to dwindling out, and every memory eventually fades like an old family photograph, but even after all that time, a name remains. The name of somebody who may not have fought because they felt it was their duty, but because they had something worth fighting for. The name of somebody who, so many times, just wanted to give up, but remembered something, or someone, that kept them trying to get back home. The name of somebody who threw away everything they had because they wanted to help someone else in their time of need. The name of a hero.

In my opinion, Maya Lin’s simple design couldn’t be more beautiful. The Memorial may not be considered art in the eye of a cynic, but it means something. Maybe she was trying to show us that it’s the words that matter. Sure, a statue can be beautiful and inspiring, but does it really bring out every valiant soldier that made the ultimate sacrifice for a worthy cause? Their names are a symbol of honor, valor, courageousness, and are more hope inducing than any depiction of what had happened during a dark and turbulent war- the only one we’ve ever lost. So maybe a spouse or child never saw their family member’s body, or couldn’t be there for the burial, but at least they were given the consolation of knowing that their own hero’s name lives on forever, etched into the darkness.

Steve Brill’s Time Cover Story (Click to read)

Time Magazine contributor Steven Brill has created a bit of a sensation due to his recent, February 20, 2013, article and Time Magazine cover story entitled, Bitter Pill: Why Medical Bills Are Killing Us: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LkTuy5lv.  Mr. Brill caused controversy both due to the length of the article, 26,000 words, and his revelations about the high prices and seemingly arbitrary pricing methods in our so called healthcare system.  His article has prompted a number of other reporters to pick up the themes and provide both points and counterpoints to his article.  One such story is Steven Brill’s 26,000-word health-care story, in one sentence, by Sarah Kliff published in the Washington Post Wonk Blog: http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/23/steven-brills-26000-word-health-care-story-in-one-sentence/.

Wonk Blog Article by Sarah Kliff (click to read)

The supposition is that America’s healthcare costs are high and that the problem is that the government doesn’t regulate prices, as it does in other countries, or that we do not have government sponsored healthcare, so called single payer, or universal care.  Their data points support the thesis and they make convincing arguments that some form of regulation is needed to fix the problem.  The problem is that hidden inside the data in the report is actually the root of the problem, and the reason why the articles lead to the wrong conclusion.

This is not a simple problem of greedy hospitals and doctors conspiring to have confiscatory prices to rob consumers.  It is also not that the insurers are much better at negotiations and therefore they can drive bargains that individual consumers cannot.  Also, it is not quite accurate to think that our cost of care is significantly higher than other countries and that the outcomes for dollars spent in the US are woefully poor.  Finally it is also a bad assumption to think that some form of regulations will cure the issue.  The reasons for these statements are not to attack any of these writers nor their research.  The reason is to point out that there are many more things at work in the disjointed, dysfunctional, and disaffected self-predatory industry we call healthcare that are causing this problem.

Why this issue is so complicated, and how it became to be this way is also so complicated that I had to almost write my last book, “The History and Evolution of Healthcare in America: The untold backstory of where we’ve been, where we are, and why healthcare needs more reform,”  just to explain it for myself.  The first problem with the supporting data is that it is actually on its face correct.  You can look at any hospital bill and see an unbelievable disconnect between the invoice price and the amount reimbursed from Insurance companies, TriCare, Medicare or Medicaid.  For any normal person, this looks just like what both Mr. Brill and Ms. Kliff report it to be, that uninsured individuals are getting raped by hospitals, and the healthcare system, while those with buying power get better prices.  The problem with this assumption is rooted in the history of how our expectations from the healthcare system evolved, how indemnity insurance and employer sponsored insurance evolved and how an already self-predatory disjointed set of competing industries evolved to maintain their viability.

Why Healthcare Bills are so high

There are many, many, significant factors that are driving up the cost of care.  Again, my book discusses most of these in some detail but for this discussion we will focus on two that cause problems with the current systematic solutions.  The first is that high prices evolved not as a way to over-charge consumers but as a method to keep pace with the ever shrinking reimbursement rates from insurers and the government as indemnity insurance evolved into PPO, HMO and other forms of coverage. In the past thirty years, hospitals and other providers were faced with a billing system endemic in the practice of healthcare that was originally adopted during the days of indemnity coverage.  As the system moved on, the basic practice stayed the same.  As more was demanded under coverage by employers and consumers, policies were expanded, and the rates for reimbursement to hospitals and providers began to drop.  Hospitals and others took a simple in-system approach.  As Sponsors (people paying for care like insurance companies and the federal government) began to dictate lower and lower reimbursement percentages, each year the Providers (hospitals and other providers) increased their billing rate in order to net the same amount.

As a side note, I know of what I speak because for a time in my career, I ran a decision support group (DSS) in a hospital. One of the largest parts of our job was to analyze these rates and prospected changes and reassess our billing rates to maintain the needed level of reimbursement. 

Here is how this worked in practice…

False Price Invoicing

Hospitals have a variety of contracts with insurers and other payers.  At each contract renewal, Sponsors negotiated—you can read dictated—a lower reimbursement rate and, in order to get paid the same amount the hospital increased the invoiced amount.  So to use a historically accurate example, Hospital X in 1995 charged approximately $10,000.00 for a non-perforated laparoscopic child’s appendectomy.  The reimbursement rate from all the Sponsors of care ranged from 28 cents on the dollar to 22 cents on the dollar with the average across all Sponsors, not including the self-payers—which are the root of the issue today—at 25 cents on the dollar invoiced.  The hospitals DSS group predicted that in the next contracting cycle Sponsor Y was going to reduce their reimbursement rate from 25 cents per dollar to 22 cents per dollar. So DSS recommended that the billing rates would increase to provide the same amount of dollars reimbursed.  In other words, if Hospital X received $2,500.00 in reimbursement for the current $10,000.00 invoice price; they now needed to charge $12,820.51 to get the same $2,500.00 reimbursement—not adding anything in for inflation.

The problem with this method, as both the authors point out is that the individual uninsured, self-payer, got presented with increasingly larger bills.  For a while hospitals made it easy, but not public, for people that could not afford these services to not pay the full price invoiced.  For a time, this lack of collection was easily subsidized through government programs that provided funds for uncollectable amounts.  Additionally, some smart lawyers began to challenge the high bills and some hospitals lost cases based on the argument that the consumer needed to pay what was the usual and customary rate of reimbursement not the inflated invoice price.  This is when things got messier.

If you fast forward today, and if you were to reexamine the invoice vs. reimbursement rate issues you would find that in today’s dollars, accounting for the disproportionate inflation of healthcare—which is another big piece of why healthcare costs so much—you will find the same child’s non-perforated, laparoscopic appendectomy would be billed out today as high as $42,000.00 and the hospital was reimbursed about $8,500 from Sponsors, on average.  This is a rate of about 20 cents on the dollar.  Regardless, the individual payer is getting hosed if they actually pay the invoice.

Govt. Mandated Rebate Programs

The second big driver of unrealistic costs, particularly with medications, is in the issue of rebates.  If you thought the previous discussion was complicated, this one gets even more so.  I am going to stay very simple for this discussion.  All medications flow through a distribution system that includes multiple steps and destinations to get the product from the manufacturer to the end user—the patient.  The steps include at a minimum, distributors, pharmacies (either independent, chains, or in provider pharmacies) and income cases direct through Prescription Assistance Programs, aka Patient Assistant Programs, both called PAP programs in the industry.  At every step of the process there are rebate programs that have evolved over time.  There is nothing unusual about these rebate programs.  Rebate programs exist in almost every product based system.  The problem is not as much this system as it is in another mostly hidden part of the system; rebates to government entities and states.

As part of the initiatives to continue to drive down costs over the past years, the government through Medicare, Medicaid, Tricare and others have been leveraging federal program spend to drive down costs, Manufacturers who based their ability to make profit on economies of scale learned decades ago discounts on the front often do not realize the expected increases in volume to gain the economy of scale to support the lower price so they reverted to rebates that came after the volume was achieved.  So called fair trade laws that have been established over time also contributed to the trend of rebates after volumes were achieved as well.  When the feds and states began mandating rebates for program purchases Pharmaceuticals companies were in effect forced to comply.  These rebates can be as much as 50% of the program costs that after being paid to Pharma are then rebated back to Medicare, Medicaid, Tricare and the states.  The effect of these programs is a more than significant increase in the cost of medications.  If you look at one example.  The state of California Aids Drug Assistance Program (ADAP) spends about $500,000,000.00 per year on prescription drugs for HIV/AIDS patients.  Almost one-half of this amount is provided to the state in the form of rebate funds from the drug manufacturers due to the mandatory rebate programs.  So for every dollar that is spent on the drug under the ADAP program about one-half is provided back to California by the drug manufacturer. Effectively, this does not mean the price is raised by one half, the price is actually doubled.  California, is one of the states that shepherds these monies well and provides them specifically back to the patients in the form of more medications.  Many states do not. They take these funds into the state’s general fund and they can be used for almost anything they want.  They become a kind of black budget.  Unfortunately, there are a lot of people in governments that do not want changes to these funding sources to occur. Again, this is by no means the complete story.  It is here to illustrate the interconnectedness and systemic nature of the problems. The end result is a highly confusing pricing system that is based on fundamentally flawed pricing.  The actual pricing of sponsors and providers gets more confusing as some reimbursement rates are not set to manufacture cost or retail price but, to an arbitrary cost that is an estimated average Wholesale Acquisition Cost (WAC). This is a change from the last one which was called AWP or Average Wholesale Price which was so equally obfuscating and arbitrary a judge ordered the change to the current WAC which is little more than the same bad date with a new bad die job.

There are a number of other factors that are causing our high invoiced medical bills.  There is a disproportionate allocation of new money that has flowed to healthcare, again due to the systemic nature of how new money has been created and how the federal government spends in these categories, there has been a significant increase in costs of care due to an ever increasing level of expectations from us as consumers, that have driven employers to continually demand more coverage for their employees at the same policy costs, and we increasingly are relying on technology and biochemical methods to survive as we also live longer and sicker–all simultaneously raising costs. Add to this that none of the providers in this non system can predict what they will get paid, or reimbursed. There are many other significant factors as well. To discuss these here would be much more than the 26,000 words Mr. Brill needed.

Why Historical Context is Important in This Discussion

I have no criticism of Mr. Brill’s nor the other articles on the points they are raising.  Healthcare invoices are ridiculous and due to a number of other historical factors, the self-payer no longer is faced with a benevolent voice in the billing department winking and nodding that if they don’t pay, the unpaid bill will eventually be forgotten and the hospital will not pursue the debt.  Today despite what appears in the articles, many hospitals are not realizing the kind of money they need to keep the doors open from their reimbursements percentages. In the appendectomy example above, Hospital X needed 22% to keep apace not including inflation which in that year was significant–close to 8%.  Today, if all payments were at the reimbursement rate paid by Sponsors, hospitals would not survive.  Despite the statement that Medicare is a percentage over costs, this does not work in reality.  Hospitals have been relying on what is called cost shifting for years to make up the difference between declining government sponsored reimbursement and insurance companies EIS plans.  All the while it has been the uninsured self-payer getting caught up in the same mess with disastrous personal consequences.

Finally, to keep this article relatively short, even the amount of spending reported for the U.S. is suspect–last year $2.9 trillion.  This figure is collected from a large number of reports and sources and has a fundamental flaw.  It includes both invoice rates in some cases and reimbursement rates in others.  We simply do not know exactly how much our national healthcare is costing.  Since most people reporting on these numbers inure to the largest number for a variety of reasons, it is likely that if you could see the actual payments for services, the total U.S. spend is significantly less, perhaps as much as one-third less if not more.  If you then compare U.S. actual spending to that of other countries you find that we are often on par with them, in some cases slightly less and in others slightly more.  This is what should be expected in a system that due to our free market economy should provide a safety net for the helpless—filtering out the clueless and fraudsters, low cost care and choice for some to pay for more.

Closing

Let me say again, I am not faulting neither Mr. Brill nor Ms. Kliff for their reporting.  They have done an excellent job of identifying the issues facing uninsured, self-payers in this market. Yet, they unknowingly are addressing the symptoms not the causes of a much broader systemic problem, with a series of interconnected drivers that needs to be unwound and reconfigured into an effective and efficient real system of the provision of care. Unless we look at the historical context and understand what these historical decisions that led to this mess were solving for, simple governmental actions today will do what they have done for years, bring numerous and potentially catastrophic, in every sense of the word, unintended consequences. All the while directing us to focus on laying blame on some who are not actually causing the problem.

If you want to know more, buy my book!  The History and Evolution of Healthcare in America: The untold backstory of where we’ve been, where we are, and why healthcare needs more reform

Uncle Sam’s Pickle

The President’s Plan

In the State of the Union speech last evening, the president said many things.  He offered a real plethora, yes a plethora, of programs, benefits, stimulus, taxes, and other things that he believes will improve the lot of Americans–at least some Americans. Many were struck thoughout his speech by the breadth and depth of the things the president wants to spend money on.  He offered programs for immigrants, college students, environmentalists, women, minorities, the elderly, the sick, the middle class, teachers, the unions, the poor, the underserved, the military and just about every constituent he could think of, with the exception of two main classes: evil corporations and evil rich people. While not offering a “chicken in every pot” he offered just about everything else to someone or something.

While there were many incongruities in this speech relative to our current economy, at one point President Obama said he wanted to attract private capital.  And this is perhaps one of the best areas to discuss relative to this plan and its promise of prosperity for most, but not all Americans.   The president was clear, he said he wanted to attract private capital to invest in America. The president, throughout his speech spoke of America and its need to grow manufacturing and our economy.  He spoke at one point like an entrepreneur on “Shark Tank” pitching America: The Business. But, few, if any, investors would invest in a business where costs are many multiples of the norm for production in other businesses and where the amount of debt, cumulative interest and liabilities far outweigh the businesses’ ability to pay the investments back.

The problem with all the items he presented in his speech lies not in the heart of President Obama. Clearly, his heart is the ruling body of his being. He desperately wants to “give” certain American’s equality. But he does not equate this “giving,” under his concept of redistribution to the effect of his plan’s “taking” from others. His view of the American dream seems to be different than that of the view of at least half of other Americans and perhaps now–if instant polling during the speech is any indication–after last nights speech his view may be different than even more than half the nation.

America’s issues are not that it does not tax enough, nor are they that there are people in need who don’t have what others have. Americans are starting to understand that the solution is not in trying to redistribute the wealth to those who don’t have it. We are starting to get an inkling that there is a fundamental economic problems which neither of these methods will solve.

It might work to redistribute wealth if our “Business” (America) was growing, productive and profitable, but it’s not. We really don’t have the wealth any more in the first place. We live on borrowed money, and that which we have not borrowed has been created from the printing press we keep in the back room(Federal Reserve & Banks). We have created many new industries and technologies in the past 70 years, but despite this creativity we have, as a nation, purchased in excess of $13 trillion more than we have created and sold to the world. In effect, our wealth is not only non-existent, it has been buried under a huge amount of false valued cash and debt, with interest now accumulating on top of that.

