Sunday, November 19, 2017

How much does it cost for a hospital to treat a patient?

I am about to make some statements that are going to change the way you think about health care and health costs. Please try to remain calm.


I want you to imagine your local hospital. Think of all the doctors, nurses, support staff, buildings, and equipment.

Now, let's pretend two things:

1. That over the course of a single year, the total salaries for all the doctors, nurses and staff, the cost of all the utilities and supplies needed to operate the building totals $50,000,000. Now let's say that I GIVE that $50,000,000 to the hospital.

2. Let's assume that on Monday, November 20th, the hospital has NOT ONE SINGLE patient.



In this situation, the doctors and nurses, the staff and the utilities, all still get paid. The lights are one, the heat is working, they are all ready to work....but NO ONE shows up and all their beds are empty.



$50,000,000 divided by 364 days is $137,263 a day. So, without a single patient in the house, it cost $137,263 to have all the doctors, nurses, staff and utilities ready.....but no one showed up.



Now....it is Tuesday, November 21st.

And ONE patient shows up. Gets some xrays, gets sling and one pain pill and sent on their way.

HOW MUCH DID IT COST FOR THE HOSPITAL TO TREAT THAT ONE PATIENT?




Ignoring the sling and pain pill, the answer is ZERO.

What about a 2nd patient? Still zero for two.

Nominally, except supplies, it doesn't matter how many patients the hospital gets, the incremental cost is zero.


This is the argument FOR single payer health care. It is also it's failure.

Sunday, July 16, 2017

THE Moderate Mainstream - 50 Positions

1. Abortion: Should be rare. At some point rights attach to the growing human life. I consider the child to be human life from the point of conception, heck, even before conception the components are human and alive. But it is not "a" life. For the initial stages, the baby can not live, it does not have 'a life' of it's own. And during that time the woman's right to control her body is, absolute, sovereign. However, at some point that changes, the baby becomes viable. Over the decades that point has become earlier and earlier in a pregnancy. We may have reached a limit at 21-22 weeks. Children born at this point are dangerously immature. Many don't survive. I am for an unfettered right to abortion prior to the 20th week. Between 20 and 24 weeks I'd like to know that a woman consulted with doctors about viability. After the 24th week, six months into the pregnancy, I'd limit abortions to protect the mother's life.

2. Bureaucracy: Government bureaucracy has grown so large and dominant that even the changing of political appointees and elected officials has been insufficient to limit its growth and influence. That has to end. Still, the experience of government employees is something to be valued. I'd restrict government employment to a single 10-year term or two 5-year terms. No retirement benefits except self-funded programs. There are two exceptions: Judiciary and the military.

3. Capitalism: No system has done more to raise the standard of living of the entire planet than Capitalism. No one does it well, most do it with lots of sticks and pokes and lots of chiefs stirring the pots and yelling at each other. But no other system has done anything remotely close to the success of capitalism and capitalism has centuries more opportunities cresting the horizon today than at any other time.

4. Capital Punishment: I support it. Those that will not abide by the social constructs that we need to live by in order to have a viable society, need to be removed from it and in extreme cases, permanently. However, human justice is no different than any other human endeavor, imperfect. As Illinois found out, dangerously so. We can not with sufficient confidence say that the State can be impartial and objectively remove all doubt in all but the rarest of cases. Therefore, despite my support of the consequence, the Judge and executioner are too deeply flawed to give them the power to take life in the name of the Citizens.


5. China: The most populous nation on the planet has realized that its 'one-child' policy has come back to bite it in the ass. Men are unable to find wives. It has begun the process of changing the policy but it will take a generation to do so and its population growth will accelerate the entire time. It must grow at a pace it can not manage via government edict and either it explodes internally or it deflects its population with external threats. It is only a matter of time before either or both happen. China is the largest economy, if it had the largest free population it would become the likely successor to the United States as the largest economic power. (A boulder rolling downhill might gain more speed than a train, but its power is taking advantage of momentum, not internal effort.)

6. Climate Change: The climate changes. It has been changing for four billion years, will continue to change for the next four billion years. And? Oh, we might be causing 'more' change. Well, if someone can tell me when the Earth is at the best temperature, we can determine if the change we might be causing is good or bad. Until then, we can watch the change, adapt to the change and enjoy the benefits and deal with the damages as they come. In the meantime, we, the United States, comprise 4.5% of the world's population and anything proposed has to get the other 95.5% to get on board.

7. Corruption: Corruption has been part of every political system since we have had political systems. Political corruption or crony capitalism as it is sometimes called is causing widespread damage to our economy and to our ability to function well as a society. Getting corruption out of the political process is not about getting the money out, money is only the scorecard. It is about getting the favors out. The easiest way is to get government out of the business of granting favors to one company or industry over others is to get government out of using tax policy to affect the marketplace.

8. Crime: More than anything else I believe the infringement of an individual's rights by someone else is a crime. There is no 'thou shall not kill' on the books in any state or municipality. We punish people after they have done something; there is no prevention other than via the threat of punishment. (See Death Penalty) I want crimes against people or property to be swiftly and justly dealt with, but acts that offend the sensibilities of people are a waste of resources.

