In my last blog post, I spoke about the need to cut down on visual chaos at the polls and streamline things to make it easier for voters to help make their decisions. We saw mixed success with our attempts to inject signage that would help with that.
The 2023 Signs To reduce the visual chaos, I decided to take a “team approach” to the design of the sign, and because we were concerned with available resources at each polling station, the leaders of the Nashua Democrats suggested I make more manageable signs for each Ward that one person can hold. Just to recap the challenges I tried to solve with the new experience:
Take into account the voter’s emotions (what kind of day they’re having, where their headspace is at, etc).
Appear inviting rather than fervid of your support. Many voters see supporters and those involved in political support as “extreme.”
Assume the voter has no clue who people are on your totem.
Don’t ask for votes the day of the election as it can be seen as an extreme turnoff or a harassment tactic, especially to those who want to maintain their privacy.
Here are the signs we eventually came up with to address many of those issues:
A specific sign for each polling place that would allow people to get down ballot information for their candidates. On the back is a full sample ballot that people can read, take a picture of, and carry with them into the polls.
While we didn’t make the massive triplicates from last year (see last blog post), there are five major improvements on these signs:
QR Codes. The QR codes allowed you to scan them so you would get down ballot information off the web and carry that information in with you to the ballot box. All of the QR codes were unique to the Ward. We had over 1,000 scans with 15,000+ voters.
Tap To Support. This one didn’t get as much traction, with just under 200 uses. Essentially, you could use your phone just like you would use Apple Pay. You could hold your phone right next to the card we attached on both sides of each totem, and it would allow you to go to the same link the QR code would.
We will see more use of “TAP TO PAY” once voters and parties get the hang of it.
Sign Lights. After a certain hour, things get dark, and no one can see your signs. We deliberately installed Neodymium magnets onto the posts and attached lights to them so that they could be seen from a distance.
Sometimes the most obvious innovations are the best.
Foot Rests. Each sign came with a base that was heavier (to keep the sign balanced) and you could put your foot through to keep it stable. That way, you weren’t having to hold it upright all day, but still have it in your possession according to campaign rules.
Reusability. The signs cost about $200 each to make, but what I really dig about these is that about $90 of the cost is completely reusable for the next election. The totems do not need to be dismantled, only stored. And the QR codes and NFC Tap cards are completely re-programmable for any future links, which means those signs don’t need to be reprinted.
All in all, the signs were a huge hit with voters and officials in political parties. It’s most likely we’ll be seeing more of this in the future. I have also made observations in my travels that will be important to make note of.
Visual Chaos was still a problem and negated some of the sign’s effect with the voters. Old habits die hard. We were unsuccessful at reducing the amount of visual chaos around the signs because there was this insistence of creating totems of our candidates. Visual chaos was still at play. This impacted the sign’s ability to clearly speak to many of the voters, as the visual chaos drew many of them away from those areas. The QR code was able to negate some of that because you could take a photo of it from 150 feet away. But it negated our ability to show off “TAP TO SUPPORT” because many voters stay clear of the chaos. We still didn’t get to really thank them for voting without instilling this notion of “…but you better have voted for our people.” We missed our chance to build coalition on Election Day for future Election Days. We also missed our chance to do an A/B test to see if these signs and the experience was effective in one of these wards.
New signs competing with lawn signs. We’re still not at a point where we’re designing an Election Day experience for voters.
Innovating into the future This will not be the last of the sign innovations you’ll see. I have what I believe will be a game changer for the 2024 Election we’ll be implementing (a small pilot for Alicia’s re-election campaign in Ward 7), and because a certain technology has finally caught up, we’ll be able to debut it next November. Stay tuned!
I’m writing a book during my run across America. But the book isn’t about the run. It’s about the divided voice in modern day America… Liberal vs. Conservative viewpoint. The run is mostly a vehicle to talk to local people about politics, and find the hidden stories that have shaped the United States. Here is one of those stories.
Upon running through the Mojave Desert portion of southern California, I stumbled upon a fascinating area: a place called the Kaiser Mines… and a tiny city in the middle of the desert: Desert Center, California.
A gas station in modern day Desert Center: still exuding an aesthetic from the 50s and 60s.
As you travel off of the interstate, Desert Center gives the appearance of an old abandoned town. Its gas stations are of 50s and 60s classic architecture; stripped of both gas and human life. The only active business that remains in Desert Center near the interstate is the post office.
The Unlikely Origin of Kaiser Permanente
The hidden lake within Desert Center: Lake Tamarisk.
As we traveled deeper into the desert and away from the interstate, we were absolutely shocked to come across a serene and beautiful oasis. The oasis wasn’t bigger than a few streets. It possessed a neighborhood of about 20 houses, a golf course, a small lake, and a library with fire station. No grocery stores or basic amenities were anywhere to be found. The nearest town was Blythe, 50 miles away.
We went into the fire station and asked the firefighters of Riverside County Station 49 how a beautiful place like this ended up in the middle of the desert. Their response: around 80 years ago, it was created to support a management staff that oversaw the Kaiser Mines, a (long since closed) steel and iron mine farther up near Eagle Mountain.
A Kaiser Steel railroad car, existing in Desert Center, CA, once operated on the Eagle Mountain Railroad to the Kaiser Mines.
