June Mount Adams Climb in Winter Conditions

At the end of this June, I led three friends up a south side route of Mt Adams. Only one of them had climbed a glaciated peak before and towards the end of our first day approach, I was worried that this climb might kill them and I would lose a few friends. Luckily, everyone adjusted on the 2nd day and we all made it to the false summit at 11,600 feet. Two of us summited. Their difficulties were probably driven by the fact that this was the first time they had backpacked up elevation in the snow. I think that our bodies have an initial defense mechanism to prevent us from doing that by creating extreme muscle fatigue.

Despite the end of June date, we had to do the winter route of the south side of Adams since there was that much snow on the ground. That included hiking an additional 3 miles to the parking lot which contributed to the excessive first day for all. It wasn't even a leisurely 3 additional miles as it involved some trail finding, setting compass points, and snow whacking.

Prior to leaving, we also had a lively discussion about whether to bring snow shoes or not due to soft snow in the late afternoon. We did and were very happy since we were on the soft snow in the late afternoon. If a group can make good time and get to their destinations while the snow is still firm, then snow shoes would not be necessary.

In the summer, the south side route typically is west of Crescent Glacier. However, from the photo below on the left, one can see how the enormous cornice (aka overhanging shelf of snow) made that route too dangerous. Therefore, we took the route from the photo on the right which was east of Crescent Glacier up the unfortunately named Suksorf Ridge.














The route up Suksdorf ridge was fairly straight forward and one can see the boot tracks in the photo. It ends at the Lunch Counter (9,000 feet elevation) just like the typical south side route. However, we camped at around 8,100 feet of elevation at a wonderful spot that had a flat area for 2 tents and 1 kitchen area. There were numerous quiet campsites on the way to the Lunch Counter which provided a rest from the additional 3 miles on the snow covered forest road.

The next day, we left camp at 6 am and headed up the south route. We were extremely fortunate that the snow conditions preserved a pristine set of steps all the way from the Lunch Counter to the False Summit. We made it to the False Summit by 10:30 and it then took two of us an hour to make it to the last 600 feet to the top (pictured below):

That's Mount Rainier in the background.

Be the Change that you can Abdicate to Others

Not quite the snappiest title like "Be the change that you see in the world" which is both a popular bumper sticker and looks good on the back of graduation T-shirts from social work programs. However, I like the word "abdicate" as much as I like the word "colonoscopy" and it's easier to spell.

The fact that I completely digressed before I even started writing the post is completely impressive, too. I can't even use "But I digress" as a transition. My point is that local governments are running away from making any difficult decisions in designing health care systems. Their lack of boldness is making Wisconsin governor Scott Walker's decision to declare war on organized labor look good because at least he made a decision and stuck to it.

The state of Oregon has provided some very fine recent examples of such abdication with their Medicaid program. Rather than make difficult, thoughtful decisions to guide the program, they throw half baked ideas to health plans and providers. They are:

1. Charge copays for services. The state gave the option to charge a $1 to $3 copay to non-Native American adults for prescription drugs and primary care. This was intended to reduce the amount of money that the state paid for services by passing on the costs to the Medicaid beneficiaries. However, trips to the emergency room were still no cost to the Medicaid beneficiary. In an effort to save money, the state made an incredibly poor benefit design decision and and as a bonus, set up in a way that was difficult to administer. Providers would have to figure out who they could collect $1 to $3 from and what to do if that individual did not have any money (like send them to the Emergency Room rather than give them their $4 generic prescription drugs).

Almost all the carriers decided not to implement this copay scheme and just take less money from the state. This is an example of a bad idea to save money that the state floated to health plans and providers. It went over like a lead zeppelin. This was an opportunity to have a serious discuss about benefit designs and what Medicaid beneficiaries should pay for and what they should not pay for. Incentives could have been developed to guide positive behavior and punish negative behavior. Instead, an administratively unwieldy option was offered to punish positive behavior. The end result was a waste of time.

2. Ask health plans what the reduction in Medicaid costs should be: Oregon is facing a budget shortfall and has stated that it plans to reduce Medicaid spending by 19%. Another option is increase the provider tax in order to get more federal matching funds and face a 10% to 12% reduction. Oregon also has a rule that its Medicaid spending must be actuarial sound. That means if they want to cut costs by 10%, or 12%, or 19%, then the health care services used should also be projected to reduced by that same amount. This also provides yet another example of how actuaries are guaranteed employment forever.

Oregon has proposed some good ideas to redesign their Medicaid system to achieve those savings. However, they don't think that they can achieve the savings this year. They are squandering a perfectly good crisis and asking health plans to come up with their own actuarial sound analysis of the lowest cost to provide health care services for Medicaid beneficiaries. In other words, they are asking health plans what the cut in spending should be. This is a crucial decision in Oregon's Medicaid program and they asking health plans to do their homework for them.

A budget cut is just a loss of services but a budget cut and a health care system redesign is an opportunity. Under health reform, states have more options available to transform their health care system with Xxchanges that will allow them more control over the health insurance market. There are "pay or play" options where carriers must participate in Medicaid or providing guaranteed issue to children or face a financial penalty. This is the opportunity for bold and difficult decisions for states to make that will change the lives of their most vulnerable citizens.

This is not the time to buy a vowel.

Are ACO's DOA?

A lot of people have been staking the future of health care on the idea of Accountable Care Organizations (ACO's). President Obama thinks they will reduce health care costs, providers have been reorganizing to take advantage of the opportunity, and bloggers have praised them. Even the event planning industry loves them as it has spawned a whole new line of conference opportunities.