What investor would put their hard earned money into a business that pays its employees higher wages than it can generate in cash from its sales? What investor would put money into a business who offers mortgage assistance to its employees while making no profit nor a foreseeable one anytime in the future or, who bases the value of its business on the very debt the un-payable mortgages create in the first place? What investor would invest in a business, who continues to increase the salary and benefits to its workers and lets almost 15% of them stay at home and not work? What investor would invest in a business who spends money it doesn’t have to send people to unlimited education when what is needed is skilled labor for more manufacturing or raw materials production?  What investor would watch a business who made its economic engine sing because for years it successfully “tracked” its youth into either technical skill education or college based on aptitude, then abandoned this practice because it was not seen as “fair” forced the closure of its tech and trade schools, and now wants to invest to recreate the very system it abandoned? What investor would invest in a business that has significant internal materials and energy assets it refuses to use to generate revenues or power its “Business” because a minority of the employees (citizens) don’t want to use them?

The answer is, none! One can’t fault the president’s heart. It is in his head that it seems to be where the problem lies. Cognitively, it is likely that he really does understand that his speech was littered with fiscally conflicting statements. He has to know that we can’t regain our prosperous manufacturing base with costs that are so out of control. He does know we are now in a one world economy.  He has embraced this concept and helped tie us even further to this mechanism. The president even announced in his speech last evening an initiative to help other countries where the poor workers are only earning $1.00 a day. Yet he does not equally understand the problem facing us, in trying to regain our prominence in manufacturing, is that these very same workers will work for only 1 dollar a day while our workers cost on average $85.00 per hour all in.

While I applaud the President’s heart, he needs to go back and engage his head–we all do!

The Story of Sam

I have said this before many times, but it needs to be said again. The middle class is being crushed, not by the avarice and greed of the rich, but by the economic and political system we have evolved into. As more money is printed out of thin air to pay for increased entitlements, the poor get subsidies that help them keep pace, the rich have excess assets to hedge against the reduction in buying power, and the middle class get neither the subsidies nor the hedge. They just get screwed.

Increasing the amount of people who get subsidies doesn’t help because it increases our national (“our Business“) costs higher than those of others in the world who are more than willing to survive without the benefits that we demand. Welcome to the one world economy! So, they will manufacture the widgets we want at significantly less cost and lower prices than we are willing to do.  We will buy their widgets and they don’t buy ours. And finally, as the government spends more, and more, of the newly printed or borrowed cash directly in entitlements like; Social Security, Medicare and Medicaid, or other subsidies, the positive increases to the economy are more than offset by the loss in buying power. Further, an increasing part of this cash never shows up in our accounts so our apparent wages decline over time as the government directly subsidizes the costs.

Sam’s Simple Math.

Let’s say you (Sam) have 160 ounces of gold and, for the moment, let’s say that you can’t get any more gold. You only have 160 ounces and that’s it. You and your neighbors have agreed that instead of carrying around the heavy gold, you can each print paper that you can use to pay your bills. They recommend that you print one piece of paper (Sam’s Dollars) for every ounce of gold you have. You can print more if you want to but, the face value has to be equal to the number of paper bills you print divided into the ounces of gold you have. So if you have 160 Sam’s then each will be worth one ounce of gold. If you print 320 Sam’s then they are worth only a half ounce of gold each. Wisely, you initially follow others and print 160 Sam’s.

After a few years your family wanted more stuff, and you decided to print more Sam’s to help them get what they want. You give your wife four extra Sam’s because she is a good wife and keeps a good house. You give your son four extra Sam’s because he takes out the trash and mows the lawn every week, and you give your daughter four more Sam’s because she makes the beds and helps with the dishes. No one is really using the gold anymore, so who cares. Your family looks up to you and they deserve the things they want. So you print sixteen more Sam’s and give them to your family. They go out, buy their stuff, and you can also argue this is good for the neighborhood economy. Soon though the vendors begin to notice there are more Sam’s in the market and they raise their prices 10% to capture them. You now need more Sam’s to support the stuff your family bought with the new Sam’s you printed, so you print 16 more Sam’s. Again the vendors catch on and raise their prices 10%. Then, the same cycle again, you print more Sam’s, they raise prices and then again, and again.

Your wife has been accumulating more stuff than the other wives, and she wants to invite them over to see it and have a party. But to do this she won’t be able to clean the house and make the food. Since she has saved some of her extra Sam’s, she hires a cook and a maid. This is going to cost more than she has saved but each month or so she has been getting more Sam’s anyway. So she reaches what she thinks is the logical conclusion that the increases in Sam’s she sees will keep growing—so there is really no problem with the extra expenses. Her income will rise faster than the expenses come online.

Your son, always more frugal, has saved some of his Sam’s and is paying the neighbor’s kid to cut the grass and take out the trash because he wants to spend more time playing on his new big screen TV’s video games. And your beautiful daughter is now more beautiful from the tanning salon she goes to and the hair extensions and new clothes that the additional Sam’s she is gaining each month pay for. She simply doesn’t have enough time to make the beds and do the dishes and stay beautiful so when she asks you for more Sam’s to increase the maid’s hours to do her chores as well, you oblige because you want her to see you as a good dad and because you do not want her to lose her self-esteem by being embarrassed in front of her friends. So you just print more Sam’s and everyone stays happy…

But soon, the market has a whole bunch of Sam’s and its getting more costly just to buy the things you really need to live. Your Sam’s are worth so little you don’t even have enough to buy the paper to print more Sam’s. Fortunately, the paper vendor will sell to you on credit so you can buy more paper and print more Sam’s but in exchange for the credit he wants one Sam’s in interest for every ten Sam’s of credit he extends. So now, instead of printing sixteen more Sam’s you just print seventeen Sam’s and he gets the extra Sam’s. But each month you have to pay him  one Sam’s. And you really have to print a lot of Sam’s just to keep up with the rising prices. The more Sam’s your family has gotten for the basic things they want, the less they are willing to do the things they used to do to get them in the first place. Your wife doesn’t do any work, your son plays all the time and your daughter spends all her extra Sam’s on going out with her friends.

You can’t stop printing the Sam’s or they will get upset with you and you will be a bad father because they will lose all the things they really love, TVs, nice food, hair extensions etc. And if you’re seen as a bad father by your neighbors, or you can’t p[ay your accumulating debts as you have had to get other vendors to give you credit, your own self esteem will suffer, and that you just can’t have. You’re spending so much time printing Sam’s you don’t have much time for anything else. There are so many Sam’s in the town now that others are equating the value of their own currency to Sam’s. Fred down the street now says he will give you one Fred for seventeen Sam’s. Last month you could get one Fred for just ten Sam’s. Your son, always the bright one, starts trading his Sam’s for Fred’s because in a week he can buy more with the Fred’s as the Sam’s devalue.

Soon, you have so many Sam’s printed you spend more to print the Sam’s than the original gold was worth. And since you keep having to buy more paper from the paper vendor to keep pace, and the Sam’s keep devaluing, you now owe the paper vendor more than you even have if you add up all the Sam’s you have ever printed. And since you have been printing just enough extra Sam’s to pay the interest, you can’t even borrow enough to buy the paper to print the Sam’s you need to pay the paper vendor.

What are you, Sam, going to do?

You, Sam, are clearly in a pickle! What are you going to do? You thought about going and getting a job working for Fred, but you need to get paid 16 Fred’s for every hour you work in order to keep your family happy and just pay your bills, not including what you owes to the paper vendor others on your spiraling credit lines. But when you make your offer to Fred, pointing out that you are the best printer in the neighborhood, Fred laughs at you and says, thanks but no thanks. Jim, Bob, Mary, and Eustis, down the street will work for one half of a Fred per hour—by now that’s equal to thirty-five Sam’s–and while they may not be the best, I just can’t afford you and your high falutin’ ways.

So all along while you thought you were just printing Sam’s in effect you were taxing your family.  You gave them more money but they just bought less.  And the interest was building behind the scene as was the principal of the debt you were creating.  Printing more money did not equate to any more gold (value).  And your effect on the neighborhood was not positive as you originally thought, you have gone a long way to destroying their fortunes as well as you now will default on their bills, in the end devaluing their own, Fred’s, Jim’s, Mary’s and Eustis’s as well.

Sam’s dilemma

Sam realizes he has a big problem. What is poor Sam to do? He can’t sell anything to anyone else because his costs are too high. He can’t stop printing Sam’s or his wife will leave him, his son will go on a rampage and is daughter will get depressed and loose self-esteem and his neighbors will likely come and lynch him, make his family pay off the debts, or if he is lucky or otherwise very persuasive, perhaps they will just take away all his stuff in partial payment and outlaw the creation of Sam’s.

It’s a big pickle, don’t you know!

The Most Important Chart in American Politics (click for article)

This morning as I did my news walk, I came across this article talking about the most important chart in American politics.  And as you can imagine it caught my eye. I find charts and graphs to be either extremely informative or extremely deceptive. Seldom is there a middle-ground.  Often the deceptive charts are constructed specifically for that purpose. It is seldom a surprise to find such charts in an article about politics.

This chart was one of the exceptions that prove the rule.  But not in the way you might imagine.  “The Chart” is deceptive, but I do not believe it is purposeful in its deceit.  Why not, you may ask?  Because the story it is trying to communicate would be stronger if the authors actually new the truth behind the problem.  But, like so much today, the surface suffices to make an argument.  The other details make the argument more difficult to communicate as the story can get lost in the weeds.  Oh, but this story is the really important one.  And, “The Chart” is actually not telling the story, it is transmitting a false initial impression from the get-go.

Lets look at “The Chart”

Median Income compared to Productivity & GDP per Capita

The Chart to the right is fairly simple.  It shows three lines; one purple shows U.S. Productivity (a relative measure), one green shows GDP per Capita (a relative measure), and a red one showing Household Incomes.  Looking at the chart it would appear that as America’s increased productivity has continued to rise, the GDP has risen and actual household income has not.  The conclusion that gets drawn from this is based on who is doing the drawing.  Democrats have used this chart to show that Middle Class Americans are getting screwed by the wealthy who have taken the money off the top and not passed it down in new jobs or other programs.  Now Republicans are using the data to argue it is spending that is taking the money.  Looking at the chart the conclusions drawn by either party seem logical and valid. The problem with “The Chart” is that both of these assertions are based on assumptions as to what the chart is saying and in fact they are wrong.

“The Chart” is Misleading

They are not wrong because the chart is wrong.  They are wrong because the Chart is not telling the whole story.  There are some key indicator lines missing.  If you look at just this chart’s lines, you would come to the initial conclusion that America’s economy is increasingly productive and our GDP is growing because we are productive, therefore we must be a strong, vibrant and growing economy, and are leading the world in production.  While we all seem to come to this conclusion, we also know its false.  But how can we show increasing productivity, and increasing GDP and, even to some extent, increasing household income if we have been buying more products from the rest of the world than we are supplying; indicated by our constantly accumulating trade deficit, now in excess of $ 13 trillion, and also be in excess of $16 trillion in debt?  The answer lies in these missing lines.

The Missing Lines

By now we should all realize that the American economy is not really growing, but we don’t.  We don’t because we see charts and data all the time like “The Chart.”  If we are continuing to buy more goods than we sell as a nation, and we are borrowing 1/4 of every dollar, or more we spend, how can we be growing?  And how can productivity, a relative measure, be growing?  Lets take a look at how these numbers come to be and what they measure.  In actuality only one line needs to be added to explain the problem. If you were to add in a line showing the total amount of currency (money) in circulation (CinC) you would find the answer in the shape of the line and the timing of its appearance related to the other two indicators.

CinC Line

Analysis of U.S. Budget Performance 1960-2011 (2012 estimated) (click for larger image)

Looking at the illustration to the right, you will see a chart of the total currency in circulation since 1960. If you look at the shape of the line you will see that it is almost the spitting image of the Productivity and GDP lines in the chart above. This is not by accident.  In fact if you were to overlay the data you would find that they are almost point for point comparable.  It is not the point for point nature that is the problem it is in the timing.  If American productivity was rising, and that was causing the rise in the GDP, and the increases in production were increasing the currency in the economy, you would see that the Productivity line was slightly earlier in time than the rise in the CinC. But that is not the case.  The rise in the currency line precedes in time the rise in Productivity and the rise in GDP.  How can that be? How can we have more currency before we have the economy’s engine produce more underlying value?

The Other Important Lines

Median Housing Price compared to CinC 1960 to 2009 (click for larger image)

In the chart to the right, you can see another of these important lines, Median Housing Prices. And you can see that Median Housing Prices, for the most part, lead the rise in the CinC.  This is because of how our economy began to work after we got off the gold standard in 1972.  As a nation based on fractional reserve lending, after 1972, it was not the amount of gold that was the basis for the amount of currency in circulation, it was now the amount of debt.  For every dollar of debt the banks–federal reserve–could create, 10 dollars of new currency could come into being. And the biggest portion of American debt was mortgages.  The more people that bought homes, the more the banks could lend, stimulating more expensive homes, bigger mortgages, more lendable money.  The economy was growing. Not based on real production but on a constantly inflating index, that was being driven by its own activity.  What I mean by that statement is the more houses we purchased, the more money that came into being.  The more money, the more we could spend for houses, so we borrowed more and bought more and created more money. Housing prices rose because of supply and demand. This worked great. The economic number, and the underlying amount of currency just kept rising till housing prices collapsed. And, by then due to some other financial shenanigans, the problem was not a 10 to 1 problem it was then over 1,000 to 1.

Total HealthCare Expenditures (1960-2009) (click for larger image)

Now lets look at some other lines to see where the money went. The reason we got off the gold standard was because the federal government was out of cash and due to the international gold standard could not just print more money without a significant loss of buying power.  More money meant less international value per dollar.  Why were we out of cash? Because we were now spending a lot of money to cover things like; the increasing trade deficit, the war in Vietnam, and the costs of Social Security, Medicare and Medicaid, and a large number of other federal programs.  After 1965, when Medicaid and Medicare, and numerous disease and drug programs came into being, the federal government became an ever increasing piece of what we spent on healthcare.  Looking at the dotted line in the chart above, you will see that the curve of the total spend in healthcare aligns with the rise in Productivity & GDP and both lags and matches the rise in the CinC almost point for point.  Much of the newly printed money was going to cover the cost of these programs.  Program costs rose, because as more money was available, smart businessmen created more goods and services, therapies and treatments, and drugs and diseases in order to capture the available dollars.  More money = more spending, more spending = more drugs, services, and reasons to spend (more billable codes), and higher healthcare prices.

Why Did Household Income Not Rise as Well?

Other Product Pricing (1960-2009) (click for larger image)

Since a big chunk of this healthcare money was going to pay for federal expenses, it did not go into the economy first, it was siphoned off the top to pay the federal bills so the average person never saw it come into their account first. They did not see a boost income in the same proportion they would have if this was through a free market approach. If this was not the case there would have been a rise in household income.  There would also have been a huge increase in taxes in order to claw back the money to pay for the federal programs.  In effect having the feds take it off the top to pay for services provided to more and more Americans is the main reason it does not show in personal income in the first place, not some corporate avarice or greed. In fact, with the exception of Healthcare and Housing prices, if you chart other U.S. prices you do not see much, if any, direct effect. You see that what drove the increases in these prices was the money that did make it’s way into the wages of American Workers. It was the increases in wages that was the factor that influenced these prices. As American household income grew or contracted, it was reflected afterwards in changes in these prices.