This deserted area is the birth place of one of the largest HMOs and most important influencers of modern Health Care, Kaiser Permanente. During the Great Depression, a young, enterprising surgeon named Sidney Garfield, MD opened up a hospital to support the workers of the Kaiser Mines and the Colorado River Aqueduct Project. It was his belief that no worker should be without health care, and he struggled to keep the hospital open when he bared the brunt of workers and their families who didn’t have insurance. For those who did, insurance companies didn’t pay the hospital in a timely fashion.
Dr. Sidney Garfield walking in Mojave Desert, near site of his hospital. Image by kaiserpermanentehistory.org.
In order to fix this, an insurance agent, Harold Hatch, was able to convince insurance companies to pay Dr. Garfield’s hospital per worker per day upfront. The money from this was collected from workers in the form of five cents per day per employee. If they wanted coverage off hours, it would be another five cents. If they wanted to cover their families, it would be another five. One of the original uses of the term, “prepayment,” can be found whistling in the historic winds of Desert Center.
What does this mean for Democracy In America 2?
This speaks to two distinct and important perspectives on healthcare, each supporting conservative and liberal biases.
The conservative perspective is that prepayment health insurance was born out of private companies. Modern health care in the United States and its privatized origins are plain as day in its history. Because the United States have traditionally operated in a deadlocked and weak central government (except in war time), and states never traditionally found the appetite for taxes to provide health care, private companies found success in providing health insurance to individuals. And this has been the relationship since the beginning.
This is in direct contrast to the movements that happened long ago in Europe: Germany had national health care starting in 1883. The UK had National Health Insurance for its citizens as early as 1911. Almost all countries in Europe have followed suit.
The liberal perspective is that Dr. Garfield believed none of the workers in the Kaiser Mines should be without health care, and would serve them regardless of their ability to pay. Time and time again, he would help the employees regardless of economics until it became too difficult to serve them.
The secret of the Mojave Desert, along with many others, will be the basis of the opposing voices of Democracy In America 2.
“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.” – Margaret Mead
In this picture: the revolution of Retail Communications and Training, Mobile Payments, Retail Operations, and the creation of HealthKit, iPhone, and Apple Watch, and a lawyer who loves Pop Tarts.
Really, the only thing that remains in my life from four days ago is my girlfriend. Or I remain in hers. Most likely the latter.
Four days ago, I had the perfect job… 13 years under my belt as a senior manager at Apple within various departments. I lived in a great condo… a renovated two bedroom on the second floor that was only two miles away from Apple Park. I didn’t have to deal with the commute. My finances were under control. I had a very fulfilling side business and a beautiful girlfriend with two lovely cats.
I was content. I was happy.
AND I worked my tail off for years to get there… originally excelling as a Retail employee with a chip on my shoulder the size of a tree so I could prove I belonged at the Apple Mothership.
Saying goodbye to the teams at Apple Park
So, after all those years of building myself up, why did I give it all up?
A little over 30 years ago, my father passed away suddenly. It came as a shock to our entire family, but it instilled an important lesson in all of us: you never know when you’ll be called away from this world. So it’s most important to experience life rather than stay comfortable within it.
At the age of 40, I realize that my life is reaching another phase. It’s time to give my life, my job, even my condo to someone else so they can fulfill their own life’s work. I could hold on for another 10 years, and yes, I would continue to do cool things that would change people’s lives in technology. But I lived through one revolution at Apple (remember that iPhone thing?) and I’m happy to see another revolution someday through the eyes of an Apple customer.
“I will miss you. But I will also not have to come into work tomorrow in jeans and a plaid shirt.”
I have changed my entire life in mere days. I’m thoughtful about it, and committed to it. I’m selling my condo, and leaving California to begin anew in New Hampshire.
The one in the grey shirt and sun visor was me, 12 years ago. I was working as a retail employee in New York City, and always focused on how much of my small salary went to the US Government.
I’ve read through most of the 479 pages of the Tax Cuts and Jobs Act. A lot of it was thick reading, and pieces left out that I will talk about if people ask. I tried to cover the parts that touch everyone. I also focused on the Senate Bill, as it was built on the House Bill. Both have to be reconciled. I’ll write another analysis then.
The clear message of this bill? Stop being a worker and own your own business in America.
Let’s talk about who benefits and who doesn’t.
THE CLEAR WINNERS
THE RICHEST. While a 1% drop might not seem like much in this income bracket (from 39.6% to 38.5%), consider that a 1.1% drop in a 1 million dollar income is $11,000. That, by itself, is more income than 27 million Americans make (see below). And the estate tax COMPLETELY going away by 2024 (Page 168, Sec 1602)?
CORPORATIONS. The tax rate for businesses falls from 35% to 20%. While most economists believe that cutting the corporate tax rate CAN lead to stimulated economic growth (if accompanied by government cuts in spending), most economists also believe that historical data doesn’t completely prove it out.
SELF-EMPLOYED “PASS THROUGH” OWNERS. A person making their money through their corporation as a “pass through” has the ultimate loophole. While there are exceptions to this rule (like lawyers and accountants), If your business is passing through its income to you and you’re making more than $500,000, you only have to pay, at most, a 31.8% tax rate vs. the typical 38.5% for your income bracket. That’s a lower rate than people who make less than a third of what you make.
THE LOSERS
THE AMERICAN WORKER. Most Americans marginally benefit from this bill (the middle class sees a small benefit), but let’s not kid ourselves: the real benefits went to business owners and corporations. There will be some groups who see tax increases due to the widening of the higher tax brackets (many WORKERS in Silicon Valley and Wall Street will be in higher tax brackets, places that also have a higher cost of living). While most Americans will see a small cut across the board, there’s no question that the Republicans need to balance their massive business tax cuts with benefits to the real engine of the economy. And they didn’t. Workers get table scraps here, and many will end up paying more over time.