To those who have not been following the ACO's like fantasy league baseball owners follow spring training, an ACO is an old idea that aligns the financial incentives of providers and payers. It provides a global budget for managing the care for Medicare beneficiaries. This rewards providers for efficient health care or keeping patients healthy rather than lots of invasive procedures. Medicare projects that it will save $510 million over a 2 year period. However, the release of the proposed ACO rules by Center for Medicare and Medicaid (CMS) at the end of the March had the same effect on the party as urine in the punch bowl. Or as my blog title foreshadows, it's like Weekend at Bernie's 2 where providers realize that participating in an ACO is like partying with a dead guy. It's a lot of work, not a lot of fun, and starts to smell after a while. In summary:

Lots of work: To participate in an ACO, providers will need more reporting, IT systems, have to develop some insurance functions, and build up the infrastructure to better track patients health. This is not unexpected and was part of the ROI analysis. What pushes the amount of work over the edge is the governance requirement. There must be a separate Board of Directors that runs the ACO that includes patient representation. This is a common aspect of Federally Qualified Health Centers and also the most challenging requirement to meet. Creating a separate governance board with complete control removes a lot of control from the providers who are launching a new venture. It's not easy to give up control of something that requires this much investment.

Not a lot of fun: The fun in ACO's was the opportunity to get paid more treating Medicare beneficiaries through shared savings compared to a benchmark. However, CMS took away the fun or opportunity to make more money by doing the following:

• The benchmark or cost target that providers have to beat to make additional money is the current Medicare benchmark for the geographic area. For providers in the Northwest where benchmarks are very low because they are historically low cost areas, that means limited opportunity. For providers in Texas and Florida, where the benchmarks are very high because these are expensive areas, there is opportunity. However, these providers get paid enough by Medicare already so there is not the incentive. In other words, providers that are well-organized and poised to form an ACO have little room to get additional money. The wide variation in geographic payment for Medicare has been a continual problem and removes a lot of incentive from the ACO.
  
• CMS also keeps the first 2% of any savings. Therefore, providers have to lower costs by greater than 2% in order to get additional payment. Or yet another barrier to participation. That's like having to watch Weekend at Bernie's 2 before you get to watch the first one or just turn off the TV.

Smelling like a corpse: Given the current structure, there is a risk that no provider group will apply to the ACO's. The current rules went over like a fart in a spacesuit to the 10 provider groups that participated in the original Physician Group Practice demo. If those provider groups who are the most likely to be successful aka make additional money in this model don't participate, who will? This would be a large blow to the Obama administration's vision of designing a more efficient health care system.

Hope or Yes we Can: It's too easy to write a critical blog post about how a new idea in health care might not work. Any blogger who writes such a critical post should either balance it out with a solution or some really good colonoscopy or animal husbandry jokes. Since I don't have any new jokes, I'll pick the solution option.

Despite the fact that CMS has made participation in an ACO as appealing as a colonoscopy, this model represents the best solution to the US health care system. The fee for service model has proven to be unsustainable. Others besides CMS, like large employers or unions will start to demand this type of model from insurance companies and provider groups. While the revenue opportunities in an ACO are not good, there are not any better revenue opportunities elsewhere. Provider groups can no longer compare opportunities to today's payment but should compare it to the future payment opportunities. Provider groups who can organize under an ACO structure and lower health care costs will be more viable in the future. Those who cannot and expect to continue to be paid at today's levels will become just like the main character/corpse in Weekend at Bernie's.

Provider groups best option is still the ACO model. If CMS can't develop a good structure, that presents the opportunity for the health care industry to develop its own.

Roll Away the Dew is Speaking at the Society of Insurance Research Conference

It's road trip time at Roll Away the Dew. Well, actually it's just a plane trip with a connection in Altlanta, on the way to Jacksonville, Florida where I will be speaking at the 40th Annual Society of Insurance Research Annual Conference (SIR A.C.). Did you know that Jacksonville is the largest city in terms of square milage in the lower 48 states? That actually sounds horrifying me to as an example of uncontrolled urban sprawl that we don't see here in Oregon with our Urban Growth Bounderies. However, I did hear very positive things about Amelia Island and Florida in November is not something to look down at.

Readers may be wondering what Roll Away the Dew could pontificate upon for 45 minutes. How many colonoscopy or animal husbandry jokes will the speech include? Will the inmate and asylum analogy continue? Will familiar topics of MBA's behaving badly be broached or will this be a pure health care focus on the strengths of the Medicare Advantage program, the dysfunctions of the Individual insurance market, or the future of Accountable Care Organizations? Will the words, MediCAID for all be uttered and for those guessed this topic, you know Roll Away the Dew way too well!

Actually, I think that I need to make a "MediCAID for All" T-shirt for the conference. I will be speaking at the newly created Health Insurance track for the Society of Insurance Research. My topic will on the business opportunity that health reform created for Medicaid managed care companies. If there is a health care organization that can afford to ignore a market that is going to almost double then I want to see your business model. That's because that health care organization must be performing at a very high level in commercial, Medicare, individual, self-funded or other aspects of health care to be able to ignore 25% of the market.

If you want to hear more about my presentation, come to Jacksonville, Florida from November 14th-17th. I hear that the Property and Casualty insurance guys really know how to party. Another option is to just wait until after the conference when I'll do a full postmortem on my site.
Before I do that, I think that I really need to make myself a MediCAID for all T-shirt.

The Guards take over the North Gate: The battle for the Asylum of Health Reform Rages On

In the battle for the implementation for the first provisions of health reform, I will continue to beat my inmates battling for control of the asylum analogy like an actual inmate probably used to be beaten in an asylum. In the latest battle, the guards or the government agencies like the Oregon Insurance Division have beaten back one of the craziest inmates.

