Greta Thunberg joins a ninth grader in Charlotte for climate change strike

Her words were clear. We must “unite behind the science.” Sixteen year-old climate change activist Greta Thunberg joined ninth-grader Mary Ellis Stevens in Charlotte along with 1,200 other people for a climate change strike. I was one of the 1,200. Several young people spoke, with only a few adult voices making it to the dais. The crowd was multi-generational, multi-ethnic and multi-racial. It was wonderful to witness.

Below is a brief article from The Charlotte Observer on the strike. I was struck by several things she and others said.

– Thunberg made a point of referencing many of the indigenous tribes from our area. To me, this is representative of the saying “we are not inheriting our land from our forebears, we are borrowing it from our children.”
– a young UNCC student activist who is African-American noted that people of color are more impacted by climate change than other groups, yet they get under-represented at these events. The reason is the events are held during the working day, and not everyone has the luxury of getting away from work or school.
– Thunberg handled a heckler with the aplomb of a seasoned politician. After listening for a few seconds, she said why don’t you come back stage afterwards and we can talk about your comments?

I was incredibly proud of the young folks in attendance. I think Thunberg is a hero for her courage and candor. My favorite sign was from a young adult woman standing near me that said “You cannot renew lost time.” I told her that her sign was excellent. In my view, we have lost eleven years due to the Bush/ Cheney White House and the Trump White House. Good things have happened in spite of their lack of leadership on this topic, but these efforts could have been leveraged even more by concerted federal action.

https://www.charlotteobserver.com/news/local/article237108539.html

The most realistic path to ‘Medicare for All’ says a former Insurance CEO

I said back in 2010 to a healthcare consulting colleague, we will eventually need to consider national health insurance, but it won’t happen. When he asked why, I responded the “Healthcare industrial complex is too powerful.” People forget the reason we have the Affordable Care Act is CFOs were tired of rising healthcare costs to their bottom line.

Healthcare is a complex topic and the ACA added to that complexity. It has since gotten better, but we need to shore it up to stabilize it more, rather continue to allow it to be diminished as its opponents have down for several years.

But, national health care under the banner of “Medicare for All” is worthy of consideration with data and analysis. This retired actuary, benefits consultant and benefits manager supports data driven analysis to improve what we have and consider more substantive changes. JB Silvers, a former health insurance CEO and professor of health care finance at Case Western University, penned an article called “The most realistic path to ‘Medicare for All'” in The New York Times earlier this month. Here are excerpts from the article:

“Much to the dismay of single-payer advocates, our current health insurance system is likely to end with a whimper, not a bang. The average person simply prefers what we know versus the bureaucracy we fear.

But for entirely practical reasons, we might yet end up with a form of Medicare for All. Private health insurance is failing in slow motion, and all signs are that it will continue. It was for similar reasons that we got Medicare in 1965. Private insurance, under the crushing weight of chronic conditions and technologic breakthroughs (especially genetics), will increasingly be a losing proposition.

As a former health insurance company C.E.O., I know how insurance is supposed to work: It has to be reasonably priced, spread risks across a pool of policyholders and pay claims when needed. When companies can’t do those fundamental tasks and make a decent profit is when we will get single payer.

It’s already a tough business to be in. Right now the payment system for health care is just a mess. For every dollar of premium, administrative costs absorb up to 20 percent. That’s just too high, and it’s not the only reason for dissatisfaction.

Patients hate paying for cost-sharing in the form of deductibles and copays. Furthermore, narrow networks with a limited number of doctors and hospitals are good for insurers, because it gives them bargaining power, but patients are often left frustrated and hit with surprise bills.

As bad as these problems are, most people are afraid of losing coverage through their employers in favor of a government-run plan. Thus inertia wins — for now.

But there’s a reason Medicare for All is even a possibility: Most people like Medicare. It works reasonably well. And what could drive changes to our current arrangement is a disruption — like the collapse of private insurance.

There are two things insurers hate to do — take risks and pay claims. Before Affordable Care Act regulations, insurance companies cherry-picked for lower-risk customers and charged excessive rates for some enrollees…”

There is only one solution: pooling and financing many of the risks related to chronic and acute health care issues. A study by my former company noted generally 15% of participants drive 80% of the claims costs in any given year. It may not be the same 15%, but with major chronic issues, some could continue to be in the mix. The principle of insurance is to pool those risks, so that good risks can moderate the higher risks.

The ACA uses the private insurance system, exchanges and expanded Medicaid. Unfortunately, there are about 15 states who still have not expanded Medicaid. Medicare for All would consolidate the risk into one place, eliminating the profit load and reducing the relative administration cost of insurance companies. I have suggested for several years to do a pilot and expanded Medicare eligibility from age 65 to age 62, or even lower. This would let us measure the impact of such a change.