Here’s a comparison of the new brackets versus the old, and the amounts of Americans estimated to be in each. Does any person who considers themselves an employee ACTUALLY think these tax cuts live up to expectations?
THE POOR AMERICAN WORKER. Imagine that you’re getting by, making $20,000 a year, and your company gets a 15% tax cut while you get a 3% one. Kind of a bummer.
THE AMERICAN HOMEOWNER. In situations where state and local tax deductions benefit homeowners (IE, anyone who lives in a place where the cost of living is high and there are high property taxes), this is a massive blow. In some counties, people will lose as much as $50,000 in tax deductions each year on their home.
THE JURY IS STILL OUT ON…
THE REMOVAL OF THE INDIVIDUAL MANDATE. This one is a tough one, as it was one main reasons why ACA was able to work for several years. The mandate forced younger and healthier people into the system, which offset costs for everyone. Now, most experts agree that the cost in premiums will go up for Obamacare, even though nobody will be forced to buy it. This one is important to watch as it will affect millions of Americans, forcing them off of health insurance.
THE IMPACT ON THE DEFICIT. I’m willing to give Mitch McConnell and Republicans a pass on his optimistic view of the growth of the economy that will offset the trillion dollar projected addition to the deficit (even though Bob Corker and other Republicans have fiscal concerns over it). The issue is that most economists (and the joint committees who have done analysis) believe that we will not achieve the growth required to make up the difference. Time will tell on this.
WHAT I LIKE ABOUT THIS TAX BILL
THE REPATRIATION TAX FOR BUSINESSES. I actually really like the drastic lowering of the repatriation tax for money overseas (14.5 percent). 35% seems unreasonable for repatriation, in my view, as companies have already paid a tax to the local governments for money made there. This move could incentivize companies to bring their money back to the US where it could cause a boost of domestic investment. CNBC estimated that companies are holding 2.6 trillion dollars overseas. That’s 377 BILLION dollars of possible US tax income.
WHAT NEEDS WORK
I couldn’t get away with handwritten notes in the margins when I turned in papers in Junior High, but they can make laws with it in the Senate? Come on, man.
CORRECTIONS TO RUSHED MISTAKES. There are so many simple mistakes in the bill, like the Corporate AMT being at 20% when the Corporate Tax Rate dropped to the same level. This literally makes no sense. And there are new taxes for University endowments, but seemingly no definition anywhere.
THE PROCESS IN BOTH THE HOUSE AND SENATE. We need our Senators and House to work in a bi-partisan manner. The process is broken in government right now. Our leaders need to stand on the side of our party, not our country.
As I have expressed to many people who are close to me, I am running across the United States beginning in October 2018. And the question always comes up: why would anyone do this?
Throughout the past decade, I have gotten into a relatively good groove with my current life. Many people ask why I would consider stepping away from the comfort I worked hard to achieve. It’s a good question, one I can only answer with a foreboding feeling; I am consciously worried about us. I’m concerned about our identity as Americans and the relationships we have with each other. I worry about our ability to have civil discourse, the one principle that allowed this experiment of Democracy to last for what is approaching 250 years.
Truthfully, I’m worried about our future as Americans. And I know many people out there who are as well. I want to go talk to them.
We have had times in our country’s history where the civil discourse has been worse than it is now. Coupled with our local way of life being threatened, we have taken up arms against each other to protect the status quo. But in these times, we have understood that in order for us to progress, we must unite under a common direction, progressive or conservative, even if the direction is scary to us, and we have reservations about it.
It’s time to come back together. We have much bigger problems on the horizon that need us all.
My run is more than just a simple jaunt across the country. It’s a movement… one molded by research, listening, caring, understanding, and pride.
Every good movement needs a symbol. I needed something to express the movement whenever words fail me, something that represents America’s differences of opinion yet conveys the unifying thread that is found throughout those differences. I wanted it to express our inherent freedom and liberty, our pursuit of truth and industry, and our uncanny ability to rise above the worst of who we can be. I needed the symbol to express the notion that our civil discourse can help us come together, and burn bright towards our northern star. With the help of our friends at No Filter, we have been able to find the essence of the movement, distilled into one simple icon.
You will hear more details about this as time progresses this year. I will carry this across America as I chat with folks about the Great American Experiment called American Democracy.
There’s nothing we can’t accomplish if we believe in each other and we’re willing to work at it.
Some folks have asked me to post my 2017 OCR Humanitarian Award speech I gave at the OCR World Championships online because it was a) tough to hear, or b) interesting and wanted to see it again, so here it is. There are many people and organizations I thanked at the beginning, but it was about a third of the speech, so I removed them because they were lengthy and sandwiched in between really bad jokes. So here is the speech, without the intro, in its entirety.
People have asked me what drives a person to be a humanitarian. I feel like humanitarianism is a bestowed title, not something a person can totally grasp about themselves. There are many possible drivers. I just know that my own personal pursuit of wisdom is my LOCOMotive.
Remember that phrase. I’ll come back to it later.