This inmate in question is Lifewise of Oregon, a subsidiary of Premera, the Washington Blue Cross/Blue Shield company. Lifewise typically acts like Oz's Ryan O'Reily. They don't look very strong, kind of wiry, but are devious and will not hesitate to do whatever they need to win. Lifewise's interpretation of guaranteed issue for children 19 and under or no longer denying coverage due to pre-existing conditions was that they could wait until September 2011. However, the law states that this provision must go into effect September 23, 2010. The Oregon Insurance Division informed Lifewise that all new sales of individual insurance plans would be suspended until they complied with the law. Lifewise also needed to comply by the end of October so they could participate in the first open enrollment period for children 19 and under.

Lifewise's defense was "that it is in alignment with the “good faith” provision of the U.S. Department of Labor FAQ (dated 10/8/2010),which provides issuers a reasonable period of time to come into compliance with the requirements of the Act". In other words, they would be happy to comply but would do it later. This is the same defense that young children use to avoid cleaning their room, high schoolers use to avoid doing their homework, and college graduates use to avoid moving out of their parents' house. I think that only college graduates are moderately successful with this defense.

Technically, Lifewise files their individual plans in September which is why they though that they could wait until September 2011. They planned to continue to deny coverage to children under 19 with pre-existing conditions until that date. However, there is nothing in the law or general field of logic that supports this conclusion.

Forcing an insurance carrier to not flagrantly disregard a health reform provision should not seem like a victory. However, if Lifewise's behavior was allowed to continue much longer, it would have been much worse. It would have provided every other insurance carrier with a complete disincentive to comply with health reform or made the future riots even worse.

Oregon Health Insurance CEO Forum: Lame and Lamer

Last year I attended, the Oregon Health Insurance CEO Forum and noticed some excitement in the air around some new developments such as cost transparency, value-based benefit design, and the importance of caring for children. This year, despite their very industry being turned upside down, they talked about popular health care topics from the 80's and 90's. That was the lame part. The lamer part was four CEO's including the CEO from local Blue Cross, Regence, which used to have the largest market share, didn't attend. Considering the unpopular decisions their plans were making around not providing access to insurance for children, it was not very likely that their absence was because they were receiving humanitarian awards elsewhere.

First, the Lame:

• The popular topics from the 80's were around capitated arrangements with providers where the primary care physician manages medical costs and how 10% of the population uses 70% of health care costs. The Cigna Northwest Region CEO, Chris Blanton, still wanted to talk about how employer groups should play an active role in driving health insurance change. The only thing that was missing from his 90's flashback was flannel as employer groups are either currently pushing the innovation to the limits of what their employees will accept or scrambling to understand the post-health reform environment.
• To further underscore the stock shorting performance of Cigna's Blanton, he did a poor job of hiding the smirks on his face when questions were asked such as what did everyone think about Health and Human Service's (HHS) assessment that health reform would only increase insurance prices by 1%-2%.
  
• Robert Pallari, the former CEO of the Portland-based Legacy Health System and architect of the Oregon Health Plan was the moderator. He was also formerly colorful and bombastic as he lobbed soft ball questions like "Look into your crystal ball and tell me what you see in the future?", "How will health reform influence your organization", and "What type of partnerships are you pursuing with providers?"
• Actually Pallari did blatantly insult the Kaiser Permanente CEO, Andy McCulloch, by pointing out that the Kaiser system has been as much about setting up barriers to health care as it is about providing care. Perhaps, McCulloch was too distracted by Banton's smirking or thinking about who play 3rd base for the Cleveland Indians in the 80's since his expression didn't change at all. Nor did he respond.
• During this forum, the battle for the future of the individual insurance market was raging, the payment process for Medicare and Medicare Advantage is being completely revamped, and the new health reform provisions had been effective for 5 days. Three of the CEO's were trying to decide if their individual plans should remain open to children while Cigna and their Chief Smirking Officer had already decided to close their plan to children. Yet not one question was asked about insurance for children. Last year, CEO's couldn't talk enough about how important it was. I badly wanted to ask the question but I recognized that it would a CLM (Career Limiting Move). Next year, I'll find a plant in the audience to ask questions like this one.
  

There were some bright spots:

• ODS CEO Robert Gootee did have the great line of pointing out that we "can't drink our bath water and call it champagne" about some of the more egregious performances.
• Gootee also called the Secretary of HHS and Middle Finger Extending Kathleen Sebelius by the name, "Kathleen Celibate". That would explain a lot. Actually, I talked with someone who worked at HHS who did vouch for Celibate's er I mean Sebelius's administrative skill. That person also pointed out that just because she has been launching the political attacks doesn't mean that she wrote them or necessarily believes in them. It's just politics.
• My main conclusion from last year's forum was that we should let our children grow up to be actuaries. This conclusion was proven again by the presence of the PacificSource Chief Operating Officer, Sujata Sanghvi, who is a Harvard educated actuary!
  

And the Lamest Aware goes to:

• While the CEO's that did show up gave lame performances, at least they came. Well, Cigna's Blanton could have just sent a 12 year old boy to smirk for him so I don't give him credit for attending.
  
• On the other hand, Lifewise, Health Net, United, and Regence sent no representatives. They all have announced that they are no longer offering child only coverage in the individual market in the last few days so their lack of attendance is probably not a coincidence.
  
• Lifewise's membership has been dropping like acid at Woodstock, Regence has lost their 2 largest group accounts in the last 2 years and 40% of their group enrollment, Health Net is trying to sell itself, and United is well, still United. Given how badly these plans are currently doing, I can't imagine that they would have many great ideas to share. Perhaps it's best that they did not attend.
  

Getting a Seat at the Executive Table

We all have stories about bad experiences with employment recruiters, traffic, and eating too much at In-N-Out burger after midnight. We love to tell the stories but have no interest in listening to others. That's why blogs are great tools for providing those needs that are only at the very tip of Maslow's Pyramid.

I have learned that I am an attractive candidate for jobs because I am currently employed. Online dating doesn't even produce as bizarre relationship dynamics as employment recruiters. They seems to covet most what they can't have (the currently employed) and doesn't want those who want them the most (the unemployed).