Yet, what we don’t need is this to become political. What people do not realize is the ACA has been sabotaged on several occasions by my former party which drove some insurers out of the market and increased premiums for everyone else more so than they otherwise would have been.

So, let’s cut to the chase and study options. And, politicians should let people who know what they are doing do the analysis. The ACA was made too complex and the exchange roll out was botched. On the flip side, what the GOP did in 2017 was sloppy and poorly staffed, so what was voted on woulf have been harmful to many.

Our children deserve better

Two time Pulitzer Prize winner Nicholas Kristof wrote an editorial earlier this week in The New York Times called “Our children deserve better.” It is a clarion call to our nation showing the plight of kids in America.

Here are a few quotes to frame the issue:

“UNICEF says America ranks No. 37 among countries in well-being of children, and Save the Children puts the United States at No. 36. European countries dominate the top places.

American infants at last count were 76 percent more likely to die in their first year than children in other advanced countries, according to an article last year in the journal Health Affairs. We would save the lives of 20,000 American children each year if we could just achieve the same child mortality rates as the rest of the rich world.”

“Half a million American kids also suffer lead poisoning each year, and the youth suicide rate is at its highest level on record….The Census Bureau reported this week that the number of uninsured children increased by 425,000 last year.”

These are different views and sources of the threats to US children that note we have a problem. Another source I read a couple of years ago noted America has a much higher maternal mortality rate at child birth than other civilized countries, which further endangers children as well as the mothers.

Yet, these issues are not being discussed in the halls of government. We have a poverty problem in our country with too many living in or just above poverty levels. We have not expanded Medicaid in fifteen states whose numbers are worse than these national numbers per capita. We have not addressed our national water crisis which has a Flint, MI like exposure to lead in too many cities and a volume of available fresh water issue in other places. We have not invested as we should to diminish crime and provide more opportunities for jobs in disenfranchised areas. There are several pockets of success that can be emulated in more cities.

We also need to address better gun governance, especially with the number one gun death cause by far being suicide and a non-inconsequential accidental gun death rate. And, we have not dealt with the continuing and rising exposure to technology and artificial intelligence which have taken and will take even more jobs in the future. Finally, there is that climate change thing we need to deal with.

These are real problems. And, they will get worse. Data driven analysis of causes and solutions are needed. They are both multi-faceted. Investing more now, will save huge amounts later. This is not just an urban issue, it is rural one as well. The opioid crisis is rampant in these impoverished rural areas, for example.

None of the solutions will fit on a bumper sticker. And, political attempts to oversimplify issues should be questioned. Here is an easy contradiction to spot – if people believe gun deaths are a mental health issue, then why the effort to eliminate or not expand mental health benefits?

Please make your legislators aware of these issues and ask pointed questions. These questions deserve answers, not bumper sticker slogans. These concerns deserve to be talked about, studied and acted upon.

Colorado Family Planning Initiative

As the veracity of Planned Parenthood is being discussed, there is a program and study that was conducted in Colorado over a seven year period that offers meaningful data. The Colorado Family Planning Initiative offered low-income women and teens access to low or no-cost contraception, including IUDs and implants.

The Governor’s office released the results of the program which analyzed data from 2009 – 2013. The key findings are:

  • there was a 40% statewide decline in the teen birth rate
  • there was a 35% statewide decline in the abortion rate

If the goal is to reduce the number of unwanted pregnancies and abortions, funding the use of contraception along with family planning efforts and information is the better answer. Cutting funding will only increase these numbers. And, it should be noted there are correlations between poverty and increasing family size and poverty and single mothers. This is more true the younger the mother.

Education is a vital part of the program as well. If people want to teach abstinence as part of a holsitic program, that is fine. But, the teachers and funders need to clearly understand these teens and young adults are just like we were, if not more so. They are tempted and will have sex. It would be so much the better, if they were informed of the consequences and knew what options there were.

A key part of the education must help girls understand that self-esteem need not be tied to sex. These girls need to be able to say no and feel confident in withstanding pressure, especially today with so many ads, shows, and stars (by dress and manner) saying it is OK. And, boys need to know that no means no. It can be uttered up to the time in which sex occurs.

As a parent, I know parents worry about their kids. You hope they will make good choices. Yet, we did not always make them and they will likely follow suit. Also, please understand even kids brought up in the strictest of homes will be tempted to do things when away at school or college. It is only natural.

Three anecdotes might help illustrate the importance of education and planning.

