Avoid having to check back and subscribe to Roll Away the Dew by email. It will take a whole pail of water just to cool you down!

Tuesday, March 30, 2010

Coming Home Again Again: the Reverse Cross-Cultural Adjustment

One of my favorite local bands, Keep Your Fork There's Pie, introduces one of their songs with, "I wouldn't want to born again again because then I would have to repeat 7th grade again again."

When we leave the United States to travel in distant and foreign lands, we religiously study the local customs, language, and food in preparation for the cross-cultural experience. We are well prepared, open-minded, ready to listen, and invariably mispronounce words and accidentally say something that means penis at least twice per day. I wonder if it's as easy to accidentally say some variation of penis in English or if that's a clever feature of only other languages?

What we forget to do is to prepare for coming home again again. Yes, we spend a glorious week reconnecting with friends, eating our favorite foods, marathon TV watching, or just enjoying a hot shower. We do get overwhelmed with the number of peanut butter options at the grocery store and selecting tooth paste takes 20 minutes, but other than that we're feeling good. Then the reverse cross cultural adjustment hits.

We're faced with finding a place to live, the job search, and trying to regain independence in the United States. This is contrasted with our experience in the other county where we had purpose, carved out a niche in a community, mastered new languages and culture, and had that independence. Being back in the US rapidly loses its appeal. The job search process starts to feel like a Kafka-esque trap and our experience abroad is discounted. Friends lose interest in our stories about the number of barnyard animals on our bus or on our kitchen table. Our interest in friends' stories about office politics or upholstering their couch fades like our metabolism. After a while, there's nothing new on TV and we don't understand why the re-release of the Beatles anthology was such a big deal.

This reverse cross cultural adjustment is the untold story of coming home again again. We were having fun in our former country, are not having fun in the United States, and therefore want to return to the other country because it was fun. However, that's the wrong reason for leaving. We're running away from a difficult reverse cross cultural adjustment and not running to anything productive. Our semester or service or job ended in the former country or our money ran out. If there is a compelling job, study opportunity, romantic interest, or suitcase of gold in the former country, that is worth returning. Otherwise, it's time to move on and properly come home again again.

Here's how to avoid problems with reverse cross cultural adjustment and live in the present. The first step is to recognize that a reverse cross cultural adjustment exists and needs to be addressed. These are the next steps:
  1. Don't rush into the job search: A job search is inherently difficult since we are asking strangers to judge us while we struggle not to incorporate negative feedback into our sense of self-worth. Returning home with enough money to delay the job search for a month will make the adjustment more successful. Additionally, we need to be careful about turning a job search into a career search since a career search is even harder. There is already the gap or transition period in our employment history from being outside of the United States so we have an opportunity to experiment or get a slacker fantasy job.
  2. Relearn that the United States is fun and look for adventure: Once we've gotten over the joy of being able to easily find good bagels or coffee, it's tempting to go back to the routine or pre-traveling lifestyle. This can lead to stagnation at worst and certainly no new experiences or adventures. The new experience is what made the international experience so appealing and the United States is large enough and diverse enough to offer those same experiences. This can range from visiting old friends to traveling to taking a new class.
  3. Establish a sense of independence: It's likely that we were completely independent and fairly free of any schedules other than bus schedules while we were overseas. Moving back to home towns with few opportunities or being overly dependent will turn the trip back home into a real regression. Taking a job too quickly can also destroy our independence because there is only so much readjustment that we can do while working regular hours. Being beholden to no one is a powerful experience and we can't give it away if we want a successful re-entry.
When I returned from the Peace Corps, here's what I did well with my adjustment. On the job front, I waited a few weeks. Then, I went back to my old job as a resource social work at psychiatric facilities because it gave me a completely flexible schedule that I could control. Since that's not the new experience that I was calling for, I combined that with part-time work at a camping goods store as my slacker fantasy job. That was new.

As far as relearning about the United States, I did that very well. My jobs allowed me to take time off and visit friends within a day or two drive, visit graduate programs (where I had friends) to learn about opportunities in this country. I did more backpacking and camping.

What I did not do well as well was move out of my parent's house in the Chicago suburbs. No rent gave me the flexibility to work as needed and relearn the United States. However, it caused me to hate Chicago because I had to experience it as a suburban commuter.