There are people who are simply born as humanitarians, and those who learn to become one. I was one of those people who needed to learn. My father passed away when I was young, and in coping with his death, I discovered philosophy. Some of the most ancient of philosophers: Socrates, Plato, Aristotle, and Joe Perry, to the more modern day thinkers like Renee Descartes, John Locke, and Hunter McIntyre. During those years, i was introduced to a very simple law which has been the foundation for all of my beliefs: the Law of Conservation of Mass.
Here are a few lumps of Matter who have decided that similar lumps of Matter matter. =)
Everyone know the law? The Law of Conservation of Mass dictates that matter can neither be created, nor destroyed. But it has been shown that matter can evolve over billions of years to create something special. Give yourselves a round of applause.
If the Law is to be followed and believed, it stands to reason that the sum of humanity, and all things on this planet, living and dead, is “the Earth.” You see evidence of this Law in science and religion. Religious texts hinted at the law before it came into being. Genesis 3:19 states that “By the sweat of your brow will you have food to eat until you return to the ground from which you were made. For you were made from dust, and to dust you will return.”
Through observation, I have formed the belief that the world is a complex quagmire any one of us can only partly understand, and that each one of us is a tiny part of the world’s collective soul. In short, we are more than the world’s children: we are the world.
Where am I going with this? For the first time in the Earth’s countless billion years of existence, it has created something so powerful, so limitless, it has endangered its own existence. That’s us. We are its savior, or its destroyer. We are its finest champion, or its worst DNF.
So… how do we become its finest champion, and positively impact the outcome for ourselves and the world?
We should spend our lives accumulating something that’s seldom acquired in Twitter’s 140 characters these days: wisdom.
When you find a person you fundamentally disagree with, you can either consider them an enemy, or as I do, a complementary person the world created for you so that you can expand your thinking. The LOCOM (law of conservation of mass) suggests that because you are part of a whole, complementary people and viewpoints need to exist. Understanding those opposing viewpoints bring us closer to that whole, the greater collective, the better wisdom.
Don’t believe me? When i see two top competitors like Ryan Atkins and Jon Albon learn from each other, or exchange friendly ideas, I smile. At the same time they drive each other to be better, they prove that fierce competition is not the same as mortal opposition. One gains you wisdom, the other blinds you to it.
Everything in this world has an equilibrium, light and dark, good and evil, cat memes and the Kardashians. And wisdom can be found in all elements on both sides. But there is very little to no wisdom in avarice and excessive greed. According to the LOCOM, to take more than you give leaves a fundamental deficit somewhere else in the world. As well, the LOCOM would suggest that the reverse is true; to give more than you take will eventually leave you empty handed and unwilling or unable to help. The Earth needs balance, and so do we.
For the people silently in their heads making this political, I’m not saying to think like a humanitarian means that you need to be a socialist. I’m one of the largest Ayn Rand fans you’ll find. But any system of economics is only as good as the motive of its people. Some of the greatest humanitarian and innovative acts have been conducted during the reign of capitalism. It shouldn’t matter what version of “-ism” you identify with if your pursuits are separated from finding wisdom.
Wisdom is the only thing that can help you when you are trying to leave the world a better place than you found it. Wisdom lengthens your life’s runway by offering you chances to make longer and more meaningful impact on younger generations. The more wisdom you have, the better you are at understanding problems at their root cause, the more chance you have to make a positive impact that will span generations.
The best view in the house at the OCR World Championships. #unobstructedView
So what has wisdom taught me? Love is the most difficult thing to earn and keep. Respect is a medal you can obtain, but it’s not a Finisher Medal. You constantly have to work to hold onto it. I am genuinely happy and invested in the success of people around me. I love seeing our OCR communities reach their fundraising goals. But I REALLY appreciate the small and heartfelt gestures that I see in this group of athletes and their families every day. Even at the age of 40, wisdom continues to add to me, and make me better as my body starts to go the other way.
Tomorrow, we stand on an international stage and represent our country, our beliefs, and how far we’ve come, individually and as a human race. We will empty our souls on the course, and we will fill them with the encouragement of our loved ones at the finish line. Then we’ll celebrate, we’ll go home. We’ll live our lives. We’ll do our jobs. We will slowly turn around the sun till the end of our days. And we will continue our pursuits of wisdom, the ONLY thing we can take and give back to which the law of conservation of mass doesn’t apply. May the pursuit of wisdom be your train of thought, your Platform 9 3/4s, your LOCOM. Motive.
I’ve had one of the most incredibly unique and rewarding OCR experiences that anyone can have for the past six years (honestly, it’s the stuff of dreams). And as my time in OCR comes to an end, I want to talk about the one thing that will remain with me long after I take my leave.
This team raised over $125,000 dollars, which has helped lead to a significant breakthrough this year in Children’s Cancer research.
A dear friend of mine who I met through OCR likened me to Jim Kelly today. And while I can’t stand the thought of being compared to a Buffalo Bill (inter-division rivalry with my Pats!), I knew immediately where he was going with this comparison.
Goodness always comes back to us in the end. Yes, that’s me sprawled out in the middle of the course with a total stranger rubbing my cramped legs on LAP 2 of WTM 2014.
I’ve said for many years that the most important award in Obstacle Course Racing isn’t 1st Place at the OCR World Championships, nor Spartan World Championships, not even Worlds Toughest Mudder. The most important award is the For Those Who Would Award. This award recognizes humanitarians in OCR for their contributions to the various OCR communities. Basically, this exists for people who lead by doing amazing things not with their legs and arms, but with their hearts. Jeff Cain and the For Those Who Would organization are the Award’s driver, and I applaud and support their efforts for carrying this banner.
