Reminiscing about my Transgender Car

The first car that I owned as an adult was a white 1999 Subaru Outback. It's first name was Sipowicz since I was watching NYPD Blue reruns at the time and a big white functional but not flashy car reminded me of that character. However, Sipowicz doesn't exactly roll off the tongue and a bald, crude guy who got shot in the butt didn't exactly provide a great role model. It was nameless for most of its existence until we started calling it Baru (pronounced Barooo and short for Subaru) due to lack of a name. It also kind of looked like a Baru. When my wife started driving it for its last 6th months, it had a sex change and became a Sabrina.

Sabrina has a DNR written around the same time as its name change. Any repairs over $500 would result in a trip to hospice which it entered the end of October. In the end, Sabrina did fulfill the rock n roll dream of burning out before fading away. She ran up 137,000 miles in 11 years. Unlike a lot of cars with off road capability, Sabrina was tested and got stuck on a mountain road in Colorado.

Sabrina was also the ultimate road trip car. She went across the county and all over the west coast from Sacramento, CA to Vancouver, BC to Utah and back again as well as every corner of Oregon. There was no need to worry about sleeping arrangements with Sabrina as I could just blow up an air mattress and sleep in the back. The only problems that I ever had sleeping in Sabrina was explaining the smell and mess to carpool companions later in the week. But this post is not a roast on Sabrina or further elaboartion on a transgender car (although there are probably some disappointed google search results). I am here to praise Sabrina and reminisce about the greatest trips taken and the role that she played.

Colorado or You never forget your first: Shortly after buying Sabrina, a college friend and I drove around Colorado for 2 weeks. I had just returned from the Peace Corps while he was about to start medical school so we were both saying good-bye to our old comfortable lives. It was also an introduction to the west coast in the form of seeing snow in the mountains in July at Estes Park and roller skating waitresses at Sonic Burger. The Great Sand Dunes National Park in southeast Colorado was almost biblical in proportions and the Mesa Verde National Park in the northwest corner made us feel like we were back in the era when Native Americans were the only residents. This trip was an extended bonding experience with Sabrina as I got to know her. I also got her stuck on a mountain road so I got to know her limits.

Southeastern Oregon Tour: Southeastern Oregon has some the lowest population density in the United States. The town of Fields is out there with population of 9 but some of the best milk shakes in the state. Fields isn't even the most surprising town compared to Jordan Valley which is a Basque outpost on the Idaho border. The geology is incredible with the Steens Mountain range, Alvord desert, and Leslie Gulch. With no radio access nor current newspapers, I felt like I was almost in another country. The isolation was a welcome change from the usual city living with strangers.

The only time that I got nervous was when I shared a natural springs hot tub with an older gentleman that looked like he was almost in the movie Sling blade. The fact that he was reading the John Grisham book, The Firm, made me nervous since the book had been around 15 years and he was just reading it for the first time! That's a little too isolated for me. As you can probably guessed, I lived in Sabrina for the 4 days that I was out there. Most campsites involved pulling off the road into BLM land and firing up the camp stove.

Cross Country Skiing in Northeast Oregon: Another eastern Oregon trip that involved living in Sabrina was my excursion to Anthony Lakes for cross country skiing. Anthony Lakes had closed for the season so I was able to just camp out in my car for the night and spend the day exploring the Eagle Cap wilderness.

This was the trip where I discovered that Enterprise was my favorite small rural town. It was the only town in Eastern Oregon where I didn't get the "You're not from around here" vibe. After running into a brewer for the Terminal Gravity pub (I literally ran into her as I was coming down a slope on cross country ski and she was hiking up with her snow board), I spent the evening drinking and eating there. The local were interested in my story, how I wound up there, and I was able to listen to their stories. It seemed like Enterprise is more open to new arrivals than most smaller rural towns.

Me Speak Corporate Good

I was making myself a sandwich while holding my almost 2 year old son, Berserker (no that's not his real name but yes that's what I actually wanted to name him after the rock band in the movie Clerks) in one arm and spreading mayonnaise on a sandwich with the other. Berserker started reaching for the mayo and indicating that he wanted to eat it straight from the jar.

"No Berserker," I said, "we don't eat mayonnaise." My wife looked up. Since Berserker has reached an age where he pretty much understands everything that we say, she has been trying to get me to be better about explaining things to him directly and not say things that aren't correct. For example, when Berserker tries to climb on the table so he can pound on the computer keys, I'll often say, "No Berserker, there's nothing interesting on the table." That is incorrect since there is something very interesting on the table, the computer, which is why he was trying to climb on the table.