9. Economics: Everything you need to know about economics can be taught in one minute. Too bad the average citizen, politician and journalist hasn't given it even that much thought. First and foremost, economics is about human behavior. If the price of something goes up, you get less of it. If the price goes down, you can have more of it. Everything else flows from that. I need forty seconds to give you an example. We need to make things we want less expensive, like working, and start making things we don't want, like crime, more expensive.

10. Education: There are two types of education: one is learning from experience, the other is learning from books - which generally are written about and by people that have learned from experience. I support education, by experience and by books. Not everyone needs or should go to college. We have many jobs, necessary and valuable, that need more experience than book education. We should not be driving our children into needless education at outrageous prices unless that is the best thing for them individually. I'd like to see more money going to community colleges for apprentice and training programs. (See Military)

11. Environment: First we want to preserve as much of the natural environment as possible - our health depends on it. What that doesn't mean is to do so at the expense of caring for the humans that depend upon it. I believe that the Federal Government needs to return the land within State boundaries currently under it's control but unnecessary for Federal Government activities. Development of natural resources can then be decided by States. California is facing a natural drought to exacerbate the one caused by environmentalists' demand fish get more water instead of farmers.

12. Equality: Under the law. This is not a statement that we should have equality of outcomes. We all have different skills, abilities and resources and as such, our efforts will have different results. This is not a bug, it's a feature of our system and one to be embraced not legislated against. ‘All men are created equal’. Our society acknowledges a diversity of choices. We do not expect, nor require equality of results.

13. Faith: Is fundamental to almost everyone and it should be respected both as a society and as a matter of law. However, it is not the foundation of our law, nor should it be. Faith can not be the dictator of law.

14. Federalism: There are limits to the Federal Government, enumerated in the Constitution. We need to prune government back to its roots and stop trying to use the Federal Government to fix society from a perch beyond the sight and oversight of the People. We need States to reassert their sovereignty and stop using the Federal Government as a rich uncle and whipping boy for State's follies and foibles.

15. Federal Reserve Bank: Was created, in part, to get politics out of sound money. Over the last decade the Fed has embraced both politics and the profound mistake that it can fix or control the economy. It has sown the wind.

16. Green Energy (Renewable): We should continue to seek ways to replace oil and coal as sources of energy but wind and solar are never going to be more than bit players. Solar could supply a significant portion of our stationary needs if we consider solar satellites. Additional research into alternatives needs to stop using the food supply as a source.

17. Gun Control: The 2nd Amendment prevents government from interfering with the right to carry weapons. That hasn't stopped it well enough in the past and major efforts are made every time the media picks a story to give the idea that government can fix stupid. Fear mongering is a well-tried method to get people to seek security anywhere and anyway they think, or are told will work. Guns are a tool. Like any tool they can serve a purpose chosen by the person holding it. Taking guns away from a 100 million responsible gun owners to stop a thousand irresponsible criminals is not just cause.

18. Health Care: Is not a right. It is necessary for long life and while everyone wants long life, the cost needs to be a factor in his or her choice. If we continue to remove the cost considerations from individuals and place it in government bureaucrats we will get a one-size doesn't fit all application. Government cost shifting has created much of the cost of health care. There is a place for government in health care, providing it is not that place.

19. Homeland Security: We have accepted the idea that a crime-fighting approach to national security is insufficient. We assumed that the large distances most threats had to cross to get to us would protect us from all but the largest foes. A man can wake up in Pakistan and kill millions in New York before nightfall. However, this is not a police state and we have armed our local police with the tools of an army. We have deputized a nation into an army on our own soil. We need to stop pretending everyone is a threat so that no one feels picked on. We need to focus on the threats.

20. Homeless: We can't stop people from making bad mistakes that lead to homelessness. We can make it easier for people to get out of that state by focusing on why they are there and addressing those issues. Some, a small percentage are chronic cases with no solution. Most can be helped if they are found early. This is a project of the States, not the Federal Government.

21. Immigration: I am first born to immigrant parents. This Country is built on the blood, sweat and tears of millions of immigrants that came to this country for better, everything. The vast majority came legally. Those that didn't should not be rewarded for having broken laws from the first day. No path to Citizenship, deportation for those that have broken additional laws. Fines and legal recognition for those that voluntarily present themselves (with no chance of future citizenship). For that, they will have to leave and re-enter legally.

22. Innovation: Is the lifeblood of our economic future. Rather than cut spending on research and development, we need to spend more. Basic research into biology and technology needs more funding.

23. Iran: Has sworn to destroy Israel and do all it can to destroy the United States. I am willing to take them at their word and do whatever is possible to prevent them from obtaining a nuclear weapon, and I am for doing it as soon as possible.

24. ISIS: ISIS has taken to heart the worst aspects if Islam and has become a plague upon the Middle East. We need to step in and utterly destroy them. Swift, brutal and without mercy.

25. Jobs: It is not the job of government to create jobs. It is the job of government to get out of the way and let the market work. The President can't create jobs. (See Military)

26. Korea, North: I can't understand the desire of China to continue to prop up North Korea except as a bulwark against Taiwan and South Korea. It is a brutal dictatorship with a nuclear weapon. It is the poster child for not allowing Iran to do so. Yet, no amount of negotiation will change it and we look like idiots when we try and fail.