I also learned what new customs to leave behind. Yerba mate is a very bitter South American green tea that is repeatedly sipped through a metal straw in a cup. To the average US citizen, it looks like you're taking bong hits. It caused my slacker fantasy job to end prematurely so I was glad I had that experience with a minimum wage retail job as opposed to something that followed my career path. Track your progress with your reverse cross cultural readjustment so you know when you're make a cultural faux pas or basically saying penis again.

Friday, March 26, 2010

Let S/he Who Has Not Sinned Decide who are the Deserving Poor

I recently read a blog post from one of the few libertarian bloggers, Milena, that doesn't cause me to sputter like Daffy Duck at my computer screen. It was about one of this country's favorite topics which is, who are the deserving poor and who are the undeserving poor? Whenever there is talk of expanding a safety net benefit like unemployment insurance, food stamps, or something really crazy like health insurance expansion, the following proclamations are issued:
  • These people live a lifestyle of luxury on $400/month! When you give people just enough money to not starve or be homeless, they have no incentive to ever get a job!
  • I know an obese person on food stamps who eats junk food all day! They should only let people on food stamps eat vegetables and drink skim milk!
  • I have a job with health insurance! Why should people without jobs have health insurance! They clearly must f#cked something up if they don't have a job with health insurance!
Milena's blog post connects the food stamp program with artists and uses that angle to examine the government support/subsidization of art. The idea of using safety net programs for a specific field is an interesting concept. However, the idea of asking who deserves access to these programs is not as interesting.

One of the few things that I learned in social work school is that the country's safety net programs were set up very differently if the recipients were thought to be deserving poor compared to undeserving poor. Medicare and Social Security were for the deserving poor, or elderly who had spent their lives contributing to society and needed a retirement program that didn't involve being broke and slowly dying in a hospital. The enrollment process is very easy. Turn 65 or 62 and the government signs you up automatically.

Thanks to the National Kidney Lobby, if you have End Stage Renal Disease, you are also deserving poor. You automatically get signed up for Medicare health insurance if are diagnosed with the disease no matter how old you are. However, if you have tuberculosis and can't work, it's too bad so sad.

If you need cash assistance from the state or want to qualify for Medicaid health insurance, the enrollment process alone makes it very clear that these are for the undeserving poor. It requires extensive documentation to overcome the assumption that you are not spending extensive amounts of time and effort to cheat the government out of approximately $400-$600/month. If someone was skillful enough to defraud a government assistance program, they would use those talents on a much higher scale and defraud the private sector of millions.

What about Ronald Regan's welfare queen who had "eighty names and 12 social security cards" to defraud safety net and government assistance programs of $150,000/year? She was never proven to exist. There was a story about a woman who managed to defraud welfare programs for $8,000 with 4 aliases before being arrested. As I had said before, it's really hard to defraud government assistance programs for a large amount of money without getting caught. If Regan's welfare queen was as good as he claimed, she would find more lucrative opportunities.

As a result of dividing the poor into deserving or undeserving, we create extremely inefficient safety net programs. Programs spend money on more administrative aspects, create additional bureaucracy, probably deny assistance to beneficiaries who should receive it, and operate a program based on the exception rather than the norm.

If I were president and could force Congress- no, that's not realistic. The president can't even force Congress to be polite during his speeches. If I had enough weapons and bombs and barricaded Congress in a building, here are the 2 choices that I would give them to reform our safety net and assistance programs:

1. Create a program that follows 90% of behavior and assume that all poor are deserving: If someone's income or disease state prevents them from supporting themselves, simply allow access to entitlement programs. Being on these programs is not a life of luxury so 90% of all applicants are not trying to defraud the system but simply need help. There will probably be enough savings from removing the extensive application and review process to expand programs somewhat.

2. Assume all poor are not deserving and end the programs: Let the exceptions rule and just end assistance programs that are a charade or promise of assistance. For those who don't want to subsidize health insurance, then let's end the Emergency Medical Treatment and Active Labor Act (EMTALA), also known as not letting hospital emergency rooms deny treatment based on ability to pay. Why start paying for services when someone collapses on an emergency room floor from a very treatable chronic disease but refuse to pay for the doctor office visit to prevent it? That is completely economically inefficient and still fairly heartless. For the libertarians, let's just be heartless but at least be fiscally consistent.