  • My brother-in-law taught eighth grade science in a high poverty rural area. Annually, he had a number of girls in his class get pregnant. To them, it was being like an adult a right of passage. Only when it was too late, did they realize the consequences.
  • A colleague was viewed by teens in her church as being the kind of person who would shoot straight with them. She was asked questions that told her these kids thought they could not get pregnant the first time and if they had sex standing up they could avoid pregnancy. When she mentioned to the minister to have a sex education class, he scoffed at her request.
  • A friend who has run several non-profits and is very devout told me the children of his friends would go off to a religious university nearby. He said these kids would go wild when finally away from their parents and shocked some of his friends by what they got into.

So, Planned Parenthood and organizations that provide holistic family planning need more funding to reduce the number of abortions and unwanted pregnancies. Kids need to get good information and access to tools. It is their lives. And, while I focused on pregnancies, STDs and HIV are very viable threats to manage through contraception and education.

Let me close with this thought. As the former Board Chair of an organization that helps homeless working families, single mothers is the predominant group that is helped. It is also the fastest growing homeless population in America. Key tools to help lessen the propensity of poverty and homelessness in this group are family planning, sex education and low-cost birth control.

Helping people climb a ladder – a perspective

The following is an edited version of a comment on Hugh Curtler’s (a retired college professor of philosophy) post regarding whether we should help people in need or let them fend for themselves. I provide a link below to his post. I am going to cite the work a charity I used to be a part of that builds off the book “Toxic Charity,” written by a minister who lived with the disenfranchised people he sought to help. His name is Robert Lupton.

Lupton’s thesis is simple: true charity should focus on emergency or short term needs. What he argued for to help others long term and we did (and still do) is help people climb a ladder back to self-sufficiency. That should be the goal. An easy example is he would advocate for food and clothing co-ops rather than giving the food and clothes away. People love a bargain, so let them maintain their dignity while they get discounted help. This dignity thing is crucial – people would rather not have to ask for help.

Note, we cannot push people up the ladder. They must climb it.  A social worker I have advocated with used to say “we walk side by side with our clients.” The folks we helped are homeless working families. We had two keys – they received a subsidy for rent based on their ability to pay, but they had to plan, budget, get financially educated working with a social worker and attending required training programs. Our homeless clients had to be responsible for rent and utilities up to 30% of their income, which is threshold for housing risk. Another key is we measured success. Success to us is being housed on their own without help after two  years.

As a community and country, we need to better identify what we mean by success in our help for people in need. Also, are things like healthcare a right? Is food on the table a right? Is a roof over the head a right? What we need is better measurement of what we spend and how it helps. It actually is cheaper to provide housing to chronic homeless and partially-subsidized housing to those who are more acutely homeless (due to loss of job, reduction in hours,  loss of healthcare, problems with car, predatory lending on a car, etc.) than let them go to the ER or commit petty crimes and be jailed. People should know all homeless are not alike, so the remedies to help need to vary.

My former party likes to argue off the extreme anecdotes – the significant majority of people do not cheat the system, but the perceived thinking of such is much higher in Republican ranks. When I have spoken to church groups, chamber groups, rotary clubs, United Way campaigns, etc., I come across this bias which is firmly believed. Just last month, the US president announced curtailing a rule on food stamps which will put 3 million people at risk, as one man was able to purposefully game the system. Yes, there is a small percentage of folks that do that, but the significant majority do not.

What people like David Brooks, a conservative pundit, tout is a dialogue on what kind of country do we wish to be? Our economy is a fettered capitalist model, with socialist underpinnings to help people in need and keep people out of poverty. What is the right balance? Is it better to pay a much higher minimum wage or have a higher earned income tax credit, e.g. Is it better to have a Medicare for All system, subsidize those in need or have a free market system only? A factor in this decision is many employers now employ a larger part-time or contractual workforce (the gig economy) to forego having to provide benefits. This is especially true in retail and restaurant industries.

At the end of the day, Gandhi said it best – a community’s greatness is measured in how it takes care of its less fortunate. With so great a disparity in the haves/ have nots in our country, I can tell you we are out of whack as our middle class has declined and far more of them fell into a paycheck-to-paycheck existence. Ironically, even in the age of Trump promises, we have many people who do not realize they are voting against their economic interests. Doing away with the ACA and not expanding Medicaid are very harmful to rural areas, e.g.

So, I agree with Gandhi, Lupton, and Brooks that we need to help people, but decide what is the best way. We should measure things and adjust them when they get out of whack. It is hard to fix what you do not measure. The group I was involved with would alter its model, if the numbers showed less success than hoped. What I do know is over 80% of the people we helped are still housed on their own after two years of leaving the program. In other words, they live without a subsidy.