In effect, the newly printed currency was disproportionately distributed, causing corresponding rises in housing prices and healthcare costs that have been disproportionate to the American household income and ultimately the root cause of our rising debt.  In effect, it may be our own fault.  In realty, it is the fault of those leaders from both political parties who have failed to address the fundamentals of our economic system and who knowingly, or unknowingly set us on a path to our own destruction.  Our leaders set us on this path when they changed the engine of our currency creation from that of real value gains, through the hard work and cost effective U.S. production that resulted in us being the historic supplier to the world; to that of a nation whose currency was no longer set to tangible value production but instead set to intangible value driven by debt-based Finance, Investment and Real Estate purchases.

Today, we purchase from the rest of the world more than we make, our humanistic approach to the provision of benefits to workers may elevate and define our humanity but it also puts us in a non-competitive position because our American goods are more expensive than those in the nations who do not care as much. We are left with printing even more money, based on nothing, to artificially subsidize through federal programs, the American Purchase of American products that we otherwise could not afford to buy. We therefore increase the spending of new money, at the federal level, so that it never makes it into the American workers wages and their purchasing power further erodes disproportionately.

Conclusion

So “The Chart” really means nothing.  In fact, it is worse than worthless because it gives the false impression that America has a successful economic engine, and that there is some federal program that will cure this condition.  The condition is systemic and it will require a systemic solution.  Cutting federal spending is part of the solution, but it in itself will not solve the problem at all.  It is beyond just spending.  The other sides concepts of stimulus and subsidies likewise will not work because money spent at the federal level to boost purchasing power, or to pay for things for American’s will not filter into wages.  This is abundantly clear no matter how you look at it.

America, needs to reassess who we are and what we need to be in this new global economy that is no longer dominated by the American economic engine based on efficient and cost effective production to the world.  We need to get back to where we are the nation that supplies the world. But, we cant get there without some hard choices in what we expect from government and the realization that our income as individuals is now tied to what we can produce and sell to the rest of the world. If we cost too much because of wages and benefits, we loose, if we are efficient and priced correctly we win.

Coke ad stirs controversy, but this article takes it from sublime to ridiculous (click to read article)

Having heard of the controversy over the Super Bowl ad by Coca Cola the past few days, this morning I was captured by the above article.  I expected it to be along a similar vein of remarks showing how Coke was insensitive to Arabs and painting them in a bad light.  When I first heard this argument on the TV news, I was looking for the Association of Los Vegas Showgirls to show up any minute and complain, followed by the African American Cowboy Association, National Hispanic Cowboys,  etc…

What stopped me in my tracks was not the casual assertion of racism due to insensitive stereotyping in the pursuit of parody that I was expecting, but the allegation that Coke, like many other soft drink companies, has a long and purposely racist history.  The author of this article draws some quotes from an article in the New York Times by Grace Elizabeth Hale.  I did not read the original article, and her segment may have been taken out of context, but the facts as laid out in this article are a modernist revision of the real and quite fascinating history.  Perhaps, I would not know this if it weren’t for the extensive research I did for the patent medicine section of my last book, The History and Evolution of HealthCare in America: The untold backstory of where we’ve been, where we are, and why healthcare needs more reform.

America’s Long History of Addiction

America has had a long history with narcotics and addiction. The above article does get it correct that Coca Cola started out like many other patent medicines with a mixture of alcohol and a narcotic, in this case cocaine.  The article would lead you to believe that John Pemberton (a pharmacist), concocted his original drink purely as a commercial venture with the intent to make people addicted for profit.  This was not in fact the case.  Mr. Pemberton (not a pharmacist), like so many wounded Civil War veterans in 1865 left his service to the south severely addicted to morphine.  Back then the basic treatment for that addiction was to switch to Vin Mariani – a tonic wine, basically a Bordeaux infused with coca leaves. The theory was that the cocaine in the wine simply replaced the addiction to the morphine and later, again supposedly, the person could wean themselves to just wine.

Birth of an Enduring Brand

Vin Mariani was quite bitter and very distasteful to Pemberton.  In a quest to find something more drinkable he began to develop his own cocktail, using red wine and coca leaves with some other spices.  He settled on wine, refined cocaine, and the leaves of the damiana plant.  He called his concoction, Pemberton’s Red Wine Coca.  It became a very rapid success in Fulton County, Georgia where he lived.  The local pharmacy (Jacob’s Pharmacy) sold over 25 gallons the first year and over 1,000 gallons the next.

Fortunately for Mr. Pemberton, America was addicted to patent medicines.  Everyone in the late 1800s up through the 1920s relied on Patent Medicines to cure just about anything and everything.  In realty they cured nothing, but since their active ingredients were either cocaine and alcohol, or morphine and alcohol, or in many cases mixtures of all three, no one really cared.  They did not have the expectations of cures as we do today.  In that period a cure was seen more as the elimination of suffering from the disease or cause, not the elimination of the disease or cause itself.

Ripe Market for Addictive Substances

By 1870′s America was addicted.  In fact the rate of addiction of these three substances by 1900 was almost twice that of the worst periods of addiction in the 1960s or 1970s(at the peak about 18% of the population in 1960s – 1970s were addicted to cocaine, alcohol or other narcotic).  The main difference is people did not know what they were taking in the 1850s-1920s.  This background helps lead to the extraction of the key quote, and significant leap alleging a history of racism by Coca Cola asserted in the article, and also why it’s not true.

By 1900 a huge part of the population was addicted, and between men and women, significantly more women were addicted than men.  The main culprit of women’s addiction was cocaine.  Even the venerable Sears & Roebuck catalogue offered relief for women from their “monthlies” with a cocaine kit including a dose of cocaine and a small needle for $1.29.  There were numerous powders, cocktails, cordials, pills and other concoctions targeting the “high strung” female and the prime ingredient was cocaine in one form or another.

Tides Turn

The good news is by 1880s, some women were waking up, many stimulated by the suffrage movement, and religious leaders were now advocating against the evils of drink, and drugs. The biggest problem was the power of the patent medicine men.  They were united through the Proprietary Manufacturers Association and were one of the largest, if not the largest, and most powerful associations of their day. In 1891, the members of the Proprietary Association owned or controlled over 80% of the newspapers and publications in America.  They also were one of the early groups who had their representatives standing in the lobby of the Willard Hotel (where the term lobbyist comes from) in Washington to influence congress to keep the world exactly where they wanted it–addicted.

As the women woke up, and suffrage took hold, their attacks against the evils of alcohol took root in cities, and the Temperance movement expanded and got results.  Many cities and towns began to pass laws banning alcohol.  So was the fate in Fulton County, and in the City of Atlanta Ga., where Mr. Pemberton was located.  Like many other patent medicines, he was forced to eliminate most of the alcohol from his product in order to continue to sell it.  New technology was invented to solve this problem, called carbonic acid machines.  We call them soda fountains.  One of the reasons for alcohol in these medicines was to keep either the morphine, or cocaine in solution.  The patent medicine men found out they could use the acidified water in conjunction with an undetectable, in that period, amount of alcohol to do the same thing.

Coca Cola the Product is Born

In 1886, John Pemberton, reformulated his concoction using the new carbonic acid, soda water, and his accountant suggested they needed a new name to avoid the damnation of alcohol.  So Pemberton’s Red Wine Coca, became Coca Cola!  Asa Chandler did buy Coca Cola from Pemberton a year later in 1887 for $2,300.00. And, it was Chandler who moved Coca Cola from a small regionally distributed syrup, dispensed through pharmacy carbolic acid machines, into the bottled drink (1894) that became one of the first nationally distributed “soft” drinks and led many other patent medicine men from patent medicines into the soda market we have today like; Dr. Pepper, Heir’s Root Beer, “Bib-Label Lithiated Lemon-Lime Soda”(Now 7-UP), and Jamaican Ginger Beer (Now Ginger Ale), among others.

“The best laid plans of mice and men, often go awry!”

Where the article goes most awry, is in an attribution of a quote from southern newspapers that “…’negro cocaine fiends’ were raping white women, the police unable to stop them…”  The quote is accurate but the history behind it is not.  I suspect the historian herself may not even be aware of how, and why, this attribution started in the first place. The facts behind this disgusting statement are one of the more diabolical and disconcerting marketing cases from our past.

Tribunal of Conspiracy

By 1900, the pressure was mounting against the patent medicine men.  The Proprietary Association had been in an uncomfortable partnership with the National Association of Retail Druggists and Distributors (Now part of the American Pharmaceutical Association APhA), and the American Medical Association (AMA).  But due to the pressures on the hidden and often deadly issues of the elixirs they were peddling, the powerful AMA began to waver in its support  of the patent medicines and started to publish negative reviews of many of the so called cures. Interestingly though, for a while they published the negative reviews only against those Proprietary Association men who did not advertise in the Journal of the AMA (JAMA). Later, Colliers Weekly ran a series of articles by Samuel Hopkins Adams, that exposed the collusion and conspiracies of the Proprietary Association and the evidence of the ingredients that in his words were, “the shameful trade that  stupefies helpless babies and makes criminals of our voting men and harlots of  our young women.” This rising tide, first against alcohol, and later against the hidden drugs was taking hold.  The Proprietary Association needed to move the cause of the issues from their cure-all elixirs to another convenient source.

The patent medicine industry’s Proprietary Association fought back against these and other attacks by the AMA and by Collier’s Weekly by creating what is now a common defense; casting aspersions on the victims of its concoctions. If medicines were being abused, it wasn’t the manufacturer’s fault. The fault lay with the abuser.

The Source of the Myth

The Proprietary Association, retained a writer at one of their controlled publications, named Joel Blank to write an article, disgustingly titled, “The Niggers in the Wood  Pile.” Published in a 1905 edition of the Practical Druggist periodical, Mr.. Blanc, made a mighty attempt to play down the whole problem of the rising tide of concern about addiction and the problems with patent medicines. The root of the problem was the “fiends who are abusing these harmless medications.” The title of the article was more than a curious usage of a pejorative of the day. It was a part of an orchestrated campaign by the Proprietary Association to lay the problem caused by the “fiends” directly at the feet of freed slaves. Blanc never made direct reference to race in his article, but he used certain code words that laid the source of the problem at the feet of the lower classes and the disenfranchised. The Proprietary Association technique, of targeting minorities as the cause of any related issues, had a long history in the patent medicine trade. During this period, the blame not directed to simply the poor classes, it was now seen repeatedly in newspaper articles, often in the south, where it began to attribute the concern to rising violence and rape of “white” women by addicted Negroes” or in the West as an expected outcome due to the unscrupulous nature of  China-men.” While society rejects this type of invective today, race-based execration was all too common in this country’s sad history during this period, which directly contributed to the distrust and disaffection among the races for many years.

Why the idea that is was “Negros” and “Chinamen”? And why raping women?

The link was cocaine.  Women were the prime user of cocaine, and it was becoming evident that cocaine addiction among women, more than others, was leading to serious consequences and death among the population. Newly freed in the south, the climate was rife for justification to paint freed slaves in a poor light.  The Chinese, who were seen as the source of the problem with opium, and opiates like morphine, also were a minority rife for exploitation.  The Patent Medicine men may not have been able to control Colliers, but by god they had the newspapers in the south and in the west.  Mr. Blank’s article was at first reproduced and then attributed for local expansion and embellishment, and finally just a footnote in the history of this calculated campaign.  The current form of main stream news outlets citing unknown or dubious sources to further political agendas is neither new or practiced as efficiently as it was in those days.

By the time this attack had commenced, Coca Cola no longer had cocaine in its formulation, having removed it in 1903, replacing it with increased amounts of caffeine.  Coca Cola’s Asa Chandler had been a strong member of the Proprietary Association but by the time of the article by Mr. Blank he had already made the strategic decision to move from the patent medicine game into the soft drink world.  It is clear from this history that Coca Cola was at least not an active purveyor of the “negro cocaine fiend” argument and likely not involved in it at all. African Americans then, as now, were an important customer base of Coke and attacking them would have done little to help Coke’s sales.  Asa Chandler was first and foremost a salesman and marketer, it was his key read of the trends in the market that led him to drop the cocaine in the formulation, 5 years before the Pure Food and Drug Act forced disclosure of the ingredients.  As a quick note, It was not the Pure Food and Drug Act of 1909 that forced the removal of narcotics from these formulations. It would take till 1935 for that to become law. All the act did was require that certain compounds, designated by the government, were to be listed on the bottle or its box; along with a skull & crossbones also affixed if some specific ingredients in the list were present.  It was in actuality the sea change in attitude of America’s women, stimulated from the Collier’s articles by Samuel H. Adams, that forced the final change and sounded the death knell for the patent medicine era.

The More Things Change the More They Stay the Same

While patent medicines may have died, the companies and the products did not.  Many still remain in the market and you can find them in your icebox and on the shelves in supermarkets and drugstores.  Ponds Cold Cream, Listerine, the sodas mentioned earlier, Catsup or Ketchup however you want to spell it, Halls Cough Drops, Horehound Drops Candy, Alka Seltzer, Vick’s Vap O Rub, and many, many, others started their lives in the mid 1800s as cures for almost everything.

Oddly enough, the old patent medicines and the industry and business they started are still with us today.  Many of yesterday’s patent medicine companies are todays pharmaceutical companies.  Miles Laboratories, Squibb, Pfizer, and others began their life in that era either as a purveyor of patent medicines or the provider of the raw ingredients.

No Modern Racial Component

The racial component, of the patent medicine men’s battle to maintain control over the sales of their elixirs, and their attempt to use minorities and victims of their addictive substances as the cause of the problem will forever be a stain on us as human beings. But I do not think it is either necessary, nor a good practice, to attribute racial intentions where none exist.

I hope you enjoyed the history lesson.  Feel free to comment.

Yes Football is a violent sport!

After reading a recent spate of articles on how the president should, could or would ban or regulate football, I started to wonder what my father or grandfather might say? Then I wondered, how we got to this place where things that others choose to do to themselves is now our responsibility to monitor, manage, restrict and pay for?

50 years ago if we  spoke to our parents about the federal government making laws regulating football, or restricting peoples access to cigarettes and punitively taxing soda, they would think we had lost our minds.  Cleary, much has changed since the 1950s and 1960s.

We may choose to believe that we have become more learned, enlightened, that we now have more evidence as to the dangers of smoking, and the problems with soda intake in ourselves and children leading to obesity, diabetes and other conditions and diseases.  And, to a great extent the knowledge acquired over the past 50 or 60 years has led us to understand much about the consequences of the dumb and irresponsible things we do!

But, at least in my case, and I suspect many more, Our fathers and grandfathers would have still said the federal government has no place in restricting peoples activities.  Why would they say this?  Because in their view, what you chose to do was your decision and the consequences were your responsibility.  And they were correct!  If you got cancer, or you jumped out of a plane with a parachute, or you got fat, diabetic and died an early death, that was your problem.

If you were racing in a car hit a tree and had a severe spinal cord injury, or if you were playing football without a helmet and got a concussion, or if you smoked and got cancer, it sucked to be you!  People were just as sympathetic, and empathetic–maybe even more so.  Churches and associations would take up collections to help you and your family.  Family and friends would have taken turns helping you change your diapers, and moved you from your wheel chair to your bed. And, your neighbors might even have contributed to a fund to support you going to an asylum where you could have been taken care of till you died.  But ultimately, while they felt sorry and wanted to help, it was in the end, your problem.

When did this change?

How is it we moved from the concept that if you got catastrophically ill it was not my problem; it was yours?  How could we ever think that way?  Well, because it was your problem.  Even with insurance in that period the impact to others for such problems was minimal in terms of policy costs.  Risky activities were not covered, and many so called self-inflicted diseases had limited to no coverage.  For the most part insurance was geared for catastrophe not normality, and the coverage was very limited.

