~synthesis~

healthy wallets, healthy bodies, healthier US?

Why are healthcare costs around the world rising so dramatically? The costs of innovation, lawsuits, and an aging population are among the “claimed” reasons. Of course they have an effect, but are they the only reason?

If you have an expense account or your parents’ credit card, your “generosity” with their money is much greater than with your own money. You’ll buy more expensive things and be more careless with them - after all - you aren't paying for it.

Health insurance = other people’s money.

If it's your own hard-earned money, you’re more likely to think before you spend; put more effort into preventing expenditures (live healthily), be diligent with your medicines, etc.

American health care was regulated [fascinating read] in the early 1900s; it resulted in better hospitals, but initially very few licensed physicians; this scarcity increased costs, and health insurance was created to ensure that patients could pay their bills. Insurance became pervasive through the 1960-‘70s, and when Medicare and Medicaid were introduced, we were off to the races. By distancing the cost from the consumer, people progressively became more cavalier.

The very existence of health insurance assures excess.

Any issue/injury/ailment/ingrown toenail is worthy of a doctor/hospital visit. We aren’t paying so what the hell! As coverage became based on procedures, doctors "found themselves" doing more tests, but since we aren’t paying, test away!

Costs escalated, insurance companies panicked. Rates increased, employers panicked. Lobbying increased, politicians panicked. Laws were written, and now citizens are panicked.

But then the economy began to slow, unemployment rose, and more people were without coverage.

This increased the use of Health Savings Accounts (HSA) and High Deductible Health Plans (HDHP), which allow individuals (and employers) to set aside before-tax monies in a savings account for routine medical care, and purchase lower premium disaster coverage with high deductibles as a backstop.

Now it's your money, from your account, and you're more careful. The effect? Health care spending growth slowed!

We not only think twice about going to the hospital, we even pay more attention to diet and behavior to keep our costs down. Doctors, knowing it’s the patient’s money, are ordering less tests and expensive or frivolous extras. When GE implemented an HDHP-type plan for its employees, there was a noticeable decline in the use of their own expensive imaging (MRI, CT) products! Not good for GE, but absolutely indicative of better overall behavior. :-)

If you’ve read this blog for a while, you know I’m a proponent of universal health care. But it is subject to abuse and mismanagement. I believe all Americans should have healthcare, but let's learn from previous mistakes. Our implementation should be universal, prioritize patient health, and save money by mandating a minimum of HSA/HDHP for everyone:

• Government pays HSA + HDHP for those earning up to 1.5 times the poverty level.
• Government pays HSA only for those earning up to 2.5 times the poverty level.
• All government employees (including ALL elected officials) receive HSA + HDHP.
• All others are self/employer insured.
• All insurance providers must offer HDHP for anyone without descrimination.
• HSA is tax-free/pre-tax; any unspent $ can roll into an IRA or next year’s HSA. 
• This supplants Medicare/Medicaid and any prescription drug benefits.
• High school graduates qualify for lower rates, as do those with a post-high school certification (see below).

Potential upside:

• Doctors say they can’t assure health because patients don’t take care of themselves or take their medicines properly. This doesn’t solve that, but people might pay more attention if it’s their money, and spend a little today (preventative) to avoid spending a lot tomorrow.
• Less excess = lower costs.
• More self-care = healthier people.
• Direct payment by the patient via HSA (debit card) reduces administrative costs.
• The elimination of Medicare/Medicaid in favor of subsidized HSA/HDHP for those that need it most.

Education mandate - it seems obvious that the more educated you are, the healthier your are, and the longer you live. Now there’s data. So why not tie universal health care to universal education? It only makes sense.

Health insurance costs in the developed world are rising much faster than GDP, and the US is in the worst shape. This approach blends universal access with the very American idea that that we should all have a vested stake.

If we see success (lower costs, improved well being) with this approach, maybe we should also try it for public education?

America is a unique country - it's approach to social services (health, education, etc.) should also be unique.

life choice

Politics in America is polarized and infantile; governing in America is even worse. Governing should be about the whole country; it should prioritize the well-being of all citizens now and in the future. It does neither. Short of a revolution, there doesn’t seem to be a way to change this dynamic. Or is there?

What if we put the most fracturing issue of our time on the table? If both sides can find common ground on this, their most polarizing issue, might that open the door to further compromise?

If the first presidential debate did anything, it showed that one event (in a campaign that began more than 18 months ago) + the right conversation + the right audience + the right visibility can markedly alter the election dynamic.

Maybe a similar approach can be used to alter the governing dynamic.

Abortion - more than taxes or socialism, abortion is the litmus test in American politics. It is the pivotal question when choosing Supreme Court Justices; it plays a role in our choice of political candidates; and it is an enormous sink of effort, money, passion, and divisiveness in America. This despite clear laws for almost forty (40) years.

It is a complex argument fraught with nuance, but I think the politics are simpler; and if presented in the right way, perhaps open to compromise.

Background:

1. Over 80% of Americans belong to a religion that proscribes sex outside wedlock.
2. 70% of boys and girls in America have had intercourse by their 19th birthday.
3. By age 44, 95% of Americans have had premarital sex.
4. 80% of young evangelical Christians have had premarital sex; 1/3 of their unplanned pregnancies ended in abortion.
5. Abortions have shrunk from 1.61 million in 1990 to 1.21 million in 2007.
6. 49% of pregnancies in 2006 were unintended; 43% of these ended in abortion.

With this undisputed data as context, what if we were able to bring the five most ardent and visible advocates/politicians on either side to a televised panel, where a moderator asked each of the ten people these questions:

1. Do you agree that in a perfect world, no fetus is destroyed; that every child is wanted and lives a healthy and fulfilling life?
2. Do you agree that every abortion is a tragedy; and that we should do everything possible to prevent it?
3. Do you agree that the best way to prevent an abortion is to prevent unwanted pregnancy?
4. Do you agree that the data above shows that we are failing to prevent abortion more than one million times a year?
5. Is creating a national goal to dramatically reduce unwanted pregnancies and the resulting abortions something you would support wholeheartedly?
6. Do you agree that reducing unwanted pregnancies and thus the more than one million abortions would by far be your highest priority?

Would all ten would unanimously reply “yes” to every question?? Would you?

I think so; and I would too.

How could they not? How could you not??

What then have we accomplished? We’ve bypassed the questions of a woman’s right to choose, and when life begins; and gotten agreement that preventing unwanted pregnancy is paramount. We have recognized that while there may be areas where we disagree, it is possible to find common ground, and more critically to act based on that common ground to serve the greater good.

During 9-11, Congress united with the White House to pass laws aimed at protecting America. We acted as one in response to the killing of nearly 3,000 Americans. The issue before us was without party affiliation; and we were able to rise together and as one to make progress.

Can we now act as one to dramatically reduce the more than one million abortions that happen in our country every year? Surely that is an even greater calamity?

Might this act of cooperation lead to new avenues of accord between the Left and the Right?

Is that not after all the essence of governing?

impossible??

You are what you measure. What gets measured gets done. These and other phrases are taught in most business schools around the world -- if you want someone to do something, pay them based on getting it done.

In sales, it's commissions -- if you don’t sell, you don’t eat; outside sales, many use MBOs (management by objectives). The process is slightly different, but the effect is roughly the same. The key is designing the measurement to ensure the desired outcome.

When students are measured based on test scores, the skill created is not understanding the curriculum, but rather knowing how to pass tests (an unhelpful skill in the working world). More insidiously, if schools are paid based on standardized test scores, an easy was to improve is to expel the poor performers. Sure the numbers look good, but is that really the right outcome? Are we measuring the right thing?

You need money to live, you work to earn money; like students who learn test-passing but not curriculum, adults learn how to game their system, how to interpret and translate their MBOs into the greatest income at the lowest effort.

Health care is rife with “gaming,” and like any other player in this game, (some) doctors are no exception. I was listening to Marketplace recently, and their fascinating show on billing codes -- every patient-related activity has a code assigned to it, and doctors must map their work to these codes to then bill the insurance companies and get paid.

To “clamp down” on rising costs, the insurance companies are reducing the $/code - so if lancing a boil used to pay $100, it now only pays $90. The result? Increased payouts, and more sophisticated gaming. Not exactly the desired outcome.

According to the show, 2.2 people are employed to do billing for each doctor in America. They even have their own conference -- CodingCon, where they “equip medical coders, billers and related healthcare professionals with best practices and tools needed in correcting codes from the start, avoiding claim denials, maximizing productivity and increasing practice’s bottom-line.”

Or, “learn how to not only overcome the $10 cut on boil lancing, but also add $100s more to your bottom line.”

The Marketplace doctor’s codistas have increased his revenue by 70% ("hundreds of thousands of dollars per year”). A codista at a hospital discovered that instead of claiming knee surgery and rehabilitation under one code, they could discharge the patient from surgery and then readmit them to the physiotherapy clinic downstairs, thus billing against two codes, and making much more.

How big is this? An additional $360B (yes, BILLION) per year is spent on the whole coding process - a concept that was introduced to standardize care and lower costs... We reap what we sow.

Net -- the best way for a doctor, clinic, or hospital to dramatically grow revenues is not by providing better care, adding more doctors, or serving more patients; it is by hiring more coders, and sending them to CodingCon.

We are what we measure, and what we measure gets done.

What if instead of student test scores and attendance, schools were paid according to how well their graduates did after they left that school? (Click for more info.) Now principals, teachers, staff, unions, etc. have a common purpose: the more prepared their students are for the future, the more money they earn. You’d better believe they will work together to ensure that their students are prepared for elementary (if a pre-school), middle, high school; or college/university, and the workplace. Attendance and tests are a piece of the picture, but the key measure is student preparedness.

The (state of federal) secretary of education’s only concern is tracking how students do after they graduate (something they, and the census system already does). By eliminating tons of redundancy and complexity, we should be able to educate all public school students at half the cost of today, saving $2-300B/year.

What if instead of procedures, doctors were paid based on how healthy their patients were? (Click for more info.) The job of health care is not to perform procedures, it is to assure a healthy community. This measurement would save $2-300B/year in coding procedures and such.

It is possible to create centralized (federal) funding with autonomy at the point of execution. The key is to ensure that the recipient of funds does NOT control how their performance is assessed or reported. Create the right measures...

For both education and health care, we can accomplish this with existing measurement systems and existing funding mechanisms. Not only would we achieve better graduates and a healthier population, we would do it for as much as half a $trillion less.

These are but two examples - consider the 39-year long war on drugs (metrics: arrests and interdictions). The result is $billions spent jailing street corner dealers (3 years in jail @$33k/yr for a $200 transaction) and intercepting tons of easily and inexpensively replaced drugs, with NO corresponding drop in consumption (constant for the last decade). If instead the last 39 years had been spent helping addicts, the war might already be over.

To quote a man of immense wisdom: “Impossible is just a big word thrown around by small men who find it easier to live in the world they've been given than to explore the power they have to change it. Impossible is not a fact. It's an opinion. Impossible is not a declaration. It's a dare. Impossible is potential. Impossible is temporary. Impossible is nothing."

social reality

I’ve received a lot of email over my last post :) - my thanks to all of you! Most questioned the alignment between advocating killing Social Security and community-related posts like this or this.