I habitually apply to jobs at other companies as a networking technique. It's part of the Generation X shark mentality where we need to keep swimming in order to stay alive. It keeps my resume fresh and my interview skills sharp, I meet people at other companies, and learn about opportunities. Some would argue that this is a terrible approach because the transaction always involves the word no. Either I say no to an opportunity or the company says no to me. However, I no longer become just another application to the recruiters and hiring manager for any future opportunity.

Therefore, I applied to a job at a company where I used to work to gauge my market worth and network with a new department. On Tuesday morning, I had an interview scheduled with a lead manager and vice president. On Tuesday afternoon, I talked with the recruiter. By Tuesday evening, I had no interviews, a fairly difficult questionnaire to complete, and the job requirements were changed. Not surprisingly, I considered this to be a fairly negative interaction with the recruiter. Here are the details:

• The recruiter was waiting for the results of a questionnaire that she thought that she had sent me. But she had actually forgotten to send it which created a problem. If I did not complete the questionnaire before interviewing, then one could question the value of it. Therefore, she had to preserve the process and cancel the interviews.
• One should question the value of her questionnaire. It combined the obvious details (Are you eligible to work in the United States) with the vague (Describe your experience in consulting, health care, project management, data analytics, and reporting. In other words, Tell me about yourself).
• The recruiter's biggest concern was that I had not been fired from this employer previously. She was very good at zeroing in the obvious. To be fair, I've learned that people do like re-applying to companies where they exhibited the impulse control of a meth addict and the ethic of an Illinois governor. However, she had access to my file and could have easily answered the question.
• Poor grasp of geography. The recruiter's concern was that I work in a region where they do business which could have been addressed with a compass and a road map. Actually, you don't even need the compass.
• She closed by telling me that they had numerous qualified candidates already implying that she was doing me a favor by talking with me.

From reading Human Resource and employment blogs, I can even guess the defense from other recruiters. They could point that if they didn't need the information, they wouldn't have asked for it. All candidates have to follow directions and they won't go on a scavenger hunt looking for where we live or our employment files. It's their job posting so we follow their rules.

However, it was fairly clear to me that the recruiter was late to the game in the hiring process and had to stall or she would have lost control of the process. The recruiter's value-add would have been questioned. My blog is the one place in this world where I get to be judge, juror, and executioner (even when I babysit my 2 year old, I don't have that power). Which leads me to my main point that recruiting or human capital management has to have their basic operations in place before they can ask for the seat at the executive table. That step is still being skipped for those looking to transform Human Resources.

At my organization, I have watched responsibilities and budget steadily being stripped from Human Resources when they could not meet their objectives. When they lost applications, they were forced to focus on application management for basic positions and executive recruiting was removed. When they showed improvements, they were steadily given back responsibility. While basic blocking and tackling doesn't provide great fodder for recruitment and Human Resource transformation, it can prevent future business leaders from giving those assignments to the Human Resource department.

Olympic Penninsula: Marmot Pass and Buckhorn

Our most recent climb was near the Quilcene Ranger Station in the northeast part of the Olympic Penninsula. A friend recommended Buckhorn Mountain near the Marmot Pass as a good peak to scramble up to enjoy the views of Mt Constance, Deception, and Mystery and some potential wildlife. To the left is a picture of the Marmot Pass, a 6000 foot trail intersection.

When we arrived at the Big Quilcene trailhead (#833), there were quite a few day hikers that I would characterize as a good representation of the Medicare Advantage demographic that I have blogged about. When they talked about their day hike to the Marmot Pass, I started to wonder about my selection of an overnight backpacking trip or fear that these seniors were getting steroid prescriptions instead of Viagra.

The Big Quilcene trail is well-marked and follows the Quilcene River. After 4 miles and 5500 feet of elevation, I reached Camp Mystery which was my intended campsite. Camp Mystery is not marked but there are several obvious campsites with flattened areas, sitting logs and nearby water sources. According to the climbing guides, I could either scramble up the scree slope pictured below and to the left or hike towards Marmot Pass for a southwest ascent. Summit Post recommended the scree scramble so I followed that web site's advice.

The scree slopes were steep. I looked for an opening among the trees at around 5300 feet of elevation. I followed what I thought were other climbers' tracks through the scree but was probably goats. It was steep, like quick sand, and pretty painful. I moved towards the southwest corner since the slope looked more forgiving and I was hoping to find that trail to Buckhorn Mountain (pictured below to the right).
















I happily took the trail the rest of the way up and was glad that I did not have to go down the scree slopes on a return trip. I told myself that the scree slopes were a good way to avoid the fierce marmots who surely must inhabit Marmot Pass. Luckily, there were no wildlife sightings in camp as I had heard that bears visit Camp Mystery. Only wildlife incident somehow involved the nuts that I left in the car being eaten and the bag being torn up. Next time, I'll take the path most traveled and leave the scree slopes to the goats.

Idealizing Rural Life in Southern Oregon

I have lived in rural South America and rural southern North America for a total of 2.5 years. Therefore, my idealization has an actual foundation. This is different than my idealization of spending a week in an opium den in Morocco which is grounded in fantasy from watching Naked Lunch.

I can't exactly put my finger on why I idealize rural living. I've spent some time in fields doing subsistence farming, know that night time entertainment options are drinking around a smoky charcoal pit, and trudged down muddy roads to get supplies so I know the less glamorous sides of it. I realize that I obviously like solitude, don't mind seeing the same people all the time, like that you can talk to strangers without creating suspicion, and probably really like the big open sky, towering forests, and foothills. The rural country store that includes a seating area, random religious-based gifts or folding knives and lighters that are decorated with screaming eagles also appeal to me. They're vaguely reassuring like the consistency that one finds in a Starbucks.

