Monday, April 30, 2012

Mad Cow Disease

Mad Cow Disease is in the news again after authorities detected it in one dairy cow in California.  A recent article points out how the beef industry reacted quickly to calm any possible panic.  I described the potential for this kind of panic in my discussion of Global Warming (April 27, 2012) and called for moderation in our response to such news.  This article points out that the rapid response to the mad cow “crisis” was motivated by lessons learned from the pink slime commotion (April 2, 2012) resulting in a public outcry and loss of jobs because the industry misjudged the impact of media reporting on consumer behavior.

Another interesting article appeared immediately following the announcement.  It was intended to calm people – admirable but unusual for the news media – but it was in a subscription-only format on the Internet so I can’t provide a link.  The reporter asked for comments from experts at a large university in the Midwest.  The director of the animal disease diagnostic lab said, “This was one isolated cow in California… It was a dairy cow, but studies have shown that BSE isn't transmitted in milk… [T]his case poses no risk to people or other cattle.”  A professor of agricultural economics emphasized that it was an isolated cow that did not move into the food supply, and added, “I believe it will not have any lasting impact [on the market] unless they find more cows or other animals, or there is enough media attention that somehow motivates groups in the United States to say that U.S. beef is not safe.”

I call attention to the last part of the comment.  Have we become a nation of cattle ourselves - or antelope peacefully grazing on the plain until the least sound of a twig breaking or a rustle of trees sends us into a stampede?  It appears that the moderation that comes from perspective is so lacking that honest people who run legitimate businesses providing valued service to society must always be on guard lest a fiery news headline or the ranting of a well-meaning, but misinformed celebrity shuts them down.  This can only happen when the public behaves with a knee-jerk reaction to every new announcement.  This is not behavior strong in perspective, and it does not serve us well in the long term.

Friday, April 27, 2012

Climate Change

In case you haven’t been paying attention, climate change is the current name for global warming.  I think it’s a good idea to remind people about the fact that the climate is changing.  The climate is always changing.  As the Buddha reminds us:  Everything changes, nothing remains without change.  Now here is an article about an admitted global warming alarmist changing his mind about the urgency of the problem.  He says that his predictions were too extreme, but the last sentence of the article is very instructive where he says:  If he had rightly been more cautious, it would have spoiled his book.

There are a few things to learn here.  People in all walks of life are often motivated financially by such things as book sales and the need for funding of their research.  This causes them to express their opinions more forcefully.  Among other places, it is particularly evident in attention-getting news headlines.  In the face of these pronouncements we must keep a cool head.  Strong behavior in the area of perspective is characterized by moderation.

What ever happened to the hole in the ozone layer that people, especially NASA – think funding -- were so worried about twenty or so years ago?  When we stopped spraying the wrong chemicals into the air, it started to close up.  Now some scientists are worried that this may add to global warming!

How do they explain that some of the glaciers in Asian mountains are getting thicker?  Well, they don’t.  In that case they admit that they don’t really understand the situation well enough.  They are just guessing.

Just as we should expect more from advertisers, politicians and the news media, all of whom have a stake in our believing what they say, we must hold our scientists more accountable to fully justify their claims and be willing to debate those with a contrary point of view.  Whenever you hear any of these people stooping to name-calling, you know it's time to be skeptical of their claims and moderate in your reactions.

Monday, April 23, 2012

Psychic Healing

In February a Colorado woman was accused of stealing nearly $300,000 from clients and ordered to serve five years in prison and to pay restitution.  According to testimony, she told her clients that she needed their cash to draw out the bad energy and needed to check their credit cards to see how frequently the number 6 appeared.  She kept the cash and used the credit cards at local department stores.  She was found guilty on 14 counts of fraud and 2 of tax evasion. 

Imagine how desperate people must be to consult a psychic healer to help them solve their problems!  Despite articles like this one, and many others besides, that show psychic healing as well as other so-called psychic abilities are unsupported by scientific theory or actual results, Americans still pursue this as an avenue of relief.  In this case they were lucky and may get some of their money back.