So...

I believe that the role of society is to care for those that can’t. When pre-humans began to coalesce into communities, they discovered that it was possible to specialize - hunters, child raisers, security-providers, shelter creators, etc. As these specialists became more efficient, wealth was created; in this case, it was the wealth of time and reflection and communication and innovation.

Over time, they used fire for cooking and protection, they used farming to grow and improve their diets; they used knowledge of the human body and medicine to reduce infant mortality and increase life spans; and the community was able to “support” caring for the ill and aged, learning, art, and other “civilized” pursuits.

This is the essence and power of society and community, ...and civilization.

Then why nuke Social Security?

Western society has “evolved” to the point where necessities (healthcare, education, infrastructure, security, etc.) cost too much, and our organizations (governments, corporations, etc.) are so big, inefficient, and pendulous that real change/improvement is impossible.

For more than a generation, Western nations have had to borrow massive amounts of money just to maintain status quo. Despite deep programmatic cuts, operating costs today are still much higher than revenues. Bureaucratic inertia + embarrassingly juvenile (apologies to the world’s youth) and avaricious elected officials have prompted credit agencies to put most governments on “watch,” and recently, downgrade America and Italy, among others. This plus the prospect even bigger dufuses being elected in 2012 assures a future of worse government, greater ineptitude, and growing (more expensive) debt.

What to do? Short of a total national reboot, we must prioritize at the program level, and make some tough calls.

What programs must remain, and which can be eliminated? I say education and healthcare for all are more important than Social Security. With an effective education (early childhood through post secondary), and the comfort of basic healthcare, we give people the building blocks to not just survive, but thrive. Eliminating a safety net like Social Security creates an impetus for people to care for themselves and their families, or else.

Unfortunately, the Republicans/Democrats/Tea Partiers are proposing small, inconsequential but politically palatable cuts to everything; if they do recommend the elimination of programs, they are small and budgetarily inconsequential. Our situation is far too serious and dire to tolerate this kind of futzing around.

To protect the essence of our society and the viability of our community, we need someone with serious cojones to step up, take the bold step of throwing partisanship, politics, and silly amendments aside, and lead.

the hole in the middle

The professional baseball season is 162 games long, and the players have a saying: "Every team's going to win 54 games, every team's going to lose 54, it's what you do with the other 54 games that counts."

This is also true in politics. The fervent Right (1/3 of voters) will always vote Republican, and are lost to Democrats, who have the Lefty third in their camp. The theoretically “balanced” media is just as polarized, and only attracts audiences who are in violent agreement with them; few if any “minds” are changed.

Both sides realize they need the Center to win the Presidency, and despite redistricting efforts, many Congressional districts and states are also decided by Centrists.

Normally, politicians lean toward the Center once elected, but the 2010 elections have resulted in a level of dogmatic obstinacy that has rendered the White House impotent, Congress a disgrace, and America a laughingstock.

Was this a one-time occurrence? Will the political landscape come back to its senses with a natural regression to the mean? Or has the American voter become so polarized that the middle 1/3 is no longer meaningful?

As a Centrist, I hope not - I don’t want to see a cluster f&*k like the one that we’ve experienced so far in 2010/11.

I don’t speak fo all Centrists, but I believe most would agree that ensuring the sustained wellbeing of every citizen is the #1 priority of Government.

Today is Labor Day, but more than 25 million Americans are un- or underemployed (i.e. not earning enough to survive); the two greatest sources (public sector and small business) of jobs are retrenching; and larger corporations are doing pretty well.

The White House and Congress are oblivious; they think making government smaller, eliminating jobs, and pandering to the Tea Party (lower taxes, less debt) are the path to prosperity.

This at a time when more families are unable to feed themselves every day, individual debt is untenable (student loans are at an all time high), and those who might have a dollar or two of disposable income are saving it, preventing the very commerce needed to put people back to work.

To earn my vote, I’d like to see candidates focused on:

1. Investing to create jobs.Individuals and small businesses need improved access to debt, and assurance that their jobs are not about to go away. People create the demand that will drive the need for supply, production, and jobs. The obsession with shrinking government (the country’s largest employer), reducing debt, and cutting and cutting, has created a ripple effect in the commercial sector (shrinkage), and with individuals who are increasingly scared to spend.
   
   Government prioritized supporting corporations over the last couple of decades and it worked. Large businesses are more profitable than ever, and they are more cash-rich than ever. But they are not investing because they see no need to. There is no pressure on corporations to expand capacity because consumer demand is weak.
   
   Government must now prioritize the individual, to help them become consumers once again, and give corporations a reason to invest their savings back into the economy.
   
   Lowering individual taxes are not the answer - this has never worked. We must improve cash flow by refinancing existing consumer debt, changing the way student loans are awarded and priced (if we can deduct mortgage interest, why not student debt?), and providing individuals with some assurance that at least their children’s education and health will be taken care of (see below).
   
   These acts will immediately put money in consumers’ hands, and give them the motivation to buy stuff.
    
2. Creating a safety net that includes universal education and healthcare. Public education was a response to the demand for Industrial Revolution workers, and to protect young children from slave-like labor. It was decried at the time as a socialist act, but justified because an educated and employed workforce would accelerate Capitalistic economic growth, and prevent child abuse, which was thankfully agreed to be a good thing. Today we accept public education.
   
   Universal healthcare is no different. The ONLY constituent that suffers is the health insurer (and the politicians funded by them). By ensuring that everyone is covered, we grow the healthcare industry even more rapidly (it is one of the few that even today is adding jobs), and we recognize (as we did with child labor) that this is part of society’s obligation to help ensure the sustained well-being of every citizen.
   
   But we accomplish one more thing - we enable the bold, daring, capitalistic mindset of the “exceptional American” (sorry) by freeing them to invest and spend and grow the economy, safe from the worry that their families won’t be able to go to the doctor when needed.
   
   The value of this peace of mind can not be underestimated when it comes to a national, positive, growth-oriented outlook.
   
   
3. Banning government intervention in individuals’ lives (provided they aren’t harming others).
   
   I want my government to stop wasting time worrying about abortion (it is the law of the land), gay marriage, teaching creationism, and the myriad other “social” issues that are important to individuals, but which as a Centrist, I don’t want to make political.
   
   It is bizarre to me that Congress (a bastion of piety, morality and right-mindedness) should even be allowed to opine on these issues, must less legislate them. They simply have no standing.
   
   I think we can trust the American people to live within their moral fabric and rely on domestic law enforcement to protect them from those who would do them harm.

Once the economy stabilizes, we must absolutely focus on cleaning up Government - this will require a clarity of vision and cojones. Attributes both President Obama and the Republican candidates are sorely lacking.

It is ironic that the non-extremist nature of Centrism precludes the impetus to advocate for rational government.

pro child-labor

What's the return on investment of education? Why bother? Why especially in poor communities? Just because I/you/we believe education is a silver bullet doesn't mean it is. As a skeptic, I can find many examples of education shooting blanks or even causing harm.

If I'm a parent of a family living in one room in a shanty town or village, why should I bother wasting my kids on education? How is grammar going to feed us? How are fractions going to heal my sick baby? How is history going to clothe us? I need none of this; it's a waste of my children's time and life. Go away.

Today UNESCO released The Hidden Crisis: Armed Conflict and Education, which states that: "Armed conflict is robbing 28 million children of an education by exposing them to widespread rape and other sexual violence, targeted attacks on schools and other human rights abuses."

Their agenda for change includes: "tougher action against human rights violations, an overhaul of global aid priorities, strengthened rights for displaced people and more attention to the ways education failures can increase the risk of conflict."

UNESCO is asking for US$2 billion to cover current budgetary shortfalls, and changing the proportion of humanitarian aid that goes to education (currently only 2%). All worthwhile goals, aimed at giving "them" what we have. But as Einstein famously said, the definition of insanity is doing the same thing repeatedly, and expecting a different result.

Yes - 28 million children aged 5-12 are not in school, yes this is a crime, and yes it will result in bad things (disease, starvation, rape, war...). BUT - building more schools isn't the complete answer, nor is training more teachers or distributing textbooks or laptops.

Philanthropy is the least effective way to affect change. The best way is for the community itself to change because it values that change over existing subsistence priorities. This is the crux of sustainable transformation.

To get kids into schools, the parents need to be convinced that it is the right thing to do. Not "right" based on some abstract morality, but right based on what they care about, they need, and they value. This is what matters most; what we believe is irrelevant.

Parents will compel their kids to go to school if it enables survival of the family. If you can't directly and immediately connect to that, parents will choose other subsistence (food, shelter...) needs over education - you would, I would. Moreover, the "ROI" of education happens after graduation - that's at least a decade out! If you're starving now, that kind of future is meaningless.

We in the wealthy world delude ourselves into believing "if you build schools, they will come," or "it's so obvious - why don't they understand it?"

Ironically, we're clothing our ignorance in empathy, and believing that empathy will save the wretched from their ignorance!

We must give parents something they need now in exchange for their children's attendance:

1. School as a farm. The students will learn innovative farming techniques; they will plant and harvest crops; they will be required to work the farms in exchange for being fed and bringing food home for their families.
2. School as a factory. The students will learn innovative production techniques; they will create and produce goods that we will sell; they will be required to learn factory-work, in exchange for being fed and bringing goods home for their families.
3. School as a clinic. The students will learn about health care; they will assist in providing services to the injured and sick; they will be required to clean and cook and feed patients; in exchange for being fed and bringing food and medicines home for their families.

Yep - this is putting 5-year old kids to work. CHILD LABOR - get used to the term; learn to like it.

Children are not in school because their parents value subsistence over education. "In exchange" for being fed and bringing food home every day, these children will also happen to learn literacy and numeracy + skills that can help improve their family's health and standard of living. BUT if they don't get fed and bring food home, they will not have reduced the family burden sufficiently to warrant their parents' commitment.

We suffer from the desire to assuage our own guilt and feed our intellectual egos by over-engineering things. The issue is not education, it is survival. Education is nowhere near the top of Maslow's hierarchy for a reason. It's not important enough when you and your kids live on 500 calories/day, with dysentery and AIDS.

This feels dastardly - railing against child abuse/sweatshops/etc. is ingrained in us - but we're wrong.

If UNESCO is serious about getting 28 million kids in school, they need to first employ them, and then educate them. Let's spend money on that.

a notre sante

In the face of the Republican onslaught against the Health Care Reform Bill, here's a speech I'd consider if I were President Obama.

[The Oval Office]

My fellow Americans, good evening. Almost 30 years ago, President Reagan delivered his first speech to the nation from this very desk in the Oval Office. His speech was about the economy, and the tough times ahead. I wish I could report that tough times are coming to an end, but I can't. Turning our economy around is my highest priority, and today I wish to focus on our health and how it affects the economy. To paraphrase President Reagan, I regret to say that Americans have never been more unhealthy than they are today - there is no comparison in our history; this despite the fact that we spend more on health care than almost every nation in the world.