27. Lobbying: It is not money in the political process that is the problem, it is the favors government grants to companies and industries that spend significant money getting them. Get government out of the business of granting favors (tax abatements, cuts, and waivers) by getting government out of the business of taxing business. Petitioning the government is part of our rights and because some do it better doesn't give us reason to infringe upon it.

28. Markets: Can't fix everything wrong in the economy. There has to be some neutral force that can mediate and punish. Government can be that force as long as it doesn't try to pick winners and losers.

29. Medicare: The program that began the cost shifting from the older generation to younger ones. It manipulated the market and every attempt to fix the consequences has made it worse. It has taught market participants how to manipulate government to make them the beneficiaries of further twists in the marketplace. We need to end Medicare cost shifting and recognize that 95% of the dollars spent on each person's total lifetime medical care will be spent in the last year of life. Implementing a Hospitalization and Provider Plan would work.

30. Military: At the end of the Cold War a movement began to 'civilianize' the military - to convert non-combat jobs to civilian contractor jobs. The assumption was the cost savings would be better than wholesale cutting, gutting of the military. The shortsightedness of that idea was manifest when we tried to send troops into combat and none of their support could be mobilized. 1) Return support functions to military personal; 2) Bring home most of the troops stationed overseas (some exceptions); 3) Increasing military members in support functions will require significant 'hiring' of younger people to whom training in a wide range of fields will give them job skills for the civilian world; 4) Opening additional bases in the United States for training and staging purposes will positively impact local economies.

31. Multiculturalism: We live in a secular society in which all are free to follow their own pursuits towards happiness. However, we need a level-playing field, more to my point, we need to all be ON the same playing field with agreed upon rules. If we let people play their own game on their own field, we get a nation of such diversity that it becomes every man and woman for themselves. Such is the state Hobbes noted and it is not a place we want to be. We were the melting pot of the world, everyone contributing to the flavor, the heat supplied by the blood, sweat and tears of every immigrant's efforts. Not every culture is equal; none are equal to our own. We are a nation of immigrants, not a nation of cultures.

32. Nuclear Energy: We don't do it well. We are stuck with 1950's technology built with 1970's technology. We need to do better and there is better technology. We need to get over the fear, falsely stirred, and get back on the bike. We have spent almost 40 years on alternate technologies and nothing is else is close to providing for and replacing current hydrocarbon generated power needs.

33. Nuclear Weapons: Mutual assured destruction only works if the other side is worrying about destruction too. When the other side welcomes it, there is no deterrent having a bigger or more guns. I'd like to move away from nuclear weapons but we can not do so unilaterally. That means continued research and upgrades to our existing arsenal.

34. PAC: Political action committees were a natural consequences to attempts to limit campaign cash to political candidates. Like floodwaters, political spending will find the weak spots and exploit them. I am ambivalent about them. I see no reason to ban them and lots of reasons to dislike them. But they are the symptom, not the problem.

35. Poor: People make choices they don't understand, in circumstances they are not responsible for. In the end, everyone is responsible for his or her choices but not everyone can be held accountable. We need a safety net, but it can't be so big that everyone sees it as 'good enough', otherwise we get people choosing the safety net instead of falling into it. There can be no government provided lifestyle. Get people on their feet, get them back being productive. The Poor in this country tend to be richer than 90% of the rest of the planet.

36. Pothole Politics: There is a purpose to government, keep the playing field payable. Make sure the refs are honest; be agnostic about winners and losers. Too many politicians want to fix us and think fixing the potholes around town is beneath them. Those politicians need to be voted out. And yes, the President and Congress have pothole type responsibilities they are neglecting: advise and consent, separation of powers....

37. Public Schools: WERE essential to the concept of an educated electorate. Today they are a toss up between indoctrination centers and rabid cesspools of crime and institutionalized juvenile delinquency run-amok. The few places where education, actual real education not the pap served up by most Left-wing artichokes we call educators, are so in demand that strict policies of admission - IN PUBLIC SCHOOLS - are enforced. We have been accosted with stories of run down schools, out of date textbooks, lack of supplies, lack of sports, the arts and book-less libraries while pouring thousands of dollars per student at the problem that gets worse every year. Colleges are spending years teaching graduated high school seniors remedial English and Math. As an institution in our country, public schools have failed, the only reason we don't close them down to protect the children is that for a majority the school is a day-care center for kids with nothing else. Short of dismantling the entire institution the only option is massive overhaul. Too bad we don't have, unlike schools everywhere, a zero tolerance policy about failure.

38. Racism: Us versus them. Yes, it exists. Amongst every race, in every State. Institutional racism is all but gone. Well, that is not true in this sense: we have gone from 'we don't want that kind here' to 'them poor souls can't do it themselves'. The first is abhorrent, the second utterly destructive. We have proven however that getting a Black President did nothing to help and it was the claim of millions that it would. Racism ends one child at a time, which is too bad because it seems to be taught dozens at a time.