"Deadhedge," my wife said, "We do eat mayonnaise and Berserker knows that we eat mayonnaise so he probably doesn't believe you. What you should have just said is, 'Berserker we don't eat mayonaise directly out of the jar but we can give you some mayonnaise on a sandwich." She paused, her expression slightly changed and a grin emerged as she thought of something else.

"Deadhedge, when you talk to Berserker, why don't you talk to him like you would talk to your coworkers at a business meeting? At a business meeting, you are direct and think about the best way to describe something before speaking. You could use this an an opportunity to improve your presentation skills." Ah, that was an ingenious way to get me stop being lazy while talking with Berserker and relying on easy phrases like, "That's not interesting", or "We don't do that," or "The cat ran away from home."

However, I thought about how I talk at meetings at work and realized this wouldn't work.

"Wifey," I said, "If I talked to Berserker like I talked with my work colleagues, I would say things like:"

"Berserker, let's put eating mayonnaise from the jar in the Parking Lot."
"Berserker, we haven't prioritized eating mayonnaise from the jar on this year's strategic plan."
"Berserker, we haven't built a business case for eating mayonnaise from the jar."

With this type of corporate communication style, it's pretty incredible that we actually accomplish anything at all at our meetings.

I avoided the Quarter Life Crisis but can I escape the Mid-Life Crisis?

The quarter life crisis is the new mid-life crisis. A search for "Quarter Life Crisis" on the Generation Y career website Brazen Careerist reveals entries on how to assess if you're having a quarter life crisis, what happens when previously clear paths fog over, and the existential struggle in between.

It does not surprise me that this crisis involving the search for meaning, uncertainty about the future, and ambivalence about the past now hits us in our mid-twenties. Previously paths were more certain as you worked on the farm, your parent's business, or got married. Paths were also delayed as apprenticeships or paying your dues were typical so tough career decisions could be delayed until we were in our 30's. Now, Generation Y has to worry about the right decisions on their Facebook post let alone the choice of graduate school, entrepreneurship, corporate jobs, or year long bender in a Thai opium den.

I dodged and juked past my quarter life crisis like Barry Sanders used to dodge the Green Bay Packers defensive line. My early 20's were spent in the Peace Corps, working on-call at multiple psychiatric floors with complete control of my schedule, or living in a commune. Actually, I should clarify, communes are now called Intentional Communities since commune's got a bad name in the 1970's. During these jobs, I spent the time thinking about what kind of graduate degree I should get to be able to do what I wanted in the health care field. At the end of the 3 years, I had decided on an MBA. I had complete confidence in my decision and future path. Additionally I embraced the small victory of each skill developed. I had experience in construction, grant-writing, and social work. I knew how to knit a sock, spin a pottery wheel, traveled most of South America, cooked for 50 people, garden, used power tools, made soap, spoke 4 languages, and butchered a pig. Actually, my ability to butcher a pig excited one of my rugby classmates so much that everytime I answered the phone, I thought that I would hear squealing in the background with my classmate yelling, "Come on over and let's barbeque!" In summary, I had more than enough stories of adventures to take center stage at most cocktail party conversation. On a serious note, I felt accomplished, lived a life less ordinary, and had confidence in my ability to make decisions about my future.

My method of avoiding a quarter life crisis is not a new one. The idea of spending 2-3 years finding your way in the world, sewing wild grains, and experimenting is a pretty standard career path for my undergraduate class. I know there are those with bigger student loans, visa issues, or family expectations or culture that playtime was over and it was time to get a job that could not take this path. My point is that a quarter life crisis is, for the most part, a relatively modern construct of our making. Some part of it does involve the collapse of the American dream where 4 years in college leaves you with a staggering load of debt and no health insurance. The ability to spend 2-3 years traveling, being a subsistence organic farmer, Americorps, working part-time and doing art part-time, moving to San Francisco and seeing what happens, homesteading in Alaska, or any of my other classmate's pursuits has faded. However, the quarter life crisis emerged well before the economic crisis so I will stand by my position that the quarter life crisis is our own invention and we have more control over it than we may think.

I turned 35 this year so my mid-life crisis is approaching. In some ways, I'm ripe for it as I am married, have a child, clawed my way to middle management, and am 20 pounds heavier than I was in college. One of my high school classmates with a suburban lifestyle lamented how he's realized that we've reached the age where we have as much chance picking up young Generation women in a bar as our grandfathers do. My car died recently and I saw a perfect opportunity to embrace a mid-life crisis by buying a sporty red convertible. My wife said that it was fine as long as the baby's car seat fit in the front seat. We bought a station wagon.