I recently asked for a health care report card, and here are some high (or low) lights. You won't like it. I didn't like it. But we have to face the truth and then go to work to turn things around. And make no mistake, we can and will turn it around.

The incidence of obesity, diabetes, cancer, heart disease, and others is highest our history. Today more American children are at risk of chronic health issues than ever before; we spend more per person on health care than ever before; and we waste more per person on health care than we can afford. Focusing on our children, 14.5 million (over 20%) live in poverty; over 16.7 million live with anxiety and depression and do worse in reading and math because there isn't enough food to eat. More than 1.5 million American children are homeless, resulting in a lack of safety, comfort, privacy, reassuring routines, adequate health care, uninterrupted schooling, sustaining relationships, and a sense of community. And things are not improving; two million children will be affected by the housing crisis and resulting foreclosures; and in 2000, 39% of children lived in low-income housing, by 2009, it was 42%.

These are shocking numbers, as are their consequences.

Children who begin life in difficult circumstances are most likely to end up struggling throughout their lives, most likely to run afoul of the law, and most likely to become a burden to society to the tune of about $500 billion per year. It breaks down to $160 billion in increased health care costs, and $170 billion each in increased law enforcement costs and lost economic productivity.

Setting aside the moral obligation to ensure that every child in this country has shelter above their heads, is well-fed, healthy, and well-educated, can we afford the economic impact of sick and impoverished children? I know the incoming Congress pledged to cut our budgets by $100 billion, and I'm very interested to see where they propose to make these cuts. But I'd like to up the ante - let's find a way to save $500 billion/year! With deficits ballooning and rising defense and social services costs, I challenge our Congress to make a real and sustainable dent in our budgets, with an impact that will last for generations.

Many will claim that America has the best hospitals, doctors, and nurses; the best technology; the most innovative researchers and the best treatment options available in the world. I agree. There is no better place to be than the United States if you need any kind of medical help, provided you can afford it. But as we've seen, millions of our children can't.

The definition of health care is the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. I believe we have the best management and treatment system in the world, but we fail when it comes to prevention and preservation.

Why? As with many things, it comes down to money. The current health care system from pharmacology to treatment to long-term care gets paid when you get treatment. Their success is dependent on your ill-health. Let's think about that for a minute - if you don't go to the doctor, he or she doesn't get paid. If you don't need any medicine, the pharmacist and the pharmaceutical companies don't get paid. For them to be successful, you have to be sick.

Now you might say that being healthy favors the insurance companies, and I thought so as well, but it's not the case. People who are healthy don't buy as much insurance, and don't contribute to rising costs, which help justify premium increases; people who are unhealthy buy more. Insurance companies might prefer not to pay claims, but they realize that they have to keep the machine running - the more people visit doctors, go to hospitals, and seek treatment, the more they can keep raising premiums and growing profits.

Last year, we passed the Health Care Reform Bill, which aimed the state of our - your health care. While it does help, we must do more to address our children's struggles, and to improve the overall state of our economy.

So I challenge us all to find ways to save $500 billion a year, every year by investing in prevention and preservation for our children. From pre-natal to early childhood to young adults, by providing every child with free health care and a great education, we can not only save $500 billion/year, but also lower unemployment, decrease crime, and increase income taxes; all of which will help accelerate our path towards a stronger, healthier and wealthier country.

To close, once again in the words of President Reagan, my fellow citizens, let us join in a new determination to rebuild the foundation of our society, to work together, to act responsibly. Let us do so with the most profound respect for that which must be preserved as well as with sensitive understanding and compassion for those who must be protected.

We can leave our children in poverty, with an un-repayable massive debt and a shattered economy, or we can leave them liberty in a land where every individual has the opportunity to achieve their greatest potential. All it takes is a little common sense and recognition of our own ability. Together we can forge a new beginning for America.

Thank you and good night.

deFUDdle

Back when I worked at IBM, if we didn't have the "winning" solution, our strategy was simple - we used FUD. It was brilliant, and worked more often than you might think. FUD = Fear, Uncertainty and Doubt. The idea was to push the customer's emotional buttons, poke holes, create scary what-ifs, do whatever it took to force a delay, redefine the problem, or whatever so that we were in a more favorable position.

The Republicans FUD skills are renowned. They are able to create a sense of tension in the electorate in ways that routinely befuddle Democrats. Take health care - they did a brilliant job of associating the reform bill with "bad for the economy" and "a perilous step towards socialism" - fantastic! First, I'm willing to bet that most of us don't even know the definition - according to Webster, socialism is a: a system of society or group living in which there is no private property; b: a system or condition of society in which the means of production are owned and controlled by the state.

Is there any real risk that America turns into a socialist country through health care reform? Hardly. There is no correlation between the government providing a service and the elimination of all private ownership, but it's a fabulous way to create FUD. The first people to oppose socialism are our much-vaunted Congress, who let's face it, enjoy private ownership of a lot of stuff, some of which was funded by special interests and the tax payers(!); they will do everything in their power to preserve the fruits of their avarice. So - socialism is an absurdity.

What about "bad for the economy"? Again - there are many ways to make numbers mean what you want. You only have to look at this NY Times article about law schools using misleading data to shore up their performance numbers (graduate employment rates, etc.) to help improve their rankings, and you can see how universities ("reputable" universities) will lie.

When it comes to the economy, there are two things that matter most - I want a good job, and I want to take home more money than I am now. But then here's one pretty diabolical piece of FUD: taxes are bad. Well... I don't think it's that simple. How much tax do you want to pay? As little as possible - right? Me too. Thus the resonance with the Republican push on lower taxes. It makes total sense - or does it?

Do my taxes really matter or is there more to this?? Put another way, the real question in my mind is: how do I maximize my net earnings? What I really care about is how much I take home at the end of the day, the nature of the deductions from my earnings are less important than the value I get for those deductions and whether the net amount I'm taking home is going up. <-- Does that make sense?

If it does, then it's not really about taxes is it? Why not make it about personal profitability? Profits being what you get to keep in your wallet after all your expenses are paid. So if there is a change to our economic system that costs me more in tax but lowers or eliminates another (bigger) salary deduction, and after all that I end up ahead, why should I care?

According to this (well worth a read), the American health care system is the most expensive in the world; in 2006, we spent more than $6,700 per person on health care, compared ~$3,500 for most Western nations. The cost is actually higher since every other Western country has universal health care, and about 10% of Americans don't have any coverage at all, so the $6,700 is actually closer to $7,500 per person.

Digging a bit deeper, 70% of Canadian health care costs are borne by the government vs. 46% in the US; the Canadian system costs about $3,700 per person (just about half of the US cost), and yet Canadians live longer and have a lower infant mortality rate - these are the two primary measures of national health care effectiveness.

Bottom line: Canadians spend $3,800 less per person for better health care. If you're American, you might think - yeah but my employer pays my share - what do I care? Well - if personal profitability is your goal, then you will know that you are paying EVERY penny of your medical insurance costs, whether it is in taxes, payroll deductions, a lower salary, or lower prices at the store. No matter how you cut it, the $3,800 difference DOES come from your wallet, and means those of us who live in the USA earn that much less every year, and die earlier to boot.

Even if the US decided to spend $4,500 per person (for every person), that's still a savings of $2,200 for each of us plus the knowledge that no-one gets left behind. Every person in this country gets access. Every person also gets to pad their wallets a bit, and rarely is that a bad thing!

But how to communicate this? It's a pretty complex analysis, and given the state of education in America, I'm not convinced that every voter is going to understand it. Think back to the last person that had a tough economic message to share with the populace - President Ronald Reagan in is first address to the nation from the Oval Office in 1981 - a brilliant speech.

If President Obama had addressed the nation in just this way - not talking to politicians and special interests as he did in his attempts, but talking to the American people, sitting in his office, and not standing in the House; if he had applied simple metaphors as Reagan did, perhaps each of us might have been able to look forward to an extra $2-3,000 in our wallets in 2011.

the D.T.s

In this time of reflection, I've been asking myself - what monumental legislation did the US government pass over the last 30 years? What laws have had a profound and lasting effect on people, the economy, and the world's view America?

I thought of two - the War on Drugs and the War on Terror:

WoD: jailed the second-most people in history (after the internment of the Jews during the WWII); cost $billions in increased law enforcement, court delays, prisons; demonstrated to the world that America cares less about its people and more about self-righteous politics.

WoT: created the Patriot Act and the Department of Homeland Security (aka the War on Americans), killed more Americans than 911 (and counting) with wars in Iraq/Afghanistan; cost the American economy $trillions; proved to the world that everything looks like a nail in America, because the only tool they have is a hammer.

Have drugs or terrorists been defeated? Is America better than it was before either War?

2011 brings us an even more polarized nation/government; a revitalized Republican Congress; and impending redistricting based on the 2010 Census that will allow the newly-elected State and Federal politicians to draw the lines of their district to ensure a partisan electorate and future reelections. This is a perfect storm, giving Congress the impetus to "do something big" in 2011.

I think they will want to declare a War on something. Potential "enemies" - overall government spending (nuke all socialist programs); repealing the Health Care Bill; and Education.

The average age in Congress is 57, we have an increasingly aging electorate, and lest we forget, the Republicans are also known as the GOP - the Grand Old Party; Medicare, Social Security, etc. are relatively safe.

Health care - the incoming Congress is already contemplating repealing ObamaCare; but the Democrats will (per the deal on tax cuts) negotiate some tweaks, but keep the essence intact.

That leaves Education, where costs are rising, performance is declining, and (pro-Democrat) unions are strong. The latest PISA scores (OECD global student achievement testing) have the US toying with average, while others are excelling in literacy, numeracy and science. This, despite spending more per student than almost every country in the world. Powerful ammunition in the right hands...

Congressional Republicans are supporters of school vouchers (un-bundling the public school budgets, giving parents vouchers to pay their child's tuition at a school of their choice); a "free market education system"; and they are strong supporters of faith-based schools.

With an increasingly polarized electorate, and armed with equally polarized candidates, the extreme right (conservative, pro-religion, pro guns, pro-military, anti-abortion, anti-homosexual, anti-socialism, etc.) are stronger than ever. They advocate Family Values, and want to see America restored to its "rightful path."

According to Pew Research, American scientists are 55% Democrat, 32% Independent, and 6% Republican. If you can stomach her, listen to this speech - Palin is a political force with a large and energized following, and the wit and vocabulary to incite them to action. She appeals to that growing extreme right who wishes to take back America from the "intellectual snobs that have put us in this mess," and to return America to "just plain folk" vs. those elitist science-mongering snobs. Scientists aren't their people; science disputes Intelligent Design; it questions their right to burn coal and petroleum (GOP disbands committee on global warming); it advocates for stem cell research, abortions, and all manner of foul and evil acts; science disputes the very existence of God.

