Tuesday, July 31, 2012

Waste Not Want Not

Today I share some information from the Public Outreach at The Mesothelioma Center at Asbestos.com

There is much made regarding the current restrictions on how to remove or eradicate toxic waste from our building structures. As a result there is much often made about how "regulation" prevents job creation. Well it also prevents a health care crisis and frankly you can't work when you don't have your health. Its the most precious resource we as individuals have, so saving it is very much a part of our sustainability.

Asbestos and its Health Effects


In general, we like to think to think of natural substances as harmless. We look for environmentally sourced alternatives to toxic cleaning products. We choose all-natural foods over processed ones. And we encourage sustainable use of natural resources.
Unfortunately, one natural resource has caused thousands of people to develop serious diseases, including mesothelioma and lung cancer.

Asbestos – a completely natural mineral – can be so small that it is easily inhaled or ingested if it is circulating in the air. Once it is inside the body, the long, thin fibers are easily trapped and cause internal damage to tissues and organs. For some people (typically those with an extensive history of exposure to asbestos), this damage can eventually cause cancers or other health conditions.

Most people who encountered asbestos came across it on industrial jobsites. Manufacturers used the mineral to reinforce or fireproof their products.
Environmental asbestos exposure was also a significant threat. Many rock deposits across the United States contain the fibers. People may have accidentally stirred up the fibers by walking through, biking across or playing with the asbestos-contaminated rocks. Anyone who lived near active asbestos mines also have an elevated risk of environmental exposure.

Asbestos-Related Health Effects
Asbestos is a known carcinogen. Four cancers are conclusively linked to asbestos exposure:

Pleural Mesothelioma
• Lung cancer
• Ovarian cancer
• Laryngeal cancer

Research also implicates that asbestos exposure can raise a person’s risk for other cancers, including esophageal cancer and gastrointestinal cancer. All of which have a very low life expectancy if not detected quickly.

Asbestos also has the potential to cause benign conditions such as asbestosis and pleurisy.

Because of the links between asbestos and a history of mesothelioma and other diseases, asbestos is no longer mined in the United States. The last mine closed in 2002. Newly produced materials also are subject to heavy asbestos regulations. While several materials can still legally contain trace amounts of asbestos, an increasing number of companies are turning to less toxic alternatives.

Some of these alternatives come from natural materials. Some options, such as wollastonite, may also contribute to respiratory illness, but companies are still working to find a totally safe solution.

Flour fillers are one of the most health-friendly alternatives. Made from rice or walnut shards, these fibers lack the insulating properties of asbestos but generally do not pose any threat to human health.

Author bio: Faith Franz researches and writes about health-related issues for The Mesothelioma Center. One of her focuses is living with cancer.

Monday, July 30, 2012

The Hippocratic Oath

Our Medical system is sick, its broken and damaged. And in its worst state it can do harm. There is a part of the modern Hippocratic Oath that states:

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.


Across the board that is something we need to all embrace regardless of our profession but its even more so true regarding medicine and the state of health care in this country.

There are these articles from the New York Times -the first about a woman named, Sabrina Seeling, and her death at the hands of those who were to save her life. Or there was this story of young boy Rory Staunton, who was also killed literally by the hospital in charge of his care. Isn't that what it is, Murder? Are these stories is becoming so common now we seem to turn an eye - if I say blind I wonder if you recently saw an Ophthalmologist - as no guarantees there.

Then today another editorial by Dr. Sanjay Gupta of CNN regarding the state of medicine in this country. Or this article on how much we spend on medicine. Or this from the New York Times Magazine about the "state" of Mississippi and its attempts to reform its hideous state of care. Or that Massachusetts is now trying to cut medical costs in the first State to actually have "socialized" medicine.

We have so many competing organizations, states, counties, as well as organizations that govern and dictate medicine there is no single source of regulation, information and oversight that its impossible to have a standard of care in this country. We decry Government intervention but when it comes to the standards of safety in this country from Medicine to Building one wonders why not?

If we had better oversight in banking, in building, in education and more importantly in health would all of the disasters in these industries be happening. We get so distracted by our supposed independence we don't realize we are in this together with the same desires to be healthy, to be educated, to be financially secure, to live in clean safe housing that we simply put band aids over the mythical unicorns to somehow believe that it will work.

It now comes down to where you live to somehow find ways to make this work. Just move apparently is the new Just Do It. We cannot all move to states and cities that offer clean air/water, better housing, education and medicine. Its not possible. We shun bigger Government but how about BETTER GOVERNMENT? Finding people who care less about the party they belong and the very special interest groups and acronyms that solicit them and finding ways to transcend a system that is not sustainable. We all breathe the same air, drink the same water, travel the same roads, we have all gone to school and we all live and work in buildings and we all need health and care. Why must it be better for some, different for others. The Hippocratic Oath states "First Do No Harm" isn't that applicable in every business everywhere?

Not the Greatest Generation

We as a Nation are very keen on prescriptions for drugs, countries, others to do or fix what ails them. I call it the Gladys Kravitz complex. The nosy neighbor from the 60s show Bewitched who seemed to be aware of the doings in the neighborhood and quick to judge or asses the situation as she saw fit. Floyd the Barber or Mrs. McCluskey of Desperate Housewives also come to mind when I think of those on the outside looking from their inside on what is wrong and how to fix it.

Well that defines perhaps the best of American mythology way more than "up by your bootstraps" "wild west cowboy" "the rich have earned it" or "NIMBY" when it comes to defining the American archetype. This blame the boomer mantra is becoming de rigueur when it comes to explaining the problems in America. Good try but the Boomer Generation ran over 20 years in length with nearly 80 million in numbers so to generalize, stereotype and assume that there is one "type" of boomer is another American myth destroyed - the one where we appreciate and encourage diversity.

I am a "boomer" for whatever that means. I have no clue. I look to the Greatest Generation and laugh as that was a term devised by a boomer to sell a book. They fought in a war, came home some damaged, some not and accepted a strong Republican General as a President who built the Interstate highway system while also taxing the population at 90%. And yet our country grew in leaps and bounds and the donations to charities were much higher than they are today. So if we are the Entitled Generation I am still trying to find what that means. Its not that "great" I can tell you.

We have no idea what that means nor do we want to. We want to once again find either extrinsic factors - such as politics/politicians, laws or regulations that are somehow preventing us from attaining our "rights" or we use intrinsic ones to blame the "victim" as somehow you and you alone are at fault for not pulling those bootstraps up hard enough. There is always some blame making, finger pointing, excuse grabbing that is very much a part of the American archetype, stereotype or mythology.

I put below today's latest from Bill Keller. Former Editor of the New York Times who neglects to mention his own missteps as a boomer during his helm at the Gray Lady. He is the Editor who authorized Judith Miller to write the falsehoods in the early drumbeat up to war with Iraq. Greg Mitchell wrote an excellent piece in The Nation about Keller which dutifully explains the Keller history at the Times.

But today's column struck a nerve as he cites the last bashing the boomer column by the once interesting Kurt Andersen who also wrote a scathing retort about boomers too also published in the Times. I simply roll my eyes in the same way I did in Denver last week when the man I once respected called me "babe" one time too many. After awhile you simply lose respect and in turn they lose legitimacy as a result. Kurt was once a great Editor and Writer once. But now like his former contemporary, Graydon Carter, I honestly don't care much about what they have to say. I wonder if that is the lot in life for us "boomers" or is it simply the case of successful white men with too much money and narcissism on their hands?

The Entitled Generation

By BILL KELLER

IF you were born before 1946 or after 1964, you are free to go. Kindly close the door on your way out. I need a private moment with my fellow baby boomers.

So. I imagine you’re all feeling a little unappreciated these days. We seem to have entered one of our periodic seasons of boomer-bashing. In rapid Op-Ed succession, we children of the postwar demographic bulge have been blamed for turning religion into an indulgent free-for-all, for giving elites a bad name and for making greed respectable, or at least acceptable. That’s just this month, and just on this page. And it’s not only conservatives beating us with the Woodstock whip. Kurt Andersen, a confessed liberal and one of our more prolific cultural omnivores, started the latest thumping July 4 with an argument that amoral self-gratification is just the flip side of social liberation: “Thanks to the ’60s, we are all shamelessly selfish.”