There were the feelings that I had in my rural Southern Oregon road trip this week. Despite bad weather conditions and snow levels up to 5000 feet, I drove out to Klamath Falls for some hiking and climbing. K Falls, its nickname that is too good not to overuse, looked beautiful as I approached the town. On the upper Klamath Lake, with Mt Shasta and McLoughlin in the background it changed my spirits. Kind of like approaching Philadelphia with the view of the Sunnoco refinery also changed my spirits but in the opposite direction.

Due to the conditions, I only attempted to scramble up Union Peak off route 62 near Crater Lake. The Pacific Crest Trail (PCT) was well marked so the fact that it was covered with snow wasn't a problem. At the right elevation, I picked a compass path off into the snow to find Union Peak. As I write this, I'm trying not to sound like I'm high fiving myself for my mad navigation skills.

Union Peak was steep and snow covered as I had expected. I kicked some footholds and punched hand holds halfway up the peak before snow conditions got worse and I descended. The picture on the left is Union Peak and the picture on the right is the view of Mt McLoughlin on this overcast day.














Given the weather, my next stop was the North Umpqua Hot Springs for a soak. The fact that someone built a shelter and carved this hot springs out of the stone is another reason I idealize rural life. Low population density and lack of foot traffic give incentive to build free public facilities like hot springs overlooking a river.















The hot springs is not clearly marked from the gravel road. It's 2 miles from the fork of route 34 and I noticed it because of another car parked on the road. There were a few people camping around there so look for signs of life or partying. After parking, cross a log bridge with no hand rails, head right and go up the hill that do have hand rails.

Portland, Where you don't gotta dance with them that brung you

Molly Ivins was right about politics when she wrote, You Gotta Dance with them What Brung You. That phrase usually applies to dancing too. However, I've got to say that the dance scene in Portland, OR is unique where you can dance with anyone anywhere.

Publications have praised Portland's beer, wine, spirits, food carts, bicycle lanes, quality of life, strip clubs, greenery, volcanoes, and hospitality. I'm here to praise the Portland dance scene which is not something traditionally praised in a city with a population that is 74% white. However, there is a sizable Cuban population in this town that has resulted in a good salsa scene. Someone told me that Cubans who don't want to settle in Florida are given a choice of resettlement assistance in Portland or some towns in upstate New York. I haven't been able to confirm this. Portland also ranks 12th highest in number of refugees who must be attracted to some combination of the Portland dance scene, beer, strip clubs, or bicycle lanes.

In Portland, I've danced salsa, belly, contra, and Irish, Macedonian, and Israeli folk dancing without even trying. It's lively dance scene that is easy to find and access. Last week, we attempted to find some contra dancing but stumbled upon Israeli folk dancing instead. We stayed and tried to keep pace with the class that had been dancing together for some time. What made the dance so accessible is that the class was composed of people who one would not typically expect to see in a dance class. The class was made up of the very young, very old, and very stiff and slow moving. My only complaint was that one of slower moving dancers had a very quick digestive system if you know what I mean. Fart smells aside, it was really great to such a variety of people dancing.

It's part of a unique dance scene that is as open and inclusive as your average pro gay marriage ballot measure. I'll raise an organic microbrew to the Portland dance scene and ride my bike from the latest food cart that was open by a graduate of culinary school to find the latest folk dance movement. This open and inclusive dance scene should also be as praised and publicized as anything else that the New York Times has made famous in Portland.

Don't Let your MBA Suck the Soul Out of you Hobbies

The latest issue of my Wharton alumni magazine arrived a week ago. As usual, I looked at the class news sections to see who wrote about their new job using nonsensical corporate buzz, investor relations pitch, and rationalizations. For example, "I am starting my own long-term, early stage mezzanine fund with a focus on transforming legacy systems in emerging economies to dynamic, nimble, green-based cloud systems. I work 18 hours a day and drink my own urine because I don't have time to drink and go to the bathroom but I wouldn't trade this experience for anything!"

After that enjoyable perusal, I saw an article about Lei Wang's attempt to become the 10th person in the galaxy to climb the highest peak on each continent and ski both Poles. Wang's background makes the story even more incredible. I also knew Wang, was a classmate of hers, and saw Luna in concert with her (another example of her sense of adventure). I like her but hate her climbing philosophy. I hate the sin but love the sinner or in more modern parlance, I won't hate the playa, just the game. I ain't no playa hata but I am going to criticize her quotes in the article. This does not mean I am critical of Wang herself and everything that she has done.

This is part of the larger issue of MBA's who take the fun out of any hobby. They are not content to have a leisure activity but need to be the best at the leisure activity and establish metrics to dominate that leisure activity. These metrics are pursued with the intensity of a quarterly earning reports where it is not enough to meet analyst expectations. No, the ideal MBA will attempt to kill themselves with exertion to meet those metrics or even better, or achieve the holy grail of exceeding them. An MBA will not just take up knitting and maybe make a scarf and hat or two. An MBA must knit a wardrobe for a small village while starting a side knitting business that will be taken public.

Wang is guilty of this (but I'm not being a playa hata it's for illustrative purposes of a larger problem). I had previously read she wanted to initially accomplish her goal by the 2008 Beijing Summer Olympics. That's because MBA's don't just like to accomplish incredible goals in their lifetimes but they like to finish them early. The Wharton magazine article talks about Wang battling hypothermia, food poisoning, and fire breathing dragons with big swords in an effort to summit. This is actually a bigger issue of climbers making bad decisions to reach the summit rather than try another day. Or, the desire for MBA's to push their bodies to the absolute limits for their hobbies. There is no distinction in effort between jobs, relationships, or hobbies. If an MBA became a monk, they would pray and chant harder than anyone else in order to achieve enlightenment by year end in order to achieve first mover advantage in their cloister.

