2012 in review

Happy New Year All. The WordPress.com stats helper monkeys prepared a 2012 annual report for my blog. Thanks for taking the time to read and comment on my blog. Your comments and interaction with me is much appreciated. Have a wondrous 2013. You are the best. BTG

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 4,100 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 7 years to get that many views.

Click here to see the complete report.


A Dearth of Leadership and Customer Service

On this final day of 2012, I thought I would combine two topics which will make more sense as you read on. I do this as each of us must continue to take on more responsibility for what happens to us and should be less inclined to abdicate that role to others. In the US, I sit here convinced that our leaders in Washington will be unable to reach a compromise to avoid a self-created crisis, the fiscal cliff. As the House of Representatives is at the height of dysfunction, they have shifted over to the Senate to try to come up with a deal that will for the most part be window dressing to solving a problem that going over the cliff would actually bring us closer to solving. My blogging friend Barneysday in www.mountainperspective.wordpress.com keeps advocating for us to go over the cliff. He argues, while more abrupt, it actually makes a greater dent and removes the infamous Bush tax cuts that are a huge contributor to our deficit woes. I do not disagree with his long term eyesight. Yet, smarter people than me say falling off the cliff will throw water on our recovery.

Yet, here is where the dearth of leadership comes in. I have long advocated the need for tax revenue increases along with spending cuts. The math will not work otherwise. If the President and other leaders would shoot straight with the American people and say we need more revenue and here are the numbers, then we would see our role in doing what is needed. I am tired of leaders telling us what we want to hear. Of course, people will say don’t raise my taxes, but don’t cut the things we need. I saw a great line in the paper today, where someone said “put armed guards in schools, but don’t raise my taxes.” That seemed to fit the American psyche. We need leaders to show us the problem and discuss resolutions. We need real data and not contrived data. We don’t need Mitch McConnell burying a report that contradicts his party’s support of trickle down economics. That is not leadership – that is cowardice.

We also have a dearth of leadership in our businesses. The 80/20 rule applies to leaders as well. Only 20% of the leaders are worth what they are paid. The other 80% are underperformers to varying degrees. US companies are sitting on cash as they don’t know what to do with it. I like to paraphrase Warren Buffett who said concern over taxes has never stopped me from investing in a good idea. I have seen some small business leaders say the same thing. Yet, when times get tough, most leaders know what to fall back on – cutting jobs. I am not against making smart cuts nor would I advocate denying that lever to a leader. However, there is a fear to invest and possibly make a mistake. That is one reason, I have been investing more in high dividend payers of late. My thought is if you don’t know what to do with your cash, you can at least give it to me and let me manage it.

On the customer service side, we must be the navigators of our own customer service. Whether it is a bank, health insurer, retailer or some other company, you have to own the customer service navigation process. Each of us know the feeling of talking with a customer service representative who obviously cannot help you when you get them off script. You have to know what the company can do for you to help navigate to a solution. I am often complimented on my patience in dealing with customer service people. Part of the reason is I have such low expectations, that I arm myself with information I think I might need and prepare myself for the call. But, I also know to not make things too complicated for the customer service provider – in other words, don’t get them outside of their white lines. The other reason is it is not my nature to be an asshole and, in these situations, you will be better served to not be one.

If you think about it, you are leading the customer service person to a resolution. You need to be prepared to be more in control and take that responsibility. The same goes for the lack of leadership in other settings. In the absence of leadership, people are reaching across business silos and country borders to get things done. For the younger readers starting out, I encourage you to start saving immediately in any company sponsored savings plan. And, also do what it takes to save money for shorter term crises. These will help you weather storms that occur later and they will. You will be taking more control of your own financial life.

Also, on the job, most work is accomplished in teams. Offer your help and be unlike the US leaders and collaborate. The best ideas tend to come from those closest to the action – real leaders know this and perpetuate opportunities for this to occur. But, if you don’t work in such a situation and cannot leave your current job, try your best to work with others. Be a leader on the ground and work with others. I sometimes call these people the dot connectors, but people gravitate to the informal leadership within any organization. They help make things happen, especially when named leaders do not.

Finally, do you best to understand what is going on. I am not saying to be a political junkie, but have a grasp of the issues. Seek out better sources of information and question things. Also, use multiple sources – I read the paper, watch PBS Newshour, the BBC World News America and the local news. Sometimes, I will watch the national news on CNN, ABC, NBC and CBS to mix it up. For American readers, you will note the absence of a national news agency with some more conservative viewers. I would alway question any source which discredits the other sources as part of its mantra. If you do not believe me, then why were primary viewers of that network more surprised with the Presidential election outcome?