The notion that our generation has been spoiled rotten is not a terribly new thought. A dozen years ago Paul Begala (of Bill Clinton and CNN fame) published in Esquire the classic of boomer-loathing, “The Worst Generation.” “The Baby Boomers are the most self-centered, self-seeking, self-interested, self-absorbed, self-indulgent, self-aggrandizing generation in American history,” he declared. It’s a sturdy genre. Perhaps while Googling yourself you have come across the blog Boomer Deathwatch (“Because one day, they’ll all be dead”), a checklist of famous boomers who hit their actuarial sell-by dates. Even Barack Obama, who styles himself post-boomer though he was born in 1961, complained in “The Audacity of Hope” that today’s hyperpolarized political discourse began with the “psychodrama of the baby boom generation.”

Yes, yes, this criticism is glib. We didn’t start the war in Vietnam, but members of our generation fought both in it and against it, demonstrating some of the spirit of sacrifice we are not famous for. Our ranks include the outsourcers of Bain and the wizards of the Wall Street casino, but also the entrepreneurial genius of Steve Jobs and Bill Gates. The Bill Clinton of Monicagate was the first boomer president, but so was the Bill Clinton of relative peace and prosperity. Our record-buying dollars gave the world disco — so sorry about that — but also Motown and Springsteen. I’d say the argument will continue forever if that didn’t sound like such an all-about-us, boomer thing to say.

But even though the caricature is way too easy, it has stuck, and we all know that it contains more than a nugget of truth. We are an entitled bunch.

This brings me to a soon-to-be released study by the incorrigible pragmatists at Third Way, the centrist Democratic think tank. The study takes a familiar refrain and presents it with a graphic wallop. Though it was intended as a wake-up call, not an indictment of a generation, it can be read as both.

The authors examined two categories of federal spending over the past 50 years, representing two of government’s fundamental missions. One was “investments,” which includes maintaining our national infrastructure, keeping our military equipped, helping assure that our work force is educated to a high standard, and underwriting the kind of basic scientific research that is too risky or long-term to attract private money. The report calls this the legacy of President Kennedy’s New Frontier, though the largest infrastructure project in our history, the interstate highway system, was Eisenhower’s baby, a reminder of the days when Republicans still believed in that stuff. The other category was “entitlements,” a catchall word for the safety-net programs that provide a measure of economic stability for the aging and poor: Social Security, Medicare, Medicaid, etc.

You will not be surprised to hear that the red line tracking entitlements goes up while the blue line reflecting investments goes down. What is alarming is the trajectory.

In 1962, we were laying down the foundations of prosperity. About 32 cents of every federal dollar, excluding interest payments, was spent on investments, only 14 percent on entitlements. In the mid-70s the lines crossed. Today we spend less than 15 cents on investment and 46 cents on entitlements. And it gets worse. By 2030, when the last of us boomers have surged onto the Social Security rolls, entitlements will consume 61 cents of every federal dollar, starving our already neglected investment and leaving us, in the words of the study, with “a less-skilled work force, lower rates of job creation, and an infrastructure unfit for a 21st-century economy.”

Some of the entitlement bloat comes from the addition of new programs — notably the prescription drug benefit espoused by our second boomer president, George W. Bush, and the Affordable Care Act, though at least that law sets in motion offsetting measures aimed at containing the soaring cost of health care. Some of the growth is built into formulas that increase benefits faster than inflation or G.D.P. And a lot of it is us: boomers, aging into Social Security and Medicare. “We’ve reached the point where our working-age population over the next 30 years grows by one-fifth, and our elderly population grows 100 percent,” said Jim Kessler, the senior vice president for policy at Third Way.

Indignant readers are already revving up to tell me that Social Security and Medicare are sacred promises, that cutting them would be stone-hearted Republicanism. A.A.R.P., the lobby for people we used to call senior citizens until we realized that meant us, got hammered by the left earlier this year when its C.E.O. dared to convene a meeting of Washington insiders to even discuss the subject. No wonder A.A.R.P. shies away from supporting any entitlement reform.

But the traditional liberal alternatives — raise taxes on the well-to-do, cut military spending — are not nearly enough by themselves. The arithmetic simply doesn’t work, unless we face the fact that entitlements are a bargain we can’t afford to keep, not in full.

So the question is not whether entitlements have to be brought under control, but how. The Republican plan espoused by Mitt Romney and his fiscal lodestar Paul Ryan would cut the cost of entitlements largely by moving toward privatization: personal investment accounts for Social Security, vouchers for Medicare. And it’s not at all clear the Republicans would assign any of the savings to investing in our future.

At least the Republicans have a plan. The Democrats generally recoil from the subject of entitlements. Centrists like those at Third Way and the bipartisan authors of the Simpson-Bowles report endorse a menu of incremental cuts and reforms that would bring down costs without hitting the needy or snatching away the security blanket from those nearing retirement. They include gradually raising the retirement age to compensate for the fact that we now live, on average, 14 years longer than when F.D.R. signed Social Security into law. They include obliging those of us who can really afford it to pay a larger share. They also include technical fixes like aligning the automatic cost-of-living formula with reality. To curtail the raging inflation of health costs, the government could better use its market clout to hasten electronic record-keeping, replace the fee-for-service model, reform medical malpractice laws and promote living wills. (A quarter of health care spending comes in the last year of life.) But you won’t hear much of that on the campaign trail.

FELLOW boomers, we have done more than our share to make this mess. It’s not our fault that there are a lot of us, but we have resisted any move to fix the system. We should make a sensible reform of entitlements our generation’s cause. We should stiffen the spines of our politicians, and push lobby groups like A.A.R.P. to climb out of the bunker and lead. (And, by the way, we should resist the boomer temptation to take every cent of the reform from the pockets of our kids.) We should keep the heat on Congress and the president to double down on the cost-saving provisions in Obamacare.

We may not be the greatest generation, but we are the largest — and we vote. We throw our weight around. What if we threw some of it in the right direction?

Resource Recovery

Ashley Halligan, of Software Advice, recently published an article outlining innovative partnerships between resource recovery centers--and how symbiotic relationships between landfills and facilities can lead to an economic and efficient energy supply. Featuring Rutgers University's EcoComplex, Catawba County, North Carolina's EcoComplex, and BMW's South Carolina manufacturing, her article shows just how much energy can be recovered by tapping methane wells scattered throughout landfills.

Read her full story: Resource Recovery Facilities: An Economic And Efficient Energy Supply.

Sunday, July 29, 2012

Denial, Not Just a River in Egypt

I can't add anymore to this piece from the Op-Ed pages in the New York Times. As I just said we have no idea what kind of country we are - trickle down or up by the bootstraps - but regardless like our war on drugs, other countries, women, the rich whatever the current lather rinse repeat cycle of cable news likes to drumbeat, we have real problems that cannot be denied. For a rich Country we have a lot of poor people. What is more disturbing is that even the poor deny they are such. Is it shame, confusion or denial? I have no idea but the facts are what they are.

Politicians love to tout the middle class.. really do they exist or are they what they say they are not what they are in reality?



Poverty in America: Why Can’t We End It?

By PETER EDELMAN
Published: July 28, 2012

RONALD REAGAN famously said, “We fought a war on poverty and poverty won.” With 46 million Americans — 15 percent of the population — now counted as poor, it’s tempting to think he may have been right.

Look a little deeper and the temptation grows. The lowest percentage in poverty since we started counting was 11.1 percent in 1973. The rate climbed as high as 15.2 percent in 1983. In 2000, after a spurt of prosperity, it went back down to 11.3 percent, and yet 15 million more people are poor today.

At the same time, we have done a lot that works. From Social Security to food stamps to the earned-income tax credit and on and on, we have enacted programs that now keep 40 million people out of poverty. Poverty would be nearly double what it is now without these measures, according to the Center on Budget and Policy Priorities. To say that “poverty won” is like saying the Clean Air and Clean Water Acts failed because there is still pollution.

With all of that, why have we not achieved more? Four reasons: An astonishing number of people work at low-wage jobs. Plus, many more households are headed now by a single parent, making it difficult for them to earn a living income from the jobs that are typically available. The near disappearance of cash assistance for low-income mothers and children — i.e., welfare — in much of the country plays a contributing role, too. And persistent issues of race and gender mean higher poverty among minorities and families headed by single mothers.