Is it fair to paint all psychics with the same brush, labeling them all frauds?  Perhaps not, I’m sure some sincerely believe in the abilities they claim.  Still, James Randi, magician and debunker of things psychic, has for many years offered a $1 million prize to anyone who can demonstrate true psychic powers under controlled conditions.  He has gotten few takers and no winners.  Yet police sometimes call in psychics to help solve crimes.  If they don’t, they risk being accused by victims or their families of not doing “everything possible.”

Back in 1996 a nine-year-old girl for a science project devised a method of testing the validity of therapeutic touch, an “energy medicine” which claims to promote healing and reduce pain and anxiety when therapists move their hands over a patient to manipulate his or her “energy field.”  The girl contacted 21 experienced practitioners, sat them behind a screen and asked them which of their hands was experiencing the energy field from her hand.  Their success in detecting the energy field was no better than random guessing.  Results of this experiment were written up in the Journal of the American Medical Association.  Yet the State of California awards continuing education credits to nurses who learn this technique and “an American Hospital survey conducted in 2005 noted that about 30% of 1400 responding hospitals offered [and presumably charge for] therapeutic touch.”  

What we see here are further examples of uncritical acceptance of alternative practices based on anecdotal evidence rather than scientific testing.  This seems to be the trend.  We are encouraged to be open-minded, but there is a difference between being open-minded and foolish when it comes to our health and how we spend our money in general.

Friday, April 20, 2012

Healthcare - Billing Nightmares

Last time I listed eight issues that must be addressed to bring down and control the cost of healthcare.  I discussed the problems of over testing and the inconsistency in content and  pricing of services.  Both are compounded by the lack of openness built into our current system. 

Another problem with the healthcare delivery system comes under the heading of records and billing.  The records side has gotten some attention lately with politicians rightly calling for a move to electronic medical records.  The cost would be around $100 billion, but savings is estimated at $200 to $300 billion per year.  This is a topic in itself, but here is one source for more information.  Unfortunately, progress seems to be slow with no apparent "champion" for the cause.

Another problem that most of us have experienced is caused by a lack of a centralized billing system.  If you have a major procedure, the paperwork involved is unbelievable.  You get no meaningful information from the providers until they submit it to your insurance company.  Then you get an explanation of benefits (EOB) from the insurance.  An EOB has four numbers:  what the provider billed, what the bill really is (due to insurance negotiations), what they will pay and what you owe.  (Why doctors and hospitals bill one amount but are willing to accept less is interesting.)  Later you get billed for what you owe. 

Even for a simple visit you may receive two or three EOBs, but for a major procedure you receive a long series of EOBs and bills over time.  They just seem to keep coming.  You get them based on each provider, even some you don't recall ever seeing.  Months go by.  When you think you have seen the last one, another arrives in the mail.  It’s so confusing that many people, even very organized people, just pay the bills as they arrive trusting that the insurance company and the medical offices have not made mistakes.  This is the opposite of being a “smart shopper” but since you have no estimate to begin with and no clear idea of prices (as mentioned last time), what choice do you have?  The concept of general contractor is foreign to healthcare providers leaving us to fend for ourselves, fighting through an avalanche of paperwork.

Some of this might be solved if our doctors referred to us as customers rather than as patients, but the role of insurance coming between the provider and us makes them the primary payer and isolates us from any meaningful information regarding negotiation or pricing.  (This gets back to the initial issue of insurance design.)

In summary, I have shown in the last two installments that controlling healthcare cost is a lot more than providing insurance for everyone.  The entire system is out of whack and needs attention.  Without that attention, we may be able to afford our regular visits or emergencies, but the continued inefficiencies will come back to haunt us in the form of higher taxes, higher premiums, lower wages (to offset employer costs) and higher prices for nearly everything we buy - all to cover the continuing upward cost spiral.  There is no magic money tree to cover this.  It will come back to us in the end.