How might the next war be declared? Here's a possible excerpt from the speech:

America was a proud and honorable nation, standing on the shoulders of great men who gave their blood for her freedom, and so that our children could fulfil their dreams, knowing that they were protected from all forms of evil. My fellow Americans this is no longer the case. Today we are weak, our values are eroding, the very nature of the American family is in question!

We must rise once more! We must take back America, restore her to her rightful place as the land of the free and the home of the brave, as the one nation under God. Our journey begins with our children. Our schools must reflect our vision, our potential, and our values. The public school system - from the buildings to the curriculum to the teachers - is a failure. Decisive action is required.

Starting today, American parents will receive vouchers to choose a school for their children that aligns to their values and morals, and that teaches the tried and true curriculum that built this once-great nation. American baby boomers are the most educated and successful community in history; we need schools that teach what they were taught and in the way they were taught.

The voters are demanding a stronger, faith-based education system that adheres to these principles. We have heard you, and will match your voucher if you choose to place your child in a qualifying school, thus doubling the funding for the "right" schools. This free market approach, which again goes back to our roots, is how we will take back America, restore our children's education, and take back our schools.

Is it really that far-fetched to imagine the incoming Congress declaring a War on Science?

Most of us know the term D.T.s to describe addiction withdrawal symptoms. America is going through the Delirium Tremens right now with the Wars on Drugs and Terror and soon, science. But why? Every war was declared with the intent of restoring the good old days. If this declaration succeeds, it could very well drive America back into the 17th Century with trials in Salem for the Mark Zuckerbergs of tomorrow.

Congress needs to go into rehab, do the 12-Step Program and rid itself of this addiction once and for all. No addiction is healthy, and an addiction to war is the least healthy of all.

clarity

Our governments (especially elected ones) are mired in the never-ending cycle of getting reelected. This leads to the never-ending cycle of creating polarizing issues that place candidates on the side of a cash-rich and moron-filled fringe who will donate $$$ to the campaign; and even more insidious, the never-ending cycle of creating ever more pointless laws, oversight, and pandering to feign congressional value-add.

Lest this be a rant on the depths to which politicians have sunk, let us take another tack. How does one help government be less ...pendulous?

Why not reboot the country every century or so to eliminate incumbency, any laws written by Congress, the tax code, all departments, etc.? Let us revolt and create a new system with a clean slate!

Whether we like it or not, some governments are already there with bankruptcies, and others are close behind. If the US national debt continues to grow by more than $4 billion per day, it's seems pretty certain that a reboot is impending.

I would design the next government around very clear and specific boundaries; being explicit about what government will and won't do for its citizenry. Here are the five things my government would do (and NO more):

1. Education - Free, and starting at age zero (yes, zero), to where the student has completed their undergraduate certificate (2-year/4-year), or until about age 22.

   You start organized education at birth because we know it makes a HUGE impact on a child's development. You also do this to ensure that every child is well cared for and nurtured. The fruits of this are more independent (economically, physiologically, and psychologically) children/adults; less youth crime and hopefully less adult crime; healthier kids ('cause they'll learn about health, eat better food in school, etc.); and hopefully things like less teen pregnancies, gang activity, etc.

   This will require more teachers, more classrooms, etc. It will also require an education system that imparts knowledge in practical facets of life (how to prepare for and participate in a job interview, communication skills for the workplace, diet, fitness, banking, parenting, birth control, etc.) - these must all be mandatory for every student. It is through these last that we make the rest of the system less expensive.

2. Healthcare - full coverage for all residents from pre-natal to death, including medicines.

   Prioritizing diet, preventative care, and a mindset of quality service for all is fundamental. The system should be completely free to all residents of the country (IMO it should be free to anyone that needs it, irrespective of status), and include medical, vision, dental, prescriptions, etc. Elective work for purely cosmetic reasons will not be covered. This implies there will no longer be a health insurance industry, physicians, nurses, etc. will likely make less money as most will be federal employees.

3. Security - from creating laws, to enforcing laws, to civil and national defense.

   First - the primary motivation for Congress should NOT be to create new laws, but rather to ensure that the existing Code be well-adhered to, and that the citizenry be incented to better behavior. There should be one law-enforcement body in the country spanning local, regional, transportation, organized crime, etc. There will be an emergency response system that includes fire departments, ambulances/paramedics, nature-related calamities (weather, volcano, earthquake, etc.), and any other type of civil support. All of these capabilities will be linked and operate as one unit.

   National defense will focus on protecting the nation from others, not proactively engaging any nation in armed conflict. Since the system is rebooting, there will no longer be mandatory minimums, or idiotic wars (drugs, etc.) on anything.

4. Civil Service - core professional/infrastructural services plus employment for those that aren't easily employed in the private sector.

   This is the most complex organization, and one most at risk of untamed growth. It delivers all national services to the country, including infrastructure (roads, rail, , airports, ports, etc.); utilities (energy, water, etc.); foreign and economic policy; and things like election systems. It also includes an employment machine aimed at those unemployable in the private sector; the work done will span a variety of public service/peace-corps/disaster relief-type services. If you wish to earn a living, you must contribute. There will be no welfare system.

   Limits on the size and scope of this organization will be one of the most critical and contentious pieces of legislation that the new government will write. The core set of services performed will be enumerated in the new Constitution, along with a mechanism to control budget and organizational size. Amendments to this part of the Constitution will require a mega-majority (at least 75% of Congress).

5. Taxation+ - a simplified (progressive flat income tax mechanism to cover the costs of #1-4, basic government operations, and a bit extra for an emergency fund. There should be no sales tax, state tax, or local tax - just a simple income tax. The "+" connotes other forms of economic oversight like the SEC.

Yes, these are expensive and complex undertakings. Fundamental to this is a Constitution that rewards government (and government officials) for being as small as reasonable and no smaller.

To help rein things in, the government is NOT allowed to give money away (bailouts, unemployment benefits, social security, welfare, etc.), it is also not allowed to pay for things like food and shelter. It encourages a simpler service delivery model - one police force across the country; one school system; one healthcare system, etc.

Human nature is such that when a thing is given, it is expected (entitlement); and when you get one thing, you also expect related things. For example - if you get food stamps, you aren't as desperate to work because you know it's available; then you wonder why there aren't "home stamps" so that you can "afford" better accommodation. Thus begins the dependency-cycle.

A system where people willingly abdicate responsibility to society is not acceptable.

If you've read this blog at all, you know I believe a fundamental precept of society is to care for those that can't. But every parent knows that you also have to teach your children certain lessons; they have to fend for themselves, not always look to others to bring them food from the kitchen, or walk them to school, or whatever. At some point, they must be pushed out of the nest and allowed to fly on their own. This is also a form of caring for those that can't. It is more difficult to do, so society instead throws money at it. Wrong.

People need to take responsibility for themselves and their destinies; if you're living hand-to-mouth now, why bring a child into the world? Why not heed what you were taught about family planning and contraception, and take advantage of the healthcare system (free contraception) to prevent bringing one more child into your already difficult reality? Today you might want to have children because Social Services is more likely to care for you - that's the wrong incentive.

Similarly, if you have a job and are worried about how a disability might prevent you from keeping food on the table and a roof over your head, invest in insurance to reduce your risk. If you wish to change careers and need training and some help tiding you over, save or borrow what you need - it's not the government's role to help you with that.

Systems that promise everything for everyone are not sustainable. Almost every government on the planet is facing a significant budget squeeze; whether we like it or not, a reboot is in order. Let's not repeat the same mistakes in the next cycle.

If there is absolute clarity about what government will and won't do, people will use what's given (education, healthcare, security) and find other means bridge any gaps - this too is in our nature.

sex and selling

Among other things, The Art of War teaches us that we must understand our opponent - know their situation, their motivations, and their strengths and weaknesses. Aikido teaches us to then transform that energy into mutually-positive outcomes.

Recent conversations with parents tell me they're still at a loss about broaching sex with their kids.

Most children have sex way before adults believe they do; they like it as they like other things they're told they shouldn't (alcohol, downloading unlicensed content, staying out late, etc.). It got me to thinking - rather than take the fear and forbidden fruit approach to sex, why not take advantage of what's already there?

Here's my sex speech:

I know sex is something you're going to want to try, and if you're anything like I was, once you start, you'll want to get it as often as you can. There are three things you need to know that'll help you get as much as you possibly can:

1. You can't have body parts falling off - there are a ton of sexually-transmitted diseases, and if you catch one, not only will it hurt, but you might never get laid again.
2. Pregnancy is a sex-stopper. Once you are or get someone pregnant, sex stops - period. You don't want any part of this.
3. The best sex is with someone who wants it just as much as you do. If your partner says 'No' - that's it - stop; and you have to make sure your partner will stop if you say 'No.' If you ignore this, you might go to jail where you'll get way the wrong kind of sex.

What do you do? Always, always talk about sexual history and diseases - you gotta know you're both free of disease; condoms do help, but the conversation is just as important, and your partner will like you more for it [If it's a boy, say: girls will really respect and like you for bringing this up, and it will help you get more sex]. Condoms will also help pregnancy, so it's a two-fer.

Let's review - first - you've gotta talk history; second - condoms; third - 'no' means stop.

You know they're going to do it anyway, I'd rather it be safe, protected, consensual sex than the alternative.

This is a bit of a departure for this blog, or is it? While more personal, this is basic marketing. A old friend Nick Stodin once said the key to successful selling is the organizing principle - if you package something correctly, people will buy it - no selling required. His example:

• Take a bunch of vegetables, chop them up and throw them in a pile in the back yard. What do you have? Compost. What do you do with it? Turn it over, wait for it to rot.
• Take a bunch of vegetables, chop them up and drop them on your kitchen floor. What do you have? A mess. What do you do with it? Clean it up.
• Take a bunch of vegetables, chop them up and put them into a wooden bowl. What do you have? A salad. What do you do with it? Eat it.

The organizing principle is the bowl, or in the previous case, the path to prolific sex; the desired behavior is assured, no selling required.

strength v integrity

For most people in a position of strength, whatever they're facing, their approach is more aggressive. Whether you have a gun and they are unarmed; or you have the chip lead at the poker table; when you're a parent and your child is still dependent on you; if you're in a gang, and your "victim" is alone; or even when you have a majority in politics - you assert power because you can.

But the tables can turn quickly, be it when you run out of bullets, lose chips by betting recklessly, see your child turn into a teenager, face your "victim" when you are alone, or of course when a senator dies and the people vote in a candidate from the other party.

Oddly, strength is more ephemeral than integrity. Look at Haiti, where so many have died and even more have suffered because there is no integrity in their system. Today, in a show of global strength, many are working together to help; but as David Brooks of the NY Times wrote, at some point, the immediate crisis will pass, the passion will fade, and the world will have moved on. The work of helping Haiti build an infrastructure with the integrity to withstand future crises will be left undone. This is not because Haiti is an easily-ignored foreign land; just look at the levees in New Orleans which years after Katrina are still a huge source of risk to the city. We act with bluster and ego and forsake integrity.

When Lord Acton wrote these words in 1887, he knew whereof he spoke: "Power tends to corrupt, and absolute power corrupts absolutely. Great men are almost always bad men."