The first thing needed if we’re to get people out of poverty is more jobs that pay decent wages. There aren’t enough of these in our current economy. The need for good jobs extends far beyond the current crisis; we’ll need a full-employment policy and a bigger investment in 21st-century education and skill development strategies if we’re to have any hope of breaking out of the current economic malaise.

This isn’t a problem specific to the current moment. We’ve been drowning in a flood of low-wage jobs for the last 40 years. Most of the income of people in poverty comes from work. According to the most recent data available from the Census Bureau, 104 million people — a third of the population — have annual incomes below twice the poverty line, less than $38,000 for a family of three. They struggle to make ends meet every month.

Half the jobs in the nation pay less than $34,000 a year, according to the Economic Policy Institute. A quarter pay below the poverty line for a family of four, less than $23,000 annually. Families that can send another adult to work have done better, but single mothers (and fathers) don’t have that option. Poverty among families with children headed by single mothers exceeds 40 percent.

Wages for those who work on jobs in the bottom half have been stuck since 1973, increasing just 7 percent.

It’s not that the whole economy stagnated. There’s been growth, a lot of it, but it has stuck at the top. The realization that 99 percent of us have been left in the dust by the 1 percent at the top (some much further behind than others) came far later than it should have — Rip Van Winkle and then some. It took the Great Recession to get people’s attention, but the facts had been accumulating for a long time. If we’ve awakened, we can act.

Low-wage jobs bedevil tens of millions of people. At the other end of the low-income spectrum we have a different problem. The safety net for single mothers and their children has developed a gaping hole over the past dozen years. This is a major cause of the dramatic increase in extreme poverty during those years. The census tells us that 20.5 million people earn incomes below half the poverty line, less than about $9,500 for a family of three — up eight million from 2000.

Why? A substantial reason is the near demise of welfare — now called Temporary Assistance for Needy Families, or TANF. In the mid-90s more than two-thirds of children in poor families received welfare. But that number has dwindled over the past decade and a half to roughly 27 percent.

One result: six million people have no income other than food stamps. Food stamps provide an income at a third of the poverty line, close to $6,300 for a family of three. It’s hard to understand how they survive.

At least we have food stamps. They have been a powerful antirecession tool in the past five years, with the number of recipients rising to 46 million today from 26.3 million in 2007. By contrast, welfare has done little to counter the impact of the recession; although the number of people receiving cash assistance rose from 3.9 million to 4.5 million since 2007, many states actually reduced the size of their rolls and lowered benefits to those in greatest need.

Race and gender play an enormous part in determining poverty’s continuing course. Minorities are disproportionately poor: around 27 percent of African-Americans, Latinos and American Indians are poor, versus 10 percent of whites. Wealth disparities are even wider. At the same time, whites constitute the largest number among the poor. This is a fact that bears emphasis, since measures to raise income and provide work supports will help more whites than minorities. But we cannot ignore race and gender, both because they present particular challenges and because so much of the politics of poverty is grounded in those issues.

We know what we need to do — make the rich pay their fair share of running the country, raise the minimum wage, provide health care and a decent safety net, and the like. But realistically, the immediate challenge is keeping what we have. Representative Paul Ryan and his ideological peers would slash everything from Social Security to Medicare and on through the list, and would hand out more tax breaks to the people at the top. Robin Hood would turn over in his grave.

We should not kid ourselves. It isn’t certain that things will stay as good as they are now. The wealth and income of the top 1 percent grows at the expense of everyone else. Money breeds power and power breeds more money. It is a truly vicious circle.

A surefire politics of change would necessarily involve getting people in the middle — from the 30th to the 70th percentile — to see their own economic self-interest. If they vote in their own self-interest, they’ll elect people who are likely to be more aligned with people with lower incomes as well as with them. As long as people in the middle identify more with people on the top than with those on the bottom, we are doomed. The obscene amount of money flowing into the electoral process makes things harder yet.

But history shows that people power wins sometimes. That’s what happened in the Progressive Era a century ago and in the Great Depression as well. The gross inequality of those times produced an amalgam of popular unrest, organization, muckraking journalism and political leadership that attacked the big — and worsening — structural problem of economic inequality. The civil rights movement changed the course of history and spread into the women’s movement, the environmental movement and, later, the gay rights movement. Could we have said on the day before the dawn of each that it would happen, let alone succeed? Did Rosa Parks know?

We have the ingredients. For one thing, the demographics of the electorate are changing. The consequences of that are hardly automatic, but they create an opportunity. The new generation of young people — unusually distrustful of encrusted power in all institutions and, as a consequence, tending toward libertarianism — is ripe for a new politics of honesty. Lower-income people will participate if there are candidates who speak to their situations. The change has to come from the bottom up and from synergistic leadership that draws it out. When people decide they have had enough and there are candidates who stand for what they want, they will vote accordingly.

I have seen days of promise and days of darkness, and I’ve seen them more than once. All history is like that. The people have the power if they will use it, but they have to see that it is in their interest to do so.

Its the Money, Stupid

As I returned from the DOE Building America meetup I commented on how few tradespeople were in attendance. Since these concepts and ideas directly affect them I would of appreciated hearing from those in the field who actually do the work and deal with customers and the issues that surround them - both in economics and practicality. Its easy from an Ivory Tower to tell people what to do but its another to do it. I still haven't quite recovered from the stinging rebuke one panelist gave to a builder as he offered up his current work regarding energy efficiency and insulation; the panelist response was less than favorable, it was arrogant, rude and bullying. But this is our climate now - my way or the highway and no apologies. It seems to be working well!

Of course I was greeted daily by the same individual's business partner, another acclaimed individual in the field, with "I still love you babe." I thought "well I have either entered the 70s and this is Sonny Bono or I was being patronized." I decided regardless to ignore it and take it from the source. And the irony is that usually that type of sexism is thought of us from those without the Ph.D's following their name. It goes to show that education doesn't change a leopard's spots.

And then today I read the cover story in the New York Times regarding the problem of a Doctor shortage that will have significant affects on the upcoming Affordable Care Act and the Insurance mandate and coverage that will result. I have already written about the state of Medicine in this country and its quite a potpourri of quality and accessibility throughout the country. And much of this is because we have no single standard of care, regulation or body to ensure consistency. Like our Building regulations we rely on local State bodies and individual organizations to self police and devise a system that somehow meets the ideal - whatever arbitrary ideal that is. Its not specific or well even consistent, but hey no one said 50 States with competing political parties, agendas and budgets allow would be easy to corral.

I then read in another article about a boot camp/institute for start up tech geeks. Once again Silicon Valley leads the way when it comes to doing anything in this country. Of course its all about making a quick buck and little to do with actually something that is needed to fix our broken infrastructure. Its about money, stupid and that soon enough like any pyramid schemes it will end up with someone burning their feet walking across coals.

We live in the immediate and delaying gratification or accepting that we must simply SHARE MORE in order to DO MORE. We are not good about that clearly. From the notion that we are an up by the bootstraps, ground up country to the opposing but equally absurd idea that its a trickle down world in which we live. Which is it? With only 1% of the population benefiting I am not sure I am seeing this equality notion that we also hold as dear to us as that tattered copy of the Constitution that people like to wave about. I guess its all relative when you are the one either doing the pulling up or the trickling down upon. Saw it personally this week and I was more embarrassed for us having to witness it.

The ivory tower is a tall one and when one is getting trickled down from it we could easily attain a head injury. And since there aren't any Doctors available - either willingly or not - things are not looking good for building any America.

Doctor Shortage Likely to Worsen With Health Law
By ANNIE LOWREY and ROBERT PEAR
Published: July 28, 2012

RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”

In the Inland Empire, encompassing the counties of Riverside and San Bernardino, the shortage of doctors is already severe. The population of Riverside County swelled 42 percent in the 2000s, gaining more than 644,000 people. It has continued to grow despite the collapse of one of the country’s biggest property bubbles and a jobless rate of 11.8 percent in the Riverside-San Bernardino-Ontario metro area.

But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.

A government council has recommended that a given region have 60 to 80 primary care doctors per 100,000 residents, and 85 to 105 specialists. The Inland Empire has about 40 primary care doctors and 70 specialists per 100,000 residents — the worst shortage in California, in both cases.

Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.

Providers say they are bracing for the surge of the newly insured into an already strained system.

Temetry Lindsey, the chief executive of Inland Behavioral & Health Services, which provides medical care to about 12,000 area residents, many of them low income, said she was speeding patient-processing systems, packing doctors’ schedules tighter and seeking to hire more physicians.