I've been climbing for about the same time as Wang. Last summer, I backpacked to the beautiful Lake of the Angels in the Olympic Penninsula to climb Mt Stone, a modest 6,612 foot peak. I tweaked my ham string during the hike and decided not to climb. Instead I enjoyed the lake, goats, and hiked to the top of a ridge to enjoy the views. The mountain will always be there, I'll have the vacation days, and I can climb it when I wouldn't risk my safety. I preferred to climb the 10,778 foot Mt Baker for a glacier experience rather than the 14,411 foot Mt Rainier. The reason is that the glacier travel experience on Baker is similar to Rainier without having to gain 5,000 feet of elevation for the approach. The "prestige" of climbing Rainier is not worth it for me. I take climbing classes, I take opportunities to improve my skills, and I enjoy climbing as a hobby. It's not about achievement for me.

Future MBA's, remember this when you first experience the powerful force of hundreds of MBA's together in a small building. Placing all those type A personalities in one room violates a law of physics since energy gets created in greater quantities than the mass that produces it. Or something like that. Channel that competitive spirit into appropriate places like your job, career, or philanthropy. If you like to jog, you don't have to run an iron man marathon. If you like to write, you don't need to publish a best seller in 5 languages. If you like to snort cocaine, you don't need to inhale a small Colombian jungle.
Don't let the MBA competitive spirit consume your soul by taking over your hobbies.
And Lei, congratulations, on your climbs.

Powerful Medicine: Cross Country Skiing in Glacier National Park

Native sacred sites are often natural scenic treasures of such beauty that they make you want to quit your job and move your family to be near to them. The power that radiates from their rushing waters, towering stark stone, or impossibly green vegetation make it obvious why native populations believed that area to be inhabited by their gods.

Machu Picchu in southern Peru and Iguazu Falls on the Paraguayan, Brazilian, Argentine border were the first natural sites where I felt the presence of a higher power. Glacier National Park in Montana created a similar feeling. Previously when I thought of Glacier National Park, I thought of the poor melting glaciers and the only reported incident of a bear actually eating and digesting a human. Now, I fully understand why the Blackfeet and Flathead tribes hung around the area.

Switching to how-I-spent-my-spring-vacation mode, we took the Empire Builder AmTrak train on a 16 hour train ride to Essex, MT.

The town of Essex pretty much consists of the Izaak Walton Inn where we stayed in a refurbished blue locomotive engine pictured to the left. While it may look rustic, the locomotive engine had two fire places and a flat screen TV and DVD player.







When we weren't playing in the locomotive's intact engine room where we could pretend to drive the train, we covered 10-12 miles per day on cross county skis

The river (McDonald Creek) and mountain combo on the left is off the Going to the Sun Road which is the Covered with the Snow road in the winter. The starting point is the immense Lake McDonald.


On the right is the road to Two Medicine on the eastern edge of the park. The enormous mountain pictured is called Rising Wolf. With the name, imposing face, and the stillness of the area, I really would not want to do anything to anger this mountain.



Some may feel that I obviously spent too much time hitting the peace pipe in college with my comments on spirituality and powerful medicine.

However, the story behind the picture on the left will make even the most hardened pragmatist believe in a higher power. Located in the Two Medicine area, it's called Running Eagle Falls and is the burial site for a great female warrior. The frozen ice in the middle of the water fall looks like a heart.

The final photo on the right is for any readers who need something more tangible or have mocked vomited for the last time because of all my spiritual references. It's a story of steel, rail, commerce, manifest destiny, and taking credit for Native American discoveries. This photo is from a trail near Marias Pass which is the lowest point in the Continental Divide. Marias Pass is the reason for the financial success of the Great Northern Railway (or success until Warren Buffet recently bought it). Since the grade was not very steep due to the lower elevation of the Pass, the railway could operate more efficiently and less expensively than competing transcontinental railways.

The success of the railway led to the the opening up or rediscovery of Glacier National Park and my spiritual journey about 120 years later.

It's about to get even nastier in the health care industry

This summer was a pretty nasty time for the health care industry. The only thing that was missing from the angry Town Halls was pitchforks and torches. Their absence was probably only due to the fact that people don't own pitchforks anymore or know how to make a good medieval torch.

The next series of developments has the potential to make the Town Halls look peaceful.

Hospitals and insurance companies have had a truce for about a decade. Hospitals consolidated and gained enough market power to get paid what they wanted from insurance companies. Insurance companies had no more leverage and for the most part paid hospitals what they wanted with modest discounts. Ugly battles like the 2001-2003 struggle between Sutter Health System and Blue Cross of California where both took to the air waves to denounce the other as greedy were rare.

In the Pacific Northwest, the health care wars are starting again. Health Net, a large west coast carrier with about a 10% market share in the region, struck first in Central Oregon. Central Oregon health services are controlled by the Cascade Healthcare Community (CHC) hospital system. Most of all health care services in that part of the state from surgeries to bed pans flow through CHC's hospitals. Central Oregon also has some of the highest health care costs in the state and CHC spends more time worrying about flossing than their reimbursement negotiations with insurance companies.

Health Net added an additional 10% to the price of their health insurance plans in Central Oregon and attributed the increase directly to CHC. Just like Sutter and Blue Cross, they took their negotiations public and accused the CHC hospital system of making their health insurance plans 10% more expensive than the rest of the state.

The second blow was struck this week by Lifewise, a smaller health insurance plan with 75,000 members and a relationship with Premera, a Washington Blue Cross plan. Lifewise accused the Portland-based 5 hospital Legacy Health System of making just too much money. Specifically, they issued a press release that the hospital system was making a 30% profit margin on services provided to patients with Lifewise health insurance. In this era of bonus and greed scrutiny, the publication of a 30% margin is not accompanied with a Company of the Year article but speculation of a Congressional investigation.