How do great men become bad men? Maybe power is one part amnesia + one part imperviousness? Amnesia because you immediately forget how difficult the journey was, who you were and how you felt before you rose to power, and your conviction that when you got there, it/you'd be different. Is a side effect of the amnesia also a loss of compassion - the ability to empathize with both your people and those you vanquished? I think so.

The amnesia makes you suddenly wake up in power, believing that this is what you were born to do and be, and not only can no-one take it away from you, but that every decision you make is right, every judgment you have is correct, and every idea you conceive is brilliant. There is also a lingering, selective amnesia that immediately vindicates or absolves you of any "small" mistake you might make while in power.

Now look back over the last 12 months at how the majority party in Congress has behaved. Heavy-handed, acting behind closed doors, and with an aura of self-righteousness. Maybe the President has been less corrupted by power than either the House or Senate Democrats, but that hasn't really mattered because he has relatively little say in the actual law-making process.

If the Dems had behaved with integrity, maybe they would have discovered a better and more communal path towards effective healthcare. Now they are contemplating a massively watered-down version of the bill or even unbundling it and trying to pass sections piecemeal. Pathetic.

The House had a Democratic majority in the last midterms during WBII (President George W. Bush's 2nd term), and accomplished NOTHING. Their excuse was the Republican presidency. They learned NOTHING from the Republican majorities during the Clinton presidency, and NOTHING from their failures prior to Obama's presidency. Pathetic.

Harry Reid and Nancy Pelosi - both insipid, integrity-free "leaders" - are now in a pucker moment. My guess is they will find something or someone to blame for losing the Massachusetts seat, and continue to blunder through Congress as the grape-brained blithering fools that they are. The midterms will hopefully see them unseated, and the Republicans will enter the next session of Congress with parity or a very small majority.

Sadly, there is no redemption in the Republican power circle either - they relish the failure of the Dems but have demonstrated NO desire to act with integrity in their service of the American people.

What would I do? If I were President Obama, I'd invite a moderate Republican (with a bi-partisan team of two from each party, and one each from the House and Senate) to form a commission to write a healthcare bill by the end of April 2010. The President should personally spend at least one day/week with this group, but claim NO credit for the result - this was their work, not his. In exchange, the President should agree to campaign for that moderate Republican whenever s/he wants. The commission should be fully open to the public, and the conditions for success (cost, coverage span, etc.) should be laid out up-front.

The President can go before the people today and admit that the current approach has failed; admit that while there are good things in the bill, things he supports passionately, the process was wrong. He should point to the data the National Geographic published recently on healthcare cost vs. life expectancy, and how the US spends so much more, and yet her citizens see the doctor less and don't live as long. In the end, our outcome of healthier Americans is at risk, and that's not acceptable.

If I were with the insurance company leaders, I'd recommend an industry-wide preemptive strike to proactively eliminate many of the issues that the current bill has raised about their behavior (exclusions for preexisting conditions, caps on payments, etc.).

Thus far, they and the opponents of proposed healthcare reform have won with scare tactics. If instead they choose to act with integrity, especially when the tide is turning in their favor, they will control the agenda, chose exactly how to adapt to their new model, and maybe prevent regulatory intervention altogether. If they do this right, it might actually be a more profitable venture for them in the long run, irrespective of which party holds the majority. And they will have acted with a measure of integrity.

Integrity is laced with ethos, humanity, and a sense of what's right. It is shaped by accountability, transparency and the belief that your power is less important than the right outcome.

acceptance

Ask ten people what the opposite of "love" is and chances are at least nine will say "hate." I don't agree. I think its indifference. When asked what "love" means, most will speak at length about many facets of what makes them feel good, but I think it's simpler - it's unequivocal acceptance. In most (ideally all) cases, this is how your mother feels about you. This acceptance is what we all seek.

There is power in knowing that you are accepted just as you are, just as you behave, just as you act, dress, think, play, whatever. When you are in this place of acceptance, you are empowered to be you; in fact, you're just plain empowered to be.

Most of us recognize the sense of comfort we feel when we arrive at a place where we are loved, a sense of ...de-burdening - the load lightens, the stress fades away, words flow smoothly, smiles are more frequent, expressiveness is more unfettered... There's more - we also feel safer, more cocooned, perhaps even impervious to harm. It's a sense of home isn't it?

I was talking with a good friend a couple of weeks ago about the differences in our two upbringings, how we were educated, and the role that people around us played. We looked at schools that are successful (measured by student success after graduation) and also have happy, energetic, and engaged students, and we saw that we had traveled similar paths. While we both successfully emerged from our respective public schools systems, many students don't. 25% of American students don't graduate from high school, of those that do, more than a third require remediation before entering tertiary schools (but it's really worse - more than 60% of those that were accepted into university required remediation). In our two cases, we saw also that others helped make sure we stayed on the straight and narrow, that we were given the impetus and support to stay in school, do well in school, and aspire.

I was talking yesterday with another close friend about binge drinking in the UK - more than half of all teenagers in Britain have been binge drinking in the last month. Scandinavians and Americans are also prone; and the drinkers are getting younger, developing other issues (poor academic performance, health issues, delinquency, etc.), and costing the system increasingly more money -£2.7 billion annually in injuries and illness in the UK alone.

Whether education or binge drinking, governments have attempted to isolate micro points of failure (poor teachers, drinking hours), and tried to fix these issues in the hopes that they will lead to widespread change. But things haven't improved; instead it's increased the tension with teachers, teacher unions and pub owners.

There is no research on macro common denominators that indicate increased learning performance or reduced drinking, so there's no data or foundation for what follows, it's my conjecture.

When you look at successes in education or when you look at places where binge drinking isn't as much of an issue, there is one (at least) common denominator - community. When I think of community, I think of a place where acceptance reigns - the group accepts and cares for the individual, and every adult is a parent to every child, every one a sibling to each other. Look at almost every successful school and you will find a community of people (parents, teachers, administrators and students) that share in the goal of raising great children; you can judge the strength of that community by whether students and their families stay connected to the school after graduation. Schools like this have a sustained record of success, and are led by people who care and people who are committed to the best for their community.

The indifference towards the individual, the absence of real community from birth onwards could be a predictor of poor academic performance, drinking, other addictions, the tendency towards criminal behavior, etc. Most people go out drinking because it's the only time they have a connection (albeit ephemeral) with others - a chance to belong for those moments to a group. Children join gangs because of the pride of belonging. When there is no alternative to real connection, real acceptance and real community, an easy way out is to drink your way into that feeling for at least those few hours where your behavior is accepted, your words are listened to (and enjoyed), your seat is held for you.

But if you can find a real and safe place to call home, a place where you belong, are accepted, and can just be, things change. Look at the Harlem Children's Zone and similar places where people invest in the community, and in turn the community invests in the individual, and you will find better students, less crime, less drinking, and a chance for redemption. Some centers are able to do this in a small way, but they will always struggle because they can't care for the whole child - that requires a broader effort.

Investing to build communities that live, that care, and that last are where I would put energy if I were running the show - I would center it on the youngest children and work upwards. It will take time, it will not yield immediate politically compelling results, but if we keep at it, it will work - acceptance will happen.

on time off

America enjoys this wonderful period from Halloween through Thanksgiving to the New Year, where there is more optimism in the air, more energy in the workplace, and a legitimate feeling of community:

• Fun is pervasive - lots going on - all centered on celebrating life, friends and family
• There are more days off per week during the last two months of the year than any other time
• Even the media gets into it, celebrating stories of goodwill and the golden rule (do unto others...)

I don't know about you, but when I'm happier, more rested and more connected to the people around me, I am more productive, more engaged, and just plain get more done. I wonder if this is true across the board? I presume there is a seasonality to America's GDP - is it higher in the last quarter of the year? If it is, there is a business case for the power of restorative thinking.

We have winter break, spring break, summer holidays and Christmas/New Year's holidays for students - why not do the same for adults? (OK - maybe not give everyone the whole summer off ;-).) If in the end the nation achieves more and is happier, I'm all for it! Who knows - it might even lead to less anger and violence in this little corner of the world.

Related to this, and paraphrasing a quote my great friend Larry shared with me a couple of days ago:

Those who can, do
Those who can't, legislate
Those who can't legislate, legislate war
Those who can't legislate war, legislate healthcare

Should Congress take more breaks? I think they should only be allowed to work one week/month and be required to have full-time jobs for the other three weeks (like the National Guard Reserves). This would viscerally improve their grasp of the realities their constituents face every day, and require them to be much more focused and succinct when at the Capitol. I think it would lead to fewer, better, simpler bills, and who knows - maybe even a more effective Congress?

Enough of this - I'm taking a nap...

fatheads

I was listening to Weekday (on NPR in Seattle) this morning - the show was about healthcare, obesity and economic status. In Seattle for example, there are six times (5% vs. 30%) more obese people in the poorer neighborhoods than wealthy ones! Even if this number is slightly off, there's no arguing this correlation.

According to the guests on PBS, if you have less money, you have less to spend on food; fatty foods are cheaper and more plentiful than non-fatty foods, and if you only have a few dollars, surely you're not going to want to waste it on boring flavors (like raw vegetables and whole wheat bread), you're going to want tasty food that fills you up.

This is related to something called the Lipstick Effect, which was first documented during the Great Depression, where people who had very little disposable income still bought small luxuries as a treat during tough times (mood management if you will). Some people might buy junk food, others cosmetics, yet others see a movie, and even others will go to a tanning saloon.

So our worthy (and wealthy) legislators who have their own healthcare, gym, and lobbyist-funded condos in the sun have decided that it's appropriate to "help" the poor fat people in America by taxing soft drinks and tanning saloons to help pay for the new healthcare bill that still ignores between 18 (House) and 23 (Senate) million of the poorest Americans.

Why? Like students, poor people don't fund lobbyists to fight on their behalf. They are victims of the false assumption that society's job is to protect the weak and defenseless.

Neither healthcare bill considers the idea that increasing the focus on healthier living in public schools could dramatically lower healthcare costs. There is nothing in these bills that requires standardized tests to include knowledge about personal healthcare and fitness; there is nothing in these bills that mandates the quality of food that must be served in schools, or that students must exercise every day while in public school; or anything else that could create behavior that helps the next generation actually be more healthy.

If I had been in Congress, rather than hold this bill hostage to get the pork that ensured my reelection, I would have traded my vote for a bill that prioritized healthier Americans vs. assuaging any lobbyist. I would have demanded:

1. Public schools - curriculum on healthcare and fitness, and phys-ed in all 13 years (K-12), standardized tests must include literacy, numeracy and personal healthcare and fitness (including sex education), only healthy food in the schools (no pop, candy, junk food, etc.).
2. Doctors and hospitals/clinics get paid based on the health of their constituency - not by procedure or visit; i.e. a hospital gets paid based on the healthiness of the entire community it serves; doctors get paid based on the aggregate health of their entire patient load (*** doctors can not choose to only serve certain (healthier) patients).
3. Government + insurance companies must create a pool of funds available to any doctor or hospital to be used to provide basic healthcare services (per #2) to uninsured patients.