“We know we are going to be overrun at some point,” Ms. Lindsey said, estimating that the clinics would see new demand from 10,000 to 25,000 residents by 2014. She added that hiring new doctors had proved a struggle, in part because of the “stigma” of working in this part of California.

Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.

“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.

Physician compensation is also an issue. The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.

The Obama administration has sought to ease the shortage. The health care law increases Medicaid’s primary care payment rates in 2013 and 2014. It also includes money to train new primary care doctors, reward them for working in underserved communities and strengthen community health centers.

But the provisions within the law are expected to increase the number of primary care doctors by perhaps 3,000 in the coming decade. Communities around the country need about 45,000.

Many health experts in California said that while they welcomed the expansion of coverage, they expected that the state simply would not be ready for the new demand. “It’s going to be necessary to use the resources that we have smarter” in light of the doctor shortages, said Dr. Mark D. Smith, who heads the California HealthCare Foundation, a nonprofit group.

Dr. Smith said building more walk-in clinics, allowing nurses to provide more care and encouraging doctors to work in teams would all be part of the answer. Mr. Corcoran of the California Medical Association also said the state would need to stop cutting Medicaid payment rates; instead, it needed to increase them to make seeing those patients economically feasible for doctors.

More doctors might be part of the answer as well. The U.C. Riverside medical school is hoping to enroll its first students in August 2013, and is planning a number of policies to encourage its graduates to stay in the area and practice primary care.

But Dr. Olds said changing how doctors provided care would be more important than minting new doctors. “I’m only adding 22 new students to this equation,” he said. “That’s not enough to put a dent in a 5,000-doctor shortage.”

Saturday, July 28, 2012

Sam, As in Houston

I lived in Austin for a year once. And while its debatable that Austin is in Texas it is and as much as I enjoyed it, I would not live there again. Its a state of irony perhaps than the State itself that I found troubling. Politics reign there and frankly its not a state of affairs I find interesting or actually intelligent. A great State history does not make a great State and Texas leads in this country for many troubling statistics.

But then there is always a green side. Houston, eponymous with Energy is going green. Below is an article from the Economist discussing Houston's commitment to moving towards a more sustainable front and as they used to say about California... there goes the nation... perhaps they can say that about Texas. Oh wait maybe not that extreme.

After my three days at the Building America conference I find this heartening. As it was said numerous times much of this will have to come from the ground up, literally and figuratively, when it comes to changing behaviors, attitudes and ideas about what it means to live sustainably. How that is done comes in many forms - costs of energy, health, environmental issues, whatever gets you to come to the sustainable party I say its BYOSG, bring your own shade of green.

However, that for many seems pale indeed. And in a State like Texas where regulations, government and industry are all tied together to the concept that any regulation is bad regulation its a state of affairs I cannot endorse. Having lived there and remodeled a property there we joked there were more restrictions and guides in Oklahoma. We have to start thinking that having competing interests and having States with independent, indifferent rules and regulations are not working to make this picture a whole one. And there is nothing wrong with Government and Private Industry working together to achieve a common goal, its just what is that goal? To industry its profit and the Government its a higher order - just what is that order well there is the preamble to the Constitution that states:

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.


I always to build a home it must be as good as its foundation. And that is where must start. Finding ways to Build America that we will not always like what is best for us, we might not agree on ways to do it but we must just put that aside, find the ways that enable us to Just Do It. Change is gonna do US ALL good.

Changing the plans
America’s oil capital is throwing up a few environmental surprises


Jul 14th 2012 | HOUSTON | from the print edition

STEVE KLINEBERG, a sociologist at Rice University, mentions a couple of events that made Houston’s leaders take notice of a looming problem. One was the day, in 1999, when their city overtook Los Angeles as America’s most polluted—evidence that the rise in asthma attacks among the city’s children, and the students passing out on football pitches, were no coincidence. Another was when Houston came up short in its bid to compete to host the 2012 Olympics. No one on the United States Olympics Committee voted for it, despite the fact that Houston had a brand-new stadium and had promised to turn an old sports field into the world’s largest air-conditioned track-and-field arena.

At a casual glance, Houston looks much as it ever did: a tangle of freeways running through a hodgepodge of skyscrapers, strip malls and mixed districts. A closer inspection, though, shows signs of change. The transport authority, which branched into light rail in 2004, is now planning three new lines, adding more than 20 miles of track. Most of the traffic lights now boast LED bulbs, rather than the incandescent sort. More than half the cars in the official city fleet are hybrid or electric, and in May a bike-sharing programme began. Every Wednesday a farmers’ market takes place by the steps of city hall.

Other changes are harder to see. The energy codes for buildings have been overhauled and the city is, astonishingly, America’s biggest municipal buyer of renewable energy; about a third of its power comes from Texan wind farms.

Houston, in other words, is going green. Laura Spanjian, the city’s director of sustainability, says that businesses are increasingly likely to get on board if they can see the long-term savings or the competitive advantages that flow from creating a more attractive city. She adds an important clarification: “We’re not mandating that they have to do this.” That would not go down well. Houston is the capital of America’s energy industry, and its leaders have traditionally been wary of environmental regulation, both at home and abroad.

In fact the city has been sceptical of regulations in general, and even more of central planning. Houston famously has no zoning, which helps explain why the city covers some 600 square miles. It is America’s fourth-largest city by population, but less than half as densely populated as sprawling Los Angeles. People are heavily dependent on cars, the air quality is poor and access to green space is haphazard. At the same time, Houston has jobs, a low cost of living and cheap property. Many people have accepted that trade-off. Between 2000 and 2010 the greater metropolitan area added more than 1.2m people, making it America’s fastest-growing city.

Still, the public is taking more interest in sustainability, and for a number of reasons. As the city’s population has swelled, the suburbs have become more crowded. Some of the growth has come from the domestic migration of young professionals with a taste for city life. And despite living in an oil-industry hub, the people of Houston are still aware of the cost of energy; during the summer of 2008, when petrol prices hovered around $4 a gallon, the papers reported a surge of people riding their bicycles to bus stops so that they could take public transport to work.

The annual Houston Area Survey from Rice’s Kinder Institute also shows a change. This year’s survey found that 56% think a much better public transport system is “very important” for the city’s future. A similarly solid majority said the Metro system should use all its revenue for improvements to public transport, rather than diverting funds to mend potholes. In the 1990s, most respondents were more concerned about the roads.

People’s views about houses have changed, too. In 2008 59% said they would prefer a big house with a big garden, even if that meant they had to use their car to go everywhere. Just 36% preferred a smaller house within walking distance of shops and workplaces. By 2012, preferences were running the other way: 51% liked the idea of a smaller house in a more interesting district, and only 47% said they wanted the lavish McMansion.

Friday, July 27, 2012

Building America


My final thoughts about this years Building America conference are actually all complementary. I come every year to this the building geekfest knowing, in advance, that this is often highly technical and theoretical as much of what is discussed are studies done in the field as the DOE works toward the goal of reducing home energy use by 50% by 2030.

And while I find much of the information specific to trades and more importantly to the building scientists there is much to be gained for the average "joe" in the field. Sadly there are FEW in attendance and often many seem to be ducks out of water and at times maligned, mocked or ignored. I get that a Ph.d in Engineering is well a Ph.d in Engineering but let's be honest the closest anyone in the field gets to a Ph.d is when they come to fix their broken house. Ultimately those who do, do and those who don't research - as they sure as hell don't teach. The art of pedagogy is not on display much at these events but then again they aren't teachers.

But my real complaint is that there is no discussion on how to engage, invite or encourage those in the field to come, to present to bring real challenges and issues that they face in their jobs and how they are to meet this heady challenge. Its not from a lack of desire but of economics and opportunity I suspect. I come and sit alone, I rarely speak and when I do its without filter and at times I am respected for it but often I too feel very "duck out of water." It can be distressing day after day to sit, eat and have no interaction of any kind. I have a tough skin but its well something I have gotten used to - sort of. Glad its in Denver a city I cannot wait to move to next year for the people here long compensate for the lack of camraderie at the conference.

I do find it interesting however that the usual suspects who would have no problem attending as they are vigorous bloggers and attendees at other events. From Curmudgeons to Huggers they are not here at a conference that simply seems to be a perfect fit. I am not sure if they used to attend and decided that the geekfest was well even too geeky or that when actually in a room of accomplished, intelligent and well no less passionate individuals was not their cup of "green tea."