For those who don’t have context, I am the only two-time nominee finalist for this award in its brief three year history. If you win, you can’t be nominated again. That being said, you can PROBABLY see where my friend was going with his comparison (Jim Kelly infamously led his Bills to four Super Bowl appearances, four losses, and one Scott Norwood “wide right”).
While I love my friend, I ain’t no Jim Kelly. Being a finalist for a humanitarian award isn’t akin to going to the Super Bowl and losing.
This is a situation in which the award is more important than winning it. It’s the ONE AWARD in OCR where you can’t win it simply by beating your competitor. You need to actively help improve people’s lives. You need to make people smile. You need to reach out your hand, armed with the qualities you were blessed with, and offer people assistance in your own unique way.
You need to make people feel.
And even after all that, you might not be the one holding the trophy at the end.
I will never remember Ryan Atkins for his wins. I will remember him for his heart.
Always consider this: the very idea that someone would take the time to write about how you’ve touched their lives means you’ve won regardless of holding a trophy, being a top 4 finalist, or simply being nominated. In a world full of anger, hate, greed, and oneupsmanship, you all stand as important role models.
Congrats to everyone nominated… not on your victories, but on taking the responsibility to be the best version of you.
And for the record, I was rooting for Norwood to make that kick.
If anyone is interested, check out the other nominee finalists and their contributions to OCR here.
“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
– the very first line of the Preamble to the U.S. Constitution
“…promote the general Welfare.”
There it is, black and white, right there in our U.S. Constitution. It could mean that the sworn duty of the government is to promote health and wellness among our citizens. Or it could simply mean that the government’s role in health care is to intervene in times of crisis.
This MRI was taken when I injured my neck last year and required spinal fusion. It was $500 out of pocket, and covered by top notch insurance.
We’ve seen a battle of ideals for the past 10 years over health care on Capital Hill. Regardless of the final conclusion, there will probably be some upcoming cuts to the Affordable Care Act, removing several million people off of their current health insurance.
I am not making a judgment on this approach, nor am I going to argue that a Single Payer system is better or worse than a non-Single Payer system. There are good reasons for all of us to believe that the entire health care system, as we know it, is headed towards disaster. And we, as a nation, need to rise up, understand the fundamental issues, and ask what we can do to help promote the general Welfare for ourselves and our communities.
I’m hoping you’ll leave this article with a bit more knowledge around the challenges we face as a nation, and an avenue in which you can express ideas for the improvement of health care. You CAN make a difference. First, let’s go over some fun facts and figures.
US HEALTH CARE IS THE MOST EXPENSIVE IN THE WORLD.
As a nation, we are riddled with the most expensive health care in the world. Per person, it costs the United States almost $9,900, compared to an average of under $3700. Breaking down the $9,900, almost half of that cost is publicly funded through our taxes, while the other half is funded through your premiums and out-of-pocket expenses.
And yet, here we are… worrying about a Paris Accord commitment of two billion dollars that we no longer have to pay. Our health care bill, annually, is over three trillion dollars. This means that, when we see annual increases of 5 percent, we are paying 75x more than what we saved by exiting the Paris Accord. Yearly.
The entire GDP as a country was 18.46 trillion dollars in 2016. The health care bill is 17% of our GDP. All other countries are between 8 and 11.5%. Almost one out of every five dollars in America is Health Care.
We clearly have a system more expensive than any other country in the world. Why?
THE US GOVERNMENT DOESN’T PLAY AN AUTHORITATIVE ROLE IN CONTROLLING HEALTH CARE COSTS.
Let’s revisit the Preamble to the US Constitution for a second, and note that RIGHT AFTER the part where it says “promote the General Welfare,” it follows up with “…and secure the Blessings of Liberty.” Liberty has incredible breadth of interpretation. Some people believe that Liberty is achieved through freedom from government. Others believe it is achieved through freedom from obligation or hampering conditions. The battle for this definition has raged across our nation’s history, destroying political parties, and rising them up again.
Why am I bringing this into a discussion about Health Care? Because I think the control of health care costs are where our citizens (and by proxy, elected officials) take sides. People who don’t believe the US Government should take a big role in controlling health care costs will err on the side of company profits, suggesting that the free market can regulate appropriately. They will point to the Lasik industry as a prime example of this ($11,000 procedure when it was first mainstream now costs $3500 today). Those who do believe that the US Government should step up and force drug and administrative companies to control costs think that this is a major way to reduce the burden on the individual citizen.
The ACA does a great job at bringing health care to the masses, but maintains very little power over price negotiation for health services and products. After all, it’s not Universal Health Care, and there are many factions out there in the health care industry who don’t want costs to be controlled (insurance companies, hospital workers, and labor organizations to name a few).
That being said, there ARE cost cutting incentives that the ACA provide for, and we’ll address that in a minute.
WE HAVE LOTS OF SPECIALISTS, AND USE A LOT MORE EXPENSIVE TECHNOLOGY.
More than any system in the world, the United States relies less on general health practitioners, and more on specialists. We get MRIs, EKGs, and other types of technology services that require specialists to run them. We also rely less on Primary Care Providers than other countries, which has a huge impact.
Lack of transparency of prices contributes a great deal to the health care economy. There is no easy way to compare costs of services, and there is reliance on the health insurance companies and providers to dig into the market to compare similar prices for services.
WE ARE CURRENTLY A DISEASE CARE SYSTEM, AND TURNING US TO A HEALTH CARE SYSTEM HAS DUBIOUS EFFECTS ON COST.
