Update: Health Care - Incent vs Tax

A few weeks ago, I wrote about using incentives to drive down the cost of health care, rather than laying on onerous new taxes on sugar, fat, and other harmful foods. Today, it seems the Senate has adopted at least some of the concepts I was talking about.

Read about it, and let me know what you think

The Network Effect - Part Two

If you follow me on Twitter, you know that yesterday I recommended buying Lars Brownworth's new book, Lost To The West. You also ( hopefully ) have read my first post about The Network Effect as well.

Lars is the brother of Anders, whom I mention here with some amount of regularity. Yesterday was the release of Lars' new book for worldwide distribution, and is a tremendous testament to two things: Doing what you love and building a loyal following.

I first heard about Lars when I started working with Anders at Bandwidth.com. At that time, he was a teacher at Stony Brook School in NY. Lars started building a following when he started his podcast, The 12 Byzantine Rulers. A pretty dry subject, one would think. But, if you have ever listened to them, you know that he did a tremendous job of bringing these ancient rulers to life. His passion was infectious to say the least.

Over the course of a few years, Lars built enough of a listener base to have his podcast ranked #1 at one time on Itunes. He had professors at major universities recommending it, and momentum started to build.

It was at this point that the publishers came calling. One thing led to another, and yesterday his book was published by Crown Publishing.

Lars is contemplating what's next, and I think there will be some other really cool stuff come of his initial efforts around the 12 rulers podcast. But, I think the best thing about all of this is that he was just sharing with the world a subject that he loves to talk about, and enough people cared about it to get him a book deal, as well as other opportunities yet to be determined.

Great story.

Health Care - Incent vs. Tax

There was a really good article in the NY Times last week about the effects of diet on American's general health and well-being, and consequently, health care costs.

For anyone that pays attention, this is no surprise. If you live in suburban America, you would have to be blind not to see the rampant obesity that is driving around our cities. I say driving, because this problem does not seem to exist in major metro areas where people use their feet as the primary mode of transportation.

The point of the article above was simply that until insurance companies start enforcing better eating behavior through the use of things like the soda tax in NYC, our costs will continue to spiral upward. I agree with the premise, and with the overall goal, but not the means.

I was in Albany, NY in June for my niece's wedding. I got in really late, and on the way out of Albany, we stopped at McDonald's for a quick bite. I eat McDonald's probably 4 times a year, but on this particular night it sounded really good. I ordered my usual Two Cheeseburger Extra Value Meal, which costs about $4 here in Raleigh. In Albany, however, it cost me close to $7! Almost 2x as much for the same food. I asked my sister what in the world was going on, and she explained that the state had imposed a "fat tax", much in the same vein that they have imposed enormous cigarette taxes to discourage smoking.

I have no doubt that there is more of this kind of thing coming as lawmakers again try to make decisions for us that we should be able to make ourselves. However, I got to thinking after reading this article, and it seems to me that if health insurance was incentive-based, where the rates I pay are dependent on things like my age, my health history, and my risk based on family factors, the system might be able to fix itself for this particular issue.

Imagine if you had to have a yearly exam wherein the results determined what you paid, rather than the current "here is a population, we will absorb this much risk." It would provide the incentive for people to get in and stay in good health. If you could pay $200 a month if healthy, but knew that if you became overweight or had high cholesterol or smoked, you would pay $600 or more, I think most people would work toward paying $200. A couple years ago, I went for my annual physical and was told by my doctor that I needed to lose 15-20 pounds before I turned 40. At the time, I did not consider myself overweight, but did what he told me to do anyway. On the other side of it, I feel way better, eat far less, and have formed the right kinds of habits to keep the weight off.

Think of all the things that already work this way. If you have good credit, you get a better mortgage rate. If you have no accidents, you pay far less in auto insurance.

We are all incented in various parts of our lives to do the right thing, and to live a certain way. This happens not because of government making it so, but rather because of the laws of a free society working the way they are supposed to.

Let people make the choice, and then let us deal with the consequences of that choice. It seems to be a better long term strategy than just opening up the public coffers and throwing money out to the masses, or soaking the so-called "rich" to pay for the next public sector boondoggle.

Talking vs. Doing

I work for a large software company, and the things that go on here on a daily basis take me through a large range of emotions, most of them unpleasant. It's the first time I have ever worked for a global company with 15,000+ employees, and it has been a tough adjustment to say the least.