I would like to see more diversity, more debate and more important voices to add to the dialogue new ways of how to make these goals and tests reality for all in the field so that this 2030 goal is not just a goal but a reality.

Corporations are People, my friends

Given the current climate about Citizens United and the decision that awarded corporations the status of people when it comes to political donations and in turn influence I would write a thought. Well its no question that money talks and wow that is one loud voice when its attached to a check with lots of zeroes.



It also enables controversy when an Owner/CEO speaks about his/her personal views in line with the company as the recent Chick-fil-A situation illustrates. While the company it appears has no illegalities or issues regarding its franchises or whom they hire, serve etc, the ramblings and thoughts of the owner are very much a reflection of the corporation "at large." And in turn customers have the right to partake or boycott the company in line with their own personal beliefs. Simple equation but the cable news cycle of wash/rinse/repeat has made a business that until then I had never heard of into the equivalent of a butchered chicken running around with its head cut off. Never eaten there and frankly never will - the problem is not about the owners views because frankly the food it serves is not my idea of food. There is a whole other problem with that business that has little to do with the owner's predilection in my world (and for the record I think marriage is hideous for anyone regardless of sexuality but I would never stop anyone from partaking and learning the hard way).

Then we have Jeff Bezos of Amazon donating 2.5 Million to Washington State's same sex equality movement. Again, Mr. Bezos' personal/political views are not my problem nor interest. I have way more concerns with regards to Amazon that have little to do with this issue. Amazon has done more to destroy bookstores and small businesses while also compensating his workers in his shipping warehouses with substandard wages, using agencies to offset the requirements of health care benefits and establishing working conditions that have been well documented as appalling. Frankly Amazon to me is the WalMart of the Internet. I go out of my way to avoid Amazon and Mr. Bezos generosity about what is a personal belief is not going to make me change my mind anytime soon.

We have a real problem in this country regarding the rich and the relationship to "job creators". I am a job creator every time I fly on a plane, eat in a restaurant, buy a book or leave my house frankly. We are ALL job creators and should have the same rights and privileges that are seemingly awarded to the elite class. What we criticize or commend one group we seem to do so based on our politics and that often has little to do with reality.

And again this is not sustainable. Corporations are not people. I can't marry a corporation how ironic. So unless Mr. Bezos wants to pay his people a living wage, benefits and stop the crushing of local businesses I don't plan on marrying Amazon very soon.

Working Man

One of the leading producers of tools used by the working trades man is Caterpillar. And its notorious for its treatment towards the men who make those tools while simultaneously profiting from it.


Posting Profits, Caterpillar Raises Outlook
By REUTERS

Caterpillar, the world’s largest maker of construction equipment, raised its 2012 profit forecast on Wednesday and said the global economy was slowly improving amid pockets of weakness.

The outlook came after Caterpillar posted a quarterly profit that exceeded Wall Street forecasts because of higher sales of bulldozers, marine engines and mining trucks.

Caterpillar’s sales rose 31 percent in North America, the area of strongest growth for the company, executives said in a conference call with investors.

Business for many customers has not returned to prerecession levels, but aging equipment is forcing them to invest in new machines, a boon for Caterpillar.

“Contractors, even if they’re doing the same amount of work as before, just have to buy new machines,” Caterpillar’s chief financial officer, Ed Rapp, said in an interview. “That’s a factor that we’re definitely seeing in our numbers.”

The company raised its annual earnings forecast by a dime a share but beat second-quarter expectations by 26 cents. Still, analysts cautioned that Caterpillar faced challenges.

“It’s not that there’s lots of fear in Caterpillar numbers, but everyone is affected by the much weaker global outlook,” said Eli Lustgarten, a Longbow Research analyst.

For the second quarter, Caterpillar reported a profit of $1.67 billion, or $2.54 a share, compared with $1.02 billion, or $1.52 a share, a year ago. Analysts on average expected earnings of $2.28 a share, according to Thomson Reuters.

Revenue rose 21 percent to $17.37 billion. Analysts expected $17.11 billion.

The company now expects to earn $9.60 a share in 2012, up from a previous forecast of $9.50. For the year, analysts expect a profit of $9.54 a share.


That is great right? To hear that an American company is doing well despite it means its a win-win. Yes for the CEO, Executives, the board and the "shareholders" What that really means is actually a win for Wall Street. Wall Street sets standards and expectations and in turn sets the loan rates and interest that companies use to borrow to grow, operate, etc. And when businesses don't meat "expectations" regardless of their profitability, success or what-have-you Wall Street gets mad. When Wall Street gets mad they penalize them because ultimately its not about the company and its ability to survive a storm, maintain a business, this is about Wall Street and their fees and profits. Its a bad marriage that well goes well beyond four walls. But most people believe that if the stock market is happy they are happy and validate it via their only link - 401k's. Not even knowing if that company is part of the portfolio let alone who is actually making money off said portfolio but that well is hard...

We are easily swayed by the CNBC PR Machine or the hype that is what Wall Street wants. Just like Silicon Valley and the absurdity that Entrepreneurs are these silly boys passing money between themselves for their "innovations" Americans are easily convinced that they are somehow affected by the Stock Market's ups and downs. In some ways that may be true but in most ways Americans live off wages, they save very little and are forced to rely on Social Security as their support in retirement years. So earning more while one is earning can be the key to offset that fact. But that is not the fact, CEO's make 300% more than the average rank worker and have guaranteed pensions not 401K's and still qualify for Social Security at rates we can not imagine. Parity, fairness or even sustainability are the real facts here. And Caterpillar a great American brand does much like many other American brands, and if not outsource pay American wages the closest equivalent to outsourced ones. And they seem proud of. The irony that an American company that Builds America and the world refuses to compensate their workers appropriately. Its just another way of showing we have a lot of work to do to truly Build America for all of its population not just the elite few.

At Caterpillar, Pressing Labor While Business Booms


By STEVEN GREENHOUSE
Published: July 22, 2012

JOLIET, Ill. — When it comes to dealing with labor unions, Caterpillar has long taken a stance as tough as the bulldozers and backhoes that have burnished its global reputation. Be it two-tier wage scales or higher worker contributions for health insurance, the company has been a leader in devising new ways to cut labor costs, with other manufacturers often imitating its strategies.

Now, in what has become a test case in American labor relations, Caterpillar is trying to pioneer new territory, seeking steep concessions from its workers even when business is booming.

Despite earning a record $4.9 billion profit last year and projecting even better results for 2012, the company is insisting on a six-year wage freeze and a pension freeze for most of the 780 production workers at its factory here. Caterpillar says it needs to keep its labor costs down to ensure its future competitiveness.

The company’s stance has angered the workers, who went on strike 12 weeks ago. “Considering the offer they gave us, it’s a strike we had to have,” said Albert Williams, a 19-year Caterpillar employee, as he picketed in 99-degree heat outside the plant, which makes hydraulic parts and systems essential for much of the company’s earth-moving machinery.

Caterpillar, which has significantly raised its executives’ compensation because of its strong profits, defended its demands, saying many unionized workers were paid well above market rates. To run the factory during the strike, the company is using replacement workers, managers and a few union members who have crossed the picket line.

The showdown, which has no end in sight, is being closely watched by corporations and unions across the country because it involves two often uncompromising antagonists — Caterpillar and the International Association of Machinists — that have figured in many high-stakes labor battles.

“Caterpillar has been a leader in the past 20 years in taking a hard line,” said Richard Hurd, a professor of industrial relations at Cornell. Last winter, Caterpillar locked out about 450 workers at its locomotive plant in London, Ontario, and then closed the factory after the union rejected its demand to cut wages by 55 percent. In the mid-1990s, the company vanquished the United Automobile Workers after a 17-month strike by 9,000 workers at eight factories; the union surrendered and accepted the company’s concession-filled offer.

The machinists have carried out largely successful strikes at Boeing and Lockheed Martin, ultimately winning better raises and benefits for thousands of members.

Robert Bruno, a labor relations professor at the University of Illinois, said Caterpillar was trying to drive compensation down to a new floor. “Caterpillar sees this as ‘the new normal,’ while this union local feels you have to draw a line in the sand to hold on,” he said. “Some people are saying the union should be more deferential, more compliant, that it’s a bad time to strike. How can you counter a powerful multinational in this economy?”