This chart shows an overall ranking by the Commonwealth Fund, expressing expenditures in USD. You’ll notice that the enormous cost difference we incur as citizens doesn’t necessarily translate into better care.
According to the National Conference of State Legislatures, 75 percent of health care spending in the US goes to treat chronic diseases and conditions, a much greater percentage than other countries. Most of these chronic diseases are preventable, or can be treated using alternative methods.
For five years, my friends and I have concentrated on raising a great deal of money for Veterans’ non-profits. We focus on expanding preventive and alternative health care programs for vets. Acupuncture, physical therapy, yoga, meditation, and cleaner eating vs. swallowing prescription drugs proves to work for many veterans with PTSD and significant injury. Many lifestyle programs have helped veterans go back into their former lives.
While I’ve seen the benefits of preventive care, does it reduce overall health care costs? The Congressional Budget Office doesn’t seem to think so. The CBO, in attempting to analyze the budgetary effects of preventive care, wrote: “when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway.” Taken by itself, the CBO makes an excellent point. Preventive care COULD just be a net cost to any system, and it’s difficult to measure the impact on the 75 percent of chronic disease treatment I mentioned above. Data is needed, and the CMS Innovation Center(more on them later) must get it to justify continued expansion. Other countries have data, but we must compare the country’s situation as well (for example, the US has a higher percentage of elderly and those with pre-existing conditions).
Preventive and alternative care is not a “one size fits all” approach for everyone, and it doesn’t solve every issue. There are diseases that have to be dealt with on a day to day basis with prescription drugs and hospital visits, and that will not go away. But there is no question that many of these diseases are preventable.
IS THE AFFORDABLE CARE ACT THE PROBLEM OR THE SOLUTION?
Companies being able to cover full cost of your benefits is slowly going away, and while it’s been argued that the ACA is largely responsible for this, the reality is that this Fortune article shows the trend was happening anyway. Health Care, ACA or not, is too expensive.
There is a great deal of talk to “repeal and replace” the ACA with the prevailing opinion that the ACA is the problem. The opposition for ACA states that, while the Act has brought more people onto health care than any other time in our history, many have been older/sicker than expected, which has increased the cost of health care for healthy Americans and businesses who have shouldered the burden. The idealogical battle between offering businesses tax incentives and full blown Universal Healthcare in the US rages on, with the pendulum shifting depending on who is in power.
But the root cause of our issues, the costs of health care, keep rising. Is this the ACA’s fault?
The answer is yes, but really, no =). On the “yes” side, if you’re a healthy middle class American, then you are shouldering the costs for many of those folks who now have been given health care. Through your rising premiums (which are rising faster than the cost of health care), private health insurance companies are making you and your company pay more for your health insurance to share the burden of the unemployed and those with pre-existing conditions.
But the answer is really “no.” The rising OVERALL costs of health care are not the fault of the ACA, and to the contrary, the ACA has done a great job at controlling the rise of costs in comparison to the previous decade. After ACA was enacted, rises in health care have been at an average of 4.2% per year vs. 7.1% the previous seven years before the ACA. This is a record low since 1960.
WAIT, HOW IS THE ACA CONTROLLING COSTS?
The effectiveness of those measures can be debated, but we should call out the top four:
1) The ACA mandates that all citizens need to have some form of health care, theoretically driving down the cost for everyone.
The individual mandate has its roots in the Republican Party, introduced by Mitt Romney on the state level in Massachusetts, later adopted by Obama for the ACA. This is one of the most controversial aspects of the ACA. It mandates that all citizens must have a form of health care, OR must pay a tax penalty based upon their Modified Adjusted Gross Income (MAGI) Every year, the fee has been steadily increasing. But if the cheapest health care plan in your state is 8% of your MAGI, you are exempt from having to pay the fee. There is cost assistance, Medicaid, and other options available for folks to be able to get some sort of affordable health care, including bare bones catastrophic plans for younger folks. Much of this depends on your state marketplace.
2) Rate Review & The 80/20 Rule
The Center for Consumer Information & Insurance Oversight, established under the ACA, has helped to implement two very important cost measures. The first is the Rate Review, a process which brings scrutiny and transparency to health insurance rate increases for Americans. The second, the 80/20 rule, regulates the percentage of premiums that go to administration of health insurance (20%), and require Health Insurance companies to spend 80% of their premiums on Health Care.
3) The Center for Medicare & Medicaid Innovation
The Rate Review and 80/20 Rule do a great job at helping lower costs for Health Insurance companies, but do NOTHING for Health Care provider costs (hospitals, etc), the real root of the issue. This is where the CMS Innovation Center comes in. Among other ideas, they have created a financial incentive program for issuers to participate in if they focus on cost reduction for their services.
IS THE ACA CONSTITUTIONAL?
This is the core of the debate that pits both parties in Congress against each other. On the one side, having federal or even state government force a person or entity to own insurance can be seen as an attempt to obstruct liberty that the Constitution provides us. After all, the VERY NEXT LINE after “promote the General Welfare” in the US Constitution is “…secure the Blessings of Liberty…”
This is an argument echoed by some judges. Judge Roger Vinson was the first to rule this in the affirmative, and in citing the original Boston Tea Party, stated that “it was difficult to imagine” that the Founding Fathers meant to create a government “with the power to force people to buy tea.”