By understanding the issues, you can keep these leaders more honest. We need to be the watch dogs and navigate the our own customer service even from our elected leaders. As for our business leaders, please know they have changed the equation. People will rarely work long term with one company – they won’t let you. So, you are perpetual free agent. Develop your career, save your money and work well with others. That kind of networking will pay off and let you find the jobs that will further your career. It may be within that company or elsewhere. You navigate it.

Everyone, I wish you the best in 2013. Take better control as the navigator of your life and the service you get whether it is from leadership or customer service people. It is your responsibility.

Lets Keep Piers and Send a Few Others Packing

The British talk show host Piers Morgan has apparently offended a great number of gun advocates with his staunch position against America’s ineffective gun laws. Based on comments he made on a recent show with guest Larry Pratt, the Executive Director of Guns Over America, over 80,000 gun enthusiasts and counting want to have Mr. Morgan deported. Of course, he has joined other public figures such as Mayor Michael Bloomberg and Senator Diane Feinstein, in stating the painfully obvious – America has gun laws which coupled with our violent culture cause us to be the world leader among the wealthiest nations in gun deaths and it is not even close.

Just for context, the US has 80% of all gun deaths when measured with the other 22 wealthiest nations and 87% of all children gun deaths. In 2010, the Children Defense Fund reports that 2,694 children and teens died from gun deaths. You would need to multiply the 20 children that died at Sandy Hook Elementary by a factor of 135 to get that many deaths. Since 1979, the US has seen 119,000 children and teen gun deaths. As bad as these mass killings are, the greater tragedy occurs on a daily basis. There are many responsible gun owners who would agree that we have to stop this gun violence now. This is a unforgiveable lack of stewardship by our elected officials.

Let me state that I am not a huge fan of Mr. Morgan, but I have on occasion watched his show if he had an interesting guest. I did not see this particular show, but have read the news reports. Apparently, Mr. Morgan was not a very congenial host and tended to talk over his guest. This is one reason I don’t care for his show, but this must be the new normal as many talk show hosts now talk over the guests. Even though I like Bill Maher’s show, I get frustrated with him when he talks over a guest making a good point. I have always been in a favor of civil discourse.

But, even though Mr. Morgan can be an asshole at times, his concerns over our inane gun laws in America are still valid. We have a problem and will continue to have a problem unless we address our gun laws, culture of violence and unhealthy combativeness, lack of civil disagreement, and mental health care access. We should not overlook the middle two reasons. We have people who argue and do not know how to reasonably agree to disagree. Yet, here is where the Wayne LaPierre and the NRA are wrong. Access to guns when angry lead to unnecessary deaths. People with access to guns kill people; people who do not have access don’t. 

Yet, back to Piers Morgan. In our country, we give people the right to state their opinions, even if you do not like what they say or how they say it. So, we should not deport Mr. Morgan for stating his opinion or for being an asshole about it. If that were the case, there are few people with strong opinions who would move way ahead of Piers in the line to deport.

– The entire congregation of the Westboro Baptist Church, who pickets military funerals demonizing the deceased soldiers and says God is punishing America for tolerating gays in the military. As of this writing, there are over 247,000 signatures on that same website advocating for Piers’ deportation who want this church registered as a hate group.

– Reverend Terry Jones of Dove World Outreach Center in Florida who has inflamed many by burning Korans. His actions were chastised by our generals and the President as they led to the death of American soldiers. Even when confronted by the impact of his actions he continued down his path.

– Reverend Charles Worley of Maiden, NC who said in a sermon we should put all gays and lesbians behind an electrified fence. We should feed them he said, but they will die off since they won’t procreate.

– While were at it, let’s throw Rush Limbaugh in the mix. He said he would leave the country if Barack Obama won the first time. Limbaugh is actually far worse than Morgan as he is a bombastic provocateur on purpose. It sells commercials. Although he is in the entertainment business like Morgan, he has a cult-like following that believes what he says is gospel regardless of its relationship to the truth.

I am being facetious to a large extent, yet I want to make a point that there are people who have greater reason to be deported than Mr. Morgan. Heck, if this blog was read by more people, the Old Fart may find himself on a list for deportation. But, here is where I like to throw in my punchline. I am independent voter and thinker (when I am accused of thinking) who seeks the real truth. And, the real truth is we have an unhealthy problem with our poor gun control laws in America. So, it is time to act as we are beyond the tipping point.

Two Love Stories

I was telling one of these stories the other day, so I felt it might a nice way to celebrate the day, with two love stories. The names have been altered, but the stories are otherwise true. I will add that neither story is about my wife or me, but I personally know all five participants. And, as Forrest Gump would say, “That is all I am going to say about that.”

Arriving Late for the Game

The first story is set in the early 1950s. Dave and Betty both went to a small college where everyone seemed to know everyone else. The future couple was no exception and had met in class. Yet, on this night, at the big basketball game on campus, Dave was on the court. He was a good player on a good team and was known for his hustle. Betty was a pretty young lass from a rural area. Calling where she grew up a town would be a stretch.