There is a direct correlation between level of education and economic status; there is a direct correlation between economic status and fitness; there is a direct correlation between fitness and healthcare cost. There is also a direct correlation between the way doctors and hospitals get paid and the type of work they do. These facts are not disputed.

If the White House and Congress' goal is a healthier nation, the path forward is incredibly obvious - only a fathead would see it otherwise.

the war on peace

One of our (Americans in particular) most powerful motivators is winning. From its inception, America has had to fight for what she believed, and keep fighting to achieve progress. More often than not, America won - the economy grew, its role on the world stage grew, its contribution to the sciences and entertainment grew, its ego grew, etc. It is therefore clear why this competitive instinct is so deeply-rooted in the American "system," and how it is fundamental to her approach to life, the universe and everything.

From birth to school to work to love to death, Americans view life as a zero-sum game. At birth we're competing for cutest baby, baby closest to the XXth percentile of development, etc.; next it's getting in the right schools; then the best jobs; the best girl/guy; etc. In every instance, keeping score is about besting someone else - the pie is only so big, and for us to win, others need to lose.

The competitive instinct can sometimes lead one astray - there have been many American declarations against rather unlikely foes. Some of these "Wars" include: Poverty (Johnson, 1964 - winner: poverty); Drugs (Nixon, 1969 - winner: drugs); Terror (Bush, 2001 - winner: terror); Greed (US Congress 2008/9 - winner: greed); ...

Even corporations have gotten into it - one recently declared War on Cost. If they actually win, price = free; success = bankruptcy. Not sure the shareholders will approve.

It is pretty hard to spot(!), but did you notice a trend among all these wars? Each has cost a ton of money, wasted a ton of lives, burned a ton of energy, and in every case, resulted in more of the "bad" thing than before the "war" was declared.

Hmmm...

"My fellow Americans there is a cancer among us, it is evil, it is insidious, and it is fomented by those will not stop until they have found the best in every one of us. I call upon every red-blooded American to stand with me, and in the spirit of our founding fathers who prevailed against a superior foe armed only with the power of their ideals, rise as one to combat what is surely the most diabolical axis of evil that has beset our glorious nation.

My fellow Americans - I stand before you today with pride and purpose to declare War on Peace. Peace is the most powerful foe America has ever faced, but I am confident that our relentless pursuit of failure will once again restore our faith and ensure our prosperity.

This is just the beginning - lead by Peace, this axis of evil contains two other collaborators that must also be quelled. Immediately upon losing to Peace, and in the spirit of all that is great, we will first declare War on Wellness, and then War on Education.

Thank you, God bless each and every one of you, and God bless America."

Yes we can!

absurdity

The recent healthcare debate has been angst-ridden to say the least. With something this big, everyone's bound to have issues, and compromise is the word of the day. But there's a limit isn't there?

The New York Times singled out two constituencies today - overweight people, and people who care about abortion rights. The "fat pride" [their phrase not mine] people argue that being heavy is not unhealthy (!?!). According to Linda Bacon, a professor of nutrition at City College of San Francisco, “What we’re doing in public health care policy is harmful. We give a direct and clear message that there’s something wrong with being fat.” The Pro-Life people argue that the government should not fund abortions because they are morally opposed to it.

The Center for Disease Control and the Office of the Surgeon General say that obesity is unhealthy, increases the risk of other diseases, and requires more medical intervention over the life of the patient. These are not guesses, there is data to back this up. Of course we're giving a direct and clear message that there's something wrong with being fat! What kind of moron (other than Ms Bacon) would say that's a bad thing? And yet, we have a huge (sorry) lobby that's now actively pursuing this agenda! Given how politicians whore themselves out to lobbies with voters, I have no doubt that we will see some Congressional panderer put forth a bill making obesity an American right.

IMO societal obesity is a failure - but our focus should be building a culture of health and fitness in our children. That's how we change things.

People are discriminated against based on how they look; obese people are obviously so, and therefore subject to discrimination. This is inexcusable. BUT - let's not mistake anti-discrimination as reason to argue that we should encourage obesity! Jeez!

In 1973, the United States Supreme Court held that a woman may abort her pregnancy for any reason, provided that the fetus is younger than 24-28 weeks (after which it is deemed to be viable - able to survive outside the womb). After 24-28 weeks, abortion must be available when needed to protect the woman's health. 

IMO every abortion is a failure - but our focus should be on preventing unwanted pregnancies. That's how we change things.

The Supreme Court is the law of the land. If the law of the land states that abortion is legal, then how is it possible that the government's health insurance plan won't cover it? If a healthcare bill does get passed, I hope someone appeals this exclusion and that the Supreme Court has the fortitude to hear the case.

But this is all just sophistry. Here's the real absurdity:

The greatest impetus for healthcare reform is neither abortion nor obese people - it is serving the millions of citizens that don't have access to medical care. It is recognition that these un(or under)-insured Americans ought to have access as a matter of societal rightness. I couldn't agree more - a society is formed when people want to live together for mutual benefit; it is when the community works together to care of the one. IMO this is at the core of being human.

Which segment of society is more likely to be obese? Which segment is more likely to have an unplanned pregnancy? I'll give you one guess.

"Democracy" is a powerful word. According to Webster, two definitions are: "a government in which the supreme power is vested in the people and exercised by them directly or indirectly through a system of representation"; and "the absence of hereditary or arbitrary class distinctions or privileges." Both American political parties are supporters of the democratic ideal - this is a big part of American foreign policy - bringing lawful democracy to those that don't have it. But when it comes to their own citizens, elected leaders on both sides of the aisle are flaunting both their own laws and the essence of democratic equality.

The absurdity must end.

define winning

When a good leader embarks on a journey, he knows why they're going, where they're going, and when they'll finish. The goals and outcomes are clear. Achieving them is a matter of execution and circumstance, but beginning with a clear statement and vision of what success looks like is crucial.

Seth Godin wrote about the problem with transoms being that it's too easy to throw stuff out there in the hopes that something sticks. He argues that without credibility you will likely struggle to make yourself heard above the fray, that companies could make it easier for people to share ideas with them, and who knows what could come of that?

It underscores idea that good leaders know their destination when they embark. If you want your idea to be heard, or you want to be open to new ideas, create the circumstances to ensure that you will get what you want. Don't just hope that good things will come.

But in our world, the focus all too often is on the symptoms and processes and not the underlying cause or the eventual outcome. Your odds of blundering into a good outcome this way are infinitesimal. This is why so many people feel like their company or government seems to relentlessly churn over the same ground every bloody day. There is never real progress, just "metrics that show progress." It really does suck to be us, and worse, we don't seem to be able to get past the suckiness.

Take education - what is the goal? Is it happy teachers? Beautiful schools? Quality curricula? More budget? Competition with other countries? Improved assessments? What about healthcare? What outcome do we want to create? Is it happier doctors? Cheaper medicine? One payer? Happier insurance companies? Universal access? Better hospitals? More innovation?

In both cases, we rudderless because there's no clarity about the end goal. Shouldn't education be about ensuring that every child is best-prepared to excel in whatever future they choose? Shouldn't healthcare be about creating the healthiest society possible? Why don't we measure effective education by what students are capable of doing after they graduate? Why don't we measure effective healthcare by how infrequently people need to go to the doctor?

Without clear guidance, a team flounders. Without clear guidance, a nation can flounder as well. Take the "war" in Afghanistan. What is success? Is it the eradication of the Taliban? I despise what they stand for, but that feels awfully like extermination, or genocide. The Taliban are a socio-political faction in Afghanistan. Others might not agree with their principles, but that doesn't mean anyone has the right to erase its member from existence. I know many people who are passionately opposed to President Obama and the Democratic Party, or Gordon Brown and the Labor Party in the UK, or whatever, but I don't see those opponents building a military machine to exterminate them. We are civilized ...aren't we??

Is it the eradication of Al Qaeda? Terrorism is the use of violence to provoke social change - this is a criminal act, requiring a police force not a military. You don't stop violence with violence - you feed it. It is exactly the reaction they are looking for, and exactly what they can then use to recruit more poor and desperate people to their cause. Racism is a form of terrorism, but Martin Luther King Jr. taught us that "Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that."

If the goal in Afghanistan is to exterminate a political party, we should stop and ask ourselves what that says about us. If the goal is to eliminate terrorism, we should stop and ask ourselves how that work began in the United States of America with the (ongoing) elimination of terrorism against black (and other) people.

Frank Rich's OpEd in the NY Times compares (as many others have) Afghanistan to Vietnam - wondering if we will make this same mistake yet again? I see that the President is taking a step back to deliberate. It is true that Al Qaeda attacked America, but they are a band of criminals, not a sovereign nation.

I hope at a minimum the President's deliberation yields a clear statement of the meaning of "winning"; but I really hope he realizes that the only nation that has declared war thus far is America.

dropstop

Eli Broad has put a ton of philanthropic energy and money into education; his foundation's site has some interesting statistics:

1. 1.2 million students drop out of high school every year, 44% of dropouts under 24 are jobless
2. Dropouts pay less taxes (costing the Feds potential revenue), and 65% of US convicts are dropouts
3. It costs $12,956 more per year to house an inmate ($22,600) than educate a student ($9,644)

Assuming dropouts only spend two years in jail over their adult lives, then each dropout costs the government $45,200 + $? in arrest/court costs + $? in lost tax revenue = $100k (guessing $5,000 in arrest/court + $50k in lost taxes). I think the actual costs are much higher, but let's be conservative and say it's just $100,000 per dropout over their lifetime.

This means every year, the American government (American taxpayer actually) takes on an increased burden of $78 billion dollars just from the 65% of dropouts who will become convicts. Just for the dropouts since the year 2000, this burden over their lives is over $700 billion. To put that in context, the annual operating budget for education is $450 billion, which serves almost 50 million students. [See update below.] I couldn't find the data I wanted, but still believe that the burden on society is significant enough to warrant the investment below. 

Why do students drop out of high school? The three most frequently-cited reasons are: family issues ~25% (pregnancy or becoming a parent), employment ~32% (couldn't combine school and work, or needed to get a job), and motivation ~69% (didn't care, no-one pushed them). How about this: two thirds said that they would have tried harder if more was expected from them (i.e. someone cared).

The National Dropout Prevention Center proposes fifteen strategies for improving graduation rates (about twelve too many); if I were to pick three, besides the obvious ones (centralization and teacher improvement), my third pick would be mentorship, or as I proposed, "minternships."

I recall hearing about a Big Brothers Big Sisters study that said effective mentorship requires a minimum 18 month commitment; less can actually do more harm than good. The quality of the mentor is of course also a critical factor. But if you're good and you stick around, the results are strong and positive - the mentee is more likely to complete and graduate school, etc.

Is there a common thread among the three main reasons kids drop out? They're not being counseled well about family planning, birth control, safe sex, etc.; there are no clear options for financial support for children in high school; there's no-one who believes in them, encourages them, and provides them with a model of how to achieve gainful employment. There doesn't seem to be one, but I think we can create it :-).