Monday, March 22, 2010

How I Learned to Stop Worrying and Love Health Reform

The evolution of my posts on health reform have been a Dr. Strangelove tale of "how I learned to stop worrying and love health reform." Initially, I called it health insurance reform when the Obama administration was just resorting to changing the most egregious insurance practices. Later, I called it plain health reform when the focus was expanded to the rest of the health care system. Actual health care reform will come later when we address the unsustainable practice of paying providers for volume rather than outcomes.

I have not done a complete analysis of the bill. I just came back from California and am still recovering from my In-N-Out animal style burger feast. There's also the NCAA college basketball tournament where I now have no regrets that I didn't fill out a bracket due to all the upsets. However, the passage of this House bill and improvement in some provisions might have been the biggest upset of the weekend.

To reiterate, the bill is not a government takeover, socialism, or a case of dictators not doctors. I do love how the right manages to accuse the Obama administration of socialism and fascism at the exact same time. In its simplest forms, the bill simply requires everyone to have insurance and forbids insurance companies from denying insurance to anyone. To pay for it, the Medicare payroll tax is raised on the wealthy, some high end or Cadillac plans (although this provision was gutted like the Kansas Jayhawks basketball team) lose their antiquated tax exemption, and health care companies pay more as an entry fee to being 1/6th of the American economy.

You can find a good summary here. Here are the new provisions that got me excited:

1. Primary care doctors will get paid more by Medicaid: Medicaid payments to primary care physicians and pediatricians will be increased to the same payment levels as Medicare. Keep in mind, that's not all doctors but just the primary care physicians. Primary care is finally getting the respect that it deserves. At med school reunions, they can start to make fun of urologists who sold out by making a career choice to look at penises all day.

Given there are complaints about how little Medicare pays, you can imagine how little Medicaid must pay if it needed to be raised to Medicare levels. Since Medicaid will be expanded to cover more people, doctors needed to be paid higher than current levels. This will dramatically increase the odds of a Medicaid beneficiary being able to get a doctor's appointment before 2014. This provision was so logical that even the Republicans thought that it was a good idea and they weren't even paying attention.

2. Medicare Advantage payments are getting fair: Seniors sacrifice in health reform was the loss of benefits for those with Medicare Advantage plans. However, not all seniors were treated equally. Health plans received 50% more money from the government to offer Medicare Advantage plans to seniors in Florida than to seniors in Oregon. As a result, seniors in Oregon did not have access to the same level of benefits. Nor did they have access to the same level of providers who are also paid less in Oregon than in Florida for services. These are the results of antiquated payment methodologies. This bill works to correct that by paying 5% less to Florida Medicare Advantage plans and 15% more to Oregon Medicare Advantage plans. There will still be hair cuts in overall payments but Oregon will just get a trim while Florida gets the mohawk that its needed for a long time.

Overall, there will still be cuts to Medicare Advantage plans but the party had to stop eventually.

3. Congress is starting to understand the importance of the mandate to purchase insurance: If no one can be denied insurance coverage, than everyone needs to purchase insurance to keep costs from blowing up like most people's NCAA tournament brackets. In previous versions, the penalty for not buying insurance was so low, that people would probably ignore the mandate. This is like removing one leg on a stool with 3 legs. Individual mandates goes together with no denials for coverage like peanut butter goes with chocolate, like Batman and Robin, like child movies stars and drug overdoses. I think that you get the idea.

The penalty for not buying insurance was increased slightly, from $695 to $750 in one version of the penalty. That increase is probably too small to actually change behavior so that's why I'm celebrating that Congress is starting to understand. They haven't quite fixed it.

4. Death Panels for our grandparents and more money for abortions for babies! You betcha! Actually, no. No cross generational jihad was ever really planned but some folks who had no actual ideas for health reform needed something to talk about.

There will be some unanticipated consequences, of course. That's the fun part of looking at legislation, kind of like trying to guess which #3 seed in the NCAA tournament will lose in the first round.