But does evidence for government involvement in Health Care exist at the time of the Founding Fathers? The answer is yes. In 1799, the Act for the Relief of Sick and Disabled Seamen was supported in a bipartisan manner by Federalists and Democratic Republicans. Many of these people were part of the Constitution’s writing and adoption. The act authorized 20 cents a month out of the paychecks of seamen, marines, and the officers of the United States Navy in exchange for health care services from the established Marine Hospital Service, an organization of Hospitals set up to care for them. Because yellow fever and other diseases were rampant at the time, the 5th Congress felt the need to step in and start driving better health care for seaports.
This one action DOES suggest that the US Government in the 1700s didn’t see itself as independent of health care. But it also doesn’t go so far as to suggest that they supported individual mandate and non-profit health care. At least with this act, it is safe to say that certain aspects of the ACA are not without Constitutional merit.
IS PROVIDING HEALTH CARE FOR ALL CITIZENS THE RIGHT THING TO DO?
Alexis de Tocqueville is misquoted sometimes as saying something very insightful about America’s moral values in the early 1800s. “America is great because she is good. If America ceases to be good, America will cease to be great.” While he DIDN’T say that, and while he never touched upon the subject of health care, he did make this observation of our citizens:
“Men attend to the interests of the public, first by necessity, afterwards by choice: what was intentional becomes an instinct; and by dint of working for the good of one’s fellow citizens, the habit and the taste for serving them is at length acquired.”
Excerpt From: Alexis de Tocqueville. “Democracy in America — Volume 2.”
200 years later, we, as a nation, are working towards those instincts specifically in Health Care. In 1989, during a defense of the individual mandate, politically conservative Heritage Foundation member Stuart Butler drew an important distinction: “If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.” Health care should be qualified and judged on a different level than any other type of shortfall.
The “right thing to do” simply can’t be a financial, constitutional, or even moral discussion in isolation. All aspects must be researched, examined, and concluded TOGETHER to create the right way to move forward.
CONCLUSION
Because you made it this far, I wanted to thank you. I know that health care has a tendency to politicize people and opinions, and it was my genuine hope that we keep this topic to facts. Health care is the difference between living or dying, and quality of life. This article was written with honesty, research, and the motive to get people involved.
In my view, the general health of Americans is more important than caring about whether an approach is “big government” or not. If better health care is enacted through state governments, or even through the private industry, so be it. The goal of ANY approach, whether enacted through privatization or socialization methods, should be to reduce costs to MAKE HEALTH INSURANCE AFFORDABLE for as many citizens as possible. My conclusion is less of an answer to the problems of health care, and more of a call to action for you, the reader. I encourage you to design methods that will bring down our costs, and post your ideas in the comments. I also invite you to submit your ideas to the CMS Innovation Center. They want to hear from you, and they WILL listen.
The lives and those of our loved ones hang in the balance. Let’s promote our General Welfare together. It’s the first three words of the Preamble, “We The People,” who will ultimately solve this puzzle.
Many of you don’t know me, or what I stand for, but I’m a Product Manager by trade. My perspective is that you can build tools to solve big issues, provided you do enough research on what the problem is. I’ve built many tools over the course of my career to solve large and complex issues for the biggest company in the world, from communication, to training, even including critical operations. And now, running for public office in the US in the future, I want to do the same.
Someone told me long ago that running for office required me to stand for stuff. So I want to stand for learning.
How does one practically stand for learning? By standing for Education? I don’t know that the Education issue can be solved by throwing more resources to charter schools and less to public education (and vice versa). So let’s back up and identify the real problem.
What’s the problem?
I posted a comment on LinkedIn and Facebook two months ago that started with a problem statement and question:
“68 percent of Americans 25 and older do not have college degrees. Is this failure?”
There were a lot of keyed-in responses (especially some from friends I didn’t expect to hear from). I especially enjoyed the TED Talk by Sir Ken Robinson, as well as an article written on LinkedIn by Matt Fowler, opening the discussion of alternatives to college learning.
There are many options for college, but the fundamental problem of learning still resonates as part of its DNA: K-12 education exists so that you take advantage of 13-16 and beyond. And with only 32 percent of people finishing their 16th year, it might be time to think up a solution that’s COMPLETELY different.
So… how do we fix education when it is failing people at a worse rate than marriages in the US? Easy. We use a small amount of taxpayer dollars to create something that focuses on learning, introducing a self-service to you as an American citizen. This system should SUPPORT the Education system, and all of our working industries as well.
What would we make?
We need something that can support the actual way people learn… real learning vs. simple institutional support and assessment. CREDIT: Brazil Scientific Electronic Library Online
It would behoove me to have a system that would allow me the following:
Store my interests and skills to share at my choosing to schools and industries
Show me those who have the same interests and skills (and are willingly sharing this information) in order to hone my craft
Provide me a method for peer-based assessment on those interests and skills so that those interests can EVENTUALLY become skills. Those assessments are there for me to share as I see fit.
I want something like this from the very beginning of my life, where my parents are fumbling through putting stuff in there (interests and skills), and at a certain age, this gets turned over to me to start updating. Then I own it till the day I die. I put interests and skills in from my early days in education, all the way to the end of my days in my nursing home (going to the bathroom might be my top skill at that point, but hey, it’s still a skill).
That’s it. That’s pretty much all this would do.
Great. This sounds cool. So… how would we build it? What would we need? Who should own it long term?