To be fair, hospitals generally make these types of margins on services provided to patients with private insurance since they lose more than 30% on patients with Medicaid and get paid little for services provided to uninsured patients. Hospitals probably break even at best with Medicare patients. Therefore, hospitals need a healthy margin on patients with private insurance to make up for losses on patients with government insurance or no insurance.

Hospital margin by line of insurance will likely become public knowledge because this is probably only the beginning of some renewed very public battles between hospitals and insurance plans. This can also be called the first unintended consequence of health care reform. There will be less money flowing into the health care system in the future so stakeholders are already positioning themselves to lose as little as possible.

The previously opaque negotiations between health care intermediaries will become increasing acrimonious and public. Which is unfortunate since a more systematic approach with closer cooperation between health care stakeholders is what is really needed.

Mt Hood rescues, Locator Units (MLU's), do you need a rope, and how tough is it to climb

Unfortunately, there has been a winter climbing accident on Mt Hood. Two climbers are still missing on the west side of the mountain near Reid Glacier and one was found dead. It's always heart wrenching to hear these stories. No matter how many times that I climb Hood (3 times), I am still drawn to it and plan to climb it this winter. I always hope that my training, conditioning, and safety measures will get me down safely. After that, everything else is out of my hands.

Whenever there are these highly publicized accidents, 2 questions emerge in the media which are:
1. Why aren't all climbers required to carry Mt Hood Locator Units (MLU's) or other tracking devices?
2. Should climbers have to pay for their own rescues?

Portland Mountain Rescue, a volunteer organization of highly trained rescuers and educators, answered both questions very well in their press release. However, I will elaborate on the first question since I think that it's a hard one for the public to understand and climbers have a hard time explaining it.

There are limits: MLU's are little boxes worn on a strap that is carried outside someone's jacket or backpack. They only work on Mt Hood where sensors are set up, the climber has to activate the signal, and this signal is only detected if someone is actively looking for it. It's not like a bat signal that goes out in the sky when there is danger. If a group is taken by surprise by an avalanche or the person who is carrying the MLU falls and is knocked unconscious, the signal will not be able to be activated.

It is not the most important piece of equipment: The other limits to MLU's is that it doesn't create an instant rescue. A climber needs warm clothes, food, or a bivy sack to survive cold conditions. Even better, the climber should have rope, pickets for creating anchors, maps, compasses, or first aid gear so they can avoid the need for a rescue or possibly move themselves out of harm's way. Or even better yet, climbers should review weather and snow conditions to they know if they should be climbing in the first place.

It's the most intensive measure: In summary, focusing on MLU's for the primary tool for mountain rescues is like focusing on pace makers or cholesterol lowering drugs as the primary tool for preventing heart attacks. It's the equivalent of ignoring diet, exercise, education, monitoring or other preventive measures. It's like someone ordering a Hardee's Thick Burger, large fries with mayonnaise, and a Diet Coke. The Diet Coke doesn't cancel out the other mistakes. The MLU is held up as a silver bullet of mountain rescue when it's really about the planning, conditioning, and proper equipment. Focusing on MLU's is really misplaced focus. Yes, they are helpful but not as helpful as the other things that I mentioned. I think that I have run out of analogies to use and encourage reading the Portland Mountain Rescue site for other examples.

Is Mount Hood tough to climb and do you need a rope? I get a fair amount of google traffic with these questions and I have yet to completely provide my opinion. Quite simply, yes it's tough to climb and you do need a rope and pickets (also called protection). I have only climbed the south side which is the easiest side and the chutes have become quite steep. Going up and down the chutes involves snow climbing so some loose snow or foothold could easily result in a slip. If someone slips, they risk a fast slide off a short ridge. Unless someone is very experienced or comfortable, I wouldn't climb it without a rope team and pickets. Pickets are 2 foot long metal bars with a carabiner clip attached. A climber drives them into the snow and clips the rope through the carabiner. A rope team without a picket or protection mainly allows the whole team to potentially fall if one member falls.

Caveats abound and I gear this advice for a fairly new climber who is researching. Someone looking for specific route information or climbing routes other than the south side have already stopped reading. Someone who is wondering about a less tough climb should check out Mt St Helens. Someone who was really wondering how tough my hood was, has already put a cap in this blog's @ss.

A Food Cart can be a Disruptive Market Force but is it Free?

Food carts in Portland, OR are in the middle of a renaissance. They've come a long way from the days of street meat or porksicles or colon-bombing greasy goodness. According to the linked article, culinary school graduates are bypassing restaurants in favor of opening food carts. With assessments, and fees a lot lower than restaurants (a food cart license is around $300), it's the start-up of the food industry.

For established brick and mortar restaurants, this is not necessarily good news. The new technology of an infusion of highly trained chefs and interesting menus is turning food courts into potent competitors. With their lower cost structure, and higher quality food that is not typically served on a stick, restaurants are concerned. While this isn't exactly cloud computing dealing to a blow to operating systems or the internet disrupting the media, food carts are becoming a disruptive force to restaurants. One of the only differences is that mobile refers to a Korean food truck that twitters its latest location as opposed to smart phones and Iphone applications.

Since this is America, the bastion of the free market, how do restaurants respond? Do they review their marketing strategy? How about a segmentation study to understand how to attract their most profitable customers? Do they work on the variety of the menu and cleanliness to highlight areas that a food cart on a rainy street corner with a small kitchen cannot? No, in America, we now look to the government or at regulations to address new competitors.

Restaurant owners instead talk about how they face more regulations and fees which makes opening a restaurant more expensive to start and operate. They don't want to drive the food carts out of business but they want a break with their own fees and requirements.

Comments like these are why I struggle with the demand for free market solutions when there are strategies aimed at convincing the government to change the playing field. These same regulations, like having a bathroom, initially built up barriers to entry for restaurants. The purpose was public health not to define the business model. Now, the message is to deregulate in order to lower the cost structure to help compete.