For example, the improvement of the individual market and penalties on large employers (those with 50 or more employees) who don't provide affordable insurance will probably result in employer dropping coverage. They may give employees some extra money in their flexible spending accounts to go buy insurance on the open market. However, that is not a terrible consequence as employers who are uninterested in offering health insurance or can't really afford it, can get out of the health insurance business.

The doughnut hole in the Medicare prescription drug plan will likely be filled. I always thought the doughnut hole was an elegant benefit design that was unfairly attacked. It simply provides a powerful incentive to slow down on the prescription drugs use. However, if someone really needs all that Viagra, there is a catastrophic cap after the beneficiary has spent a certain amount of money for their erections. It provides an incentive to limit utilization and a cap or protection for those who need it.

Wonkish analysis of geographic disparities in Medicare payments aside, this bill make the United State a more humane country. In 2014 when the provisions are all in place, we will no longer be a lay off away from not being access medical care. Also remember that desegregation was met with huge protests in its time.

Sunday, March 14, 2010

Why it Looks like Generation Y has not started a Revolution

One of the unanswered questions for most Boomers is not why their kids don't want to be Facebook friends with them. It's more why their kid's generation or Generation Y has not started a revolution. I mean a full revolution with marches, roses stuck in rifles, blown up buildings, protest songs, and a real Iran-style Green revolution. Not just turning their Twitter profile green in support of Iran but physically creating mayhem on the streets.

A former ultimate frisbee teammate was an intern for the weekly respectable alternative paper. She told me that the Boomer publisher would continually ask the young interns why they haven't full-fledged revolted over the fact that the government has raised their university tuition, sent them to war, put the price tag for the current generation's social safety net on their tab, and shown no indication that the safety net will be around in 30 years. Today's corporations and businesses have blown off this generation with unpaid internships instead of real job offers. At least Generation X had the dot.com era to make some money and get some jobs but the best Generation Y got was the real estate bubble. The publisher was seriously befuddled. Boomer musicians were also befuddled as Neil Young was the first one to produce a major war protest album. When a 62 year old Canadian gets visibly pissed off before 20-something Americans over a quagmire, clusterf#ck of a war, we have entered an alternative universe.

As I write this, I realize that there has been major protests on college campuses this week due to tuition hikes. However, there was no lasting collateral damage like the Boomer protests in the 60's. On the other hand, I have realized that Generation Y is not going gently into that good night. They are raging in a much more subtle and clever way. The Generation Y revolution is alive and well and you do not need to stop bathing or shaving to join it. What's made it so potentially powerful is the Generation Y revolution is more like the fox that has you halfway digested before you even realize it.

As I write my Generation Y thesis, I also realize that not all Generation Y is the hyperconnected, digitally bar scanned generation that I depict. The Economist wrote an excellent article showing that a good portion of Generation Y is just as digitally frustrated as any other generation. However, there were also a good portion of the Boomers who cursed out building destruction and national guard provoking protests because they prevented them from getting an afternoon snack at the student union. This part of the bell curve is not blogged about and I will not break that tradition.

Generation Y's protest is so clever because they are building a parallel corporate structure that may get powerful enough to defeat today's entrenched corporate interests. They are tuning out and dropping out of today's corporate America and trying to build the future corporations with their entrepreneurial ventures. Rather than learn folk songs and retreat to communes, they are building new web-based communication tools, web-based businesses, and the corresponding work cultures. While they are revolting, they are creating skills that will also make them valuable to today's corporations if they choose. Generation Y had to develop a resume and learn skills earlier than any previous generation. Their revolutionary activities are resume building and their wardrobe is still business rather than psychedelic casual.

I came to this conclusion after throwing my last fit at a Generation Y business idea that caused me to sputter like Daffy Duck at my computer. Over the last few months, I've read much fewer Generation Y blogs because the lack of nutritional content in their posts made my stomach hurt. I lost interest in more tools to organize and throw up more user generated content that served as rationalizations for choices or decisions, comment bait with unformed ideas that begged for others opinions, another analogy that compared some daily job function to sex or cartoons, and recycled how to lists. All the video blogging struck me as being an excuse for being too lazy to write something. Is all this material creating a hockey stick graph of worthless crap on the internet?

However, the producers of this crap seem to have some talent. Others seemed to be really excited about it. Venture capitalists even funded some of it. The Economist article that I linked above explained how Generation Y uses a you tube video that way that I write an essay. It's the same effort to create the content but different medium.