One of the more interesting changes that I have observed in the last few months in my particular business unit is that the folks at the top decided to adopt the Agile software development methodology. If you want to read about Agile, you can do it here.

The fact that we have made this move in itself is not all that interesting. The team that I work on has used something resembling Agile ever since I have been here, and that is pretty much all I have ever used in some form or fashion. I like to call our methodology "GLH", or go like hell.

What is interesting to watch, however, is the adoption of all of the nomenclature but not really much of the process. We have all the right people saying all the right things, using the correct terminology, etc. But, when it comes right down to it, it's still a lot of the same old inflexible people developing software the same old inflexible way.

I would equate it with what it must be like to adopt Six Sigma or something. You have all of the roles and terms, people jump in and make it look nice, but in the end you are still turning out lousy products or being wildly inefficient.

I would be much more impressed if we would just stop the banter and actually work in a way that reflects the spirit of the methodology, rather than the letter.

Annoying Software Product Demos

One of the my largest pet peeves has to do with software product demos and the lack of attention paid to information I provide ahead of time.

I cannot tell you how many demos I sit in on where the sales rep asks me for specific things I want covered ahead of time, and then proceeds to give me a standard demo of their product.

If you are going to ask me to take my time to evaluate your product, do me the courtesy of answering my specific questions in the most complete possible way.

Katrina - A Spike Lee Joint

I was cruising the channels late Saturday afternoon and stumbled across the airing of the movie 'When The Levees Broke - A Requiem in Four Parts', a docudrama directed by Spike Lee. The movie recounts the events leading up to and following the disastrous landfall of Hurricane Katrina in New Orleans.

I have always been a big fan of Spike Lee. I have seen all of his movies, and generally find them both disturbing and thought provoking. I also know that his movies are presented from a viewpoint that I have absolutely no context for ( being that I am quite white ), and as a result I have a tendency to be dismissive when it gets to various points in the movie where black people suffer at the hands of white people. I generally will mutter something like "It's not like you don't have a say in how your life turns out. Do something different if you don't like it!" I realize this is arrogant, and a character flaw, but it happens. I have lived a life of extreme privilege, as I am now realizing day by day, and am humbled by it.

After watching the horror of Katrina unfold in grave detail some four years ago, I had two primary reactions:

1. The government was looked to as the savior in this disaster by many in New Orleans, and it failed miserably in that role. From Mayor Nagin issuing a mandatory evacuation only the day before and not providing any means for getting people out that had no transportation, to George Bush committing to providing "all the help that would be required" and completely bonking, the government made commitments that it failed to keep. As several in the film said, we had help on the ground in Indonesia faster than we did in New Orleans. If it is your position that the government belongs in the middle of mitigating a disaster like this, then it is inexcusable what happened in New Orleans. I was also stunned as I watched people recount trying to leave New Orleans on foot and being turned back by police in neighboring cities.
   
2. I, as someone who lives in the US, failed in my role as someone who could help those in desperate need. From my cushy home here in North Carolina, I observed the devastation and chose to believe that it was "not as bad as it looked" on TV. I had severe myopia, and did very little, if anything, to help out. It is not necessarily guilt ( as it is four years later, and there is nothing I can do about it now ), but rather it is one of resolve. I will pay more attention next time, and get involved.
   

I don't think it is the government's responsibility to be directly involved in this kind of disaster relief. Prior to the 1900's, you would struggle to find the government's involvement in any of our nation's largest cleanup efforts. Even the earthquake of 1906 in San Francisco was cleaned up primarily by the residents of San Francisco. We, as a nation, should do a better job of taking care of our own. The government may fly the planes in, but we should provide the water, the food, the workers, the capital etc. to help rebuild.

We are disillusioned when we put our faith in a large bureaucracy that fails to deliver on it's promises time and time again. ( By the way, don't think that it will be any better with the promises of a health care panacea ). I would like to think that at some point we may learn that we would be so much better off if we gave our government the collective finger and leaned on each other a bit more. Maybe I am hopelessly naive.

Lastly, should we consider perhaps not rebuilding a city that is below sea level and is destined to have this kind of destruction again? From Hurricane Betsy in 1965 to Katrina 40 years later, perhaps it's time to think about people finding another place to live.