This is probably the least effective and mostly costly strategy for restaurants to pursue. As a disclaimer, I am viewing this from the lens of the new competitive force of food carts. The real agenda may be to get rid of fees, assessments, or regulations that the restaurants have always disliked and the food carts are really just Trojan food courts. My other disclaimer is that I have always liked eating at food carts so that's the horse I'm riding.

The restaurants' government intervention strategy faces an uphill battle since localities are cash strapped themselves, this will take years, and this strategy is largely outside their control. A review of their own internal capabilities or market would probably be more successful and a better use of their time. For example, are restaurants really competing for the same customers as food carts? They may be looking or a cheaper or quicker meal than restaurants could provide. Families with young kids are more likely to eat at restaurants since they need that bathroom. Business deals will be done over a full meal as opposed to a corner waffle sandwich. Finally, there's the liquor license. With these differences, restaurants will not be driven out of business. Since restaurants are having a tough year, additional competition is not a good thing. However, why the call for government interventions? It's not like restaurants could compete on cost no matter how many fees were cut.

In reality, this is an example of how I wrestle with calls for deregulation as a free market solution. Government regulations and decision should be made to protect consumers, the environment, or for use of public resources. If it's a good idea to have bathrooms in restaurants before food carts started serving duck than it still should be a good idea. Restaurants were given media space and attention which they could have touted their smoke-free environments, healthier food options, video poker machines, or any number of features. Why did they use their media opportunity to call for a government intervention?

A free market economy vs heavily regulated economy should be more straight forward. Instead it's starting to feel like Me and Bobby McGee song where "Free [markets] is just another word for nothing left to lose"

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.

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 Y 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.

Buying a House or Car: Considering how much your soul is worth

This year my wife and I had the fortunate yet-gut-wrenching-experience-that triggers-doubt-and-doomsday-thoughts experience of buying a house and a car together. These are the two largest outlays of money that any couple is likely to make besides education, a hip replacement, or that last kilo of cocaine before you retire and go straight.

Our circumstances are very fortunate, we were conservative, and I knew that if our mortgage and car security were sold individually, pension funds would even buy them. If worse came to worse, I had sold my bodily fluids before so that wouldn't be new. Therefore, I was able to ponder how homes and cars are bought and sold, the parties involved in the purchase, the business model, and purchase experience.

The housing market still seems as unstable as a Southern California hill side during the raining season. Transparency has improved but is not completely there. The biggest problem to me seemed like those who work in the housing industry are either overwhelmed or aren't the brightest candles on the menorah too begin with.

We were refinancing the house (which still felt like buying it all over again with the financial paper work). I started with my current lender, Wells Fargo, which was able to give an easy trade in from a 6% interest rate to a 5.5% with no closing costs. We didn't find anything better so accepted and attempted to sign, initial, and notorize their tablet sized closing book. Wells Fargo has an "easy" 1-2-3 Do It Yourself (DIY) closing process where they give you instructions on where to sign and initial. Of course, we missed on signature somewhere on the back of page 8A, Section G. Wells Fargo didn't tell us until I call them asking for an update, and that offer had already become null and void. They offered to resend us the closing book so we could try the DIY process again. I told them what they could Do It Yourself with their closing book that involved physically impossible acts. They didn't really seem interested in actually helping us with the process.

I had also sent my information on Lending Tree prior to accepting Wells Fargo. Looks like the mortgage business was doing better since I got flooded with so many calls and emails that I felt like Lending Tree was run by a Turkish bazaar. The offers were better then the month before and I was now looking at 5% interest rate. Our main criteria was a lender with a local presence to prevent the DIY disaster. This narrowed it down to 2 lenders.

One of the lenders, Arivian Financial, put together a very accurate estimate with the right amount of days interest, months of state taxes, and other factors based on actual state laws and lending requirements. The other broker underestimated those factors to make their offer look better and included his photo in the email signature with his hipster soul patch and side burns. Arivian Financial not only had the best deal but was able to send me state legislation to support their terms. Finally, any documents that they sent us clearly showed me where to sign.

The final piece of incompetency in the mortgage lack of value chain was the Title company sent me someone else's initial estimate. The inability to handle personal financial information combined with inability of some banks to handle their work load, the Turkish bazaar atmosphere, and the ability to still misrepresent closing costs makes me understand the mortgage disaster even more.

On the other hand, the car market is remarkably clear and transparent with access to easy to compare information. The last time that I had been involved in a car purchase was during the Clinton administration so I felt like a cave man entering the Bronze Age. Car features were clearly outlined as well as the dealer price and the sticker price (although it was no longer actually on a sticker so it didn't leave glue on the windshield). The dealers told us their profit, their incentive plans, and how they got paid. I can't think of any other purchase where you know this much about their compensation and business model.

The sales force had some interesting approaches. At the first car dealership, the head sales guy came out with a piece of paper that had the dealer price. We talked about this family, my family, and my favorite cars. At one point, I thought that he was going to look at my teeth as part of the horse trading. Finally, he wrote down his profit next to the dealer price, added it up, and told me the total price. He told me that he was giving me the same price as his father-in-law which could mean he really liked me or really hated me, depending on the relationship with his father-in-law.

Ultimately, I bought a car from another dealership. After I agreed to their price, the sales person told me that part of their compensation ($25 per car sale) depended on their performance in a customer satisfaction survey that I would receive in the mail. They showed me the survey, explained it, and emphasized its importance to their compensation. As a result, it ceased to be a customer satisfaction survey but turned into a customer compassion survey as in how did I feel about the sales person receiving full compensation for their work. My satisfaction was irrelevant as I realized that my influence on their compensation did not stop with my decision to purchase a car from them.

Personally, I would rather have that influence on how much the participants in the mortgage business get paid.