On this night, Betty arrived late for the game which was underway. The home team fans usually sat right behind the team with the bench being opposite the door she came in. If you can picture those wooden fold out stands that telescoped from the wall, you would have a correct image of the gymnasium seating. Since play was underway and the players were coming toward her, she sat down immediately on the lowest bench near the floor. During the rush of action, the basketball bounced her way, with Dave in pursuit. After diving for the loose ball, Dave wound up in Betty’s lap. Embarrassed grins and laughter followed. After the game, Dave was smart and bold enough to find Betty to apologize and the rest shall we say is history.

Good Handwriting is not always a plus

Jack was a hard-working consultant, devoted to his clients. Pam was the same way working for the same company, but in a different town. They had never met until they went to the company training event in the headquarter city in the late 1970s.

Before traveling there, Jack had shared his frustration with Darren who had let one of Jack’s clients down on a deadline. Jack was all about client service and wanted the same level of attention from anyone he brought in to work on his clients. Darren was saddened that he had let his friend down, especially since he could not tell him face to face. So, he did the next best thing and sent Jack an apology note with the words inscribed “You are in my thoughts. D”

While this note was being penned, Jack and Pam met at the company training event and hit it off. They bonded during the social and team building exercises. Yet, outside of having a marvelous time together, there was no romantic involvement. After they traveled back to their respective cities, Jack’s thoughts drifted toward Pam. After a few days, Jack opened his mail and saw Darren’s note of apology. Yet, there was a problem. Darren’s note had been separated from the envelope by the Administrative Assistant, so Jack did not know who sent it.

Jack’s reading of the note and its less than stellar handwriting led him to interpret the “D” as a “P”. Maybe he wanted it to read that way, but he thought it was from Pam. So, he called her and said, “I may be presumptuous, but did you send me a note saying ‘you are in my thoughts’ because if you did, the feeling is mutual. Pam said she had not, but wish she had. After getting together again and starting a long distance romance, she transferred to the same city and the rest is history.

I have spoken to all five participants in these two stories, even the poor scribe, Darren who confirms his role in the matchmaking. I wrote this morning in a comment to a post by www.lilypetal91.wordpress.com that “love, like life, is a journey.” What I did not say is the journey can start with the oddest of beginnings, so never be surprised by opportunity. If you have not seen the movie “We Bought a Zoo” there is a very powerful moment that occurs twice in the movie. The most poignant moment is when Matt Damon’s character got the nerve to ask the most beautiful woman he had ever seen “Why on earth would someone like you ever consider talking to someone like me?” Her response was “Why not?”

Dave was bold enough to go up to Betty after the game. Why not? Jack was bold enough to call Pam and make his query. Why not? Any person who has had sweaty palms over speaking with someone knows this feeling. So, it does take some gumption. Life is too short to not ask. Why not?

Happy holidays everyone. May the new year bring good tidings and good answers to your many questions. Best regards.

A Few Holiday Wishes

It is a wonderful time of the year for reflection and to remember what is important – family and friends are at the top of the list. The tragedies the pair of Sandy’s (Sandy Hook’s shooting tragedy and the havoc wreaked by Hurricane Sandy) caused on people, families, friends and homes will hopefully be the tipping points for action to not let this happen in the future on the same order of magnitude. If I had to focus on a few global and national holiday wishes, two that would be high on the list would be doing something to remember those harmed by these tragedies.

So, let me note a few holiday wishes that may impact all of our families:

– First, I hope we heighten the focus on reasonable gun laws in the US which will let us join the rest of the civilized world on appropriate gun governance. The issue goes beyond Sandy Hook and the mass murders that have occurred over the last few years. We have to address the gun deaths that occur every day, especially with 2,694 children and teen gun deaths in 2010, 100x the number who died at Sandy Hook

– Second, I hope the US will begin formal discussions addressing global warming which is upon us and enabled by our human actions and inactions. The President has done some good things but not nearly enough and we need the other political party to join the conversation and stop listening only to their fossil fuel funders. Hurricane Sandy launching off an elevated coastal sea level is the new normal unless we do something about it. This new normal has been predicted for several years, so it should not be a surprise any more.

– Third, I hope the Taliban’s recent actions targeting a young girl on a bus and killing the Polio vaccine workers and patients, will show the Muslim world who the real enemy is and it is in their midst. Until women and girls are afforded rights in these countries, they will forever be competing economically with only half their population. Plus, it is grossly inhumane and unfair to treat women and girls as property.

– Fourth, I hope the Assad regime will step down soon, so no more innocent people are killed and die of starvation in Syria. The latest tragedy had the government bombing people standing in a bread line who had not eaten in a days. I also hope reasonable heads can intervene as the new government is constructed.