Therefore, I pictured a world where these Generation Y blog businesses and marketing start-ups became revenue-producing businesses. If that happened, I pictured a world where I would produce videos instead of power point presentations or where I had to learn to compress my business communications into 140 character tweets. On the other hand, these Generation Y businesses could fail, video blogging could revert back to only being the primary marketing tool for the sex worker industry, and the world could decide to lose the attention deficit disorder and learn to read more than 140 characters. If that happens, Generation Y dusts themselves off, updates their resume, and more easily gets hired into the current corporate structure.

A revolution that no one knows about after it already declared war is a very clever and potentially powerful revolution. I may have to decide whose side I'm on.

Friday, March 12, 2010

[Guest Post on Untemplater]: Finding Community Intentionally

I am pleased to share with everyone that my first post was published in the Untemplater website today. Untemplater is a work/life style site that shares stories of those who are pursuing unconventional ventures or trying to live a life less ordinary. Personally, I think that can be accomplished by cross dressing at least once per week but the folks at Untemplater have some other ideas, too.

My post is about the juxtaposition between traditional and digital community development and the professional and social paradigms that exist between the two. Or in other words, it's about how I spent 6 months working in a commune and might have never left if I hadn't applied to graduate school beforehand.

If you are interested in reading more, check out my post entitled "Finding Community Intentionally."

Or if you just want to read it below, here is the post:

There are many studies about the importance of a belonging to a community for our general well-being. The value of it hasn't changed but the definition of community is evolving from neighborhoods that hold block parties and church groups to on-line communities that bond around common interests, activities, or fetishes. I found my on-line community at the Business Week Message Boards from 2003-2005 where I made on-line friends, on-line friends that I met in the real world, even found part-time work, and made lots of jokes about how I work with nuns.

As the notion of on-line community has grown, the Community Manager has appeared as a new profession in the field of social media. Decades ago, these folks' best alternative would probably have been cruise ship social directors but now they have a digital calling. While this new notion of community is growing, the old notion of community is still going strong with a little rebranding. This old notion that I am referring to is the commune movement which is still strong and has diversified. Now marketed as intentional communities, it is described on their web directory as:
Intentional community is an inclusive term for ecovillages, cohousing communities, residential land trusts, student co-ops, urban housing, intentional living, alternative communities, cooperative living, and other projects where people strive together with a common vision.

One does not have to leave mainstream society or even move to find an intentional community. While most on-line community managers have only a few years of experience with digital community-building, there is decades of experience, experimentation (lots of experimentation), and culture within the intentional community world. Intentional communities have adopted the digital tools as their directory is on-line and group message boards allow community alumni members to keep in touch. In other words, there are all the tools of the on-line communities in addition to connections based on sharing housing, food, a way of life, or an idea.

One of the classic intentional communities that I've visited is called Twin Oaks, located in rural Virginia. The community supports itself by selling vegetables, tofu, and making really high quality hammocks. I almost abandoned my grad school plans after visiting due a sense of fulfillment that I felt from its members. The community meets Maslow's needs from housing and income to friends and conversation to time and resources to pursue hobbies with moments of self-actualization (like I said, lots of experimentation). The communal lifestyle is not for everyone as members told me stories about how the decision to purchase coffee turned into the most divisive issue since this August's Health Care ReformTown Halls. Half the community thought coffee is an addictive drug and didn't want funds to support the industry while the other half of the community really, really wanted and needed that addictive drug.

Twin Oaks represents the more traditional concept of intentional community. However, for those who resonate with the communal concept but not necessarily the intense debates about their choice of beverage, there are other options in the Intentional Community directory. Communities are forming around the desire for green housing and living as sustainably as possible. There are communities for those who want to dedicate free time to promoting multiculturalism. There are also always communities built around shared meals and shared bulk food purchasing. Food is actually the original community organizer even predating Barak Obama.

My personal story with intentional communities involved 6 months working and living at Innisfree Village outside of Charlottesville, Virginia. I had completed my grad school applications, had 6 months before I started school, no lease, no debts, and no dependents. In other words, it was the perfect opportunity to do something that I would never have the chance to do again. Prior to working on grad school application, I spent 2 nomadic years in South America as a Peace Corps Volunteer so I was looking for something where I could consistently sleep in the same bed.