So what changed?

In 1964, then President Johnson, as a result of rising poverty due to a number of systemic economic issues and the cost of both the Korean War and the Vietnam War, declared a war on poverty.  As part of the battle against poverty, legislation was offered to provide “supplemental” and “temporary” assistance to poor people until they could be raised by the guaranteed “rising economic tide that would surely float all boats.”–Medicaid

Additionally, there were a number of impoverished old people, who had made their money in the 1930s through the 1950s and now, due to inflation (loss of buying power), they did not have enough money to pay for their living expenses nor insurance. So we needed another “temporary” and “supplemental” program to help them cope.–Medicare

This seemed like a great idea at the time to some, and to others like Wilbur Mills (D and head of the powerful Ways and Means committee) it was initially seen as a ticket to fiscal disaster.  Mills warned the president that these expansions were unaffordable.  But with a change in the political winds, Mills got the religion, and supported Johnson’s efforts publically while privately still warning of the potential fiscal consequences if these programs were not strictly limited and remains supplemental and temporary.  As is typical, our revisionist memory does not accurately reflect what the programs were originally designed to do.

The concerns Mills was worried about came true, and quickly, like the prior “temporary” and “supplemental” program they extended, Social Security, these programs became permanent and rapidly expanded.  Mills’ predictions of fiscal catastrophe rapidly became true.

Shortly after assuming office, President Nixon was faced with the first of these catastrophic predictions.  President Nixon found he did not have enough cash to pay the federal government’s bills.  Due to the international gold standard that established a basis for the exchange of dollars into other currencies he could not print more money without it reducing America’s international buying power.  In effect, all printing more money did was to create more paper that was proportionately worth less.  More arbitrary cash did nothing as the new cash was simply divided into the value of the gold reserves and the dollar was worth less; exactly at the same rate that it was expanded.

This was a big crisis, one we have historically faced many times before.  What Nixon did was follow the prior paths, taken with the backdrop of war, and remove the U.S. dollar from the gold standard.  Now, the treasury could print more money and the president could pay the nation’s bills.  While initially the recipients of the cash would realize it was probably worth less, there was no real way to measure the actual devaluation and some claimed gains could be made.  The government also needed to come up with a method to calculate an increasing value to the economy. They decided the best way to do this was to use the value of U.S.real estate–in effect mortgage debt.  Crisis averted–the bills got paid and for the most part no one was the wiser.

What were the big bills that were draining the money from the Treasury?

Well, Vietnam was a big part and the debt from the Korean War, but the biggest part was the rising cost of Social Security, Medicaid, and Medicare, as well as a number of other federal programs.  So this new money paid for these services. As these services were paid, and became more popular, they became more and more “socialized” within the population. Demand for additional services and coverage increased. Now that the costs were not an apparent problem, politicians–always willing to benefit their constituents out of the goodness of their hearts–reciprocated for their constituent support with an ever expanding list of covered services, and new programs.

We got a program for that!

Hey got diabetes, here’s a program for that; addicted to drugs, we got a program for that; got HIV/AIDS, we got a program for that.  This is not to say there were not legitimate reasons to try to help people in these circumstances.  Clearly, there were very valid reasons!  One of the biggest reasons was that the proliferation of these afflictions and diseases were now rapidly increasing the costs to the nation.  In the short run the increased spending was simply not a fiscal problem, we could change some rules, expand the debt, put more money in the economy which was making housing prices rise, increasing the dollar value of mortgages, allowing the printing of more money.  The new FIRE economy, based on Finance, Investment and Real Estate (FIRE) was just singing along. The more money we printed, the more money we could theoretically justify!  Economists rationalized why this was a fantastic system and we all just went along.

According to the prevailing theory, there was no spending problem!  In fact the more we spent, on credit, the more money we could print, allowing you to spend more money!  So get a credit card, buy a home, and your wages will always catch up because the economy is growing faster than you can spend it–literally!  The government said simply, hey spend more and the economy will simply grow!  And we all believed it! So that’s what we did.

Football and the other stuff!

OK, so what does football and the other stuff have to do with it?  Well, this easy increase in the ability to have the government pay for everything with little to no sacrifice on any of our parts, and certainly no real consequences for our own decisions and decreasing personal fiscal responsibility, has led us to a place where our expectations have changed!  We now all expect, at least in some part, that we are to be taken care of by the government if any disaster strikes.  Get flooded – call FEMA, your old and get cancer – Medicare, obese child with diabetes and earn less than some arbitrary amount — Medicaid, infected with HIV/AIDS – Ryan White.  This list can go on and on.  And even if you earn lots of money and have great insurance, now insurance companies are expected to cover everything, with no limits.  And not just things to keep you alive, some are now expected to cover sex re-assignment, breast augmentation, routine visits for medical, dental, vision, and much more.  Again, I am not saying this is bad, or that these things aren’t horrible for the people that suffer them.  I am not even saying we should, or should not, do them.

Back to football! So today there is an increasing number of people that believe if you are doing something like drinking soda, or smoking, or football, it is increasing the costs on the rest of us.  And you know, they are correct!  It is increasing the costs on the rest of us.  It is one of the many, but by no means the only or even the most significant,  drivers of the increasing costs of healthcare and spending in the United States.  So now we believe it is ok to restrict your freedoms because your freedoms are costing us money!  But why are they costing us money?

Why are our freedoms now seen as costing us money?

These freedoms are now costing us money because we arbitrarily made the decisions over the past 50 or 60 years to accept the fiscal responsibility for things that you do.  We are accepting them by either requiring the nation to pay for them or by forcing insurance companies, by either government legislation–moved on our behalf, or by our employers who we required to offer these things if they want us to work for them in the first place.  We have come to believe that if it is good for me individually it must be good for the nation.  The problem is, it’s not good for any of us.

Can you show me proof that spending is a problem?

What is the proof?  The proof of this is in our economy.  It is why much of the problems we think we have in HealthCare are driven by our own history, our economy and our rising false and mythical expectations.  In 1972 we had $500 billion dollars of money in circulation.  Today, we have over $17 trillion.  Our real asset value in the U.S. has only increased by a few trillion and at the same time we have spent as a nation $13 trillion more internationally than we have sold.  Our economy collapsed in 1972, the last 40 years have been a shell game, one for the most part we have unknowingly played.

Two spending classes in our national economy tie directly, in fact almost point for point, in their rise in cost compared to the rise in new printed money.  HealthCare expenditures (including the dominate expenses of Medicare, and Medicaid) and average home prices.  The new money has gone to pay for programs like Social Security, Medicare, Medicaid, and others. Housing prices rose because this is the prime engine of the intangible basis for the printing of the currency in the first place.  If you chart other expenses they do not come close to this correlation.

So if we want to, we can now begin the process of federalizing control over everything we do.  We can tax soda, Mc Donalds, and 7-11s. We can ban football, car racing, skydiving, mountain climbing, and we can regulate what we eat, when we sleep, how we have sex, when we go to the doctor and at what age we die, but it is not going to change the fundamental problem underlying all of it!

First and foremost we have a spending problem! Next, we really need to take a hard look at the path we are on nationally whether it’s in HealthCare, in defense, and in almost every other facet of our lives, and we need to decide what is the role of government and what is our role as individuals.

Our economy collapsed somewhere around 1972.  What do we do now?  In the face of a disaster years ago it sucked to be you. Today it sucks to be us!

A week or so, at the request of some long time friends and readers, I wrote a review of Windows 8.  I wrote the review not only because they had asked my opinion but also because I was disgusted by the lack of real work in using and understanding the system by the many so-called reviewers I had read.

I briefly spoke of the MS Surface RT.  While I have been using the RT since it first came out, having given my Apple iPad to my 14 year old son, and I have not looked back, this week I had to go to Boston for the week for work.  It portended to be a fairly complicated endeavor, one that in the past I would have brought my fairly powerful, and large and heavy, laptop.

Of course, lugging a laptop through airport security is no picnic as you must take it out of your bag, at the same time you are getting close to naked in order to clear the checkpoint.  This time, with a very small amount of trepidation, I decided to put my money where my mouth is and take the risk to leave the laptop at home and rely only on the Surface RT.  While I have been using the device, I have been reading all the negative reviews, and I suppose they had some effect.  I can’t say that I did not have some worries relying on the device.

Well the worries, were completely unfounded.  I found the Surface RT, yes lauded exalted Technology Reviewers the Surface RT you have basically decried as inadequate for months, worked not just as well but much better than my laptop. I was able to use it nonstop for more than the work day in every case.  Each evening when I got ready to go to bed at my hotel, I plugged in the charger and there was still power to spare.  All of the applications I needed to use; Word, Excel, PowerPoint, One Note worked perfectly.  In one dinner meeting I was able to pull out the Surface, quietly and unobtrusively and show some charts to a client without having to find a power receptacle after a long day working at an office.  I even had the occasion to connect to a projector and seamlessly move screens from the tablet to the wall quickly and efficiently.

Finally, while clearing airport security still required me to remove half my clothing, including shoes, watch, belt, wallet, card case change etc, I was able to keep my beltless pants from falling much easier because I did not have to touch the tablet just put my, now pounds lighter, backpack in a bin and walk on through.

I would recommend this tablet to anyone.  And would overall say my productivity was higher, and I frankly was astounded at the use I got out of the device.  When traveling in the past years with iPhone and iPad, I always still needed the laptop.  No more!

Congratulations Microsoft for a job well done!  And take that you MS Haters and Technophilic Elitists!  Real World experience trumps your negativism.

No Taxation Without Representation!

By now, we all know that the Supreme Court upheld the insurance mandate of the Affordable Care Act (ACA) also known as Obamacare.  To recap, 26 states brought action to have the mandate, declared as an unconstitutional expansion of federal power under the commerce clause, the necessary and proper clause, and as a minor point its taxing authority.  The Supreme Court agreed with the states and found the mandate unconstitutional under the commerce clause, and the necessary and proper clause. However, in what many felt was a stunning decision by Justice Roberts­—and judicial over reach, the court upheld the mandate as a proper execution of congresses’ right to tax, to the extent that the penalty is a proper tax.

While at the time of the ruling, one-half of the nation, and the Obama administration, believed the last word had been uttered and Obamacare as passed was now the law of the land; this was not, in fact the case.  The law is already being altered by both legislative action and the affected departments like, IRS, HHS, DOL, and others newly created ACA rules.

The law has seen a number of its provisions repealed. Those like the employer reporting requirements and the CLASS act were repealed in the recent fiscal cliff legislation.  Some segments of the law have been delayed or defunded by other recent legislature including the CO-OP stimulus provision and the pending 27% Medicare Doctor Reimbursement rate reduction. Additionally, there are numerous other challenges afoot to alter the law or to impact its implementation.

Currently, many states are refusing the required expansion of Medicaid.  A similar number of states have made the decision to not, or are indicating they will likely not, establish a state based exchange.  About 17 states already have, or currently are enacting laws that prohibit implementation of parts of Obamacare within their state. Some states are in the process of passing so called sovereignty legislation that will make the entire federal law illegal.  Fight over the Affordable Care Act is far from over.

One of the more interesting arguments comes from a research paper from Jonathan H. Adler and Michael Cannon, of Case Western Reserve University Law School entitled, TAXATION WITHOUT REPRESENTATION: THE ILLEGAL IRS RULE TO EXPAND TAX CREDITS UNDER THE PPACA.  The basic premise of the paper is that in states that choose not to establish exchanges, the IRS does not have the authority to pay subsidies to people who qualify because it has no authority to do so under the law and only congress has the right to do so under the constitution.   The paper, makes a convincing argument why this is true and also reports the contrary arguments to this finding.  I would encourage you to read this paper for yourself. At this point, the argument is no longer theoretical as at least one state, Oklahoma, based on the arguments in this paper, has filed a suit against the IRS ruling stating their intention to make such payments.

The members of the original 26 attorneys general who brought the prior litigation over the commerce clause are continuing their aggressive pursuits to block this legislation. Since the Supreme Court ruling, the CBO and others have continued to re-evaluate the cost of this legislation as parts are repealed and the rules for specific sections get written.  The net effect is that the original, at the time of passage, estimate of the costs of under $1 trillion have escalated to over three times that initial amount.  This estimate is specific to the cost of implementation of the law and does not include other costs to the American people and business like premium costs, which have already increased by 1/3 since passage, and are very likely to increase 50% more prior to full implementation. Nor does it include the staggering loss of care to Medicaid and Medicare patients as more and more health care providers are making the decision to no longer accept the current reimbursements for these patients.

This divisive law, passed in the dead of night, and rushed through congress using a method that has never been used before to obscure its provisions from visibility before it was passed, continues to be disliked by almost everyone who worked on healthcare reform in the first place, and disliked by a majority of the population.

The final act of this tragic play may be that when all the arguing is done and all the money spent to both fight and implement this law, Americans will find that they still have an ineffective, inordinately expensive and undesirable health care system.

I am sure there will be much more to report in the coming months as this legislation will remain front and center in the partisan divide we are all living.

Hey people! Meet the new Windows 8 Start Button!

Authors Note:  While the main purpose of this blog is to discuss healthcare and related issues like the economy, and political implications and drivers, I have had a long history in the PC industry going back to the dawn of what we call the modern pc era.  As such I have had more than a few people asking me what I think of the new computing trends for touch-based tablets and pcs as well as Windows 8.  Please forgive this digression to my past life.  Indirectly the trend toward individual personally centered transactions systems is key to our future healthcare needs.  Perhaps I will write an article on that as well in the near future.  Regardless, I hope most of you will appreciate this article and forgive its intrusion into the healthcare dialog.

I have been both fascinated, and appalled, at the recent reviews of Microsoft’s new Windows 8 operating system.  I have been fascinated by the continuation of the journalistic trend to initially bash anything from Microsoft or at a minimum begin reviews with lead lines about where or how their products simply missed the mark.  I have been appalled, at the lack of real usage of the system, or any attempt to understand what this new system will mean to users prior to the rush to review. This is just not a system you will learn in a few hours or a weekend and get the benefits from.

As an illustration of the lack of use, or understanding, one of the biggest complaints, at least one of the most consistent complaints, is how those idiots at Microsoft (italics unsaid but implied in the tone of the article) eliminated the beloved start button!  I have seen this statement in almost all of the reviews I have read.  Further, the reviewers go on at length at what a problem this has caused as they try to use the system.  This is simply not a true statement and it’s wrong in its application.

The first thing you see when you load Win 8 for the first time is the start button.  Now the start button is called the start screen.  Like the start button of old it is the center point for access to any application you may want to run.  Like the start button you can show items pinned to it and you can also hide programs you seldom use from it.  Unlike the old start button, the programs are listed as dynamic tiles that can range in size from small to large and can, at your discretion, be “live” tiles that can quickly communicate visually, changes in the application state, or information the application manages for you, in a quick visually appealing glance.  Also unlike the start button of old, this screen is the geocentric hub for direct access to almost anything you want to do system wise.

If you want to search, unlike the start button, you simply type the terms or phrase you want to search for and voila, an interface lists every file, application, or setting that the phrase occurs in.  I think this is much quicker, and I find it much more accurate, than the older search function.  Further, most Win 8 apps have direct search enabled, so from within those apps, like the ‘app-store’ app, you can do the same thing. Just type the term and get a search within the scope of the app.