– Fifth, I hope economic trade can occur routinely amongst people whose leaders cannot get along. There is something about free trade that can create an economic vitality that can go beyond borders. When people interact in a positive way, then better outcomes can result. Economic sanctions punish the wrong people – the leaders skim off the top and do fine. The rest of their citizens are the ones who are screwed.

– Sixth, I hope the leaders of our country can start acting like leaders and less like little children. We have real problems that require holistic solutions. The failure to act on the fiscal cliff, which people say would be less optimal if it occurred, is actually worse than the cliff. People see an incompetent and grossly negligent body of leaders. I hope the leaders can prove them wrong in this case and come to an agreement. I heard tonight in a CBS Poll that 2/3 of Americans whose income is over $450,000 support a tax increase. So, do CEOs who came together in October. I would suggest Congress listen to these folks and less to Grover Norquist. And, Democrats you better find some cuts you can live with.

– Seventh, poverty is rampant in America. We have people who work hard at several minimum wage jobs or cannot find work. I wish people who are more fortunate can walk in the shoes of others. There are some that have made judgements painting people in poverty with a broad brush based on the observations of a few they may see in the street. The recent recession has imposed poverty on people who had never dreamed it could happen to them. We all need to help those in need climb a ladder out of poverty.

– Eighth, let me close with a wish for people to pursue civil disagreements rather than arguments and insults. I failed to mention this as one of the reasons we have more gun deaths. People perceive an insult and then access a handy weapon and someone is dead. If we choose not to take offense and have civil discourse, then we can avoid senseless deaths. This goes in combination with greater tolerance of people and our differences. The more we understand each other, the fewer disagreements we may have to begin with.

I have many more global and national wishes, but I will limit them to these eight, plus a final one. I wish for all to have an enjoyable holiday season and a safe and content 2013. Take care all. I have treasured your comments in response to my posts and reading your wonderful posts as well. I look forward to more treasures next year.



Gun Deaths and the Bigger Context

As a parent, I am both saddened and angry over the tragic gun related deaths at Sandy Hook Elementary. Any senseless death is troubling, but when kids are murdered at such a young age, it goes beyond belief and we can only look to the heavens and ask why Lord? Yet, as tragic as all of these deaths are, a greater tragedy occurs everyday in America that when added up dwarf these deaths. Due to the accessibility of guns in our country, coupled with humans who get angry, impulsive and depressive, gun related deaths occur that could have been avoided if the guns were not at hand.

In August, I wrote a post called “Another Day on America – 16-year old kills 13-year old friend.” This post was written after the Aurora and Wisconsin shootings that occurred earlier this year. This post has been getting more hits of late, as it attempts to speak to this broader context. I would encourage you to scroll back and read the earlier post as I have some statistics that might be of interest. I will cite some of them below.

I am writing this now for two reasons. First, we can no longer tolerate the number of gun deaths we have in America. We are beyond the tipping point and must act. Second, some of the ideas thrown out to remedy the Sandy Hook type massacres will actually not solve that problem and will create far greater problems down the road. We have to look at the greater context at what is happening everyday in America.

Let’s set the stage with a couple of statistics noted earlier. Per the Journal of Trauma and Acute Care Surgery and Medicine, the United States has:

– 80% of all gun related deaths when measuring deaths in the top 23 wealthiest nations;

– 87% of all gun related children deaths of these same 23 countries; and

– 14 gun related deaths per 100,000 people as compared to Mexico with 13, Canada with 4 and Great Britain with 1/2;

The comparison to Canada is very pertinent as Canadians love their guns like Americans. Yet, we have over 3x the gun related deaths that they do. There are many reasons noted in the earlier post – but Canada has better gun laws, less poverty and better access to mental health care as three of the reasons.

Quoting the NRA who likes to pontificate “guns don’t kill people – people kill people” I find this trivializes the point. The more true phrase is people who have access to guns kill people. And, generally, the converse is true – people who do not have access to guns don’t kill people. The greater context to this issue is humans are an impulsive, imperfect lot. As noted earlier, we get angry with family, friends, acquaintances, enemies and people who we perceive as treating us with disrespect. Every day in America, someone has killed another person as he or she has acted impulsively and was in close proximity to a weapon. Someone got mad in a Pizza parlor the other day, went out to his car, retrieved a gun, went back inside and killed the person who offended him.

However, it goes beyond this. In my previous job, I sometimes consulted with a Behavioral Psychologist who helped employers provide improved mental health benefits in their healthcare plans for employees. She often cited two statistics that resonated with me – 20% of people will at some point in their lives have mental health issues needing treatment. At any given time, 10% of an employer’s healthcare plan participants will be accessing mental healthcare treatment. This treatment may be as simple as being prescribed with antidepressants or it may include ongoing therapy. Her modus operandi was to get people with antidepressants prescribed by a medical doctor to also see a therapist. The meds help, but the care by a professional psycho-therapist is crucial.