What's saved me from a full blown mid-life crisis so far has been maintaining a life outside of work, family, and social life. I still climb a mountain or two a year which keeps me connected with life and the wilderness outside of the normal 9 to 5. My high school classmate who lives in suburban Chicago doesn't have this outlet and I can tell that he needs it badly. By some quirk, I am also in better shape than I was in my 20's. I can run farther and faster, get into more yoga positions, and rock climb harder routes. Blogging also keeps my feeling connected and involved in what's new in the world, whatever that may be.

However, I can't pronounce my mid-life crisis to be avoided until I have had at least 5 more years of hindsight. There's also still my plan to grow my hair down to my shoulders again when I turn 40. Long hair is part of my plan to embrace a mid-life crisis since I may not be able to avoid it.

How an MBA will view buffalo wings and other potentially irritating habits

We went out to dinner at the newest location of a local buffalo wing restaurant called Fire on the Mountain. The Grateful Dead reference, variety of food, local beer on tap, and comfortable northwest atmosphere all made it an enjoyable outing. I also used to play against the owner in some pick up Ultimate frisbee games. One of the highlights of my Ultimate career was forcing a stall with my lock down goal line defense against him. As you can guess from that highlight, my Ultimate frisbee career was not very illustrious.

We had previously been to their first location which was smaller and located in a transitional part of town. Given the size and central location of their new restaurant, we ventured that wing business was booming and Fire on the Mountain was doing well. Like any good Pavlovian conditioned MBA, I immediately started thinking about how the business model drove success. Just like a Peace Corps Volunteer becomes conditioned to salivate over the local bitter tea or gut rot grain alcohol, MBA's become conditioned to view the world in terms of margins and cost structures.

While dipping a french fly in blue cheese dressing, I wondered what the margins were like on buffalo wings. Given that places will give them a way for a nickel each, the gross margins must be incredible. $6 for 6 wings must be at least an 80% gross margin even if they bought from the farmer spent extra on free range chickens that were given cello lessons and yoga balls to sit! All right, that doesn't include the blue cheese dressing but we're still looking pretty good. They also don't need the most upscale kitchen or chefs to primarily make buffalo wings so the kitchen operations is probably pretty low cost. While wings look like a good business, the margins are probably as good if not better on their beer.

While those margins are great, there is only so many $6 wings or $4 beers that can be sold in a day. It's a similar problem that coffee stores face since there is only so many $3 coffee drinks that can be sold. While the new location looks great, I don't know if it was financed by loan shark debt or could be considered a rounding error in their bank account. At this point in the conversation, the rest of my dining mates had tuned me out in favor of the Trivial Pursuit cards, football game, and dipping their french fries in my water glass (the age of my dinner mates varied). As you can tell, this is that glamorous post-MBA life that you hear about.

Post-MBA life, you too will view the world in the context of gross margins, variable costs, and fixed costs. You may even try to bargain at closing time by trying to pay slightly above variable costs for the wings that will otherwise be thrown away.

While bargaining based on business model is rooted in the time honored tradition of haggling, I'll ask MBA's to avoid a more annoying post-MBA habit of talking about "operational efficiency." Invariably, when food takes a long time to arrive at a restaurant or the line is longer than some would like, one of your classmates will say, "They could really improve the operational efficiency in this place." The problem with that statement is the only operational improvement skills that any MBA learns is the newspaper vendor model and timing someone with a stop watch. That's really it. We really have no clue how to motivate an hourly cashier to move quicker when it has no impact on their salary or personal satisfaction. We have no great insight on how a waiter can prioritize a drink order, new table being sat, and soup being ready at the same time. Our knowledge of business process redesign is limited to key stroke short cuts on Excel. Talking about improving the operational efficiency is just a fancier and extremely irritating way of saying, "I'm bored/hungry/in a hurry/about to start eating my groceries in line, please hurry." That is why the FedEx commercial is still so popular.

Fellow MBA's, the sooner that we embrace the fact that we have no clue how to make someone unload a moving trucker faster than anyone else without using a Taser, the less annoying we will be to the world at large. That is a goal with an excellent business model.

Review of the House Health Care Bill, Affordable Health Care for America

My review of the Affordable Health Care for America Act, HR 3962, is based on 2 key aspects. First, it's a health insurance reform bill, not health care bill reform. The prevailing mood around reform has been that if we just get everyone insured, we'll win. Insurance reform is not time for a victory lap but rather a quick pit stop to prepare for the hard work of cost containment. I am making the big assumption that government will address health care costs after addressing coverage. This strategy worked for the creation of Medicare as Lyndon Johson knew that he could never show Medicare would pay for itself initially. Instead he focused on creating the need and for better or worse, let future governments work on the financial viability.

Second, our current health care system is a mostly clogged artery that's waiting to burst. Taking the stairs instead of the elevator would be an improvement. Doing nothing is rapidly disappearing as a choice. That's why I found the Republican's decision to work on their Sudoku or their profiles on the new GOP social networking site to be so counterproductive. Their lack of interest made the narrow House vote less significant.