I have found that Win 8 is a much more effective and integrated system compared to Windows 7, but I did not have that feeling the first few days I used it. Like most of the reviewers I quickly had a, “what the heck were they thinking?” reaction. It took some time for me to modify my practices to gain the benefits of the new system.  While the interface is a very visible and drastic change, the benefits are often very subtle but none-the-less effective.  The Windows key, situated between the control key and the alt key on most keyboards, has long seen little use, now it will become an integral part of your efficient use of Win 8.  This long forgotten key, becomes the gateway to significant increases in your work efficiencies and speed.  What to search for something in an app that incorporate a text editor?  Well you can’t really type on the screen can you?  So use the Winkey “Q” combination.  Want to share this with twitter folks, Facebook, via e-mail or other methods, hit Winkey “S”.  Do you want to send the file to another device, like a printer, or a USB storage card or a second screen? Use the Winkey “K” combination.  These fast key combinations are simple to remember and really increase your productivity.

As you no doubt are aware, Windows 8 is the new touch screen interface.  I have used iPhone and iPad almost from the day of both releases and found them to be two of the first implementations of portable communication and data devices that were innately functional.  While they were useable, and initially a very refreshing implementation of other existing systems over time the novelty waned and the realities of the limits of the platforms set in.  As is always the case with technology, fulfilling one set of expectations, causes the rise of a new set.  Unfortunately, existing systems need to support legacy systems and design criteria become somewhat fixed.  For me, the limits I know saw, did not change in the subsequent releases, and in some cases they grew, so as time went on my satisfaction with those products waned.  While for many this is not the case, for me and for some others this is always the case with technology solutions.  We seek the next advantage.  We, so called early adopters, are willing to change our paradigms to gain advantage.  So as an early beta tester of Windows 8, the change to a new way of being was not as limiting, in fact it is exciting for people like me.  I relish learning a new way to do something and will experiment and seek tips and tricks to expose different, sometimes better methods, to accomplish the same task.

Using Windows 8 on non-touch enabled devices at first glance can seem counter intuitive if you become bound by your old process or bound by the concept of touch as key.  In the case of Windows 8 it at once both a radical change from the old system, and not radical enough.  You can use the new system for the new methods but due to legacy issues still, thankfully use your older applications as well, with most of the old interface.  While most reviewers decry the partial old interface, as I said earlier they are actually missing the benefits by focusing on what they wish was there!  Put another way, they adopt the position, why didn’t they just leave the old interface there so I don’t have to change anything.  The answer is, then Win 8 and what follows will never be more than Windows 7 which was bound by old Vista, bound by Windows NT, and that extends all the way back to MS-DOS.

For its entire history, Windows in its various forms has been constrained by MS-DOS. As time has gone on much has been done to mitigate the limitations of MS-DOS but still the limits of backward compatibility remained.  Over time the pundits, decried the limitations and implored Microsoft to more on.  They have tried a few times and every time the same pundits decried the moves forcing them to again go back.  There have been some very remarkable withdrawals, one of the biggest happened resulting in the pull back of some key features in Vista a few weeks before release.  What has been needed for a long time was the ability to have a major paradigm shift.  MS needed some king pin to make such a pivot.  Touch appears to have finally become that pivot point.

As an illustration of the prior point, users of any old windows system got used to having to manage the number of open applications.  We have adopted the practice of closing an app when we were done with it.  That was not just good practice in the older systems it was pragmatically required.  One common confusion for new users is there is no “X” button to close the app, nor an integral menu bar with the close or exit list item.  So how do I close an app?  Well you do not have to.  This new, relatively unchained to the past system, deals with apps entirely differently and reportedly more efficiently.  There is a method to close your app through a finger swipe, drag and drop or key combination.  But you can just hit the Windows key and go to your next app.  Windows will close it as some point when it needs to. I have tested this for a month, closing noting and have not had one problem.

We all focus on the User Interface but the benefits of Windows 8 go way beyond the UI.  Win 8 is not just a new operating system, it is an entirely new viewpoint into how we connect with others, how we deal with data, how we transact with the outside world.  For centuries transactions have been driven by an institutional centric point.  The center of all of our transaction has been institutional, even if it was person to person.  The person who validated the transaction was the maker (buyer if you will).  It was that point that ultimately controlled the process, what data was required and how the data was managed and interpreted.  The birth of the cloud has been one of, if not the first, truly evolutionary steps in our recent technology history.  Prior achievements have been revolutionary.

The birth of the cloud has been remarkably indefinable as to why many have moved to the cloud.  There are real benefits that the cloud brings but if you have asked many CEOs why they needed to move to the cloud, many of the responses have been less concrete and more abstract. For some it has been, “because we need to move to the cloud, everyone is!”  As the cloud is developing, so too is a different view of the transactional landscape.  Transactions are now moving to a model where the individual is the center point.  This is bringing many advantages.

It is not my intention to get too deep into this fairly abstract discussion, if you want to know more or discuss these ideas further just contact me.

Windows 8 is yet more evidence of this evolutionary step.  The true benefits of Win 8 lie under the hood, and the ease and transparency by which the value of the cloud is incorporated into the methods that use to make these magical devices work.  From the ability to identify, gather information, sort and search for contacts ubiquitously, regardless of whether they exist in your old outlook contacts list, exist in your twitter followers, exist as your Facebook friends, LinkedIn and I am sure many more points in the cloud; to similar redefinitions of interconnectedness inherent in other uses of the system the cloud is no longer an abstract destination based place, you and your system are now at once the destination and a destination for all devices.  This is not the only behind the scenes shift.  There are many more.  They all, in essence, change the user to the center-point of the cloud and with that comes a significantly different and efficient experience. If I am the center, I am the destination.  I don’t have to go to Facebook, or to LinkedIn or to some other destination to gain much of the benefit of connectivity because the connection now is me!

Bill Gates vision from 20 years ago is becoming a reality.  In a meeting at the Airport Marriot Hotel outside of San Francisco, Bill Gates gave a keynote address where he described a future where people interacted with three kinds of devices: a personal interactive device, a portable interactive device and a social interactive device.  Of course, today it is obvious he meant personal computers & laptops, smart phones, and televisions.  It was not so obvious, or even believable, to many in the room at the time.  After many years, and billions of investment in development, I believe Windows 8 represents the beginning of the true implementation of Gates vision.  I am sure that Apple users will see similarities of visions and evolutions in Apple’s products as well.  What I see as an old (in years, not in mind) early adopter user, who has been doing this since the beginning days of the pc industry, is that Windows 8 and Apple share similar current usability, but personally I find the integration of the Windows 8 phone (in my case a Nokia Lumia 920), my tablet (MS Surface RT), and my desktops (numerous laptops, desktops and workstations), now have a level of easy integration that is at least one step further than any of the existing systems.

Sure there are current limitations and things that need both development and improvement.  Anyone can take a look at a newly developed system based on such a fundamental paradigm shift and find lots of things that either need to improve, have bugs, or …  Yet so far, after actually using the systems for a while, I have personally found noticeable gains in efficiencies, ease of dealing with multiple tasks and integrating data, converting date to information and linking the information to some actionable result.  In the end, this is what I look for in my technological aids.

I not only expect Windows 8 to be viewed as the beginning a new era, I think it will reposition Microsoft as a true innovator, not just in technology but in the changing view of the position of individuals as the center point of their experiences.

I would encourage all of you to take a hard look, and see for yourself.

Now Crabs feel pain – what will PETA say!

A recent article in Discovery News reports that lobsters and crabs feel pain.  While this has been suspected for quite a while, due to the primitive nature of their nervous system, it has been very difficult to quantify or qualify what their sense of the pan would be.

Recent research at Queen’s School of Biological Science, published in the Journal of Experimental Biology, under the title, “Painful Feelings in Crabs,” tested crabs and showed that when shocked at a specific desirable location, soon they modified their behavior to avoid that location.  The Discovery article, notes similar results for lobsters.

All animals, have some form of feedback system to help them survive by avoiding negative stimulation.  In looking at the biology of a crab, for instance, their primitive nervous system is indiscrete and sparse.  It is likely that for a crab, as for many other animals, they sense pain, but do so in a very different manner than animals with highly discrete nervous system like humans.  For a crab, a negative stimulation at the tip of their claw would at most likely register as a dull ache throughout their full arm and claw. It is also possible that it is even less localized than that. Unless, we can find someone who has a regressive memory of their past life as a crab—I mean the horizontal eight-legged version not the vertical two-legged version we really will never know.  For us it would be like a small prick to the finger making our entire arm have a dull pain instead of the sharp prick we actually sense.

All feelings are not alike, even on our own body.  Our own sense of pain is tied to the number and type of nerves and receptors that you have in any location.  You can try this experiment at home if you want.  Close your eyes, and have a trusted friend, or calm and sedate spouse, take a pair of scissors and very lightly, I said very lightly now, press the tips of the scissors to your finger tip.  Have your partner start with the scissors closed and then gradually open them wider and wider until you, with your eyes remaining closed, feel two points not one—use a ruler to measure the width point to point.   Now do the same thing, only, this time use the middle of your back (not directly over a bone like your spine). Again measure the distance point to point. You will find that you can discern the tips quickly, almost immediately, at your finger tip, and remarkable wider on your back. This is because you have lots of discrete and specialized nerves and pain receptors in your fingertips, evolved over time to help you protect these vital tools of your survival, and very few in your back.

Little known is that that all living things have some form of negative stimulus avoidance detection system, even plants.  A number of years ago, I jokingly told a vegan friend of mine that while I did eat meat, that at least when I ate a steak the animal was dead, unlike the fresh plant that she was enthusiastically crushing with her molars.  She replied that plants did not feel pain.  In response, we walked outside and I pinched the leaf of a mimosa treat, she watched in what soon became mild horror as the rest of the leaves slowly closed up on the affiliated branches.  My joke ended up not being so funny to her.  She replied, with much more emotion than I expected, “What am I supposed to do now? I don’t want to harm any living things just to eat!”  It is not just mimosas, who have a much more responsive, system than most plants.  All plants respond to negative stimulus.  If you place a plant near a heat source that is dangerous, they will either twist away slowly, or grow always from the negative source.  It appears their system is more of a chemical response system, than the electrochemical, and biologically observable structural system that we can see in most animals.  Yet, it is none the less in place and observable if you want to see it.  It is true that plants don’t have a brain.  But it is clear that the lack of “brain” does not stop a plant from responding.  You can say if comes down to what is pain in the first place!

Today, we live in climate controlled houses, buy food from the grocery store, or have it delivered from an on-line purchasing system, we drink filtered and processed water, and we have a host of biochemical weapons to keep other predatory species at bay.  We have evolved whole cultural groups that believe that we should not kill or harm other species for one reason or another.  Interestingly, our ancestors would have agreed with that statement with the addition of one word—needlessly.

Historically few humans have needlessly slaughtered animals. In fact most primitive cultures developed rituals revolving around the harvesting of animals and plants for survival. Most cultures abhorred needless slaughter as it was understood that it was an impediment to their survival to wantonly destroy, and make unavailable their own food!

Humans, have evolved to become omnivores, we can eat just about anything, living or dead, with some exceptions.  This adaptation, in conjunction with our big brain, is what, for the time being, has put us on the top of the food chain.  Initially, it was our ability to hunt and gather that gave us an edge.  We killed for necessity not for sport.  Perhaps it was because it took so much time to hunt and kill and gather and process our food supply, we simply were too tired.  Or perhaps, like people do today, few turn their livelihood into their recreation as at the end of a productive day we really all want to get away from that activity and do something different. Over time we began to domesticate animals, and instead of gathering our food we grew it.  As we domesticated the animals and plants that we used as food, in some respect we also humanized our relationships with those species.  No longer hunting for survival, hunting became a pastime.  For many no longer having to grow their food, gardening also became a pastime. There are those that say we have an evolutionary predisposition to do these activities. Today, we have de-evolved, some say evolved, to look on our prior food sources as co-equal for survival. An interesting development that speaks volumes about our disconnection from the forces of natural selection. Today, it is fairly safe to say, that as a species we are quite evolutionarily different then we were 1,000 years ago.

Since we are no longer dependent on hunting and gathering skills to survive, we no longer are built to do it well.  As a species it is likely that our eyesight and hearing, among other things, have deteriorated as they have become unnecessary for survival.  Our physical digestive system has also modified in a number of ways. Most notably, our appendix, which not so long ago was there to help us process drinking from natural water sources laden with microbes, and sediments, now is for the most part an inactive vestigial organ (recently some research indicates that the appendix does still provide some benefit).  It is safe to say, that if all of our modern conveniences were removed tomorrow, as a species we would have a very difficult time adapting to the hunter gatherer existence we dominated so well before.

As I have reported in earlier articles, most recently, “Treatment-resistant bacteria threat rises: What are the options?” we have removed ourselves from natural selection, using artificial means to survive.  These survival improvements have come at a significant species cost.  We are more susceptible to disease, we are less capable to survive in a natural environment, and we are not equipped with the skills and knowledge to hunt or gather.  Most of us if thrust into the wild would survive for a time, but likely at some point they would eat some toxic mushroom or, has happened to those thrust into the wild, successfully killed a predator (meat eating animal) and made the mistake of consuming that predators liver, which can prove fatal.  Eating the liver of an herbivore is ok and we do it all the time.

The laws of natural selection were there for a purpose in our past.  The kept us abreast of the changes in the species that either preyed on us or competed with us for survival. We fortunately evolved this big brain thing! Our big brain has allowed us to create artificial means to remove those natural selection pressures from affecting our current survival.  But like almost everything we find in the natural world, Sir Isaac Newton’s law of physics, “For every action there is an equal and opposite reaction,” or in modern parlance the law of unintended consequences, still holds true.

Truly, there is little we can do other than to continue on this path and recognize that these consequences will continue to pile up.  The pessimistic view is that one day this pile of unintended consequences will become fatal and we will be wiped out as a species.  The optimistic view is that perhaps our big brain will continue to seek solutions and we may find some method, perhaps a genetic means to reconstitute our DNA and rebuild the biological assets we have failed to evolve naturally, and we will eliminate or reduce the building consequences pile.  Who knows?

My vegan friend was actually shaken by my humor in a way I did not intend, my own unintended consequence. She decided to eat more seafood, as she felt they likely felt nothing and for the most part were dead and cooked when she ate them.  A few years later she reverted to eating foul, as she read that they were determined to really be modern dinosaurs, and as such were primitive and aggressive.  And then a few years later, likely in a WTF moment or as a result of a building craving for a nice juicy hamburger, something she had told me over the years was the only thing she missed, she went back to being a true omnivore.

The moral of the story is, you can say what you want; you can eat what you want! What has built us as a species is 10s of thousands of years of evolutionary selection pressures.  While today we have done a great job of eliminating those selection pressures using artificial means, including biochemical weapons on microbes, it comes at an accumulating cost.  And these costs are not just figurative, but fiscal and environmental as well.  All biological populations pay a consequence for over consumption and over population.  We with our big brains have derived ways to forestall this. Eventually, these costs will come due in one form or another! Will we be ready when the bill comes due? Is they already coming due now?

Treatment-resistant gonorrhea threat rises in North America
By Julie Steenhuysen – Reuters.Com Jan. 8, 2013

Treatment-resistant gonorrhea threat rises in North America | Reuters.