With access to guns, people who have been or are subject to depression, could act on an impulse and take their own life. Or, if affronted, could possibly take the lives of others. This is a key reason letting kids have guns on college campuses is about the dumbest idea possible. You marry complex social circumstances with kids being away from home and without fully developed brains, the kids could more easily act out an impulse and their life is over.Without the gun, the suicide may be avoided. I know of one college close to where I live that has allowed guns on campus. So, the outside chance of preventing a rare Virginia Teach shooting, may lead to more gun related suicides and homicides.

So, our leaders need to focus on the bigger context. We know where the NRA stands – they want to sell more guns. Everything else said by the NRA is dwarfed by that mission. People wanting to arm everyone should be thanked for their comments and then quickly ignored as those ideas are ill-conceived. You give a teacher a gun and I can assure there will be more children deaths due to kids finding a loaded gun in the classroom. In Gun Ownership 101 it says keep loaded guns away from the kids.

At its simplest, getting a license for owning a weapon that kills, should be harder to obtain than other licenses. Gun licensing needs to have a longer waiting period and thorough background checks should occur. To do otherwise is irresponsible, end of story. If you are under psychiatric care on meds, you need to bring a note from a psychiatrist or psychologist or no gun for you. We won’t let people in the military for some mental health reasons, but they can get a gun here. And, no one in America should have an automatic assault weapon. If you do and are not in law enforcement, then I question your motivations. The Brady Law which was let to expire in 2004 will address some of these issues, if reinstated. Yet, law enforcement officers have suggested another item that will reduce guns deaths – register the sale of bullets. The police say encoded bullets will become traceable and help solve crimes, yet the NRA is against this practice. If I were a leader, I would listen to my police force who does not have a vested interest in any decision.

However, as noted above, this is only half of the story. The other half is we must encourage better access to mental health care. If you are on meds prescribed by a MD, please go see a psycho-therapist, as well. A Medical Doctor is not trained in psychiatry or psychology. Further, please take your meds. This could be said about any medicine, but people in need often stop taking their meds to save money. The Affordable Care Act will help in this regard extending healthcare coverage. Finally, referencing the 20% mental health prevalence statistic noted above, please help eliminate the stigma around mental healthcare issues. Every family has or knows someone who needs recurring mental healthcare help. Living with mental illness is something that is and can be dealt with.

Let me conclude with two final contextual points. First, poverty is rampant in America with almost 50 million people in poverty. As a result, the opportunities for gun related crime are increased in America. This issue is complex and deserves its own post, but the distance between the haves and have nots in our country is not healthy for many reasons. We have to afford opportunities to work for reasonable pay.

Second, we have a more violent culture in the US than in other countries. We have far more violence in movies and TV and we have greater access to violent video games. This prevalence of exposure to violence in entertainment is highly correlated with gun deaths. Is it causal? More than likely. To demonstrate a point for the younger readers, in the 1970’s TV crime shows rarely ended with the death of the criminal – the criminal was taken off to jail. Yet, toward the end of that decade, the trend changed where the shows concluded more and more with the good guy killing the bad guy. Now, we have video games, where your character is the bad guy killing others.

This is a complex issue and deserves concerted attention. Yet, it also requires a focus on the greater context. Who, where, why and how are the gun deaths occurring across America? As tragic as the events of Sandy Hook, Aurora, Wisconsin, and Virginia Tech are, they are dwarfed by the many gun related deaths which occur every day in America. That has to be the focus of our mission to reduce gun related deaths.

Some More Good Economic News

For those outside of North Carolina, I apologize for this NC-centric good news report. Yet, I saw four articles in today’s paper that show continuing evidence of our improving economy or better stewardship. The first three of the articles are directly related to job creation. What caught my eye is the nature of the jobs – they were all manufacturing jobs being created in NC. I will save the fourth story on stewardship until later.

Three Job Creation Stories

As reported in The Charlotte Observer:

– Herbalife, a nutrition firm based in Los Angeles, is purchasing a closed Dell processing facility in Winston-Salem, NC which totaled 750,000 square feet and will be refitting it to be an East Coast production facility. They plan to employ 500 people over the next three years. This firm produces weight-loss, nutritional and personal care products.

– A subsidiary of Canadian based Gildan Activewear called CanAm Yarns LLC will be opening a new yarn spinning  facility in Salisbury, NC revamping a 400,000 square foot building. This is their third facility in NC and will employ 170 people.