39. Religion: A fundamental part of the life of most Americans. Our goal as a Nation to be open to allow anyone to worship as they please with no interference from government, explicitly or implicitly. Part of that is under attack from within, another part from outside. I strongly support the right of individuals to express their religious beliefs as they need and choose with the single exception that it not infringe upon others. The attacks from outside religion run afoul, rightly, of our Constitution when government is the tool of the attackers. The attacks from within are from people that seek to use it as a weapon of social change or to prevent social change. Both are dangerous though I think the former has greater risk.

40. Regulation (Policy): Here it is, this is the place where government abuses its authority to grant favors to political friends, and to grant dispensations to political allies. Government has become too involved in too much of our daily lives and economy and everyone has found it to be the place where they can feast at a trough of government money. We need to get government, especially the Federal Government, out of every day American's lives. We need to starve the beast. And more and more of our government is beyond our reach to control (See Bureaucracy). Rather than report on how many new pages of regulations are issued per day/week/month/year, we need to remove whole chapters and verse. Starting with the EPA.

41. Rich: We are a nation that had the poor, the middle class and the rich at it's founding, we will continue to have poor, middle class and rich into our future unless the government continues to support the poor being poor. If every penny of income of the richest 1,000,000 people were confiscated, we wouldn't have enough money to fund government for six months, let alone a year. If the WEALTH of the top 1% were taken, it wouldn't fund government for a year, not even six months. It is that wealth, that surplus, that provides the capital we need as a nation to grow and continue to innovate. To demonize them is to demonize capitalism, but maybe that is the point. Greed is not exclusive domain of the rich but includes those that seek what the rich possess. Continuously demanding the 'rich' fund everything requires ever greater encroachment into the middle class who are unable to access any government programs but are increasingly the true source of government taxes. Most people don't understand that 'rich' by the definition of "Occupy" includes many white-collar two-income families living in our neighborhoods.

42. Russia: Will descend into a dictatorial abyss sooner rather than later and those currently in charge are working hard to make it soon. Russia is not our friend, will probably never be our friend and the sooner we understand that being 'a partner' with it is to be yoked to a nation trying to kill us as surely as Iran is. Like the United States, the shear size of it gives it great resources and reach that it is not using to improve its standard of living and productivity, but to build itself an empire. It is a threat and should be treated as such.

43. Science: Has become politicized; It has become a means to promote political goals. Lots of great science continues to be done but like a 100-head herd of cows on a million acres, it is too small and too spread out to continue to feed all but a small effort. We need more research at every level and we need politics out of it.

44. Self Determination: It is impossible for one person to dictate to another how to live their life, it is arrogance founded upon ignorance to assume one person or small group of people can dictate to an entire Nation how to do so. We must have the freedom to determine for ourselves how to live our lives, even when those choices are poorly made. Saving us from ourselves is not the purpose of government, nor is it the purpose of government to fix what is broken. Government must not impose edict for choice, security for freedom, benevolence for liberty.

45. Social Security: Arguably the first betrayal of our founding ideals. FDR blackmailed the Supreme Court and one of the first out of the blocks efforts was government providing for the welfare of individuals. Never meant to be a 'savings account' for individuals, it was a way for government to access the income of individuals to distribute it to others. Unfortunately we let it stand for so long that millions have come to rely on it. We need to begin now to phase it out over the next generations. It is already the largest part of the Federal Government and it is not going to shrink until the entire program is restricted and eventually dismantled. There are alternatives available today that were not 80 years ago, we need to look at them.

46. Solar Energy: More energy comes out of the Sun in a second than humanity has produced/consumed in its history. Converting it into usable energy for our engines and devices has been the goal for many efforts. And no matter the efficiency of our devices, they reside deep within the protective layers of magnetic fields and atmospheric blankets. If we could gather the Sun's energy in space and 'pipe' it down for use, we could eliminate a significant portion of our energy creation activities. Solar satellites could provide energy at a fraction of the cost of current systems.

47. Sovereignty: The freedom to live, to prosper, to seek our own happiness are the foundations of our rights and our ability to assert them. The individual is sovereign, we confer authority upon government to act on our behalf and it is that authority expressed in our National Sovereignty.

48. Sustainability: Whether we speak of individual, national or societal sustainability we speak of the ability to survive. Many of our resources are limited and need to be managed for long term use. However, too many people equate sustainability to a single component of our economic life: energy. The argument that we have only 4% of the population but use 24% of energy is comparing apples to cotton. The United States produces almost 25% of the planet's GDP, it does so with less than 24% of the energy used. That productivity builds our standard or living. Sustaining our society is more than just providing energy, it is about providing food, innovation and a future.

49. Term Limits: Are an attempt to limit the choices of the people to pick their own representatives. I oppose them on the basis of that liberty. The limit on the President acknowledges the power of the Presidency as the sole wielder of American Power and imposes a limit on that power in one person. Restricting the terms of one of 535 committee members serves no similar purpose.

50. Terrorism: Works only when people become so fearful that they will give up all freedom to appease it. It must be met with swift, brutal and complete annihilation, wherever it is attempted.



It has been said that all we can reasonably expect of a society based on an imperfect humanity is “one with some evils, maladjustments and suffering”. Why? Why not work to eliminate evils, maladjustments and suffering? Accept them as the natural consequence of an imperfect humanity? I agree we are imperfect, but that does not give us license to ignore those imperfections. What is worse is to allow institutions WE create to result in evils, maladjustments and suffering by design. Knowing such evils exist and to do nothing but accept the imperfection is to deny our own evil.