Let's build a formalized mentorship program (using the Teach for America concept, we could call it "Reach for Americans") where students are able to receive not just counseling and support, but also a stipend (for community service or internships that pays enough to prevent the need to get a job). The mentorship must focus on both family planning/sex ed and of course motivation, support and inspiration to stay in school, graduate and succeed. Let's not make Reach for Americans (or whatever it'd be called) a .org - let's instead make it a .gov, that way it's not beholden to fund-raising, and students can count on the counselors being there always.

The program should begin early - say at age 8, and continue through high school graduation - this would get expensive (but I bet we'd not only improve graduation rates, but also student performance, and hopefully in a generation be able to claim that families were elevating themselves out of poverty because their children were graduating high school (potentially going on to community college or university), and earning a family wage. This organization might also become a student advocacy group, and argue for student rights across the board, but particularly in low-income communities.

The business case is clear, the outcomes could be significant - I think we should pick a state and give it a try.

UPDATE - I realize (thank you everyone for your emails and comments!) that I made a false assumption above - 65% of criminals are dropouts, not 65% of dropouts are criminals. I will correct this this evening.

outcomes!

Have you noticed that in most big projects you're a part of, success is measured by solving symptoms instead of creating outcomes? Off the top of my head the best example of focusing on outcomes is President Kennedy's proclamation: "I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the Moon and returning him safely to Earth."

JFK didn't talk about how it should be done, whether we'd use rockets or levitation, whether we needed bipartisan support, or anything else that reeked of symptoms. The outcome was clear, and while many thought it unattainable in 1961, the nation (and the world) held onto the goal and found a way to make it happen.

Seth Godin's post on positive thinking has a similar feel to it. We all suffer from NIH (Not Invented Here) syndrome, our natural reaction to someone else's ides is "why it won't work" vs. "let's give it a try!" This tendency creates barriers to outcomes that can become insurmountable, because for some reason, it's easier for us to believe in "no" than "yes." It's of course much easier to say why it won't work than participate and help create the outcome. Think of every "official opposition" in politics, and even why more candidates argue against their opponent than for their own ideas.

Health care in America is one example of this. Understandably, there is intense debate on this topic - it's complex, rife with vested interests, political rhetoric, and sadly, outright lies. The difference between health care and putting a man on the moon is that the former has been around for ages, affects everyone, and has a direct effect on each of our wallets. The latter had none of those constraints. These are all of course excuses for why we can't fix it...

What if President Obama's inaugural speech had said: "We will have universal health care in America while reducing overall costs before I complete my second term as President." (Note presumptive close on 2nd term;-))

The mandate does not require that we emulate European or Canadian systems, or that we will have a public option, or that we will cut this or increase that, or anything like that. As with JFK's mandate, the "how" is left up to the experts. The only constraints are what (universal health care), when (in 8 years), and how much (less than today).

Is it possible? I think so. What would this uniquely American health care system look like? I have no idea, Would there have to be compromises? Almost certainly. Does this country have a history of rising to the occasion? Yes.

I'm reminded of the scene from (ironically) Apollo 13 - see video to the right - where the NASA team had a problem to solve. The CO2 scrubbers on the ship were damaged. The team of engineers was essentially locked in a room, given exactly what the astronauts in space had at hand, and a deadline. Guess what as in the movie, they solved it in real life too.

Having no expertise in any aspect of health care (other than being a reluctant customer), I may have some ideas, but don't know enough about medications, insurance, HMO vs. private care, the role of physicians, nurses, etc. to respond intelligently. But I think if you put all these stakeholders in a room, lock the door and give them a deadline, we might get somewhere.

If I were in their shoes, I'd start with this: the system today succeeds when more people are sick than when less people are sick. Rather than figure out how to fix health care, why not look at what it takes to create a substantially healthier America??

uniting divides

Why is abortion such a pivotal and polarizing issue in the United States? Why doesn't the death penalty get the same level of attention? If one is deemed murder, how is it that the other is not?

Pro Life proponents argue that abortion is wrong because life is life; that from the moment of conception, a fetus is alive and human. While I get that capital punishment responds to a criminal act, if life is life, then killing is murder - period. No life (irrespective of how good or bad it is) should be ended, and society is equally guilty of murder if they employ the electric chair or an abortionist. Why then doesn't the Pro-Life movement fight the death penalty with the same vigor?

By the same token, why doesn't the Pro Choice lobby advocate for the death penalty? Why are they not also proponents of euthanasia? Why is their energy not equally applied to all forms of life-related self (or societal)-determination?

Similarly, the equal access to marriage debate (exemplified by Proposition 8 in California) is also polarizing but flawed. If all men are created equal, then how is it possible for a law to discriminate against some but not others? Moreover, how is it possible for a law (Proposition 8) to exist claiming that it protects the sanctity of marriage, and yet there is a sister law (divorce) that facilitates dissolution of this "most sacred institution"? How is giving people a legal "out" to marriage an acceptable compromise, but allowing "different" people to get married wrong?

What about rape? With mandatory sentencing rules, it is possible for someone to get a ridiculous sentence for a relatively benign crime (like Billy Ochoa a drug addict who at 53 was sentenced to 326 years to life for welfare fraud totaling $2,100.00, yes - a lousy $2k), while David Harold E. Earls was sentenced to one (1) year in jail for raping a 5-year-old girl. [This just makes me want to vomit.]

It feels wrong that these other issues have such relatively small bases of support vs. abortion. Don't get me wrong, I'm not saying abortion is OK or trivial, nor am I advocating for one side or the other. I'm just trying to figure out why this one issue, which for decades has dominated American society, politics and jurisprudence, has no resolution, but rather an ever-rising level of angst and vitriol.

Einstein defined insanity as doing the same thing over and over but expecting a different result. This qualifies - both sides are insane and sadly, appear to have no intention of stopping the insanity.

Thanks to J.R., I first re-read sorry seems to be the hardest word, then read a John Baldoni post that J.R. referenced, and then listened to President Obama's Cairo speech. Like John, I was struck by this statement in response to another insanity:

So long as our relationship is defined by our differences, we will empower those who sow hatred rather than peace, and who promote conflict rather than the cooperation that can help all of our people achieve justice and prosperity. This cycle of suspicion and discord must end.

How true.

Is there anything that unites these two sides (Pro Life - Pro Choice) besides the word "Pro"?

I think there is - the unwanted pregnancy; irrespective of how it came about (consensual or otherwise), I believe both sides would wholeheartedly agree that it is a far, far better thing for all if the number of unwanted pregnancies goes to zero.

Then why not work together - Pro Life/Choice side-by-side - to educate youths and adults alike, to offer free and unencumbered (no strings attached) counseling, and to also provide free contraception to those that need it?

Their precedent is Portugal legalizing personal use drugs, causing overall drug use to fall dramatically.

Both sides would have a productive mechanism through which to participate and channel their passion. They would be able to measure success by helping more and more babies in this country and around the world be born to healthy, happy, willing, and prepared parents, thus eliminating the reason for fighting in the first place.

Imagine that.

Then imagine all of us together putting our energy and focus behind the next big issue, and then the one after that... <-- this is democracy in action.

criminal addiction

Former Seattle Police Chief Gil Kerlikowske was interviewed on the local NPR station yesterday about his recent confirmation as the new head of the Office of National Drug Control Policy (ONDCP). Kerlikowske stated that he was removing the phrase "war on drugs" from the ONDCP's lexicon which is nice, but he will not put decriminalization on the table, which is a shame.

America's obsession with criminalizing everything and putting all miscreants behind bars is well known, and has contributed to this country having by far the largest percentage of incarcerated adults on the planet (only 5% of the world's population, but 25% of the jailed population). The greatest contributor to growing the criminal ranks was President Nixon, who in 1969 declared a war on drugs, specifically against producers, distributors and consumers of substances including marijuana, cocaine, heroin, methamphetamine, and illicitly-obtained prescription drugs.

This morning I read an article in Scientific American on the impact of a change in drug-related legislation in Portugal. I didn't realize that for most of this century, Portugal has had the most liberal drug laws in Europe. I would have guessed the Netherlands; this very religious (mostly Catholic) and socially conservative country would never have occurred to me.

By changing the laws so that personal possession of drugs (including the ones mentioned above) resulted not in jail but the offer of therapy, Portugal was able to reduce the number of teens doing drugs, drug-related HIV infections, and most critically, more than double the number of people seeking treatment for addiction. Portugal has the lowest rate (10%) of lifetime marijuana use among EU countries with those over 15. The most comparable US statistic (for people over 12) is 39.8%. The Portuguese have done all this and saved money - the cost of therapy is lower than imprisonment, and with successful therapy, former addicts are able to become contributing members of society more quickly.

The ultra-hard stand America has taken during its 40-year war against drugs has resulted in four times higher use of marijuana compared to Portugal, who decriminalized drugs in 2001. Despite all of her efforts, America has the highest per capita usage of cocaine and marijuana in the world.

I suppose those in favor of current policy would argue that it would be worse if the laws were more lenient, that we should have even more stringent rules, and they'd dismiss the Portuguese results as an aberration, or those of a much smaller country that doesn't compare to the USA.

I think the current approach has failed; there are not only more addicts in this country, but we're spending increasingly more money only to achieve increasingly worse results. Change is required, and should have two parts:

I. Decriminalize

The US must decriminalize personal use of drugs. This must also apply to (and hence release) all those currently in jail for what is now legal. Like the Portuguese, panels (a psychologist, social worker and legal adviser) must be formed to handle every case, and the government must also ensure adequate treatment capacity for everyone who seeks it. This will end up costing less than the current cost of finding, arresting, prosecuting and incarcerating drug users. It will also free up the criminal courts to handle other cases, and reduce their backlog. The only losers will be the lawyers, and on this I agree with Shakespeare.

II. Control

This might be a tad more controversial. Paul Atreides (main character in Frank Herbert's Dune series) once said of another drug (the spice melange), "He who can destroy a thing controls a thing." In the same vein, the American government needs to think of alternative approaches to enforcing the production and distribution of drugs. Much of this begins outside the borders of America, which makes it very difficult.

What if the United States government became the largest (and only) domestic marijuana, cocaine and heroin producer and distributor in the country? They would be able to regulate production, quality, distribution and pricing. Imagine the impact. By out-pricing foreign suppliers, they could reduce the impact of players like the Central American and Afghan drug cartels. By controlling quality, they could reduce health risks; and by controlling distribution, they would eliminate a whole other tier of criminals.

Then we must use the profits to pay for therapy and addiction centers; contribute to national health care, education; and maybe even lower the deficit :-). I'm not saying the motivation for this should be revenue, rather, that the revenue should be put to good use, first to reduce the effects of drugs in the society, second to reduce addiction, and then to contribute to other worthwhile efforts if possible.