The current showdown is playing out on a flat stretch along Channahon Road here, 40 miles southwest of Chicago, where 15 strikers stand at the plant entrance during each four-hour picketing shift, with signs saying, “Fighting for Our Children’s Future” and “I Am Solidarity.” The strikers often shout “scab” as replacement workers drive into the factory.

Ever since negotiations began in March, Caterpillar has insisted on a wage freeze for its top-tier workers, those employed seven years or more; they average $26 an hour, or $55,000 a year before overtime. For the junior third of the workers who typically earn $12 to $19 an hour, Caterpillar has made no promises but has suggested it might raise their wages based on local market conditions.

Caterpillar has offered workers several modest, one-time payments, but is also demanding far higher health care contributions from its workers, up to $1,900 a year more, according to the union. The company had profit of $39,000 per employee last year.

Carlos Revilla, the plant’s operations manager, defended the push for a pay freeze, saying the top-tier workers were paid 34 percent above market level.

“A competitive and fair wage package is a must,” he said in a statement. “Paying wages well above market levels makes Joliet uncompetitive.”

But the union says Caterpillar, the world’s largest producer of earth-moving equipment, is in no way uncompetitive and should be sharing its prosperity with its workers.

“A company that earned a record $4.9 billion in 2011 and $1.586 billion in the first quarter of this year should be willing to help the workers who made those profits for them,” said Timothy O’Brien, president of Machinists Local Lodge 851, which represents the strikers. “Caterpillar believes in helping the very rich, but what they’re doing would help eliminate the middle class.”

He said the company wants a pay and pension freeze for longtime workers to push them into retirement and replace them with $13-an-hour workers.

Michael LeRoy, another labor relations professor at the University of Illinois, said Caterpillar has served as a model in legitimizing tough labor strategies, like take-it-or-leave-it contract offers.

Detroit’s automakers, for example, followed Caterpillar’s lead in adopting a two-tier wage system, lengthy contracts and a special health care trust fund for retirees, although “it took a bankruptcy to do it,” said Sean McAlinden, chief economist at the Center for Automotive Research.

Rusty Dunn, a Caterpillar spokesman, said the philosophy of paying market-based wages would help Caterpillar “keep competitive when times are bad.”

“We think the overall approach will preserve job growth in Illinois and the U.S.,” he said. Caterpillar has added about 6,500 jobs in the United States over the past year.

The strikers here exude an unusual defiance and pride, boasting that the hydraulic parts they produce require some of the most exacting specifications in heavy manufacturing.

“We make an excellent product here, a product that Caterpillar uses in all its vehicles,” said Mr. Williams, a machinery repairman. “That gives us a leverage that the other plants don’t have.”

Yet he admits to feeling financial pain. He receives $150 a week in strike benefits, and he said he did not have the $40 needed for his 11-year-old son to play Little League.

The Joliet strikers hope Caterpillar will soon sweeten its offer after concluding that it needs the strikers back to produce vital components.

Caterpillar says that is unlikely.

“We believe we have exhausted the negotiating process,” Mr. Dunn said. “The primary strategy, going forward, is to run the plant with the contingent work force as long as the work stoppage continues.”

He added that Caterpillar’s offer was “competitive, reasonable and fair.”

Rose Bain, a striker, grows impatient with such arguments. Earning $15 an hour after two years, she said she could not afford a six-year freeze and did not trust Caterpillar to follow through with the hinted raise for lower-paid workers.

“We’re the people who busted our butts to help them make record profits,” she said. “We shouldn’t be treated like this.”

Thursday, July 26, 2012

Get Well

That is the "wish" the "message" we send to those who are sick. Simple, easy and true right? Well I send that message to our hideous health care system. Much is made that we have the greatest health care system in the world. The truth is not that. We have the most expensive with the least results. Its corrupt, its inefficient and its run for profit.

Yes going to the Doctor/Hospital is akin to going to Vegas but instead of betting it all on black you are betting with your life. And you know the rule in Vegas - the house always wins. Much is the same in the case of Medicine in this country.

I was a big supporter of health care reform and really the ACA (Affordable Care Act) or "Obamacare" falls exceedingly short of reform. What it does do it put all Americans in the hands of private, for profit insurance, with a few caveats but nonetheless we are now in the hands of the house and they hold all the cards. Insurance for all its faults is also the intermediary between us and the overall Medical system which I give C for Chaos and not for Care, which is what it should be about.

I have read many many books on Health Care problems in this country. I can recommend Maggie Mahar's,"Money Driven Medicine", "Surviving Your Doctors" by Richard S Klein MD, and my personal favorite "How We Do Harm" by Otis Brawley MD. Reading his book at the moment brings home my own entrance to the Medical Matrix of late and while I find it comforting to know that the horror I experienced is not uncommon its also quite tragic. Shocking. Horrifying. Tragic. Yes those are all three adjectives I can easily apply to my situation and to those in Dr. Brawley's book.

Its not sustainable. We cannot continue on this trajectory. Medical costs continue to rise and as result new profit making methods are designed to retain or maintain profit margins. My favorite so far is this article from the LA Times regarding Well Point. They have managed to actually outsource medicine. While Medical Tourism is one way to offset the bankruptcies that result from American medical care, you will be able to stay home and have your Doctor in Philippines diagnose that tumor. I wonder if that will be at the same rate or will the American Doctor take a cut? Well they are charging now for faxing your prescriptions to pharmacy's now. Yes Virgina, Doctors charge extra for that!

Dr. Brawley says and I quote: Health Care for all is as much a civil rights issue as is one, man one vote. And like civil rights, the right to good health care will have to won in a public struggle.

In other words its us becoming educated citizens who are willing to advocate and demand better, affordable health care for all. Currently many are simply unknowing advocates for a pharmaceutical industry that works against your best interests. But I could say the same about many in politics as well.

We have this fantasy image of Doctors as something between Kildare, Welby and McDreamy. They aren't. Until you have entered the medical matrix and personally experienced the level of incompetence you have no idea. I do and one day I will in detail discuss how I was personally affected by such. Insured or not it really doesn't matter in this country. We are pawns to be used by the system and its all just a crap game where the dice are loaded. House always wins.



Your healthcare — it's just a phone call to India away
By Paul Whitefield

July 25, 2012, 1:00 p.m.

When I was a lad, I suffered from asthma. And on more than one occasion, the doctor in my small town made a trip to our house — usually in the evening — to treat me.

No, really.

Healthcare in the U.S. has come a long way since then — and not necessarily in a good way.

Take Wednesday’s story in The Times: "[S]ome healthcare companies are starting to shift clinical services and decision-making on medical care overseas, primarily to India and the Philippines."

Yikes! I mean, it’s one thing when “Bruce” in Bangalore is diagnosing your misrouted computer router. It’s quite another when the innards he’s poking around in are your innards.

Not that we’re there yet, of course. But when you read this — “Some of the jobs being sent abroad include so-called pre-service nursing, where nurses at insurance firms, for example, help assess patient needs and determine treatment methods” — well, let’s just say you can kinda tell which way the scalpel is pointing.

And especially because this isn’t being done by fly-by-night insurance companies. As the story says, “At the forefront of the trend is WellPoint Inc., one of the nation's largest health insurers and owner of Anthem Blue Cross, California's biggest for-profit medical insurer.”

WellPoint is doing very well these days. Its profit last year was $2.65 billion on revenue of $60.7 billion. And how do you get that profitable? “WellPoint's total employment at the end of last year was 37,700, down from 40,500 two years earlier.”

Welcome to 21st century capitalism, American-style.

And who’s getting the ax? It’s not just IT folks and payroll types and the like.

“In one of its recent efforts, WellPoint laid off pre-service nurses in Colorado and Nevada so the work could be done in Manila, according to a Labor Department filing by a WellPoint human resource manager in Denver.”

If you believe what you hear from one of the people WellPoint hasn’t fired yet, spokeswoman Kristin Binns, this is a win-win: “[WellPoint's] sourcing strategies have enabled us to make our services more effective, accessible and affordable to our customers, while allowing us to expand our programs and maintain our service levels," she said.

Yep. And the Earth is flat. And the sky is green. And down is up.