Monday, April 16, 2012

Healthcare Costs

I commented last time that when politicians talk about healthcare, they are really talking about health insurance, a related but different subject.  Just because you can pay for it with insurance, does not make it less costly.  It just shifts around the financial burden, and as I pointed out earlier, that tends to raise rather than lower the overall cost.  (Is it a coincidence that some of our worst crises are in areas of deepest government involvement:  housing prices, healthcare costs, college costs?)  So let’s apply some critical thinking to the issue.

I propose that there are at least eight reasons for high healthcare cost – few of which are in the news.

  • ·      Insurance Design:  This was addressed here on August 25, 2011.  You don’t make something cheaper by helping people pay for it.  As long as insurance companies play an intermediary role, separating the provider from the customer, there will continue to be a cost problem.
  • ·      Innovation:  This was addressed on September 12, 2011 and January 27, 2012.  New medical technology and treatments save more lives and make recovery times faster, but they don’t come cheap.  We need to understand that we can’t get 2012 medicine for 1970 prices.
  • ·      Lack of open competition:  More on this below
  • ·      Over-testing: Also covered today.
  • ·      Billing and coordination issues:  This was touched upon on January 2, 2012 and will be elaborated on next time.
  • ·      Regulations and Restrictions:  Insurance laws vary by state. One consequence is variation in the permission for people with less training, nurses or physician’s assistants for example, to perform certain basic functions reducing the cost and freeing doctors to handle the more complex cases.  More on this later.
  • ·      Liability:  The cost of malpractice insurance is passed along.  It’s not the doctors or insurance companies who ultimately pay.  These costs eventually find their way back to us.  More on this later. 
  •     Fraud:  This goes without saying, but accounts for about $180 billion a year.
The first subject not previously addressed is lack of open competition.  Open competition tends to keep prices low.  Look at those medical services not routinely covered by insurance, such as laser eye surgery to correct vision.  Over the years providers of these services have found ways to reduce the price while simultaneously improving results.  In the broader medical field, however, such open competition is hampered by confusion/inconsistency about service components and secrecy about pricing.  Both can be traced back to the role of insurance companies as intermediary.

Insurance companies deal directly with the doctors and hospitals, negotiating rates and conditions in isolation from us, the users.  If we move to a high deductible plan we are told to be “smart shoppers” for medical services, but we get little information.  Providers charge different prices for the same service and include different components as they judge appropriate.

If you see three different doctors for something as basic as a routine physical, you will have three different experiences.  You certainly will be weighed and have your blood pressure taken, but whether you leave a urine sample, whether you have blood drawn (at appointment time or beforehand), what the lab tests for and reports on, even whether an electrocardiogram is administered depends on the office.  I know, having moved lately and seen three doctors for initial examinations in the last 5 years.  You really don’t know what to expect.  Here is one of several articles talking about those inconsistencies.

So if you don’t know what you are going to get, how do you know what it will cost?  Doctors don’t post prices.  And if you don’t know what it will cost, how can you be a smart shopper?  Here is an article about the variation in costs related both to the variation in services and also to pure pricing differences.  At one point it says, “…consumers don't even ask about price because they're getting the service for ‘free,’ but also because doctor's offices don't list prices.”  Getting any service for free, an insurance design problem, provides no incentive to shop around.

 Contrast this with getting a service checkup for a car.  You take the car in and know what they will do.  You even sign a contract for the work that gives the exact price or an estimate for larger repairs.  If anything additional is discovered, they must explain it to you and get permission.  A current ad on TV shows how you can choose from three levels of routine service, what they include and what they cost.  They do this because they know their competition is giving you pretty much the same information, and that customers who are surprised generally go elsewhere.  If doctors and hospitals followed the same business model as vision correction and car repairs, it is certain that the cost of healthcare would fall.  Estimates of the savings to the system are between $84 and $178 billion, annually.