– Paumac Tubing who manufactures steel, stainless steel and aluminum tubing for agricultural, heavy truck and bus markets is opening a new plant in Statesville, NC. This 75,000 square foot plant will employ 75 people. Paumac, a Michigan based company, is the second national metalworking company to open a plant in Statesville in three months.

By my count that tallies to 745 jobs, which is not a huge amount, but shows the path forward for many companies. The continuing recovery will be built on these smaller types of expansions, although 500 jobs for one company could be viewed as more than small. The fact they are manufacturing jobs is also telling as there is a building movement to create more manufacturing jobs on these shores. It also shows the global nature of our economy as one of the companies is a Canadian company.

Fourth Good News Story is a Cautionary Tale

The last story is not about job creation, but is about making someone pay for fraudulent activity at worst and poor stewardship at best. A few weeks ago I reported on the “Health Care Industrial Complex” which discussed the business of health care. The point of that post is hospital management oftentimes is motivated to improve revenue with less concern for quality of care. In today’s edition of The Charlotte Observer and Raleigh News and Observer, it was reported that one hospital has agreed to pay a fine for such behavior. WakeMed based in Raleigh agreed to pay $8 million to settle an investigation into its practice of billing Medicare for expensive overnight stays when the patients were discharged the same day. Per The Charlotte Observer article, while the President of the hospital said no criminal activity occurred and it was all a misinterpretation, the court documents indicated “some WakeMed managers were aware of the billing practices.”

I thought I would italicize and embolden the last statement. When I hear people say we do not need regulations, this is representative of the kind of stories we should point to. By the way, since we pay a half the cost of Medicare through payroll taxes and our employers pay the rest, the hospital is in essence defrauding us.

So, good news abound, except for our WakeMed management who at best showed poor stewardship. If they did know, then it is fraudulent behavior. Yet, having worked for various companies for 33 years, I am certain the other employees of WakeMed are glad that someone is highlighting and hopefully stopping the bad behavior that occurred within their ranks. I am certain they take more pride in their organization than certain leaders who were gaming the system. But, let me close with pending congratulations for the 745 new hires that will be occurring due to the job growth news above.


Rob Roy and Linked In

I have been away from Linked In for a several months and was making some updates the past few days adding a number of connections. For those of you who have been on this network building site, invitations lead to mining which lead to more invitations and so on. My wife was using our family computer as I did this connection building on my work computer a few feet away.

She was listening to me comment on some of the names that I viewed as I scrolled down the list and became fascinated by my sorting observations. The observations are the unfiltered first reaction to a name on someone else’s inventory list which heavily influence the decision of whether to invite or not invite someone to “friend” you for lack of a better term. The reason I mention this exercise is I had just completed watching yet again one of my favorite movies “Rob Roy” starring Liam Neeson in the title role and Jessica Lange as his wife. Why is this important and what does it have to do with LInked In?

If you have never seen “Rob Roy” I would encourage you to do so. Without giving away the end, the theme of the movie is “Your honor is a gift you give to yourself.” Rob Roy’s honor is more dear to him than anything else. He would not be who he is without it. His wife, family, clan and even enemies admire him for it. I have shared this with my children as well. I tell them their name is the most important asset they have . When someone mentions your name, what do you want people to say about you? Do you want them to say “I don’t trust him” or “he is not a hard worker” or would you rather them to say “his word is gold” or “he has got your back?”

Using this context, as I sorted through the names of people on the connection list of others, recollections like these came to mind. As an Old Fart who has been in an industry and area for a long time, I know a lot of people. And, they also know me and would hopefully have more things on the good side of the ledger to say about me. I had a colleague once whose reputation was not pristine. He once commented that he had been marketing to someone for 18 years and knew them well. I made the comment to myself, “and they also knew you, as they have never hired you for any work.”

As I went down the Linked In list, by far the names I recognized provoked a favorable reaction. I haven’t thought about that person in years or where are they now? Yet, there was a handful that proves the antithesis to the Roby Roy theme is alive and well. My wife would ask about a particular sigh or “tsk.” I would comment this person is not very trustworthy (I declared some as sleazy), this person is a jerk to others, or this person is a real rectum.

These observations were usually based on concrete examples, so they were more than the result of personal interaction. One would more often than not try to game the system. One made everything more difficult than it needed to be. One went out of his way to have a very good employee fired over a minor screw-up, which is ironic since the accuser was far from perfect. One took a female colleague into a stairwell to bless her out (this one scared me when I first heard about it). One was fired for sexual harassment by two different employers by being an asshole primarily to female subordinates. Not to be gender specific, there are a few women on the list who elicit a negative reaction as well.

In my dealings with people through the years, one of my pet peeves is when someone treats a perceived subordinate of another supervisor differently than he does a perceived peer. In other words, they look down on the subordinates, suck up to the managers and treat the peers in a more appropriate way. The example of the person fired is an extreme one, but more common is the condescending tone used by these people to perceived subordinates or actual subordinates.