A Reuter’s article today again illustrates the disturbing trend in our biochemical battle with other species, like the bacteria mentioned in this article–we are losing this war!  In the last few weeks, we have seen a number of articles outlining the discovery, or at least public disclosure, of new superbugs. Here is just a recent listing of articles on some superbugs:

Methicillin Resistant Staphylococcus Aureus (MRSA)

1. MRSA Superbug Found in British Milk
2. When Is a MRSA Infection Grounds For a Baltimore Medical Malpractice Lawsuit?
3. Battles that still need the attention of the media

 Klebsiella pneumoniae carbapenemase (KPC)

1. Klebsiella pneumoniae Carbapenemase-producing Enterobacteria in Hospital, Singapore
2. The KPC Killer
3. INFECTIONS TAKE AT LEAST 51 LIVES AT PANAMA HOSPITAL

NEW AIDS-like Virus

1. New HIV-Like Virus in China
2. Highly Contagious AIDS-Like Disease Spreading in China
3. Highly contagious mystery virus with AIDS-like symptoms quickly spreading  throughout China

Necrotizing Fasciitis – Group A Streptococcus Disease (GAS)

1. Mechanic has arm amputated after small cut on his hand develops into flesh-eating disease
2. Talked-about stories of 2012 still vivid
3. Lesley Clark’s Survivor Story

General Articles

1. How hubris put our health at risk – CNN
2. Three Scary Charts On The Post-Antibiotic
3. Growth Factor: How Bacterial Infections Persist through Antibiotics [Video]

We are losing the battles

The overall message is that we have been losing the biochemical war that we have been waging against these pathogenic human predators for years.  The laws of natural selection work both for us and against us, and in this case are working very strongly against us.  The more we rely on biochemical weapons to keep these species at bay, the more susceptible individuals live and reproduce more susceptible offspring.  At the same time, the more we use our weapons against these pathogens, the more they become resistant as the strongest survive and reproduce stronger offspring.

Another problem that we face is that the new chemistries we are developing to attack these bugs brings with them higher risk and more side effects.  Many of our magic bullets like penicillin, streptomycin, and tetracycline, to name a few,  are no longer effective.  We have, for almost 50 years, been computer modeling every possible known chemistry to fight diseases and these models have yielded great results in the past.  The current problem is that the low hanging fruit, the drugs with low side effects, are long since discovered, the bacteria have become resistant,  and the drugs are no longer very useful.  Now, we are mining the ones with “reasonable” or manageable side effects.  Soon, we will be left only with options that have significant side effects that will require custom fitting of our individual chemistry–our individual phenotype and genotype–in order to avoid dangerous or fatal side effects.

Can we win the war?

Unfortunately for us at this time, there are limited alternatives. But there are some options remaining that offer new hope–at least in the short term. One area of exploration is finding new techniques to increase the efficacy of older drugs that are no longer effective due to limitations of dosage based on prior methods of delivery.  Historically drugs have been delivered in three main ways: Topically (by application directly to the site of the infection), by ingestion (through the mouth, nose, or suppository), or by injection into the muscle or blood stream. The latter two, methods historically have provided the only method to reach the inside parts of the body and have had a number of physiological factors limiting the dosage that arrived at the site of infection.

Some parts of the body, where infections can occur, do not get good blood or fluid flow.  Ingested and injected drugs get disbursed throughout the entire body so only small amounts get to any one part.  Many of the drugs we have developed have had internal dose limiting side effects like toxicity to stomach, liver, kidneys, etc. Others, have had overall dose limitations due to general toxicity or irritation to the tissues they pass through like the walls of our blood vessels. Overall, this means that in the past the effective doses that we could deliver to an affected area were often only marginally effective in the first place.

Some new hope on the horizon

There are new technologies by companies like Savara Pharmaceuticals who are taking older, so called orphan drugs, and developing methods to introduce those drugs in a internal topical manner significantly increasing the effective dose while bypassing the potential side effects. Savara is working on using an older drug, Vancomycin, and applying it directly in the lungs to help Cystic Fibrosis patients with MRSA effectively fight this dangerous and often fatal infection.

Another interesting company is ViThera Pharmaceuticals who is working on methods to use genetic engineering to alter the chemical production of normal gut flora (bacteria like lactobacillus) to produce beneficial therapies right at the site of the problem.  In ViThera’s case, their initial approach is to treat Inflammatory Bowel Disease (IBD) and potentially Crones Disease–two rapidly rising problems in America–and currently very expensive to treat.

Both of these programs have one thing in common.  They are attempting to find new ways to significantly increase the dose of the chemistry needed, directly to the site of the issue, while minimizing or eliminating the impact on other tissues, or the rest of the body.  While bacteria have developed resistance to our prior treatment options, the resistance is based on the limited doses that could be delivered at the time. In most cases, it has been shown that a massive dose can be completely effective.  These new delivery technologies, in effect, hold the promise to allow for the delivery of overwhelming levels of therapeutics completely destroying the pathogenics.  These are one area of development that hold the potential for great and rapid promise.

New research – new methods

Another key area of research is the discovery of the physio-chemical methods that organisms like bacteria use to become resistant. This article by Sean S. Kardar entitled, “Antibiotic Resistance: New Approaches to a Historical Problem” is a good source to understand the problem and current research. While many stories emphasize the overuse of antibiotics, such as in livestock, foods, and over prescription as the leading cause, this is likely too simplistic an answer.  There are many potential practices that lead to resistance. Part of the problem, as we spoke about above, was the natural selection of more resistant strains due to the inherent dose limitations of older delivery methods. Another key area is our own human behavior.  We just don’t take all the pills we are supposed to for a variety of reasons, and some of the organisms who are stronger–more resistant–survive and reproduce stronger organisms.

Understanding the physio-chemical methods that increase resistance are yielding discoveries in how the resistance comes to be in the first place. Recently, it has been discovered that at least some bacteria in effect go to sleep and stop reproducing, other research shows that bacteria can modify the walls of their cells so the antibiotics can’t stick. See this reference, “Scientists discover new method by which bacteria become resistant to antibiotics“.  Discoveries like this are illuminating the path to new treatment strategies as seen in this article, “Method Seems to Attack Bacterial Resistance” where researchers are finding ways to turn off the genes in the bacteria that lead to resistance. So there is some hope, at least for the short term!

The laws of natural selection seem immutable–but, maybe not!

Overall the future of our biochemical warfare with other species still appears to point to our eventual loss but we are an inventive and dynamic species. Perhaps we will one day yet discover the ultimate answer, even though natural selection would indicate this is a very remote possibility. Regardless of how bleak the future can look we still have no acceptable alternative but to continue to use biochemical warfare to preserve ourselves, and to seek other strategies to continue to buy our species more time on the planet!

I also want to personally thank all of you for the retweets, likes, and comments.  Because of your retweets and recommendations we know have almost 5,000 twitter followers and equal growth on Facebook.

Finally, Happy New Year to all of you, may your 2013 be an exciting, prosperous and enjoyable year for you and yours!

Best Wishes:

Tom Loker, Kristina Howell and the staff.

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Eye of the Beholder

It was Lew Wallace (1827-1905) who said, “Beauty is altogether in the eye of the beholder.”

Since I began getting involved in Washington, DC with the debate over healthcare reform a number of years ago, I have wondered more and more about how we have arrived at such a place that every issue, every decision, every need is met with such partisan, fractional, divisive and inflammatory rhetoric. Today it seems that there are no discussions on any issue that doesn’t revert to, “they said this, and what they really mean, is that.”  Or, you can hear a statement from one side or the other to the effect that, “It’s clear that their agenda is to do X, Y or Z to harm us.” Any, and all, of these statements amount to “doodly squat” as Granny Hawkins would say! – a prize to anyone who knows this reference — without using the internet!

Spin is not a new concept

Nothing related to any issue facing our national interest today is devoid of some spin to gain advantage on some other tangential issue–related or not.  Not to pick on any one side, or the other, but how often do we now hear the phrase, unfortunately most recently attributed to Rahm Emmanuel, “never let a serious crisis go to waste.”  Or to be fair, the statement by Senator McConnell that the prime goal of republicans is to defeat the president. If you think Mr. Emmanuel or Mr. McConnell are the first to utter these kinds of ideas, that they meant them completely literally, or that it is not a practice by each side of the political aisle, I have a bridge in Brooklyn I am willing to sell you; if you can convince me you deserve it!

If you think hyper-partisanship and gridlock are new I again encourage readers to go to Google Books and look up some of the old papers from the late 1800s and early 1900s and read what was going on then. There are surprising similarities.

Agenda based legislation now the norm

During the drive for healthcare reform there were a series of changes to the goals of the legislation that occurred as the process spread to one committee after another.  Senator Kennedy began the current process of healthcare reform in the wake of the disastrous attempt during the Clinton administration.  The bill that he authored just prior to his death was the result of his long-term attempt to find some legislation that would be acceptable to people on both sides and improve the healthcare system.  The HELP bill, while clearly not likely to have conservatives jump up and proclaim it a triumph of modern legislation, was still a bill that he clearly had worked hard on to find areas of support from his political opponents and an honest attempt  to find methods to improve the healthcare system.

Having read it in its various iterations myself, it was clearly legislation moderate republicans would have found the ability to support. Overall, it was my opinion then, and remains even more so now, that it was a bill that would have truly helped to fix some of the fundamental issues related to the current system. There were a number of republican ideas that he incorporated into the bill that did have support. While there were also items that many felt were a bridge too far, Kennedy’s HELP bill was far superior to the final legislation and provided a much better framework for an effective solution that both parties could have supported. So why did this bill fail and why did the ending legislation have little or nothing to do with his original goal of improving healthcare for all of America?

This is a question I have spent a lot of time contemplating and was one of the reasons I wrote the book, The History and Evolution of Healthcare in America.  As an interested participant in the process, what I observed left me to wonder how we have come so far that even the most universal goals could get subverted and co-opted to such an extent, simply to feed secondary agendas and partisan ideals on both sides.  Also, I was astounded at the extent that the public was informed of the changes in the goal from improving the healthcare system for all Americans to that of laying the groundwork for the failure of the current system in order to have a path to a federal single payer system and the elimination of private sector health care.  This was something that was stated numerous times publically, and even reported in a limited fashion on the major news networks but little to no outcry ensued.

A nation of two equal minds on almost everything

One could draw the conclusion that the majority of Americans want the federal government to provide health care for all.  The reality, like almost everything else, is there is not a clear majority who wants such a singular solution.  At best, if left as a nebulous conceptual question the country is about equally divided.  If specifics are provided in the framing of the question as to what it might mean in the opinion of the pollster the numbers become a very slight majority on one side or the other depending on the framing of the question.  At best, it is clear that most of America has no clue what they want and likely does not have the information to make an informed decision. But this is not the issue!

Historically divided

America has been a divided nation historically since founding.  One simply needs to read the writings of Franklin, Hamilton, Madison, Jefferson or Adams to see that within days of the creation of the constitution, America has had a diversity of opinion as to the role of the individual and the role of government.  It was as a result of this dichotomy that our constitution is long on what the federal government should NOT do and rather short on what it is permitted to do.  The debate then was less about empowering the common man and more on not allowing the federal government an opportunity to become tyrannical and to suborn individual rights.  Both of the antagonistic sides of the debate during the framing were in agreement that the power of the national government needed to be limited because they believed that the end point of any democracy was either tyranny or anarchy.  To this end they specifically did not create a democracy but instead created a constitutional republic!

Compromise through Tolerance

It was in the area of the underlying core beliefs that the founders held in common that their compromise through tolerance, a term coined by Benjamin Franklin, brought forth upon this nation a new form of government.  And it is specifically this form of government that has allowed us the freedom to expand it, celebrate it, interpret it, enhance it and also to screw it up at will.

I have come to think that over the past 234 years, since the constitution was ratified, we have changed in ways we are not cognizant of.  One of the areas that the founders tried to check and balance, were the decisions and changes in laws and governance that could come forth as a result of the arrogance of man.  Something they believed was endemic in mankind and as equal a threat to the republic as active tyranny by government through the development of a ruling class.   The concepts of the three equal branches were devised to check and balance many different opposing beliefs and in effect to impose a mandatory system of tolerance.

We now only tolerate intolerance

Today, every discussion at the fundamental level seems to revert to an argument as to whose fault it is that something someone wants, or feels should be one way or another, is not as they wish it to be.  We have arrived at a time where the simple act of saying Merry Christmas is fraught with controversy and argument as to its constitutional authorization.  I have said many times that the only thing we tolerate today is intolerance because there is nothing I can think of that people do any more that is not fraught with someone feeling they have a right to stop it, mandate it, or impose their specific idea on how it should be done.  Again this is neither a republican nor a democrat behavior; like so much else it has become ubiquitous but we refuse to recognize it as such.

Lets Say

You want to hunt foxes because it is part of your way of life or heritage, or because the foxes are eating your chickens, or because you don’t like foxes: there is a group somewhere who will petition the government to stop you from doing it?  You want to repair a fence around a grazing field that has existed on your property, holding cattle, since the founding of America and, someone somewhere will complain and a law will be passed that you cannot repair the fence without a obtaining building permit, and you can’t get a building permit because the latest laws say you can’t have cattle this close to a stream because their waste may wash into a bay or river.

How about, you moved to this beautiful bucolic community, an hour or so outside of the city where you work, to get away from the hustle and bustle and get to a peaceful life surrounded by farmers and fishermen. You get annoyed that the chickens crow early in the morning, that the waste of the animals sometimes is smelly and the fishermen fish right in front of your house and impede the view, or get in the way when your trying to water ski or sail your yacht.  No matter, just call your friendly politician and remind them that it was your donation that helped them get elected and pretty soon these people will be forced to stop interrupting your lifestyle.  After all, you spent a lot of money to come here for this bucolic existence and you just won’t tolerate their inconveniences.

Its still about Tolerance

You see, we have slowly come to the position that our collective concept of tolerance only works one way.  If I do not like something you are doing, then the government needs to step in and stop you from doing it.  Regardless of whether there are a few or many of us, the government has to stop it because the constitution says something somewhere that we feel makes it such and so.  But, tolerance, by definition, is the act of allowing a behavior or action by another that you do not like.  Sure, you could make the argument that they need to tolerate you desire for no smells, or your desire to sleep late, or your desire to not have them in your view or impeding your sailboat. But, if we use that argument we end up with a situation where you cant do anything unless the national government creates some law, oversight group and financing authority to expressly authorize it and control it. Hum!  Is this where we are now?

Tolerance is not the only thing

While I think lack of tolerance is one of the keys to why we are where we are today, it is not the only one.  I also have come to the conclusion that we no longer believe it is neither wrong to be envious nor wrong to blame others for our own decisions.  I do think that many of us have become immune to our own responsibility for our successes and failures.  Again, one side today wants to attribute success only to the role of the individual, and the other want to attribute success not to the individual effort but the largess of the masses that made it possible.  Both positions, when stated this way are clear to most to be wrong-headed. Likewise, the nuanced positions of these issues are wrong as well.  While most of you will agree with the prior point, I am sure many will disagree with the second point and find some rationalization why this is simply not true.  Ask yourself why you feel this way. I have many times lately and astounded myself as to my own answer.