Located near the foothills of the Blue Ridge mountains, Innisfree (named after the Yeats poem), was created by parents of children with developmental disabilities who were not happy with the existing residential options. Taking advantage of the community movement of the 70's, they created Innisfree where community members would take care of their children and run the community in exchange for a small stipend and option to follow the lifestyle that they wanted to. All members work in the weaving shop, garden, kitchen, wood shop, or do farm work.

My sense of fulfillment came from an international community membership where I heard great Irish accents and lots of German. I worked with the community director to write a successful Americorp grant and learned how to use a pottery wheel and kiln. My typical day was spent gardening, cooking, or using power tools in the wood shop. I met a girl. If I hadn't filled out those grad school applications before coming to Innisfree, I might still be there.

Next time you think about leaving the commute, your job where you create spreadsheets and power point instead of bread and roses, and entertainment options that always seem to involve a screen or monitor, remember that you are not alone. There's probably an intentional community nearby.

Wednesday, March 10, 2010

The Roll Away the Dew Diet Plan!

Everyone has a diet plan. I remember the pasta/carb and low fat diet in the 80's, and the Zone diet in the late 90's. For some reason, not everyone can locate Russia on the a map (you betcha!) but we all know what the Atkins diet is. There's also the grapefruit diet but I have never met anyone who actually was on that diet. After the South Beach diet, I stopped paying attention until recently.

Now, the new diet is the Slow carb diet which I think is an off shoot of the South Beach diet. It involves avoiding heavily processed carbohydrates with a low glycemic index that the body easily converts into sugar. It seems pretty similar to the Cave man diet which is eating like a hunter and gatherer. Hunters and gatherers didn't have heavily processed carbohydrates either. From a dieting perspective, hunters and gatherers also have the huge advantages of sleeping out in the cold (great way to lose weight) and limited food options. Personally, if I were to create a true hunter and gatherer diet, I would tell people to turn off their heat, they only get to eat once per day, have to carry all their food with them, and the food supply is cut in half in the winter.

My primary credential for being able to critique these diets is that I wrestled in high school and was capable of losing or gaining up to 7 pounds in a day. Sometimes I even lost and gained 7 pounds in the same day. In other words, I was able to create a shift 10% of my body weight in a 24 hour period.

I also have a theory that the same subsection of the population follows all of these diets. The reasons they work so well is they dramatically shock their bodies so badly with a radical change in eating habits, that they shed weight as a fight or flight response. Imagine going from eating nothing but carbohydrates to nothing but protein. Then shift back to carbohydrates but the slow kind.

The reason that this subsection of the population is always on a diet is because all these approaches dramatically change the participants eating habit and run contrary to the eating habits of general society (with the exception of those who live in Eastern Paraguay where there are still hunting and gathering tribes). In short, they are unsustainable eating habits. The dieter follows them for a period of time, loses the weight, grows bored with only eating 25% of the available food groups, and goes back to a more conventional eating pattern. They are sick of only being able to order a Chicken Casar salad with no croutons and dressing on the side at restaurants or having to quiz the waiter on the exact glycemic index of the dinner rolls.

Now, criticizing fad diets is pretty low hanging fruit, like Sarah Palin jokes, (you betcha! Sorry, can't help myself). While I am all about low hanging fruit, I also like to take a few steps up the ladder, and offer a different perspective. Therefore, I present the Roll Away the Dew diet:
  • It's all about sustainability. Dramatically changing your eating habits will result in likely long-term failure. It will also probably ensure that you annoy all your friend and family by talking about how you have had to change your eating habits and became the most aggravating dinner guest ever. If someone absolutely craves bagels, than they should not stop eating them and except to be successful.
  • If the diet advertise that you'll lose 10 pounds in the first week, it's not sustainable. While it's great marketing copy, the only sustainable habit that should cause you to lose that much weight in a week, is crystal meth.
  • A pound is 3500 calories. When you consume either 3500 calories greater than your body needs or less than your body needs, your body weight will change a pound. That really helped put weight change in perspective for me. The elliptical machine tells me that I burned 400 calories after being on it for 30 minutes. That unfortunately means that mean that I need to be on that machine for 262 minutes or 4.5 hours to lose a pound. The other side of the equation is what I put into my body. Five 700 calorie cinnamon rolls will add a pound even if I only eat once per week.
  • Small victories. Given the 3500 calorie window, it taught me that having only 1 piece of candy from the office candy bowl, eating the coffee cake in the break room once per week, and only getting a pastry with morning coffee once per week adds up.
To summarize, the Roll Away the Dew diet is a very boring methodical approach where you will lose 1 pound per week. It's not really a diet but a change in eating habits. Recognize what's sustainable and what's not. If a cookie at lunch is one of the highlights of the day, don't get rid of it. Squeeze out other calories by not eating any pastry that wasn't baked that week and comes in a chain grocery store box. It probably won't taste that good in anyway.