Friday, April 14, 2017

On being fat

As we come to the weekend of my favorite candy (how superficial of me, I know), I want to make a comment or so about....being fat.


As of this morning (ok, this afternoon as I didn't get out of bed until 1:05pm), I weighed in at 357 pounds. This is 15 pounds heavier than I was this time last year and more than 40 pounds lighter than my highest ever. The entirety of my weigh gain happened over the fall and winter as I spent time in Chicago and did not keep my exercise regime, nor my overall eating habits.

What are my eating habits?

At home:

Within 1 hr of waking up - Breakfast: 8 oz of rice, corn or oat cereal with 8-9 oz of whole milk and 7 oz of cranberry juice (low sugar)
4-5 hrs after breakfast - Lunch: 3-4 oz of meat, 2-3 oz of cheese, 3-4 oz of veggies
5-6 hrs after lunch - Dinner: 8oz of meat, 4-5 oz of veggies, jello or ice cream for dessert.

I drink 32 to 48 oz of lightly flavored water a day.

For snacks I have two different types of protein bar, plus fruit cups (no sugar added) - but I often eat neither if I'm busy


Away from home:
I keep to my basis schedule but tend towards favorites:
lunch = soda and hotdog w/ketchup
dinner = if at a sit-down restaurant, my dinner is usually much like it would be at home. Fast food might be spicy around chicken.

I don't generally have any gluten (wheat) at home: no bread, pies, pasta or wheat cereals. I tend to stay away from soy also.


My A1C in Feb was 5.3. My sugar at testing was 86. My blood pressure at last dr visit (a week ago) was 127/78. This is just a touch high for me, but my resting heart rate was 70 and temp was 96.7. I do not have high cholesterol or triglycerides. Liver, thyroid and kidney functions are all well within norms.

Yesterday I walked over 2.5 miles. I have walked over two miles four times in the last 10 days. I will do so at least twice more in the next week.

Every step I take SUCKS.

I have been working on learning/doing yoga (only twice this week, both times between 10-15 minutes. I haven't been on my bike this year.

Why all this information? I'm fat. I don't expect people to like me, or consider me 'beautiful' because or in spite of being fat. I don't have body issues. (gawd the guy that asked me to turn out the lights because he did almost ended the evening right then and there!) Come on people.

I look at thin people not out of jealousy, or 'self loathing'. I appreciate their appearance without denigrating my own. I am who I am and what other think of me...I. DON'T. CARE. But, I also know that being fat takes more effort by my body. But after almost 20 yrs of being fat, my body is NOT showing signs of that wear and tear on me. My hips and knees are in good health. But I do recognize the effort it takes to move.

My surgeon said that had I weighted the 397 I was 6 months prior to surgery, I would have most likely died on the table. However, given that he only gave me a 50/50 chance of survival and a 10% chance of walking again, I'd say that once again, people look at me and assume I am unhealthy.

Most people are fat because, systemically, they are unhealthy and their body reflects it. I think getting fat does not make us unhealthy, being unhealthy makes us fat. That will be contrary to 'common wisdom/understanding' in the medical community - but consider how much of that has been wrong in the last 50 years.

By all medical understanding currently espoused, I should be hypertensive, have diabetes, and arthritic joints. I think the medical community has cause and effect wrong and therefore are treating the wrong things. I watched a hypertensive diabetic die. That is my take away from it.

Call me fat. I am. Don't call me unhealthy. I am not. But I reject SOUNDLY the idea that people demand to be considered beautiful REGARDLESS of their appearance. If you need that type of affirmation, you are unhealthy in that space between the ears.

I like me and that comes across regardless of how I 'appear' and yes, I do clean up nice.

BTW, had my nails done, cut & color on my hair and am heading for the beach in my swimsuit this weekend. I too will be body watching!

Wednesday, February 22, 2017

Not the Mainstream...


How to comment on this.....??? Transgender bathrooms.





IF, and it is a huge, insurmountable (IMO) IF, we had a way of defining transgender specifically to those that need the liberty to act according to their intended gender, then I would be supportive. What that means is that it is not enough to 'identify' as transgendered, it has to be diagnosed and be medically followed. It is formalized in something called the medical Standards of Care.

The 76 or 98 or 24 'genders' that the Left has pronounced as 'needing recognition' all but eliminates any chance that a rational approach to transgender needs and liberty is possible - certainly not from the Federal Government.

People actively undergoing transition need some protection, but to change the entire society so that 1/10 of 1/10 of the population can be 'safe' is nuts. The current 'open door to claims of trans' leaves a gaping hole in the safety of women and children.

Sorry, but identity politics goes too far when it is perfectly acceptable for a white woman to 'identify as black' and gets LAUDED for doing so...

Do not get into the 'there are only two genders and you are born and will die in the same one' with me...you'll lose.

Thursday, February 16, 2017

Comments on Diversity report

A news article on a study about diversity efforts got me into a discussion with a proponent. He argued I needed to read the report, which I did. I am offering the bullet-point commentary here in order to facilitate the discussion.