Finally, what we need most is for politicians to check their tribal egos at the door when they enter the room. Having been a member of both parties, each party has some good ideas, but both have some bad ones, too. I do not care what a person’s party preference is or if he or she is more conservative or liberal than me  (I am fiscally conservative and socially progressive), we need to use facts and data to make informed choices. And, continue to measure the results making modifications, if needed.

Dilemma

Call me crazy

I hope everyone had a great weekend. We are living in interesting times, some would even use the word “crazy.” Here are a few random thoughts to match the times.

– A real hero is someone like Lori Gilbert Kaye, a 60 year-old woman who lost her life in this weekend’s synagogue shooting. She lost her life because she threw her body in front of the Rabbi. Please share her story rather than the name of the cold-blooded killer, who not only killed her, but shot two others, including an eight year old girl.

– I agreed with the President when he said people need to get vaccinated for measles.. Then, as I read on, he said during the campaign the measles vaccine is linked to autism. When will this man understand that words matter and people do not realize that the significant majority of the words this man says are untruthful ones?

– Speaking of lies, The Washington Post has recorded 10,000 lies by Trump as President. Former Speaker Newt Gingrich defended the President saying he is a businessman and is allowed to exaggerate. Mr. Gingrich, I am a businessman and if someone in business lied like the President, people would not do business with him very long. Further, why did an independent contractor who dealt with Trump companies say “Word on the street is if you do work for Trump, get paid in advance.”

– A recent poll conducted by Opinium said 55% of Brits now feel the 2016 Brexit vote was a bad idea. They have time for another vote, but not if they wait. A fact based process would help, but it would also help here in the states.

– With the advent of market segmentation in all things, including the pseudo-news and now data, we seem to be moving closer to another Robber Baron period. Now, it is so easy to obfuscate voters, they do not know that elected officials are making changes that help the wealthy. What is also unsurprising is how easily more strident groups can be fooled to go along, provided you play to their fears.  Immigration is being sold as the problem, but the main problems are technology and CEOs chasing cheaper labor costs. In Western countries the haves and have-nots are even more divided. Unless something is tangibly done, this bifurcation is unsustainable.

– Finally, it is amazing how little the US leaders talk about our ticking time bomb problems – job retraining as technology kills more jobs, increasing debt, environmental degradation, global water crisis, stabilizing healthcare costs, crumbling infrastructure and climate change. The GOP is running on building a wall, proliferating gun ownerships, restraining abortions and how bad socialization is. Make all candidates answer questions about these ticking time bomb problems. If they cannot, do not vote for them.

Call me crazy, but maybe, just maybe, the ones who are crazy are the ones not addressing real issues and telling real truths. You be the judge.

 

 

 

Mobile homes aren’t too mobile and create financial risk

John Oliver’s “Last Week Tonight” may have a comedic bent, but is one of the best news shows around. The latest episode included a detailed look at the mobile home industry. The key takeaway is private investor groups prey upon the mobile (and modular) home buyers through a rigged system.

Between a truly captive audience (more on this later), the fact the significant majority of mobile home buyers rent the land underneath, and the predatory lending and sales practices, the buyers are at the mercy of greedy players in a shady industry. Adding to that, the value of the mobile home will only depreciate (like an auto), so the buyer truly must beware.

We have come to this problem as several conditions have culminated together. We have an increasing number of “have-nots” in America, so mobile or modular homes are the most affordable route. The mobile home park owners have consolidated and were purchased by several private investor groups, but even the larger regional players operate under this rigged system. These folks see a market to squeeze. Finally, if the buyers do not own the land, they are truly held hostage.

Why? Over 80% of mobile homes never move due to the cost of moving. The property owners know this, so they annually jack up the rent increasing by exorbitant amounts. The renters are then inundated by collection agencies who get them to pay. When they cannot, they eventually move, leaving their home behind. Then, the property owner takes possession of the abandoned home and rents it out.

Finally, the sellers of these products often own the financing agency offering a turn-key purchase. The loans are more like predatory car loans than they are mortgages. So, the interest is higher than normal at the same time the rent is getting increased.

Oliver’s show highlights a couple of the players in the industry. One property owner has sites in 25 states and offers seminars on how to gouge your captive tenants. In one instance, this property owner referred to his tenants as “like being chained to a Waffle House table.”

There is a small movement afoot which will allow homeowners to buy the mobile home park land en masse, as a right of first refusal. Nonprofit funders are helping make this happen. What is needed is more states to have right of first refusal laws, so that the property is not sold to a predatory landlord.

The other need is education. If you must buy a mobile or modular home, place it on land you own or in a tenant owned development. Also, seek better financing than what is offered by the seller. But, know going in this home will not go up in value. If you buy a modular home for $50,000, it may be only worth $10,000 in a few years.

The “have-nots” have little recourse in this industry. Education is a must, as you will truly become a hostage in your home.