To put it in MBA terms, the Roll Away the Dew diet is those incremental improvement processes that reduce the budget by a percent here or percent there through some kind of lean or six sigma production process. It needs to be maintained for at least 6 months to be successful. It's not a big product launch or a huge lay off of workers that moves the share price a few points in one day.

The biggest draw back is there are not immediate small victories to keep someone motivated and it requires a long attention span. That's type of byline isn't going to sell more books. However, at least it's not based on extinct populations who lost the evoluationary race thousand of years ago.

Friday, March 5, 2010

Medicare understands Social Networking even Less than I Do

In the late 90's, I thought that the internet would only amount to a glorified yellow pages. In the early 00's, I wrote "Palm" on a small notebook and called it my Palm Pilot. The way that I would offer to "sync" or exchange contact info with others was to write my phone number in marker on a piece of paper in my "Palm Pilot", lick the other person's arm, and press the wet ink on their arm.

Needless to say, I am not the quickest adopter of new technology or even in the large part of the bell curve. I've written off Twitter after 1 tweet, tell social media marketers to shut up until they can show me the ROI, and have injured bystanders with a hard eyeball roll whenever anyone talks about video blogging.

However, compared to Medicare (the Centers for Medicare and Medicaid Services), I am an innovative early adopter. Medicare just released their guidelines for how Medicare Advantage plans cannot use social networking sites like Twitter or Facebook to communicate with seniors.

Not surprisingly, Medicare guidelines has an early 00's view of social networks and sees them as vehicles to push out marketing talking points. These guidelines are under the marketing section and prohibit plans from using "public interactive features" such as "chat, messaging, blogging, or wall discussions." Basically, they are prohibiting Medicare Advantage plans from using social networks to communicate despite the fact that the next wave of seniors is the largest growing segment of users of these tools. A social network site without interactive features is like a telephone that's not actually connected to the phone lines. It's a nice decorative piece but doesn't tell you much.

Even this Cromagnon cave man blogger has learned that social networking is not about the unsolicited pushing out of marketing messages to a community. It's about creating a dialogue, spreading information, and public discussions. It's a popular communication method that encourages transparency and allows participants to learn more about a company or insurance plan. It offers a variety of mediums like text, pictures, or video which can be helpful to an older population.

Medicare's reaction is ridiculous and disturbing on many levels. First, they show a lack of understanding about social networking by putting in the same category as direct mail. Second, their reaction is to block social networking or attempt to ban the use of it. However, the next generation of Medicare beneficiaries are heavy users of social networking so the agency looks pretty out of touch with the people that it is supposed to serve. Finally, this was supposed to be the year where Medicare starts to get innovative and look at new ways to do business. Instead, they attack an innovation with pitch forks and torches.

My critiques and attacks on social media have the goal of learning more about it and testing my arguments. Through this skeptical approach, I learn more and correct my misconceptions. With these published guidelines, Medicare is showing no curiousity nor interest in finding out the appropriateness of social networking. Senator Grassley may look foolish on Twitter but at least he tries. Looks like when it comes to social networking, Medicare makes a 76 year old looks like an innovator.

Comprehensively Do or Do Pass Health Reform; There is no Incrementally Trying

The previous Republican solutions to health care reform have been to change the definition of uninsured, talk about torte reform instead, talk about immigration instead, and produce torte reform bills that just happen to cover only 10% of the uninsured.