I recognize I have used extreme examples to prove my point, yet these are the ones I would sigh and pass on when I saw their names. On the flip side, there are many of whom I am proud they would accept my invitation to be in my network. They are the ones who provoke the Rob Roy type response. That is what we should aspire to be. People whose name provokes fond memories or respect. Atticus Finch is another name in books and movies that evokes such a response. I often say my wife is easily the best half of our family. She has commented to me about how wonderful neighborhoods have been where we once lived. I finally told her the neighborhoods were nice because you lived in them. You made them nicer and people responded to your efforts.

But, in-between these extremes are people who are accountable and responsible. They work hard and they endeavor to do the right thing. Sometimes they give in to temptation and feel badly about it. They would then fess up and take their medicine. One of the lessons I received early on was about the friar who responded appropriately to the question “what would you do if you found someone’s wallet filled with a lot of money?” The first person answered “I would turn it in to the law” while the next person said “I would keep it.” The third friar said truthfully “I would be tempted to keep it, but would pray that God would give me the strength to turn it in.”

Your name is so very important. How do you want to be remembered when it is heard? It is up to you, so please remember Rob Roy’s mantra – “Your honor is a gift you give to yourself.” None of us are perfect, but it is a goal we should each aspire to reach. If you don’t, Linked In can serve as the reminder to others you don’t want.

Today Let Us Mourn

Like many, I am both saddened and angry over the events yesterday that took 27 lives, 20 of them before they even had a chance to take full flight. As a parent, there can be no greater tragedy than losing one of your children, especially in such a senseless manner as occurred at Sandy Hook Elementary. My fellow bloggers have written wonderful posts on their feelings. My friend www.hughcurtler.wordpress.com in particular has laid out a greater context for the why along with his heartfelt sadness. I encourage you to read his post from today.

I am collecting my thoughts and will be offering a post building off the one I wrote over the summer “Another Day in America – a 16 Year Old Kills a 13 Year Old Friend.”  Yet, I want to save that discussion for another day. It is one we must have and one that needs the leadership of our President to make it so. The President said all the right things in a heartfelt manner, but words are cheap. We are beyond the tipping point and need to discuss what we need to do about this as a country. Hugh’s post and that of many others needs to be part of the framework of the discussion.

Today, I want to hug my family and mourn with those who had children or loved ones who had the misfortune to be in the line of sight of the killer. When I think of my own death, I don’t want it to be happenstance and just being at the wrong place at the wrong time. But, as tragic as my death would be at the age of 54, to have someone’s candle burn out at such a young age is beyond tragic. I have said often that you truly don’t know how much your parents love you until you hold your own child. To take that child away, I would have a very hard time dealing with that.

So, today I will mourn with you and them. I am also angry and have noted in comments on other blogs that “this shit has to stop.” Yet, I will save that for another day. Today, let’s pray, meditate or think good thoughts for those who have lost loved ones.

Our Healthcare Industrial Complex

I have borrowed the phrase that President and former General Dwight D. Eisenhower made in reference to being wary of the power of the “military industrial complex.” Of course, he was alerting us to the business of war and the profit that could be made by being forever prepared to do whatever battle is needed. He was right then and he is right today, as this business is still a very powerful lobby. Yet, the purpose of this post is to help define why the US is #1 in the world in healthcare…cost that is…while being #37 in healthcare quality, both according to the World Health Organization. The reason is our Healthcare Industrial Complex.

Two weeks ago, “60 Minutes” did a report on HMA, which is a for-profit national hospital chain that owns a significant number of hospitals in the US. The source of the report is an interview with approximately 100 former physicians with HMA as well as a former Medicare/ Medicaid fraud expert who was in their employ. Their stories are remarkably similar and corroborated by the expert who eventually resigned. The problem they raised is the culture which required Emergency Room (ER) physicians to admit as many emergency room patients into the hospital as possible, even if they did not need to be admitted. They shared goal sheets and emails which highlighted ER physicians who did not admit a sufficient number of patients. Those who failed to remedy this shortfall were terminated.

Why would HMA impose these requirements? Money. The hospital made more money when patients were admitted. The ER doctors noted in the interview when you admit a patient who does not need care, you are actually exposing them to things they need not be exposed to such as the risk of infection or error. In other words with no upside on care improvement, they are only exposed to the downside risk. Yet, this is not unique to for profit hospitals. Even a non-profit hospital has a gain/ loss equation and the goal is clearly to take more money in than you spend. So, the same pressures exist in non-profit hospitals to admit more patients from the ER.