Certainly Binns could get another view from ground level. It's a tale familiar to all-too-many Americans in the last decade or so. “Shannon Cunningham of Columbus, Ohio, who processed medical claims for WellPoint, was laid off last month after a colleague went to the Philippines to train people to do her job. Cunningham, 43, said she received eight weeks of severance pay. She and others working in medical claims earned $30,000 to $40,000 a year with health benefits, she said.”

It may just be me. I may be old fashioned. Certainly I’m old enough to remember doctors making house calls. But when an insurance company that’s making a $2-billion-plus profit can’t afford to employ American workers at $30,000 to $40,000 a year — well, perhaps our healthcare system is sicker than we thought. Forget Ralph Lauren making Team USA Olympic uniforms in China. These are our health needs we’re talking about, not some silly blazers and berets.

OK, maybe we can’t buy American anymore. But can’t we have our own taking care of our own?

I don’t expect the doctor to make house calls today. But I don’t think it’s too much to ask that he’s not a continent away.

Wednesday, July 25, 2012

Innovation vs Entrepreneurship

Day 2 at the Building America Tech conference and today we had a panel that brought up the concept of innovation when it comes to reaching the goal of reducing overall energy use by 50% by 2030. The idea is through innovation will come the concepts, the products and the desire to accomplish said goal. Of course they gloss over how that is to be accomplished in what I call the Chain of Command. Without educating, training, regulation, information and access that is affordable and consistent I am not sure this will be attained.

There was a constant refrain that educating consumers on what they need to do will somehow make/require/demand suppliers, manufacturers and installers to meet that need and do so universally, consistently with the same goals in mind. High ideals, high goals and no plan on how that is it be done.

And yesterday I read this nauseating piece about two "Entrepreneurs" who would be remembered for one being played by Justin Timberlake in the Social Network and the other the boy who invented Napster and was beaten up by the big boys. Well both boys are men now and they are still involved in the Tech industry. Sean Parker strikes me as more "opportunist" than "entrepreneurs" but being a huckster to get people into the tent is a skill, just ask P.T. Barnum.

I have long lamented that these supposed talented and rich individuals could do more than come up with the same wheel that is the old wheel and do so in a tiny network of privileged geeks who make the Real Housewives of Bravo seem socially enlightened. When you have that kind of incestuous community you get well - Silicon Valley. Most of the innovation seems to center on finding some new fake site of interest (aka the dot com of this decade) and promptly selling it out for millions and then lather rinse repeating it. Nothing ventured, nothing gained, heard of or cared about but hey its worth millions!

Perhaps we need to merge these two ideas and terms. Without innovation there are no Entrepreneurs and without Entrepreneurs innovation goes nowhere. So where are they when it comes to actually doing it - and by it making real jobs, real businesses and products that can truly Build America.

When we have so many outstanding problems and issues facing this country coming up with some other social/chat/network seems absurd and unnecessary. But someone has Ferrari bills to pay. This Generation is called Gen Why for Why Bother. I see why.

Taking a Risk, and Hoping That Lightning Strikes Twice

By ANDREW ROSS SORKIN

Sean Parker, the 32-year-old billionaire and former president of Facebook — played by Justin Timberlake in “The Social Network” — was sitting on the top floor of his town house in the West Village of Manhattan last month, lamenting that too few entrepreneurs continue taking big risks after their first great success.

“Every good entrepreneur I know ends up in the wasteland of being a venture capitalist. It’s really frustrating,” he said.

Mr. Parker was sitting, or more accurately, slouching, on a couch next to his best friend and business partner, Shawn Fanning. Together, they founded Napster in 1999, the online music service that upended the entire industry before closing and filing for bankruptcy after losing a court case over piracy.

“How can you as an entrepreneur that’s had success, has a reputation, ever build the courage to go and do something again?” he asked, almost rhetorically. “Most entrepreneurs don’t remain entrepreneurs. It’s just too psychologically draining to have to constantly start over.”

More than a decade later, however, Sean and Shawn are at it again. The two recently started a video chat service called Airtime. (Think Skype, mixed with Facebook and a twist of Chatroulette.)

Mr. Parker and Mr. Fanning are the exceptions to the successful-entrepreneurs-still-working theory. Sure, there are a handful of serial entrepreneurs out there in Silicon Valley: Jack Dorsey started Twitter and Square, for example, and Elon Musk, who was behind PayPal, now runs SpaceX and Tesla.

But the career trajectory of many tremendously successful entrepreneurs in Silicon Valley often looks like a rocket ship that stops in midair. Less charitably, Mr. Parker suggests some could be called one-hit wonders.

“The list of people who have started from scratch over and over and succeeded systematically over a long period of time is incredibly short,” he said. “The only person I can think of off the cuff is Jobs who had Apple, Next, Pixar, continued doing Pixar and Next and then Apple again, which is really a different company.”

He said that the tendency of great entrepreneurs was either to become merely an operator of one company or, like Sumner Redstone, move into an investor-ownership role.

The Silicon Valley version becomes a venture capitalist. For example, Peter Thiel, who co-founded PayPal, has gone on to be a successful venture capitalist through his firm Founders Fund, investing in other companies’ businesses, like Facebook and Spotify. But Mr. Thiel hasn’t endeavored to start a new company himself. (He did start a hedge fund, but that’s still investing.) He happens to be in business with Mr. Parker, who is a partner in the fund, which also invested in his Airtime.

Marc Andreessen, a longtime star of Silicon Valley, co-founded Netscape in 1994. He started two companies after that: Loudcloud and Ning. Both had modest success, but neither was comparable to Netscape. Mr. Andreessen became one of those venture capitalists Mr. Parker dreads, but with an extremely successful track record of having invested in some of the most promising technology companies, including Facebook, Groupon, Twitter, Zynga, Pinterest and Instagram (which was sold this year to Facebook for $1 billion).

Perhaps surprisingly, Mr. Andreessen said of Mr. Parker’s theory: “I sort of agree with him.” In an interview, he said many “former entrepreneurs crossed over to be V.C.’s and it hasn’t worked out well.” He added, “You don’t want to be Michael Jordan playing baseball.”

Mr. Andreessen said he differentiated his decision to pursue investing from that of other entrepreneurs-turned-investors, because he approached it as an entrepreneurial effort to “rethink the model of venture capital.” He has sought to reimagine the way a venture capital firm works from top to bottom, and so far, it appears to working quite spectacularly.

Still, to Mr. Parker, most entrepreneurs who seek out investments do so as “a total cop-out.” He explained his thinking: “You have a whole portfolio, you only focus on your successes, you ignore your failures and you get to continue looking like a player, but you’re ultimately not in control of anything.”

He continued: “Everything is probabilistic, nothing is deterministic, so you never have that satisfaction of knowing that you’re in control of an outcome. So you spend all of your time managing your reputation, managing your relationships and you spend almost no time thinking creatively or doing the things that an entrepreneur is good at doing.”

If it sounds as if Mr. Parker is talking only about others, he’s not. He’s also talking about himself.

After stepping down from Facebook in 2005, he joined Mr. Thiel’s Founders Fund and for several years worked on making investments, including in Spotify and Votizen.

He also worked on Causes, a site to raise money and awareness for issues and nonprofits. That venture only muddled along, and he said he did not commit to it wholeheartedly enough.

He said the biggest challenge for any new start-up by a previously successful entrepreneur was focusing too much “on downside protection, which is just assuming failure from the outset.” Being worried about failure and its effect on one’s reputation, he said, is “very dangerous.”

He said he was reluctant to start a new company like Airtime until just recently.

“The expectation thing definitely weighs on me. There’s a sort of fear of launching something and failing,” he said. “I had to decide I am going to try to go the road less traveled and just be an entrepreneur that’s willing to go back and start things from scratch.”

Tuesday, July 24, 2012

Just Do It!

I just happen to be in Denver this week for the Department of Energy's Buidling America Advancing Innovations in Residential Energy Efficiency Conference. I come every year and love it despite the geek-a-thon quality it is. I like to to tell people I am here cause I DID it.. DID for "dumb it down" for the rest of us.

And as always there is discussion on how to make homeowners respond to the technology available and use it in order to reduce energy consumption. From Smart Grids for the home to Insulation and Hot Water the Building America team studies numerous methods to find which one work, what climate it best works for and overall ways to Build America a little greener.

Given the budgets, the politics and well the times this is often theory that goes into practice but not always use. Builders, Remodelers, Home Owners and other Trades are all involved but rarely do they participate so it is hard to know what community's will respond and how well they do once it is it out there for the general population.