The latest Republican plan was announced at the Feb 25th bipartisan televised summit where everyone was carefully seated in a way that alternated boys and girls. Senator Lamar Alexander announced as folksily as he could that the Republicans favored an incremental approach because we "have proved we haven’t done comprehensive very well in Congress." The only thing missing was the "You betcha."

Congress hasn't done comprehensive well? By what standards? In health care alone, I recall the very comprehensive Medicare Provider Improvement Act of 2008 and Bush's 2003 Medicare Modernization Act. I recall some very comprehensive stimulus packages, credit card reform, and I don't even use my television set anymore. How incremental do Alexander's Republicans want to be? Do they want credit for showing up to work but don't want to strain themselves by being too comprehensive and turning on their computers? Can I tell my boss that I'll happily do an analysis of a problem but I won't actually solve the problem because it's hard to do comprehensive well?

The proposed incremental approach sounded good for about 15 seconds before I realized that it was just the latest version of the Republicans announcing that they are more concerned with their Facebook quizzes and figuring out which Lost character they would be than fixing health insurance.

Besides the abject disinterest that statement reflects, here's why incremental does not work in health insurance. There are 4 main markets or ways that people get insurance which are 1) through employers, 2) individually, 3) Medicare (you're at least 65), 4) Medicaid, (you make less than $14,000/year). Those markets are interrelated so if you make changes to one, the others are effected.

For example, if you do something to reduce the incentive for employers to offer health insurance, more people will enter the dysfunctional individual market with pre-existing conditions. The individual market would have to be changed at the same time to accommodate new entrants.

If insurance companies profitability in one line of business changes, they will have to raise prices in another line of business. For example, if Medicare cuts Medicare Advantage reimbursement by 2% like they did this year, insurance companies have to charge someone else, like employers or individuals, 2% more. And no, with profit margins of 3% and capitalistic and pillaging shareholders, insurance companies are still supposed to make money. Taking the loss is not really a viable alternative and cutting executive salaries would only cover a fraction of a percent.

Growing or reducing Medicaid can have an impact on individual and employer insurance. Bush opposed expanding the State Children's Health Insurance Program (SCHIP) because he felt that it would "crowd out" these private insurance markets. People would elect Medicaid instead of purchasing employer or individual insurance for their children. The "crowd out" effect is debatable but the bigger point is that even President Bush understands that health insurance markets are linked and incremental doesn't work! When President Bush needs to give you a lecture on how health insurance market, that should be an indication that your argument is starting to rank down there with the theory that polar bear farts are the primary cause of melting Arctic ice.

The two planks of the Republican health care reform also stink as bad as polar bear farts. They have held out 1) medical malpractice reform and 2) selling insurance across state lines as guaranteed ways to reduce the cost of health insurance without having to do all this complicated stuff. The CBO did an analysis of Senator Hatch's medical malpractice proposal and determined that it would save $54 billion over 10 years. That's about a 0.5% reduction in the growth of health care costs or what would be swallowed by medical inflation in about 2 months. In other words, this proposal would move health care costs from unsustainably unaffordable to unsustainably unaffordable. Notice any difference? Exactly.

I discussed the 2nd idea of selling insurance across state lines in this post where I called this idea Tweedledumber. At my place of work, I would be the one to analyze the decision to participate in this program and my recommendation would be a no, we do not want people in higher cost states buying my state's insurance plans because it will make my plans more expensive and less competitive.

With Republicans using their patented wide stance technique to piss away the chance to fix health insurance, it makes me yearn for a real conservative party. Since I spend more time reading the Economist than I do looking at my Grateful Dead bootlegs, I can now appreciate a good conservative fiscal policy. I'm still a big D Democrat due to my belief in spending to preserve a safety net and socially, I think that there should be national days of cross-dressing. However, I have stopped agreeing with everything Dennis Kucinich says. This Republican party does not provide a viable alternative and their dismissal of health care as a relevant issue is not something that I can easily forgive.

Obama's push to pass this bill through the reconciliation process regardless of the political fall out that he may face, both impresses me and makes me want to have a lighter ready the next time he goes out for a smoke. I now finally understand what he means about being a good one term president as opposed to a mediocre two term president. He would rather do the right thing with a comprehensive health care reform than just follow the polls incrementally.
Related Posts with Thumbnails