After blindly failing for 40 years, it's time we opened our eyes. Addiction is not a crime, but treating addicts as criminals is. We need radical approaches to solving the problem.

social darwinism

I'm not a fan of protectionism. I think that every business or industry must either thrive in the global marketplace or die. This is how we ensure sustainable businesses and a vibrant economy. You only have to look at the auto industry to see how protectionism and creating a false-economy (one, two, three) solely to support an expensive, unionized labor force were not sustainable, caused or perpetuated uncompetitiveness, and eventually resulted in failure.

Yesterday was a beautiful, warm, cloudless day here in Seattle. Hanging out at a nearby park/marina, I noticed two sets of parents with their infants - one was using an anti-bacterial wipe to sterilize a restaurant highchair, the other was feeding their child (overhearing this part) ultra-organic, home-prepared, "pure" baby food. Both parents had expensive strollers; bragged about their infant's already hectic schedules; and talked about how they were already looking at schools (or even home-schooling); and (this blew me away) bemoaning how careful one had to be to pick the right kids for play-dates. Next to them was a family that had just plopped their infant down (no autoclave in sight), and were feeding him restaurant-prepared junk food. The latter child seemed happy, energetic, inquisitive, looked around, laughed, etc.; the former two were both placid.

Assuming these "super-parents" succeed, their kids will never touch "imperfect" food, never inhabit "unclean" environments, have ultra-busy schedules (playing with the "right" kids in "appropriately-designed" play spaces), enjoy ultra-managed electronic access, and ideally never have an uncontrolled exposure to anything.

This is not new; a large class of baby-boomers have been raising children like this for more than a generation.

How are these kids acclimatizing to the real, post-pubescent, high school world? Being around people with different opinions, potentially more confrontational, competitive, angry, etc. will have an effect. Will their systems have the antibodies, immunity and resilience to eat in the real world? Will their bodies accept a non-hypoallergenic environment? Will they be able to adapt to dealing with "raw" situations containing stress, angst, happiness, lust, greed + alcohol, drugs, cigarettes, etc.?

Exposing children to the world suddenly, and now without the parental protection safety-net has resulted less healthy, uncontrolled, immature, binge-driven behavior in high-school and university (and beyond). Academic performance has declined generation over generation, as has the motivation to excel. Children today aspire to be so much less than their grandparents and parents - you only have to look at relative academic performance to confirm this.

Can it be because their parents coddled them to the point where they have no motivation to achieve, nor do they fear failure?? After all, their parents have always been there - haven't they?? They expect to be happy, successful and healthy, because they've never known any other reality.

I think well-intentioned "super-parents" (like their NHTSA & EPA counterparts) may be doing their children more harm than good. I hope modern American children are not already down the path of suffering the same fate as General Motors, that like GM they're so close to action, and have so much social inertia that they are unable to see the forest through the trees.

We must expose our children to the real world; build up the physical, intellectual and emotional antibodies and resistance that will enable them to participate; and create the stress, team-orientation and competitiveness that will best-prepare them to not just survive, but aspire and thrive.

A Heathy Earmark

Harvard Business Publishing's recent Daily Stat was one of those that amazed; it quotes a McKinsey report that 34% (yes, more than one-third!) of Americans are considered obese. This represents over 100 million people! Worse, this has doubled since 1980; so in the last 30 years, the number of obese people in the United States has gone from below 50 million (bad) to more than 100 million (horrible).

I wrote about preventative health a little while ago, where I related that we spend $2 trillion on health care in this country.  Someone who is morbidly obese (40+% Body Mass Index) is part of the fastest growing segment of the obese (mind-boggling) requires about $7,500/year in health care costs, almost twice what a non-obese adult costs. If we were to go back to the obesity rates of 1980 (just below 17%), we'd save the country $60 billion! That's on top of the $40 billion that Americans spend on trying to get thin in 2004. I'm guessing it's higher now.

In many cases, obesity is involuntary, due to medical causes. I figure (and I'm just guessing) that accounts for 15-20% of the population. Which leaves 80+ million people who are able to do something about their weight, and avoid the fate of being unhealthy, having a poor quality of life, and maybe even being unhappy.

Most of the 80 million people are adults; they are set in their ways, and would struggle mightily to alter their lifestyles and diets to regain their rightful shape, though this is not to say they shouldn't try. But I bet there are at least 15 million children who are obese or morbidly obese in this country, and for most of them, habit is not a problem. They can be helped.

What can be done? How can it be done at scale?

One obvious place to start would be the schools. And there, three things come to mind:

1. Improve the quality of food in the cafeterias and vending machines - only natural, healthy food allowed.
2. Change the rewards that teachers give students for doing good work, no more candy or sweets.
3. Require extensive physical education curriculum, and make it mandatory for all grades in every semester - every student must get exercise for at least an hour/day.

Each of these can easily be implemented, and end up saving money! The problem is, they will cost the education system money but save the health care system more. While this creates a net positive effect, the problem is that the education system is already strapped, and are over-budget already, and simply can't afford to add new dietary programs and physical education classes.

Well, can the health care system (public and private insurance carriers, etc.) just pay to do these three things in all public schools in the country? Think of the PR boost they would get, the amount of focus this would get in the national ethos, and hopefully how it might inspire those not in school to also evaluate their lifestyles? Remember that they'd actually come out ahead by doing this.

Imagine

Imagine if kids didn't need to bring lunch from home because a healthy lunch was available at school. Imagine if each child graduating from secondary school could run a 10K, play a team sport or do something else that demonstrated their fitness.

Imagine that after graduating, young people hate the idea of not exercising every day, and abhor junk food? I know that some restaurants (if you can call them that) would not be happy, so be it. Imagine a situation where we didn't have the incidents of diabetes, obesity, heart conditions, cholesterol problems, etc. that beset so much of this country today!

Now imagine if despite doing all of this, the nation's economy was made stronger because we were spending less on health care, and our citizenry was healthier and more productive?

That's something worth fighting for.

How does one lobby Congress to put earmarks for education diet and fitness in health care bills?

A Pound of Cure

Newsweek reported last week about the work Senator Tom Harkin is doing to focus the Presidential Transition Team's healthcare portfolio on preventative care and wellness. Bravo to him!

The United States spends $2 trillion (yep, "2" with 12 zeros!) annually on healthcare, more than any other nation on earth (according to the WHO). And yet the US ranks 37th among nations in citizen health, and 20th out of the 21 industrial nations.

Some reasons:

1. Americans are about the unhealthiest people in the world
2. Americans are horribly lazy and believe that pills can cure bad behavior
3. Physicians in this country are paranoid about lawsuits and over-test, over-prescribe, and over-treat
4. Pharmaceutical companies know how good a thing they've got
5. Insurance companies are mind-numbingly stupid
6. The policy and regulatory machine is embarrassingly out of touch

I'm thinking that #2-6 have caused #1.

Senator Harkin is right - something needs to be done. It's a combination of health-conscious behavior with appropriate incentives for the machine. It surprises me that insurance companies won't pay for preventative care, but will happily cover the result of bad behavior. How bizarre!

I'm sure the insurance companies realize that if people are healthy, they will still get premiums but won't in aggregate have to spend as much? Wouldn't it be better to spend a little bit on everyone (assuring preventative healthcare across the population), and then benefit from not having to spend so much on the vast percentage of the population that gets sick because of bad behavior?

It's similar to the drug problem in this country. We spend $billions on the so-called war on drugs in the name of being tough on crime (another ridiculous concept), but don't realize that if we spent those $ on reducing demand by helping and curing drug addiction, we'd end up starving the suppliers. All without having to put people in jail, and instead helping people eliminate their dependencies and lead better lives.

This is classic of a system that is not interested in cause and effect, but simply patching symptoms.

This is an endemic problem, ranging from failing bridges, levees and air traffic control systems, to starting wars without thought to how they'll end, to badly-designed school systems, to borrowing without considering financial capacity, to poor health, to crime, to everything.

Oddly the population of this country seems sanguine about all this. There's no sense of urgency about fixing any of this. Why is that?

I wrote a while ago about how breast cancer can be managed through early detection and about how we're presently governed by a stunningly short-sighted leadership. It feels like this society only lives in the present, and is completely oblivious to anything that might happen tomorrow as a result of indifferent or bad behavior today.

What does it take to open our minds to the reality that you can only paint over the cracks so many times before the walls fall down?

I think the first step is for this entire society to abandon the idea that there is a free lunch for weight-loss. This (yet another) multi-billion dollar industry preys on people that think there's a quick fix.

Let us once and for all recognize the fallacy of fried chicken, pork rinds, french fries with gravy, apple pie and a diet soda?

No Breast Left Behind

Marisa Acocella Marchetto is a person I admire deeply. She's a brilliant author, she draws beautifully, and she's a breast cancer survivor with a sense of humor and a huge heart.

I happened to be in the right place at the right time in August, and met Marisa on the patio of one of my fave joints in New York, Da Silvano. She was kind enough to autograph a copy of her new book, Cancer Vixen.  If you have or know someone who has breast cancer (and lets face it, this is basically everyone), this book is a must for you. I read it and have shared it, though I want to keep my copy 'cause she signed it for me:).

We had a connection on that patio. When Marisa talked about her efforts to provide free mamograms via St. Vincent's Hospital in New York to women who can't afford it or whose insurance won't cover it, and how she wanted to take her program national, I did a smart thing for once, and offered to help.

And have I learned a lot!

More than 200,000 women are diagnosed with, and 40,000 die from breast cancer in the United States every year. Mammograms can detect a tumor up to two years before a breast exam would. If detected and treated early, 96% of women are cancer-free after five years.

What does this mean?  Simple: 38,400 women in America die needlessly each year from breast cancer.

That's just messed up.

You have to believe that early detection = less-expensive treatment cost too - that just make sense. I'm going to invest some energy over the next few weeks to find data to back this up.

Now what does this mean? Simple: if every woman in America gets a free mammogram, we will not only save lives, but also save the insurance companies and the government money!

What to do about this?

As a starting point, we need to raise awareness and make it possible for every woman in America (including the 13 million women over 40 that have never had one) get regular mammograms. Marisa and I came up with this tag line: No Breast Left Behind. Here's Marisa's blog entry, and here's the link to the American Cancer Society site where you can buy t-shirts! 

But this is just the beginning.

 Neither Marisa nor I view this as a philanthropic mission.  That's just a stop-gap. What we really need is a national mission to eliminate or eradicate preventable diseases. Breast cancer the first; it's prostate cancer for men [ASIDE: our tag line for this one is: Keep Your Eye on the Ball and I have no doubt Marisa will come up with a suitably irreverent design! ;-)]; for both genders and people young and old, we MUST address diabetes, especially type-2 diabetes, which is totally preventable!

I intend to write more about this as we learn more, but believe that with the new administration about to move into the White House, the economic crisis, the ever-rising costs of healthcare, and the fact that most Americans will suffer one of these (and other preventable) diseases, the time is now for us to get started.

This is not about raising money. In fact, this idea has the unique characteristic of actually saving this country and our heathcare system billions of dollars.  All it takes is an institutional willingness to listen, and a social culture of prevention.