1. Correlations - not causation
2. Does an all minority firm out perform?
a. None available to determine
b. yes: then the marketplace will deal - more investment in out-performing companies
c. no: is there a tipping point? vs the current level?
3. interior Culture and performance demands different than existing exterior culture norms
4. Affirmative action impact on retention - ie no AA standard in performance kills AA standard in initial hire
5. 170 firms offering info are self-selected. Those with positive results tout, those with negative don't
6. I ABSOLUTELY reject % of population to % within company. failure by absence is not evidence of failure
7. Tech sector is more oriented towards technical competence than personal interaction (personal experience too)
8. Google is going after more STEM support in schools - I absolutely support - but not via affirmative action
9. Knowledge base failure within study: limited data and evidence. as Econ grad, I understand the limits of such a data pool
10. Reports rely upon 'feeling of what seems to be working'
11. A significant study of 700 companies = no positive effect on diversity efforts and may hurt Black women
12. "...efforts to isolate impact of female leadership was inconclusive" BUT LOOK!!! 9% HIGHER VALUATION!!
13. Due to minority population size, areas/fields that aggregate significant minority representation removes diversity from elsewhere
14. Women in STEM has decreased as the # of 'programs' in sociological studies increased...related?
15. What the study calls bias I call animosity - not of hatred but of 'not what I have seen work' bias via work experience (arguably false sometimes.
16. Diversity training = no positive effects so....
17. ...switch to 'unconscious bias training' - but may have same longterm results - NONE. Recall Hawthorne Study.
18. pointed out WIPRO as example - also in my business plan as a foreign competitor
19. regression analysis bar for significance = .10 this is a low bar though not 'significantly' outside the norm. But the study never indicates how FAR over that bar the results were. .11, .15. These are 'noticeable' however, given the sample size, NOT USEFUL.

All in all, the study takes a minor blip and runs like the wind with it.

Other issues. 70% of Black children are born out of wedlock, 60% of Hispanic. And these are long term trends. These populations are NOT going to create a pool of STEM candidates for the industry as a whole. Only the top 1% or less will reach excellence levels necessary for prominent positions in corporations. By the measure of calculating populatio = 30% likely to succeed, you get the 3.5-4% representation of Blacks in the tech workforce.

Diversity in corporations doesn't change culture and diversity in culture is NOT beneficial. Understand I used the term CULTURE.

Tuesday, February 14, 2017

My idea for health care - from the Proposed Federal Budget

Hospitalization Program

Right now hospitals all over the country are billing patients for services rendered but because Medicare and managed care programs have agreements on reimbursement rates, those hospitals are functioning with approximately 54% of those billed revenues. One way hospitals have dealt with the issue is to have patients spend less time in the hospital. I will not say that hospitals are discharging patients that should still be in the hospital, but I bet it is happening.

With one in five of its elderly hospital patients re-admitted within a month of discharge, the federal Medicare program plans next year to reduce how much it will pay hospitals for certain preventable re-admissions.1

Using information on hospitals in Washington State (http://www.doh.wa.gov/), I looked at expenses and patient distribution (mix of inpatient and outpatient emergency).2 Given its general good outcomes, I looked at the actual expenses per patient day (a mixture of case and patient types), how many patients were being seen, the number of beds and the population size that the hospitals serve. The type of hospitals and communities they serve cover rural and urban settings. Generally, Washington is in the middle of most medical spending/outcome metrics. Using the information available, including the number of hospitals and beds per state and averaging the expenses I came up with an alternative to Medicare funding.

Eliminate Medicare funding3? Right now, hospitals are functioning on 54% of the revenues they bill. If hospitals could replace their current billing system and all the administrative expenses associated with Medicare and managed care cost shifting and at the same time have a steady source of income, the net savings could replace the entire contribution of Medicare and state Medicaid funding.

By offering the following and managing a 100% consumer participation rate, hospital systems would receive approximately the same revenue as their average expenses.

On average, each adult pays $140.39 and each child pays $46.80 per month (varies from state to state – See Appendix B).
Premium payment is made to the hospital of the adults choice and could vary from hospital to hospital (allowing for competition).
All hospital care, either outpatient or inpatient is covered 100% for plan members.
Hospitals establish a fixed daily cost for non-plan patients (same for inpatient or outpatient).

However, plan participation is not mandatory and no matter how good the deal, there will be people that won’t, or can’t pay the premiums. The Plan includes a Medicaid grant from the Federal Government set at 25% of the 2010 total expenses for each hospital. The grant requires that the STATE reach an average 75% participation rate to qualify and the grant does not go down if the participation rate is higher. So the hospitals and the states will have an incentive to increase participation rates as high as possible - the grant money can be used to cover unemployed or chronically ill patients. The grant will cost about $117 billion a year. A realistic goal is that on average, participation will be between 80 and 85%. Currently 83.1% have some form of insurance.4

Provider Plan

Like to the Hospitalization plan, doctors and other general health service providers could begin offering a similar plan to their patients. The cost might be as low as $7.25 per month per person5. By creating a plan similar to the Hospitalization Plan, doctors could institute programs to manage illness within their practices and to stabilize costs. A family of four could have a doctor and hospitalization plan for $475 a month. The average premium paid for individual health insurance coverage in the United States in 2011 was $2,196 per year, $183 per month; families paid an average annual premium of $4,968 or $414 per month.6 Because the average health insurance plan has a deductible, an individual would pay $183 a month for the insurance and could still face hospital bills of up to $2,935, or another $245 per month.