The second topic for today, over testing, is directly related to the lack of consistency and also adds to the price.  Fortunately, the American Board of Internal Medicine Foundation is leading a campaign to educate providers and the public about unnecessary medical tests, gathering fact sheets from seventeen medical organizations.  Each group will spotlight five tests for further investigation.  This is another high ticket item, between $158 and $226 billion.  "Consumer Reports has reported what a critical issue overuse is to consumers. A 2010 reader survey of nearly 1200 healthy 40- to 60-year-old men and women, with no known heart disease, risk factors, or symptoms, showed that 44% had received screening tests for heart disease rated by Consumer Reports as very unlikely or unlikely to have benefits that outweigh the risks."

As you can see, the effort to control healthcare costs is far different from providing more insurance as we know it.  Many changes are needed, but those mentioned here emphasize the need to instill more consistency and a more competitive environment into the entire system.

Friday, April 13, 2012

Words Revisited

Recall how on October 3, 2011 I wrote about how advertisers try to get us to change our vocabulary.  I’m not talking about political correctness.  Rather, this is an attempt to change the way we think, to make certain products or activities seem more attractive.  Examples included realtors, seemingly successful in changing the word houses to homes, which sounds much warmer, friendlier and more personal; and car dealers, somewhat less successful in rebranding used cars as previously owned.  Here are a few more examples that I noticed over the past six months.

One example is the use of expressions gaming and gambling.  Basically, gaming is legal, gambling is not, but they are really the same activity, risking money to win more.  When it happens at a casino or takes the form of a lottery run by the state, it’s called gaming and it’s OK.  If it’s an office football pool, it’s gambling and not OK.

Ironically, in the 10x10 matrix used in the office pool, you pay $1 for a 1 in 100 chance to win $100.  In a pick-3 type state lottery, you pay $1 for a 1 in 1000 chance to win $500.  The office pool is a smarter bet by a factor of two, in fact the probability of winning is superior to any legalized game!

Another advertising ploy is to label products as “chemical-free,” supposedly meaning safe or pure.  The concept of chemical-free is an impossibility, since all matter from stars to mother’s milk is made from either a single chemical element or chemical compound or some mixture of both.  Yet many cleaning items, for example, make ample use of this expression.

Critical thinkers know that when you go back to the dictionary definitions, we all live in houses, use chemicals for good and bad purposes, and gamble whenever we place a bet to win money.  They are not influenced by advertisers’ clever use of euphemistic or manipulative wording.

As long as we’re talking about words, also note that, in this campaign season, when you hear a politician mention healthcare in most cases he is really talking about only insurance, not healthcare or the rising cost of healthcare.  There is a big difference.

Monday, April 9, 2012

Disney Backs Down

Walt Disney World is rethinking an exhibit on childhood obesity that was criticized for being insensitive.  They used superheroes to demonstrate good habits with villains to show poor habits such as eating junk food and not exercising.

The primary objection came from an organization called the National Association to Advance Fat Acceptance (NAAFA).  I went to their website to research their philosophy.  

Their home page has a banner that reads: “Discrimination is Wrong.”  That statement is totally incorrect.  Illegal or irrational discrimination is wrong, but otherwise we discriminate every day, about the food we eat, the people we associate with, the television shows we choose to watch or skip, the kind of car we buy.  The list goes on and on.  Rational discrimination (or even sometimes emotional discrimination), choosing one thing or one brand over another, is a natural and important human activity.  It’s the way we narrow options for decision making.  I like chocolate and will sometimes make decisions to satisfy my preference, discriminating against other sweets or desserts.  It’s not illegal and it’s not wrong – but so much for nit picking.  There are more troubling things about this organization.

First, I agree with their basic premise that everyone should be treated with respect and dignity.  Those who are otherwise fully qualified for a job should never be turned down on the basis of any non-job-related characteristic.  That’s bad business and just plain stupid.  Bullying in school for any reason is unacceptable.  This ideal of respect for all is a noble mission.