Over the past few days, I have been having a dialogue, primarily with an old and very respected friend.  Like always we disagree on some points and we agree on others.  Both of us come from the same upbringing, from the same town, same schools, same church, same friends, etc.  And, we share all the same values.  Yet, there are areas where we are each and at the same time more conservative than each other and more liberal than each other.  This discussion became of interest to me because it was driven by a larger point I was attempting to make relating to the fundamental, not partisan issues that are causing the lack of progress on almost all levels economically and politically. But we kept coming back to who was at fault and my friends belief that I was just pushing a partisan agenda.

Every time I have a discussion with this one good and valued friend I learn something.  Sometimes it is about him, sometimes it is about me.  In this case it was about both of us.  What I learned is that we all have really evolved a long way from the principals, mores, values, beliefs–I am not sure what to actually call these characteristics–that guided the founding fathers.  I have also realized that they must have believed these fundamental characteristics of mankind were immutable as they relied on them to help check the system for evolution of the very checks and balances that were built into the constitution.  Now, I wonder if the distance we have moved from these founding fundamental characteristics of mankind have damned our form of government to suffer the same fate as all foundations of government since the dawn of civilization?

Me and my Arrow–in the Land of Point

Pointed or Pointless with Tolerance we all can have a point!

There was a story, put to music by Harry Nilsson, called, Me and my Arrow. The story is a tale of a young boy, named Oblio, from the Land of Point–where everything and everyone had a point–who had to wear a pointed hat since birth to conceal the fact that he was born round headed and had no point.  He has a dog, named Arrow, and one day when it is found out that he has no point, he and Arrow are banished to the Pointless Forest because you cant live in the Land of Point if you have no point.  It is a very interesting story on many levels.

During his banishment through the pointless forest, Oblio begins to discover that everything there, while seeming to be pointless at first glance, really did have a point somewhere if people were just tolerant enough to look for it.  This culminates in Oblio and Arrow’s meeting with the Rockman.  The Rockman tells Oblio at one point that in reference to pointedness, “You see what you want to see and you hear what you want to hear!”  Oblio returns to tell the so called pointed population that as he and Arrow traveled through the pointless forest they discovered that everything there did in fact have a point.  And, if everything in the Pointless Forest had a point then he must have a point also.  To which someone in the audience says, “well he’s got a point there!” And, all the points on the heads of all the citizens of the Land of Point melted away and they became like Oblio round headed. Yet, they understood that through tolerance they could all still have a very valuable point!

Where’s our point?

Are we not becoming like the citizens of the Land of Point? Must we now refuse to see the point of anyone who dares to think any differently then we do? Are we at the point that we simply banish to our own pointless forests all who are not like us because we are too intolerant of any other position to see them?  How does one re-ignite the practice of tolerance once it is lost?  Where are our Oblios and Arrows?

Sick at Work: More than 84 percent of workers admit coming to work sick by: Ned Smith, Dec 21, 2012, Business News Daily

The premise of the above article titled, “Sick at Work,” published in Business News Daily by Ned Smith, is that  workplaces are becoming breeding grounds for bacteria and sickness.  I was struck by this article, not for the valid point that when people come to work they are bringing disease into the workplace, but more by the idea that this is some new trend.  Perhaps the author did not intend this deduction but in speaking to a few people after reading the article, many made comments from the perspective that this was somehow a new trend and also something that is morally not acceptable.

Morals aside, this is not a new trend.  It is the normative behavior and something that only recently has had any alternate expectation.  Workplaces for centuries have been breeding grounds of disease, infection, and injury.  It was so bad in the early part of the 19th century that the gains that we had made in extending life from the average span of late 20′s in the early 1700s up to the early 40s by 1810s was reversed statistically back to the late twenties by 1840 as a result of the industrial revolution.

This article is interesting to me because it illustrates an expectation for a behavior that has simply never existed.  People , for the most part, have always gone to work when sick for a number of reasons.  First, historically, they could not stay home because there was no such thing as sick days, PTO and time off—they would have lost their job and/or not gotten paid if they did not work.  For many others, not involved in industrial labor or work by the physical activities of hunting, fishing and farming.  No work meant no eating. So people when they were sick, lived with it or died trying.

Second, we were not germ conscious till the early 1800s and not hyper conscious about germs till the middle of the 1900s. Society know little of sanitation. People were routinely exposed to numerous bacteria and viruses and for the most part their immune systems were able to fight them off due to natural selection.  Prior to the discovery of antibiotics, the people that were at risk of these diseases either got sick, fought it off and recovered or they died and did not reproduce any further.

With the birth of germ theory in the mid 1800s, through the discovery of antibiotics and later penicillin in the mid 1900s all this has changed.  Today, we are more sensitive to the bacterial and viral realm that we were, and the pathogenic organisms that prey on us and harm or kill us are now much stronger organisms, due to their own natural selection. As we have used biochemical warfare to kill off their species, some strong ones survived, reproduced and the resulting organisms were soon no longer susceptible to the antibiotic. So, today we are weaker immunologically and the other species that hunt us are stronger, both are the result of our relatively modern practice of pulling ourselves out of natural selection by protecting us with artificial methods.

We are now more at risk and since we remain susceptible and we live to reproduce we are producing children that have not been selected for their resistance so these future generations will be at more risk than us. Times do change you know!

There is no alternative and I am not advocating some naturalist approach, just remarking as to the conundrum.

Merry Christmas

Tis the season to be jolly and to take account of our blessings, contemplate our friends and consider the good graces of those who support us in any and every way.

The recent tragedy in Sandy Hook reminds us all that life is fragile and the world despite all peoples best efforts and governmental controls is still a very dangerous place.  It only takes one person, crazy or otherwise, with a gun, a bomb, a knife, fertilizer, poison, bacteria from soil like anthrax, or a variety of other means to cause such vile and unbelievable atrocities.

But while such events remind us of the bad and the risk we and our loved ones face, we should also stop to celebrate the heroism of those who bravely gave all of their own humanity to protect and defend these children.  While we think of the “hard” heroes like our military, police, fire and guard who actively protect us ever day, it is more often our “soft” heroes who make the daily sacrifices and protect our lives and the lives of our children. It is the people like the Sandy Hook school teachers, staff, volunteers, students and principals, who on this day made the difference for the many who were not physically harmed.

So as we move to Christmas let us remember these soft heroes and their sacrifice on this terrible day that saved so many!  These individuals are truly heroes!

Merry Christmas to all.

Maybe its best if we just jump!

About four years ago, I was working as an executive in a company where it became clear just such cuts needed to be made.  I counseled one of the many division presidents who reported to me that the horrible outcomes they were predicting would not happen, and as distasteful and unpleasant as the process was, in the end, her division would be much improved, her employee’s futures more secure, and the morale in her division would also improve.  Needless to say, the president, and likely many of her colleagues—although no others would openly tell me their feelings— did not share this view!  She shared this view willingly, passionately, with me on numerous occasions.  About eight months after the event was complete, the president came to see me to discuss some plans for growing her division.  During the meeting, she remarked how unbelievably to her, just as I predicted, performance had improved, production had increased, employees were happier, and sales volume had grown.  It was just amazing, she said, she would never have believed it.

It is amazing how attached we get to the status quo; how our routines can drive our beliefs and our expectations. We can get so ingrained in what we want to see and how we want things to be that any thought of change often gets met with absolute rationalization for the status quo.  Like this true life example, the predicted disaster is often nothing more than fear postulated as pure justification for no change at all.  The end results typically include increases in productivity, increases in growth, better bottom-line, and more security for employee’s future.  This is a result of our human nature.  On the one hand, we are afraid of change and get satiated by the status quo.  On the other, when the going gets tough and we see people “changed” out of our system, many soon then actually do change.  People change work habits, they change attitude, and they try harder, sell more, complain less and alter all the things they feel are putting them at individual risk.  In other words people then work to not be “changed” themselves!

While, at first people lament the loss of friends and colleagues, unfortunately the reality is quickly those gone are soon forgotten.  The performers are rewarded, in this case by keeping their jobs.  Employees who typically complain, are low producers or make routine mistakes either are cut during these reductions or soon get a clue.  As the initial shock subsides, attitudes mysteriously improve along with work ethic and productivity (at least for a while).

No one ever wants to go through these processes and I certainly have never wanted to facilitate them even though I have done so many times.  But the reality is, more often than not they do make things better.  It is like an old growth forest before and after a major fire. Before the fire, on the surface the forest is a romantic and mysterious place with lots of familiar things that we have grown very comfortable viewing on a daily basis.  But just beyond the surface, often seen but likewise ignored, the forest also has deadfalls, decay, disease, detritus, and lots of areas of risk and problems.  These areas we know of but no longer see. We all know where we can go in the forest that is safe and wonderful, and what to avoid as dangerous and risky.  We see the good things and overlook the bad.  Even if we know the forest is in decline we will hold dearly to the ideal that exists in our mind.  Truly, at first, a forest fire is almost total devastation. But within a few weeks new growth appears.  Biologists who measure such things will tell you that the energy productivity of these new growth fire zones is much higher than that of the old growth areas.

St. Augustine said,

“Familiarity breeds contempt.”

In this case, it can be said that the status quo blinds us to the painful change that is necessary.  It often blocks us from accepting the distasteful actions that we know we need to take. Like in my business career, if one waits too long to implement these painful acts, sometimes recovery becomes no longer possible.

Perhaps, we are at the same point with government.  Despite the disagreement on the value of increasing taxes to the nation and the potential effect on the economy, there is much less, I hesitate to say little, debate on the ‘need’ for cuts.  Most people seem to now routinely espouse the need for cuts, but they simply cannot bring themselves to proffer any parts of the forest to cut. At the time of the sequestration’s creation, the administration and congress put forth the idea that these cuts would be necessary if… (You can fill in the blanks with the rationalization)  They now both say that they were not really serious about the cuts, they just wanted these cuts to be so dreadful that the debt crisis would be averted. Really?  This is leadership?

It is no longer a serious debate whether or not cuts are necessary.  No, significant cuts are necessary!  Oddly enough, no one disagrees with the fact that we need to make cuts or, that we need to make cuts in sacred cow programs. Yet none of our so called leaders are willing to proffer any serious discussions on the specifics of how much and the methods to use to make these needed cuts. Is it just possible, that we need the sequestration to happen to finally prime the pump to get our leaders to make the cuts that all agree are necessary?

I am not advocating for the specific cuts defined in the sequestration agreement.  I agree that these cuts will be very bad indeed on many levels.  But it appears that there are no cuts that anyone thinks are better to do or are able to mentally consider discussing.  Every potential cut has its own disaster rationalization scenario.  So, St. Augustine’s quote seems to me to be in play for all of us.

No, I am not advocating for these specific cuts.  I am not even advocating for any specific cut.  I am actually advocating for all potential cuts.  Our old growth economy is full of deadfalls, detritus, and layers upon layers of dangerous and diseased areas.  We simply do not have the cojones to collectively agree on any cuts.  Our elected officials know well that if they actually had the temerity to cut something that any one of us prefers to keep; then their future will be in significant jeopardy.  We tell them things like, “we want you to lead,” but if they do, in fact, lead, we are all assured that we will lose something as they lead.  And, as we have evolved over the past thirty years, few of us are really willing to sacrifice for the greater good of anyone.  So if our leaders lead, they know they will not be leading for long.  Who wants to take this bullet?

No, perhaps we just need to take the worst and most painful automatically programmed cuts now, and retaliate against the pain by cutting even more.  Maybe, like I advised the president in that company, we need to take these seemingly drastic efforts now in order to create the momentum to foster the real change that is necessary for our future prosperity.

I have read quite a bit about the areas to cut, and I have spoken to many people on both sides of the aisle about them.  Like everything else, all of us now have our ‘opinions’ as to the various disasters that will befall us should any one, or another, of the cuts happen.  I no longer think any of us knows for sure what any of the cuts will really mean.   I believe that just like my prior experiences we will adapt rapidly to the new normal and both our behaviors and practices will change for the better.  Why do I believe this?  Because in the end, just like in the past, it has to!

Lest at least one half of you who read my stuff,  want to attack me because you perceive there is a republican hidden agenda because I have not spoken about increasing revenue through increasing taxes— I just spoke about cutting—and you argue a valid argument that cutting just hurts the poor not the rich; let me say this!  I don’t think we need to argue about taxes to solve the problem.  The tax argument, particularly taxing the ‘rich’ more is a great political point and has some merit.  No one on either side really believes that increasing taxes on the top 2% will come close to filling the void or eliminating the need to really address the systemic problem—no one!.

I do think that we need to re-address how we tax corporations and how we tax wealthy individuals.  Remember money is nothing but an arbitrary measure of work, value and productivity.  It has been such, since the king of England so long ago used a notched wooden stick, called a ‘tale,’ to track taxes and payments instead of using gold. While I do think we need to address how corporations and individuals are taxed and receive benefits, I also believe that we all need to pay some more taxes if we are going to actually solve the problems.  While I do think the wealthy can pay more, I also think it is the height of hypocrisy to believe that some group of people due to their prosperity has a disproportionate obligation to pay for non-essentials for others who choose to not produce as much, for whatever reason. I believe that the helpless need to be helped.  Few debate the need to solve for the helpless, they are not the issue nor the drain on the economy. I also believe that the clueless and the fraudsters need to be filtered from the equation if we expect to make any system work in the long run. It is in these areas that the seeds of our current crisis have found their root.

When I had the talk with that president years ago, my role was to push each of the presidents off their own fiscal cliffs, so to speak.  As they say, I did not have to like it; I just had to do it.  I was confident that in the end it was necessary and if done timely and completely without equivocation, we would end up with significant improvements in more than just fiscal areas.  Is it just possible that if we jump off the currently looming cliff, that the end results in this case will be vast improvements as well?

Constitutional Republic: Can we keep it?

As the energy, of hate and discontent, from the election subsides and the act of actual governance once again begins to be considered the job of politicians, we are now hearing calls from the left, the right and the middle about all the things that are wrong with our political system.

Should the two party system be changed? Should there be a constitutional congress to amend our fundamental political system in order to better reflect our modern societal needs and wants? Should we make more fundamental changes and move from the constitutional republic constructed by the founding fathers to a simple democracy? (elimination of the electoral college is one such idea)

People within the parties also have their long list of things they think should change.  Depending on whether they fall in the winner, or loser camp, the changes are either based on frustrations or assumed justifications.  To my amazement and dismay, I have heard, so called conservative, constitutional republicans arguing for the elimination of the electoral college, and I have heard so called progressive democrats espousing the need for more control over peoples rights to self rule.  While this seems to be an unexplainable phenomena, it is neither unexplainable nor is it something new.

If one looks at the history of politics and more specifically at the platforms and ideologies of the two parties, you find that todays progressive democrats were once progressive republicans. You will also find that the original champion of minority inclusion and freedoms were not the modern liberal democrats but southern republicans. The pendulum of the political spectrum has swung many times in the past 223 years. Once again we are seeing a sea change of ideals.

So, the question once again is, should we change our system of government?  While we have slowly allowed the change in the practice of government over the past 100 years, the core system of governance is still there and intact, and for some on both sides is now an impediment to the additional changes that they feel need to be  made to achieve their current societal ideals.

The answer for now should remain an unequivocal NO!

We need to look no further than the current election to see that this system works.  Once again for the 56th time we have had a relatively peaceful and orderly change of presidential leadership.  If you look beyond the singular office of the president and include congressional election cycles there have been well over 1000 orderly changes of power.