The Plan creates incentives for people to participate, for hospitals to manage costs and focus on patient retention and for both parties to manage health care. Consumers have the ability to change hospitals and doctors that fail to live up to their standards or who don’t manage costs well. Because the cost of seeing a doctor or going to the hospital is fixed, patients will have an incentive to see the doctor or go to the hospital before situations become critical. Hospitals and doctors would have incentives to offer wellness programs to lower utilization needs.

As for patients with chronic illnesses, the hospital costs determined above was based on the total of the annual expenses based on their inpatient/outpatient mix. It includes patients that are treated and released and those that spend significant time as inpatient. Because payment for services is not based on specific length of stays, hospitals and doctors can manage their patient’s care for the best outcome rather than billable limits.

For people that do not participate in a plan, the hospitals will offer a fixed cost for outpatient or inpatient care. Insurers may offer plans based on the fixed cost rate, but no one will be able to offer it less expensively than the hospitals. In general, the annual cost would be less than a single day as inpatient or a single trip to the Emergency Room.

For individuals or families that opt only for the Hospitalization Plan, their occasional trip to the doctor would be out-of-pocket as would everyone’s prescription costs. Walmart’s prescription plan has driven the cost down for many people but new, name brand drugs can still be extremely costly. Hospitals and doctors could form purchasing groups for specific drugs that handle chronic illnesses. By putting patients back in control of their medical spending dollar, market forces can help alleviate some of the costs.

We don’t have insurance for oil changes, or replacing tires, bulbs, filters or painting the siding. We maintain our homes and autos, provide the fuel and energy needed to run them. We have car (and homeowners) insurance to protect us from the rare events that cause their destruction or loss. Health insurance that does not consider the age of a person or pre-existing conditions is the same as insurance purchased after the accident or home fire. It is an attempt to share the cost of events, exactly as Medicare does now. The result would be the same under Obamacare except that it mandates, requires, everyone to buy insurance. This is still cost sharing but spread over everyone.

Saturday, February 04, 2017

Plan for graduate school

Many years ago I attended the University of Illinois at Chicago and was studying economics. I was considering graduate school until I pissed off a professor that would eventually become the Dean of the Department and who's recommendation I would need for grad school. Oh well, choices have consequences.

But prior to that whimpering end to my graduate schools hopes.....I was considering two areas of research.

First: I disliked the way productivity was defined. I wanted to see if there were alternatives that worked better and were more accurate. It was going to be a very technical and highly focused (not likely to see the broader light of day!). But something worthwhile to me.

Second: Innovation was something interesting to me. Why did we have thousands of years of human civilization but it took almost four thousand years to go from the wheel (yes I know it existed prior to that) to the train? To the car? Why did 'innovation' explode in the 1700s and 1800s and absolutely hit hyperdrive in the 1900s?

One factor, to some, strangely, is calories. How much food a population has on a regular and predictable manner. And is there a level? Generally - and I was working on a way to prove it - a population as a whole needs about 1200 calories a day, year round, consistently in order for innovation to begin showing legs.

But is not just calories for the population, there seems to be a necessary amount of population required too. A town of 50 with sufficient food stocks is not anywhere nearly as innovative as a city of 500,000 with the necessary calories.

Of course, the larger the population, the greater the food supply must be.

Finally, there seems to be a need for stress on a population. How much, what type, the source were all things I wanted to look at.

More recently I have looked at another factor. Why is Western Culture generally more innovative? What tends to set it apart?


Anyway, nothing in particular prompted this post. Several minor interactions all lent themselves to recalling what interests me, academically.

Oh, and I THINK I am being told to stop trying to focus on a private project. We will see over the next couple days if that is an accurate reading of the tea leaves...

Wednesday, February 01, 2017

Trumpeting

I have promised something on Trump for a while and I have spent time trying to write something without sounding demeaning or dismissive.

Fourteen months ago I said I supported Trump's run for the Presidency. It was a recognition that he was saying what lots of people had been saying for eight years. I thought that if enough people BELIEVED him, he had a chance. There was plenty of evidence to suggest that Trump was a narcissistic opportunist but I had learned back in 2007/8 election season that it isn't enough. Fred Thompson was of the same vein but he quickly fell to the side because, fundamentally, his gut wasn't in it. Running for President IS a narcissist thing - you have to see yourself as THAT KIND OF PERSON to be at the top of humanity. But it takes a corresponding belief in yourself.

I know of arrogance. Many of you that have known me are nodding your head. But the belief in one self has to be as strong as the skill. Thompson didn't have it and the rigors of a campaign (and the virulent hatred from some quarters) was just too much. Trump almost seems to gain strength from both the people that cheer him AND the people that jeer him. I KNOW that opposition doesn't slow me or drain me. It invigorates me.