I found it ironic that today in the New York Times was an article about getting people on board the Energy Reduction Train. And once again I find that it is for profit utilities and Venture Capital funded businesses leading the way. I am all for partnerships with private industry but when the DOE has a well established name and brand of "Energy Star" I have to wonder if they are not capitalizing on it enough? Why must everything generate a profit - can't some of the savings go back to the user, the taxpayer in the form of rebates, dividends and not Amazon coupons or certificates to buy something else from someone else. And why must it be a competition or game. Why must we generate compliance and cooperation that is good for us all?

I believe Nike said it best years ago "JUST DO IT" and in turn the benefits in the environment, the lower costs of energy and well just doing the right thing should be sufficient. But we no longer do things on intrinsic values or rewards but on extrinsic excuses, reasons and applications. Keeping up with the Joneses I believe led to many engaged in the mortgage bubble, to Wall Street and its corruption and to an overall feeling that does little to build community but puts you in opposition to it.

Building America to me is building it together. And it means that sometimes you JUST DO IT because its the right thing to do.



Save Energy, Win a Prize

By DIANE CARDWELL
Published: July 23, 2012



With temperatures hovering near a sweaty 100 degrees in recent weeks, the nation’s electric utilities have been taking to Facebook and Twitter, urging customers to conserve energy in the hopes of avoiding blackouts and other strains on the system.

Tom Lyons of San Jose, Calif., said that receiving a report on his home's electricity use reinforced conservation efforts.

At Duke Energy, the country’s largest utility after its merger with Progress Energy, the effort has included something beyond the usual messages to turn down the air-conditioner. The company is promoting a series of Web videos featuring a fictitious girl named Shannon who appears with her family, the Powers, to dispense energy-saving advice.

“This summer, why not use a clothesline to dry your clothes instead of a dryer?” Shannon, also known as Bossy Pants, suggests while pinning up the family wash in a clip promoted recently on Youtility, Duke’s Facebook page for energy efficiency. “You’ll save a lot on your energy bill and your clothes will come out nice and fresh.”

The series, started last summer, is just one way that Duke and other electric companies across the country are trying to use social media, competitive games and Big Brotherish data analysis to push customers to buy less of the electricity they sell.

While it seems counterintuitive for utilities to discourage use of their product, it actually makes financial sense as they face government mandates to encourage more energy conservation and deal with the rising cost and difficulty of building power plants and distribution systems.

So in Chicago, a household that uses a lot of electricity might receive a mailing showing that more energy-efficient neighbors wash their clothes in cold water, along with a coupon for Tide Coldwater detergent. In Texas, customers can compete to be named the Biggest Energy Saver and get a shot at winning new appliances, home improvement gift cards or $5,000 to put toward a wind turbine. And outside Boston, customers earn points for saving energy that they can redeem for meals at local restaurants or a $10 discount at Whole Foods.

Motivating people to save energy isn’t really about the money, behavior experts say. Successful programs foster a sense of achievement and identity. And competing to beat your friends and neighbors at the savings game doesn’t hurt.

Many of these programs are still in their infancy, and it remains to be seen whether a significant number of customers want to work with their utility companies over energy savings; most customers become interested in their electricity only when it doesn’t work, executives and experts say. The Duke Youtility page, for instance, has fewer than 3,300 “likes,” and most of the recent comments complain about power failures, rate increases and the company’s troubled merger with Progress Energy.

But utilities hope to tap into the same dynamic that works for video games and applications like Foursquare, where users compete against one another to earn bragging rights, like becoming “mayor” of a favorite restaurant.

Opower, a leading home energy management company, has shown promising results with its keeping-up-with-the-Joneses approach, sending people reports on how their electricity use compares with households in their neighborhoods — complete with a smiley face, or two, depending on how they stack up. The company has created an app with Facebook and the Natural Resources Defense Council that can load a user’s energy data and allow people to compete with their friends and family.

Soon, said Daniel Yates, a co-founder of Opower, customers of the roughly 75 utilities he works with will be able to earn electronic badges saying things like “Congratulations: You are an energy saver” for cutting their bills.

While it might sound hokey, the strategy works. Tom Lyons, a customer of Pacific Gas and Electric in San Jose, Calif., said Opower’s feedback was reinforcing. “You’re getting some nourishment or some reward from the energy report and the smiley faces,” he said.

When his conservation efforts slip, he said, it makes him dig for the reason: extra company that month, working more from home or his daughter having a couple of sleepovers “where they were yakking, watching TV with all the lights on in the room until 3 a.m.”

States and utilities have run conservation programs for decades, with some success. Many households have compact fluorescent bulbs, Energy Star-rated appliances and even programmable thermostats.

But the current efforts are aimed at helping customers to change their habits as well.

“I think we’ve transcended the equipment and the shell of the house, and now we’re talking about the how,” said Tom Baron, senior program manager for residential energy efficiency at National Grid, an electric and gas utility in the Northeast. “Not, ‘What in my house uses energy?’ but, ‘How do I use it?’ ”

The need to find ways to encourage long-term conservation is ever more critical, utility executives and efficiency experts say. At least 25 states have set specific goals for reductions in energy use that in many cases will continue to increase even as electrical demands and the grid’s complexity keep growing.

In 2010, the total budget for utility customer energy efficiency programs was $4.6 billion, up more than four times from the $1.1 billion spent on such programs a decade earlier, according to the American Council for an Energy-Efficient Economy. The vast potential of the energy efficiency market has spurred interest in home energy management from major companies like Verizon and Comcast as well as a fleet of start-ups.

But getting people to care about their electricity and work with their utilities is a battle. Electricity is “boring and it’s cheap,” said Alex Laskey, an Opower co-founder. Many efforts have already foundered: Microsoft, Google and Cisco Systems have pulled back from their ventures, and Tendril, a start-up that works with utilities including Southern California Edison and Con Ed, lost two executives and cut its staff in May, as it raised money to finance its operations.

Part of the challenge is that while most people see saving money as a good thing, it is not enough by itself to change habits in the long term. The average household spends about 2 percent of its income on electricity, so a 10 percent reduction in power use doesn’t add up to much, Mr. Laskey said.

Instead, people can be motivated by more emotional factors, like the sense of achievement that comes from setting and reaching goals or one-upping a neighbor, or the sense of belonging that comes from mimicking friends or participating in a communitywide challenge.

Nonetheless, a little financial reward, coupled with a clear display of energy savings, can be just the nudge customers need.

One program managed by C3, a company that contracts with utilities to run loyalty programs, awards participants two points for every kilowatt-hour less in electricity they use each month compared with the year before they joined. Customers can redeem the points for gift cards or discounts at places like Staples and Amazon.com, or local restaurants and shops. The company uses demographic and behavioral information to present specific offers to customers — discounts on school supplies in the fall to households with children, for instance, said Tom Scaramellino, senior vice president and general manager of C3.

Mark Lattanzi, who has been in the program for about a year through the Western Massachusetts Electric Company, said he had shaved about a third off his bill, through replacing his old electric water heater and a range of small behavior changes like turning off the lights and using the clothesline. It helps, he said, to receive an automatic monthly e-mail that shows how his electricity use compares with the same month in his baseline year.

And the rewards points are an incentive, too. Mr. Lattanzi has already earned a $10 gift card for Whole Foods and is waiting to use the rest at restaurants that are joining the program.

“Restaurants that I already go to are giving me discounts and gift cards because I saved a little money on my electric bill?” he said. “That’s a win-win.”

Drink Green!

The Greek God of Wine was Dionysus and I think even today he would encourage wine drinkers to go green be it red or white or even pink. Wine lovers have many choices when it comes to Organic but as I have written about with regards to food that can make it more complicated vs less. And when one needs a glass or bottle of good wine adding tests to the purchase makes it less desireable.

Wine.com is where I buy all my wine. They have immense deals and information about what it means regarding wines going green. I think the handy infographic speaks volumes about what it means when selecting wine but wine.com goes beyond just graphics - they have outstanding information, comparisons, current ratings, excellent prices, frequent specials and shipping deals that add to the cost of saving. Which means more opportunities to buy great wines and try new ones as well.

You don't need to be a God to drink and enjoy great wine you can be a mere mortal and have it brought to you however by the delivery man. Its still a great deal.