But they go on to say: “This discrimination [against fat people] occurs despite evidence that 95 to 98 percent of diets fail over five years…” Assuming that diets fail at that rate, is it time to give up?  It’s not constructive or responsible for people to declare themselves victims.  Diets fail precisely because they are diets.  They entail following a certain course until the problem is fixed, and then folks go back to old habits.  What if we treated oral hygiene the same way?  We would wait until we got a toothache and then brush and floss like crazy and start keeping dentist appointments.  When the toothache went away we would go back to neglecting our teeth and then scratch our heads wondering why problems recurred.  Diets fail because they are short-term solutions.  The NAAFA solution would be to have government regulate “and closely monitor and control all aspects of the $58 billion+ diet industry” and to ban them from advertising on TV, apparently because they don't work or give false hope.  I say, don't blame the diet; take responsibility.

From the statistics on the failure of dieting they conclude, “Our thin-obsessed society firmly believes that fat people are at fault for their size.”  Well, with the exception of valid medical problems, they probably are.  And the valid medical problems are likely no more common than they were 60 years ago when obesity in the US was far lower than it is today.  So the question is, do we let people off the hook for a preventable problem?  Do we call it an addiction, call for “acceptance” and become enablers, or do we try to support them in their effort to lose weight?  As a comparison, how do we treat smokers?  People addicted to tobacco and have tried and failed over years to quit seem to be treated the opposite.  Since the behavior is bad for their health and general welfare, society takes every opportunity to warn them of the dangers and urge, sometimes nag, them to quit.  They are charged higher health insurance premiums and laws limit the places where smoking is permitted.  Yet you don’t hear an uproar over smoker discrimination.  You don’t hear calls for “acceptance.”

Let’s try this approach with children graduating from high school who cannot read.  These young people have behaved in a way that will negatively affect their overall welfare for the rest of their lives.  It is preventable in most cases.  Do we decide that it could be a medical issue, dyslexia, and excuse it, or do we support and encourage them to change?  Is having high school graduates who can't read acceptable because it adds to diversity in our society?  Ridiculous!

The change model, presented last time, shows that change does not occur unless there is some discomfort or dissatisfaction with the status quo.  The more we try to make people comfortable, even proud of any behavior or lifestyle, the less likely they will be to change to a healthier, more positive one.

Bottom line, I have a problem with the NAAFA, not because they are caring people, but because they promote excuse, apology and rationalization over responsibility, an approach that guarantees no solution, but rather a continuation of people putting themselves in danger of a myriad of physical and medical complications related to obesity.  Presented as a service, it is actually a disservice to both the individuals it claims to support and to society as a whole.

Friday, April 6, 2012

Changing Direction for Improvement

I mentioned the change process on December 12, 2011, but I’ll give more details today to tie that theory to the subject of these blogs.*

Change happens only when there is sufficient discomfort, dissatisfaction with the status quo.  If I’m happy with the way things are going, I have no incentive to change and will resist.  My attitude will be, “If it ain’t broke, don’t fix it!”

With dissatisfaction comes a demand for change.  Then someone must present a solution consisting of three factors:  a model, a plan and a cost.

The model says, “Here’s where we would like to be.”  Contrasted with the current state, the model or desired state will yield better results.

The plan then outlines steps to get there.

Finally consider the cost. If a solution is too expensive, a new one must be found.

One simplified example is planning a vacation:
1. Discomfort = you do not want to spend a vacation sitting at home; it’s not exciting enough or restful enough or fun.
2. Model = pick a destination and timeframe that will satisfy the needs identified in step one: theme park, beach, cruise, spa, golf resort, etc.
3. Plan = pick dates, decide whether to drive or fly, make reservations, etc.
4. Cost = check the budget to make sure you can afford it, otherwise you must modify the plan.

The approach to improving America is the same.  For the past 30 years survey after survey has shown dissatisfaction by the majority of Americans with “the direction of the country.”  The 2008 presidential campaign played on this dissatisfaction with a theme of “hope and change,” but recent survey results are unchanged.  It seems there is sufficient dissatisfaction but still no clear model or plan (and the cost keeps going up!).