You may say that cannot be true, but in October the Readers DIgest released a story by Michelle Crouch called “50 Secrets Your Surgeon Won’t Tell You.” These are a compilation of comments by named and unnamed surgeons in the US which are consistent with the above theme to make money on the business of healthcare.

#23 – “You should know that practically all surgeons have an inherent financial conflict of interest. That’s because they are paid approximately ten times more money to perform surgery than to manage your problem conservatively,” said orthopaedic surgeon James Rickert, MD.

#31 – “About 25% of operations are unnecessary, but administrators email doctors telling them to do more….The Cleveland Clinic has said this system of paying doctors is so ethically immoral that it started paying its doctors a flat salary no matter how many operations they do, ” said Marty Makary, MD.

#33 – “Some doctors hire practice management consultants to help capture more revenue. The consultants may want the practice to sell equipment like knee braces or walkers at mark-up…or get an in office MRI. Every time a doctors does this, he becomes financially conflicted…you order more MRIs, so you won’t lose money on it,” said James Rickert, MD.

I am glad the article included the Cleveland Clinic example, as this clinic is known as one of the best in the country. The gravitation to salaried doctors has proven to both cost effective and quality improving there and elsewhere. This is one of the solutions to addressing our healthcare cost crisis in the US. The Affordable Care Act is purposed to find these best practices and make them more mainstream.

When people say we have the best healthcare system in the world, that is not true when looking at all measures of results. We are by far the most costly system in the world and have been for a while. Of course, those fully insured and with a means to pay for the finest doctors can get access to state of the art care. But, that applies to the very few, not the many. And, those who have no or little insurance have a much different experience. This is why the Affordable Care Act is so important – getting people covered, paying for care at time of use, and facilitating preventive medicine rather than reactive medicine.

I should mention that the significant majority of the comments in the Readers Digest article were care-oriented. These doctors want their patients to be successful. Here are a few:

#22 – “Some problems just don’t fix well with surgery, like many cases of back pain. My advice is grin and bear it….many people have a degenerative disk with no pain. There isn’t a lot of evidence that we’re helping very many people (through surgery),” said Kevin B. Jones, MD.

#28 – “What really keeps us up at night? It’s not making a mistake in the operating room; it’s the noncompliant patients. When patients don’t do what we tell them, bad things can happen,” said OB-gyn Kurlan Thott, MD.

#46 – “If your doctor wants to give you a stent, always ask: is this better than medicine….Having something planted in your body is not a risk free proposition,” said Marc Gillinov, MD.

#47 – “If I had any kind of serious medical condition, I’d go to a teaching hospital. You’ll get doctors involved with the latest in medicine…At a university hospital, you also have the advantage of having a resident or physician bedside 24-7, with a surgeon on call always available,” said Tomas A. Salerno, MD.

#8 – “It is better to have elective surgery early in the week because lots of doctors go away for the weekend and won’t be around to make sure you are OK…you are going to get someone who’s covering for the surgeon (over the weekend),” said an anonymous general surgeon who blogs under the name Skeptical Scalpel.

These doctors also compiled questions you should ask before surgery:

– Why do I need this procedure now?

– Who is going to be doing it, and how many times has he or she done it before?

– What are the most common complications, and how do you deal with them?

– What will the recovery be like?

– Who is going to take care of me after surgery (pulled from #7)?

These helpful suggestions among many others paint a more favorable picture. Yet, the other comments paint a picture of the business of healthcare. There is a conflict of interest these doctors and nurses are placed under to drive patients to more costly care which is more profitable to the hospital. It is not primarily motivated by better quality of care outcomes. It is more aligned with making money for the provider. With consultants advising hospital and doctors how to make more money by unbundling services, doing more unnecessary or repeated tests, admitting patients and doing more surgeries than necessary, it is easy to see why we have the most expensive healthcare system in the world.

I recall the complaints of HMOs back in the 1980s and 1990s, which were echoed by one political party toward Obamacare, saying the insurance companies or government would stand in the way of the doctor and patient. I do know these MDs at the insurance companies would show data to the hospitals and doctors showing the differences in cost and patterns of care. The purpose is to help find the more elegant care. The comment above about back surgery is pertinent. As of this post, I know three people whose doctors messed up their spines on surgeries that should not have been done or done by those doctors. This is the purpose of the intrusion. Absent that, a hospital may be forcing a decision upon a doctor that is not fully in the best interest of the patient.

I encourage you to read the Reader Digest article. I cited another one over the summer about things nurses won’t tell you. They both are helpful. But, at the center of all the healthcare is you the patient. If you cannot speak for yourself, get a proxy to ask your questions. Take better care of yourself by exercising and eating more healthfully. And, please get a second and maybe a third opinion on surgery. It is your body after all. A healthy sense of skepticism is always appropriate, so ask questions. The ones noted above are good place to start.