The Devil doesn't appear to people because 1) it doesn't need to - people will do many evils of their own free will, 2) to do so would prove the existence OF GOD. The old phrase, slightly modified, better to keep quiet and let people doubt than to appear and remove it.

There is NO GREATER validation of a position than able opponents seeking to fight against it. This is a fundamental truth very, VERY few ever understand. And I saw a similar dynamic with Trump. The fight against able opponents is proof. "Belief" in doing the right thing becomes knowledge.

I named this Blog the Moderate Mainstream because I firmly believe that my positions are the same as the 60% of the people in the middle of our society. Twenty percent to the Right, twenty percent to the Left and the vast majority in the middle. And Trump was talking to that majority. But, would they believe him? I wasn't sure, but I was willing to support what he was saying. I joined and worked for the Cruz Campaign because it appeared he was going to be a finalist and of them, I thought the GOP would coalesce around him and forsake Trump. That never happened. The GOP flailed around for five months hating Cruz but hating Trump more. If it had gotten behind Cruz in April, it would have been over for Trump.

I talked to people that had been on the Cruz campaign in NC and IN and the vaunted ground game was an illusion. I saw it in CA, or rather didn't. When he quit, Trump's organization was there and doing things Cruz's never did - it supported THE VOLUNTEERS. It wasn't rah rah Trump, it was, what do you need from us? The hard work and effort by so many on Cruz's campaign was, seemingly, out of devotion to Cruz. The support for Trump was out of agreement with what he SAID. Cruz was the embodiment, Trump was the voice. The distinction is more obvious to me now than it was last May. But I could see results. The only question: Did enough believe what Trump was saying and that he would DO what he said.

As the summer wore on, Trump seemed to relish the fight. Every attack was an opportunity to do battle. The Left called it 'thin skinned' and many on the Right agreed. Afterall, the Left was used to slapping the Right and it was used to turning the other cheek. Here was someone that slapped back EVERY TIME. It shocked the Left and the Right...well, it just wasn't polite. Imagine that people are so prissy that when they get bitch slapped they all but thank and walk away. The way you deal with bullies is that you PUNCH BACK TWICE AS HARD - EVERY TIME.

The Left has bullied the Right for so long it is the only way they know how to work. Trump demanded a fight. COME ON!!

For people that had been bullied, or seen it happen, Trump wasn't a bully, he was FIGHTING them. Damn! I finally saw that dynamic over the Summer and knew at that point, he would win. The only question was how close would it be? Could the Left's perpetual vote gaming be the deciding factor? I wavered back and forth all Fall. I was sure he COULD win, but not sure he WOULD win.

The interesting thing about the voting booth - people do what is within themselves. I didn't watch or listen to any news until 9pm that night. When they called Florida, I knew.

Everything Trump said, he has done. So far. It can change, might. But not without a fight.

Another truth that seems lost on people: Trump is going to do what is in his best interest. For some reason people think this is bad. His apparent 'best interest' is the same as mine. Doesn't mean you always do what you want. For a couple of decades people said what was good for GM was good for the United States. Trump wants liberty and less government interference in his dealings. He has all the wealth he wants. If he does things in Office that increase liberty and limits government, it benefits him, his family, AND the Moderate Mainstream.

He has tied his well-being with the well-being of the Country. Imagine that. What benefit did it have for the American people to bomb Libya? What benefit did it have for us to reach agreement with Iran? How much of what Obama did benefited him politically at the expense of the United States. How much of what Trump has said has 'hurt' him politically even if it was an 'inconvenient truth'?

The NUMBER ONE position of the Cruz supporters that were NEVER TRUMP (and that is most of them) was the Supreme Court picks. Trump has made his and I don't know ANYONE, nor have I heard ANYONE say the pick was less than 'conservative enough'. It is early. Something might come up in the next weeks to change minds, but I doubt it.

Paul Ryan and Mitch McConnell better learn one thing fast: when Trump jumps in to battle the bully Left or to fight the good fight, nipping at his heels from the Right will get just as quick and harsh slap from him. Get in line or he is quite willing to let you hang out there by yourself. Does this mean Congress should fall in line? No. Engage Trump 'one on one' to get Congress' point across. Trump doesn't concede, but he will step back out of the ring if you've landed a point. But once the Left is engaged, get behind him or else.

To those on the Left that are just dumbfounded he won - you have been delusional. Most of us never told you that you were - it wasn't worth the trouble and your beliefs didn't matter in the long run. Obama put lie to that, but it was clear he was only setting the table. Clinton would have been the Great Destroyer. Clinton was going to do what SHE WANTED. Libya was all her pushing it.

Donald Trump is not a politician. He is "just an American" that wants to do the right thing. He talks like the Moderate Mainstream. He walks like the Moderate Mainstream. He will govern like the Moderate Mainstream. That will piss off the Left AND the Right. But that is ok. Trump and many of his supporters, like me, relish the fight - not to beat, but to win. Winning is good!

One more thing is yet to be on the table. I hope to see it in the next couple of weeks. It is 'due' next Monday. Trump's Budget Proposal for FY2018. If it is one dime less than last year, it is a gauntlet thrown down with Congress. If Trump wins, the Moderate Mainstream wins.

BY THE WAY, I TOLD YOU SO.