With those two caveats (and these caveats border on assumptions like Lindsey Lohan has finally gotten herself straightened out), I'll say that the House bill is not bad. Just like NCIS Los Angeles, I first found it to be unwatchable due to the complete lack of chemistry between the main parts. However, some role players have emerged and the writing has improved. While the Senate bill will dictate the final outcome, here's how I see the House bill using my trusted framework of the Good, the Bad, and the Ugly:


The Good:

• The House was somewhat serious about the individual mandate: Everyone is starting to understand that in order for insurance to really be affordable, everyone has to participate. The young, healthy, and good-looking have to pay for the old, sick, and ugly. The House bill has a penalty that is 2.5% of income. Considering there should be available health plans for 8% of income, that penalty should be enough to make most participate. One of the biggest problems with the Massachusetts reform was that the penalty was not significant for people to care given the cost of insurance. While I'm going to congratulate Congress for growing a pair, I'll at least offer a fist bump.


• The fact the Florida seniors get twice as much for Medicare was discussed: According to the >Huffington Post, there is a provision to study the geographic variation in the costs of health care or why it costs twice as much in Florida or McAllen, TX. I think the fact that some seniors receive twice as many health care dollars or that their doctors are paid enough to accept Medicare while others do not and are not is one of the least talked about injustices of our health care system. While I know commissioning a study is like forming a committee to address a problem, at least, it's getting discussed.


• It's an insurance reform bill: There is no great secret to paying for universal health care. It's always been a matter of requiring the Haves to contribute to the Have Not in some way to prevent people from gaming the system. The wealthy, health care companies, and employers will be taxed more. Seniors will receive lower Medicare benefits and individuals will have to pay or play. Whether this is considered to be socialism, communism, or paganism, it's just the basic concept of how you pay for insurance.
  

The Bad:

• There are no cost containment plans: Health insurance for everyone is going to be expensive and the government has had little success reducing costs. Medicare has had little to no success with disease management programs. No one in government has ever negotiated with drug companies or providers. Their only ideas around value-based benefit (value-based involves covering evidence-based services at little to no cost while charging more for services with questionable value) designs involve lower copays for preventive services. Private insurance companies figured that out 10 years ago. The government has had success with requiring providers to manage all care, including complications, for a set price (called DRGs). However, that's it and that's why I really hope that there is still the political fortitude to get serious about cost when the bills come. The bills will be about as pretty as lipstick on a pig.


• Seniors are going to be pissed: This bill will cut funding for Medicare Advantage which includes health plans that have been providing Medicare coverage for decades. This year, we have seen that a 4.5% revenue cut resulted in higher prices for Medicare Advantage by 25%, reduced benefits, and had plans already leave the business. Seniors were told not to worry about benefit cuts and that the doughut hole in the drug plans will be filled with this bill. By the way, the doughnut hole (after a certain level of coverage, seniors whose drug spending is around the 75th percentile will have to pay $1500 on their own, and then only have to pay 5% of drug costs in the catastrophic category. The $1500 they they pay on their own is the doughnut hole), is an example of a value-based design to promote better utilization of drugs. However, the government is running away from it in an effort to show seniors something bright, shiny, and new with Medicare. Taking money away from Medicare to fund the uninsured is probably a good use of the health care dollars, but no one has been that honest with the seniors. No, I did not expect politicians to be upfront with a key voting block about bad news, but this is an impressive bait and switch considering the cuts will wipe out the prescription drug program and its newly filled doughnut hole.
  

The Ugly:

• With this Public Plan Option, the government is going to start a brand new insurance company: A government-run health plan or the Public Plan was included in this bill but it requires that they negotiate with providers for fees and act like a regular insurance plans. I have written ad nauseum about how I think the Public Plan is a bad idea and the majority of the cost savings would come from paying providers lower rates. This Public Plan in the bill does not pay providers a lower fixed rate and the Congressional Budget Office notes that price for the Public Plan will be higher than comparable private plans. I have am image of dominant hospitals telling the Public Plan administrators the astronomical fees that they will have to pay them to make up for the fact that Medicare and Medicaid pay them too little. Next, the dominant hospital would tell them that they don't accept Medicare, don't accept Medicare, and where they can shove the Pubic Plan. The Public Plan has been a bigger distraction from the real issues than abortion or immigration.
  

If you're looking for more information or think I'm an idiot and want to hear other opinions, This American Life did an excellent job of explaining the key issues of the health care system that this bill does not address. Here's the more pessimistic view from an objective (but grumpy) health care insider or a slightly wonkish but accessible view.