Native born Americans tend to be the least appreciative of our system of government because we have never experienced any alternative.  We are likely spoiled by our experience.  As such, we believe that what we have now is not that special, and more tellingly, we believe that we are easily capable of improving the system to make it more appropriate to what “we” want.  But it is the “we” that is the singular indication of our arrogance.

Ask any immigrant to America, and they will caution against change.  Those who have come from truly ineffective and oppressive systems to our own know the consequences of forms of government changed to improve the ideals of those in power.  For whatever reason, America, at its founding, was graced with a number of individuals who, regardless of their differences, came together to create a system that was designed specifically to limit their own ability for future changes.  They designed into the governance a series of checks and balances; checks not just to limit the power of the nation’s leaders to oppress the people, but also checks to limit the majority from oppressing the minority.  In effect, our government was designed to provide checks and balances on our ability to make self-serving determinations where one group of people can prey on another whether they are in the minority or the majority.  On the whole, this is a remarkably well considered form of government.

So, once again we hear the calls for change.  Both sides feel that the system is not working as they wish it would.  Just, 70 years ago, America’s citizens had a strong belief in the exceptionalism of the nation, the goodness of its people, the primacy of our ideology and the prosperity of our future.  Today both sides seem to be embroiled, in self -doubt, and frustration. What has changed?

What has changed is us, the American people.  We have changed!  Our Ideals and our values have changed over the past 75 years.  We have so changed that we have lost our belief in our nation and our form of government.  In losing our faith, we have become afraid.  Many, of you will no doubt now argue this point, but there are many indicators. Instead of spending much of this article on the indicators, a debate that no one will win or lose,  and which is not the point of this article; I offer one point of consideration.

We have become so afraid, that now we limit speech and the use of words.  We ascribe very negative connotations to the areas we fear in order to stop uncomfortable dialogue.  Recently this was driven home to me by a reader of my columns who wrote me that when people discuss the change in our national values it is simply code word for religious domination and the desire to impose religious views on everyone else.

I was a bit surprised by this comment. I do not see a discussion of values as code for imposing religion on anyone.  Societal values may be influenced by religious beliefs, but they are not in themselves religion.  Societal values are derived from the mores of a society.  This discussion stimulated me to think further and to wonder if the current aversion that we seem to be building to religious expression may not in fact be predicated on fear driven by our loss of faith in our own society, our nation and ourselves.

I would agree that the imposition of values on a people could be, and throughout history, often has been the result of imposition by a certain religion or society.  In fact I don’t believe there is one religion or society, despite their own particular high ideals, that has not fallen victim at some point in its history to intolerant imposition of its beliefs on a population somewhere. But today, we so fear the discussion of what we should hold deal as our national values that we are trying to damn even the discussion under the specter of religions imposition.  Lastly on this point, I don’t think anyone would disagree that religion and its role in shaping our societal mores has significantly changed since the founding of our nation.

Our values have changed!  Or more accurately, the percentage of our population that believes or adheres to any specific set of values has changed many times in our history.  This can be seen in the change in what our various parties core principals have been throughout our history.  In the late 1800s, progressives rose to dominate over traditionalists.  Then, traditionalists rose to become dominate over progressives.  Once again traditionalists have found themselves in the minority.  The pendulum continues its oscillations.

As strongly as traditionalists believe the policies gaining prominence are misguided, those prosecuting these ideals believe they are more desirable and offer an improved future. At such an impasse these arguments default to moral justification but once again there is little sway between the opposing views. One sides argument for something does little to change the other sides argument against the same something.  Perhaps it is just our human nature that we are of at least two minds on most things.

The founding fathers clearly understood that there were two natures in our humanity.  Their constitutional construct understood that there was this dichotomy and put in place a system to account for its benefits and protect against its detriments.  Underlying all that they codified in our new constitution was the principal of tolerance. The concept of tolerance was seen as so important to our founding fathers that even before the propagation of the revolution they began to increase the understanding and practice of tolerance by commissioning articles and writings to foster the expansion of the practice of tolerance in the colonies.

They understood, that if we did not become an integrally united people then the revolution, the national America, would fail.  Tolerance is a conscious act!  The act of tolerance is the purposeful allowance of a behavior, practice, or belief by another that one finds objectionable.  In other words for me to show tolerance, I must let you do what you want to do, assuming that you cause no physical or economic harm by doing so, despite the fact that I don’t like it or don’t want to see it.  The founders new that if we did not let others live their lives as they saw fit, then when the going got tough, we would fall apart as a united people.  They also knew that tolerance was a bilateral agreement.  They knew that the unwritten rule was just as I tolerate what you want to do you must equally tolerate what I want to do.  This is not a minority-majority calculation it is a societal balance.

For centuries, it was tolerance that formed the basis for America’s promise: tolerance of religion, tolerance, of lifestyle, tolerance of methods of practice in society, tolerance in the practice of commerce.  One group may believe that the bible is predicated on a new testament and that Jesus is the savior.  Another may believe that Jesus was just a profit and that we are yet to be saved. One may call the supreme being God, another Jehovah, another Allah, another Krishna, and still another believe their is no god at all.  For centuries, Americans have allowed each to worship, speak, publish and practice as they saw fit.  While I may object to what you believe as it conflicts with my own philosophy, conversely I have to allow you the same freedom as I want for myself. We have historically practiced bilateral tolerance.

Really what has been going on has been MALT.  Mutually Assured Lack of Tolerance.  In effect, as long as we allowed each to do that which we did not like, we all have been free to do as we wished in relative peace, quiet and freedom.  We all new that once we said you can’t do X then you would say that we can’t do Y and pretty soon we would become a divided people and the grand American experiment would fail–MALT.

We clearly have changed.  One group does not like that another group is building a house of worship that has minarets and domes. Soon the argument gets couched in the framework that the building just does not look like the architecture that is characteristic of the majority of the town.  Hearings are held, lawsuits are filed and in the end regardless of the decision the act of tolerance has been diminished. Another group does not like the celebration of Christmas because it celebrates the life of a man called Jesus Christ and he is a religious figure.  So they argue that such a celebration in public is offensive and should be prohibited. Hearings are held, lawsuits filed and regardless of outcome tolerance has been negated.

These should not be majority nor minority decisions, vocal or otherwise.  These should be principled decisions based on the mores, ideologies, and values of our society. While there are many things that are in flux in the current debate on both sides that I agree with and equally disagree with, it is this fundamental change that I worry about.  It is the loss of this grand bargain that has formed the basis of our society and success that I worry is laying the ground work for our own destruction.  It also seems that it may be one of the easiest things for us to address.  All we need to do is set our fears aside and have the discussion as to what we now believe our societal values should be.  From that point then perhaps we could once again review the nature of our republic and its underlying political system. And re-learn about tolerance.

It seems today the only thing we tolerate is intolerance!   For centuries we have watched the pendulum swing and our ability to be tolerant has allowed us the stay well above the pit and avoid harm. The founders knew of this pitfall and crafted a system to avoid the sharp edge of the pendulum while we continued to exist in the exalted realm well above the pit. But our system was predicated on the practice of tolerance.  Will we relearn the value of this practice and once again re-embrace it or suffer the fate that the founding fathers knew without tolerance was our inevitable result.

St. Mary’s County Stuffed Ham: Made last year by Aleck Loker then 13 – carrying on the tradition

Today, regardless of our political preferences, we should be thankful that we live in a country where we can argue, be smart, be ignorant, be rich, be poor, worship a god (or multiple gods with many names), or worship nothing at all, own property, or own nothing, and still have an equal chance to select our leadership and decide our collective future. No alternative offers us so much opportunity. So let us all be thankful for our apparent internal disagreement. It is the source our prosperity and despite current diatribe our happiness!

Note: St. Mary’s County Stuffed Ham, is a very regional dish prepared for the most part in one small county in Maryland.  It takes forever to prepare, requires lots of steps, was derived from slaves who it is now believed invented it and for those that have tasted it is an addictive delicacy. Perhaps one day you can visit St. Mary’s and try some for yourself! You will likely find it nowhere else.

As I have been contemplating the aftermath of the election, I have been reading a lot from both sides trying to hear what they have to say about the election and what I find remarkable is the dialogue from within the parties as to;

• why they won, why they lost,
• why they have a mandate, why they don’t have a mandate,
• how the American people clearly spoke for tax increases, how they people clearly spoke against the tax increases,
• the majority voted for Obamacare, the majority voted against Obamacare

As I have listened to the various talking heads and pundits, increasingly I have become more convinced than ever that we simply can’t discern desired fiction from pragmatic reality. As a nation, we seem to see things in polar opposite. As I listened and read, a poem from my youth came to mind that I have reconstructed at the end of the article.

Both sides appear to believe they are right, yet both sides are either misreading the nation, in denial or purposefully paltering. While American’s on one side are convinced they are right and factually correct, the membership of the other side are convinced they are equally as right and also factually correct. While in rare instances this may be possible, it defies logic to think that this is now constantly the normative. 

Is it possible, that we no longer can think for ourselves?  Have we become so inculcated by our modern constant information driven society that we have inadvertently provided a method of incessant propaganda that in essence is nothing more than a form of brainwashing?  Have we so changed our education system and our initial form of government that we simply cannot discern the differences? Some on the right (a minority of the voting population) are so ingrained in their own core beliefs they cannot contemplate that a change in the nature of Americans dictates a change in their own approach or philosophy.  An equal number of those on the left (also a minority of the voting population) believe that the majority of Americans want more government and more handouts and it is now clear to them that this is who we are as a nation. And frankly a majority of the population just want it to stop. 

Since the demography of the electorate is now about 25% left leaning democrat, 25% right leaning republican, and 50% centrist, we now have a political environment more driven by propaganda than on cognitive thinking. Of course none of us believe we are non-cognitive.  We listen to or preferred media sources, all the things they say fit with our own beliefs so what they say must be correct. And if by chance we listen to our non-preferred media sources, all the things they say appear heretical to us so they simply must be lying and of evil intent. Of course we are thinking. If we are listening to what they say, and it fits our reality, then we are clearly thinking. We are participating in the political process, we are using our best judgment and we are making informed decisions! Of course we are! And we know this, because in the end we are either supported and vindicated in our victory by being members of the winning side, or we are supported and vindicated because as a member of the losing side, we become united in our understanding that it was only by the complete equivocation, misrepresentation, and deceit of the other side that they achieved victory. It is in the safety of the group (Party), that we are able to come to this clear understanding and justification? There is simply no other way that any of us could have been so manipulated and propagandized to have simply given up critical thought. There is just no way that we could be wrong! Is there?

Since both sides mostly cannot be right and correct about every issue and as such are in sometimes violent disagreement I simply can’t yet explain the phenomena, without attributing some nefarious intentions. So in such cases my reaction is to find a metaphor.  Oddly, I find the following poem substitutes well for explanation. I hope you enjoy the irony.

One very light night
two dead boys got up to fight.

Back to back they faced each other
drew their swords and shot another.

A deaf policeman heard the noise
and came and killed the two dead boys.

If you don’t believe my story’s true,
ask the blind lady
at the corner of the round table
she saw too.

My lesson from this election?  Become a Mugwump!

Author’s note:  For those interested in such things, I have composed this article on the new Microsoft Surface Tablet with Windows 8 RT.  I am finding this a marvelous device, superior in many ways to my prior iPad.  Don’t believe the various very negative and inaccurate articles written by reviewers with agendas.  Do your own research, go try one at the store and ask some that have bought one. Like in the political world, many who are currently writing reviews in technology either have a bias, or have been compromised.

How much do we truly value the truth?  Sure we talk about it, we complain about it when we don’t get it, we have even gone to war over the ideal of it, and destroyed relationships over the lack of it, but do we really value the truth? Or, like some much of our lives, is it just a false value, a mythical thing, a posit that while we are willing to use the lack of it to our own advantage, we never expect to actually apply it to ourselves.

How often have you been told, or professed to others, that you would not have gotten in trouble if you had just told the truth.  Children hear this invective from their parents all the time—starting at a very early age. “I won’t get mad if you get an “F” in hopscotch just as long as you tell me the truth!”  Children learn early on that to follow this advice is simply a path to self-perpetuated disaster. They learn that while mom and dad may say that they want the truth while they are in the middle of being angry over the grade and the lie, it is still the bad grade that rules this equation.

The first time the poor kid follows the advice and comes clean, they learn what real truth is, that it is the grade, not the lie, which got mom and dad upset, and the punishment, is still the same.  The truth they learn is that telling the truth changes naught. Once this happens, then little Mary or Johnny revert to obfuscation and equivocation.  It is simply survival instinct at work.

Thou shalt not lie, is a phrase drilled in to almost all of us from a very early age. Most often, those doing the drilling lie routinely multiple times a day. While we do not know that they, in fact, routinely lie at the time they are doing the drilling, that is one of the few truths we often discern very early.

To accommodate this dichotomy we have created numerous gradations of lies—some socially acceptable and others beyond the pale. The list includes nuanced measures of our prevarications like: the little white lie, the “that’s in a bit of a grey area” lie, the shades of grey lie, the justifiable lie, the “I don’t want to heart your feelings” lie, the naked lie, the self-serving lie, the heinous lie, and the whopper. But perhaps the most prevalent and seemingly acceptable of all is the “Politician’s Lie.”

We all lie!

No honey; your rear end does not look fat in that dress!

I have no idea what you’re talking about; I did not look at that woman with the big breasts!

Gee Boss; your one of the few people that really look great in those orange plaid golf shorts!

I swear; I know I sent that reply in e-mail before the deadline. I even turned on the read receipt thingy, but now I can’t seem to find it!

Day in and day out we lie and we rationalize all of these fabrications as just getting along, not hurting others needlessly, or protecting ourselves.

We all profess to draw a line in the gradation of prevarication, often at the point that a lie goes to foster personal gain. If asked, most of us will say that lying for personal gain is one of the worst kinds of perjurious behavior. We all agree and routinely make statements like this, yet we live our day to day lives evidencing little value for the truth. For example, we purchase products. Often the ones we buy the most are the ones that have the most inventive lies attached to them. We have had products, that so integrated into our existence that we simply just incorporate the advertising lies into our belief systems. Warner Lambert sold us Listerine based on lies for years. It took the federal government almost 100 years to get them to stop advertising it was a cure for the common cold.

We love being deceived so much; we look constantly for those products, services, and events that offer the most unbelievable claims. God forbid, if anyone exposes the lies to us—the happy consumers. We love these lies so much we may even get violent in order to preserve the myth. What? You don’t believe this? Go to a group of professional wrestling fans and tell them it’s fake! Just make sure you have on some fast shoes before you do!

If you still don’t believe this, consider politics. We so love the lies that bring us dreams of utopia, that we have developed a full time occupation for people who we will handsomely reward just for lying to us. If we value the truth so much, why do we willingly acknowledge that all politicians lie? They do! We all know that they do! And, we often elect the ones that lie to us most often, and with the most outlandish lies. We have evolved an entire professional social class of people that we pay just to lie to us.

And do you know who lies to us the most, with the most believable lies? Why, we do of course! You see, we lie to ourselves most of all. We know much of what we hear is not true, yet we willingly believe it and often propagate the same falsehoods. Maybe we simply believe that if more people believe the same thing that I believe then it might become true. Or at least, I won’t be the only fool!

Just something for us all to consider as we prepare to vote on November 6^th.