In order to make a case for what we need and who should own it, I need to point out that this needs to fill all four requirements above. I’m willing to change my theory on the case I make below in order to make a better system. But nothing like this exists today in the scope I’m talking about (especially point 4). And so we start from scratch!
Without further ado, let’s make the case for something helpful and real.
We need the greatest minds in ontologies, word associations, and contextual learning to determine the guts of this system.
I expect many people reading my last sentence to start glazing over with boredom. But I suppose that’s part of the point. Do you think most people would argue with an ontologist about the algorithm that comprises the association of words? No. It’s boring. Most politicians don’t care. And if they DO care, they’ll get involved to help question issues at a level where they would have to hire an ontologist. That’s a win in and of itself.
It turns out that the way we teach machines (i.e., Machine Learning) would actually be the way that we would keep track of our own goals, interests, and skills throughout our lives. I want a system like this for myself that could point me in a direction by connecting dots I might have forgotten about, like a skill I used to utilize but no longer do.
It could help to solve the general welfare of our country by encouraging small businesses. Lots of small businesses.
The premise of this point is not based on real data, because nobody can do research on something that doesn’t exist. But imagination is at a shorter supply than it has to be because kids are being told at a young age that there are only certain paths in which they will succeed. Enough is enough.
Sir Ken Robinson, between all of his hilarious colloquialisms, relevant experiences and insight, says the following: “We’re now running national education systems where mistakes are the worst thing you can make. And the result is that we’re educating people out of their creative capacities.” We need to open up the creativity that our democracy affords us, take advantage of the best of humanity, and start dreaming. The tech industry does this (and is encouraged to do this), and so should the rest of the country.
It doesn’t cost a whole lot of money to make. It requires brains.
The system I’m talking about is a roadmap that needs to continuously be refined. While it doesn’t take a whole lot of money upfront to build, it will require some of the leaders in the industry to gather together to create an agreed upon ontology that will be the basis for identifying subject matter experts in any given field. And it requires constant refinement and different perspectives. Some of these leaders could be Michael C. Jensen from Harvard, Tom Gruber from Apple/Siri, leaders within Korn Ferry, or some of the greatest minds in Corporate and Educational Competency Based Learning and Assessment, like Shelley Harwayne, founder of the Manhattan New School.
It seems to me that, something that could have a profound impact on education that doesn’t cost a whole lot of money would be fiscally appealing to Republicans, and the public service that it offers would appeal to Democrats. I would LOVE to engage anyone from either party to debate the value of this type of system. But I’m pretty sure that the only group that would hate this is Libertarians because “fight the man.”
The US Government should maintain this. But a person’s data should be privately owned by that person.
Let’s be frank: this system and data needs to exist long term, and unless you’re the Shirley Plantation or the Zildjian company, a private company probably won’t last as long as our Federal Government. This system should be around for the next 200 years, allowing humans to outpace artificial intelligence by deeply exploring innovative waves in STEM and beyond.
Philosophically speaking: why shouldn’t our Government own this system? The government is supposed to be the group looking after our infrastructure. The government funds the building of public roads, but it doesn’t tell people where to drive. The government funds public libraries, but it doesn’t tell people what to read. This philosophy is very important, and we must do our very best to protect the data from Deep State. Your data is yours. You share what data you want, and when you want.
Isn’t it in our best national interest to have the smartest, most passionate people, well-versed on their domains of knowledge, always having a guiding light into learning more things that are interesting to them?
Now… we just have to trust that the minds in our government are qualitative enough to be able to create and improve this type of system. We’ll need an infrastructure for this. Quite frankly, we need a Secretary of Education, fancying themselves as a technologist, who also thinks outside the box.
Why can’t a private company own this?
We have a Federal Reserve and National financial system. Why don’t we have that for Education? One theory is because Hamilton became the Secretary of the Treasury while building the Federal Government in the late 1700s. The first Secretary of Education (Shirley Hufstedler) was sworn in almost 200 years later under Jimmy Carter, long after the Federal Government had been established. CREDIT: Associated Press
There are two reasons why I’m not sure this can be owned by a small business:
Businesses don’t last for hundreds of years, typically. They change with the times and market drivers. This needs to last about as long as Hamilton’s financial system, perhaps longer.
The driver behind this system should be the desire to further the human race in education. There isn’t a great deal of money that can be made from this as a core business. Sure, you can attach other business models to this to make money off of the premise (recruiting services, talent partnerships, etc). But we need an entity who is able to garner resources to continuously improve this, much like our public roads and schools.
I’ve been slowly turning over Roshi operations to others, and as well, retiring from World’s Toughest Mudder as of next year. Other than turning my attention towards innovative stuff at Apple, why am I doing these things?
Stripping away all of my faults, I know what I’m good at. I am very good at bringing large groups of experts together to agree on and solve complex issues. That’s how I’ve survived and thrived at a certain fruit company for so long. And at my core, while cheesy to say, I really love seeing people achieve their dreams.
So… I’ve decided that I want to fulfill my childhood dream, and run for elected office.
Whoa, slow down. It’s not going to happen right away. I have a vision of how I’d like to do it, and will reveal more as time goes on.
In the meantime, I’m reaching out to my friends and communities to support me if they think I’ll be any good. My stances are on that page, and my analysis for solutions of the problems outlined in the stances will be highlighted on this blog.
I’m pretty excited.
I won’t tell you which one I am. But standing to my immediate left is Endicott Peabody, former Democratic Governor of Massachusetts and a mentor to me as a child. There is also a Republican in this photo.