This blog is about a model and a plan that works.  For over 10 months I have shown how real American solutions are based on our personal behavior in five key dimensions.  Our behavior is the primary source of most problems. Individual consequences accumulate into societal woes.  With almost 90 examples as background, I trust you are beginning to recognize in the news and in your own experience other examples of behaviors that fit into these dimensions.   More positive behaviors yield better consequences; no change in behavior yields what we have now, or worse.

The plan is to recognize these behaviors and start to eliminate destructive ones in favor of positive ones.  The sum of individual behaviors and their consequences build to societal consequences, i.e., our national problems and crises.  When we persuade a “critical mass” of citizens – not everyone, but enough to make a difference – we will begin to change the direction of America.  This is the desired state, more positive consequences and fewer crises, with people depending on themselves (not government or big business) to bring about the improvement.  (If we can’t achieve that critical mass, it means not enough people care enough to change, and we should expect more of the same.)

Surprisingly cost is not a factor.  It costs nothing to eat less and exercise more (discipline).  It costs less to forego the latest fad item - be it a fancier car, tennis shoes, designer fashions or the latest phone - to appreciate what we have and not always be grasping for more (perspective).  It costs less not to throw away money on unproven medical cures (critical thinking).  It costs nothing to admit and take ownership of our errors and problems and teach our kids to do the same (responsibility).   We support wiser and less wasteful decisions by recognizing that you don't get something for nothing, that there is no magic (government or corporate) source of free money (understanding the economic cycle).  Look at all the examples in previous blogs.  None requires an investment beyond improved behavior in those five key dimensions and doing so leads to happier individuals and a better overall America!

 *Change discussion was adopted in part from my book, No-Secrets Leadership.

Monday, April 2, 2012

Pink Slime

One of the principles of the behavioral approach is to address the behavior and not the person.  This automatically eliminates the acceptability of insults, name-calling and other personal attacks so common in our political process.  Addressing behavior replaces those destructive and often erroneous activities with attempts to solve problems with relevant facts and intelligent debate.

Now we get the case of “pink slime,” a derogatory term used to refer to, and gather support against, a beef product that has been in our food supply for years with no ill effects.  Why do people stoop to such name-calling?  Either they have no valid arguments or they are trying to catch us up in an emotional reaction to promote their particular cause (or as this news article calls it, a crusade).  And who thinks about the jobs lost?  Why are people who speak out against waste in other areas silent on this issue?  How can Kroger and the others offer twenty different kinds of dishwashing soap but not offer a simple choice to those who are not swayed by these scare tactics and want to buy the same kind of ground beef, less expensive and less fatty, that they have been buying for the last 20 years?

The uproar about the coloring ingredient in Coke and Pepsi that I addressed on March 19 had a similar dynamic - get people all riled up to rally behind a cause or complaint based on poor or sometimes even deceptive evidence.  The problem is that with social media it is now far easier to start a crusade or get people fired up about an issue using an emotional appeal.  Before you know it governments are banning products or ingredients or companies that sell them are back-pedaling due to the bad press on Facebook or Twitter.  Most consumers have little formal science education in such areas as human biology or experimental design, but they loudly express their “concerns” based on information from social media or the Internet.  The masses are howling, the ringleaders are name calling, and we are moving closer and closer to a kind of mob rule where we end up paying the extra costs, enduring the unintended consequences, and having our free choice eroded.

In this fast moving society one subject does not stay in the news long, so the following week, "concerns" arose over the use of BPA in food packaging.  At this rate we could be banning or otherwise losing access to 50 products a year based not on science but on public outcry!

Along similar lines this article tells about how old photos were intentionally used by the press to influence public perception in the Florida shooting case, which has sparked so many protests.  The article suggests that this type of manipulation by selective presentation of pictures and videos has become common practice in the media.  Another article sheds additional doubt on the accuracy and completeness of some news reports.

So my question is, when are we going to stop being influenced, frightened and manipulated, and start thinking for ourselves?  One way leads to reasonable outcomes, the other to the consequences of chaotic, knee-jerk reactions to each new manufactured crisis or well-intentioned crusade.