Healthcare in America

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Healthcare in America is a convoluted and complex subject. There are many facets, factions and special interest groups representing many different points of view. Some would have you believe that any material change to our present system will result in the end of the republic. Others posit that radical change is the only socially conscious choice. Still others including the administration seek a middle ground that keeps the insurance companies honest and provides coverage options for all Americans.

With over forty-five million American citizens uninsured and many more under insured, it seems apparent to me that the system we have now is failing a large segment of the population. During the campaign both candidates postulated when asked that health care and education were fundamental rights. That said it seems apparent that they should both be within reach of every citizen regardless of their economic status.

One of the fallacies that negate the benefit of capitalism is the introduction of false moral choices brought about by greed and corruption. Typically, these choices are cloaked as conservative principals like deregulation, free and fair competition, ideology driven by PAC contributions and a greed is good mentality. The mantra is that all the profits generated by an unrestrained and unregulated capitalist system will trickle down to the less fortunate through the largesse of the conservative illuminati. Meaning that if we just wait the uninsured among us will eventually have medical insurance bestowed on them by some generous benefactor yet unknown to them.

As long as we have, a congress and senate filled with professional politicians meaningful change will be hard to come by. With long tenure comes an attitude that longevity in office and self-gain outweigh their fiduciary responsibility to their constituents. They will pander to the insurance companies and ignore the fact that their own medical coverage is a privilege obtained by virtue of the office to which their citizen constituents elected them.

Those who would see the advent of socialized medicine are just as wrong on the other side of the equation. Something for nothing never produces a high quality something. A system devoid of profit is a system devoid of incentive. Insurance companies, doctors, hospitals and other health care providers deserve a return on investment. There needs to be an incentive for research and development of new medicines and medical procedures. Our goal should be the highest possible quality at a fair and equitable cost, which produces a fair and incentivizing profit.

Zig Ziglar is known for saying “if you help enough other people get what they want, you will get what you want.” Zig is a well-known and respected salesperson, sales trainer and motivational speaker. That quote is usually related to the sales effort but it is just as apropos in this situation. If we as a nation solve the healthcare dilemma facing us before it becomes a budget-busting conundrum incapable of being solved, the benefit accrues to us all.

Knowing that a true change of heart in our political leadership that leads to a fundamental paradigm shift is unlikely, what we have left is a popular demand for thoughtful compromise. We should insist that some kind of basic and catastrophic medical coverage be available to all people, even the homeless indigent. We should expect and insist that preexisting conditions be covered by every insurance company without exception. We should demand that the patient in conjunction with the doctor make decisions about tests, treatments, medical procedures and medications, free from any constraint or review by the insurance company.

Additionally, all hospitals, urgent care facilities, labs, and medical providers should be mandated to produce itemized plain language bills for patients to sign off. There is far too much fraud institutionalized in the healthcare system. It is rampant in the billing practices of a majority of medical providers. Also, we should accept and expect some limited tort reform regarding malpractice lawsuits. In cases of egregious negligence, legal remedies are necessary and appropriate. In cases of honest or simple mistake, damages should be limited to the actual damage and punitive damages forgone.

Any country as capable, inventive, courageous and as intellectually gifted as the United States should be able to reform healthcare to the benefit of all the stakeholders. In the process, the life we save might be the one of the little girl who someday cures aids, or the little boy who grows up and cures cancer. It is not only our collective present but also our collective future that we are trying to improve. Someday we will all be judged by our contributions to humanity. Our net worth will not be a function of dollars and cents but rather kindness and consideration for others.

This is an issue of vital interest to every American. The healthcare of your children and other loved ones is at stake. You cannot afford to sit back and let the politicians and insurance companies decide this one. Time is limited, the special interest want some minor reforms quickly so they can get this issue off the table and out of the public eye. Make you opinion known. Call, email and write your state and national representatives and tell them what you want them to do about healthcare. It is your right and responsibility to direct your elected representatives in the performance of their duties. Remember the government you get is the government you deserve.

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The Old Guard

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This is a letter to one of my sisters about the Old Guard unit from the Army’s 3rd Infantry Brigade stationed at Fort Meyer in Arlington, Virginia. The Old Guard is charged and privileged with the ceremonial duties at Arlington National Cemetery. They also provide security at the Tomb of the Unknown Soldier. The letter speaks for its self.

Dear_______,

The Old Guard is indeed steeped in tradition and honor. As a child and young teenager, there were times when I almost lived in Arlington Cemetery.

There are some inaccuracies in this email. There is no barracks under the Tomb, only a ready room. There is no lifetime Prohibition against drinking and swearing. Behavior that reflects poorly on the unit is punished.

I have stood and watched these men walk their post at all hours of the day and night. I have seen them march in the pouring rain and bitter cold. It is amazing to see them continue to march in heavy snowfall or during an ice storm.

I have also partied with some of them and am struck, by the fact that they are ordinary men doing an extraordinary thing. It brings honor to them and to those they guard who are the real hero's.

I often used to wonder if the relatives of any of the unknown had ever stood in front of the Tomb absorbing the pageantry and ethos of the place, missing their loved ones and wondering where they were laid to rest. Of course, they have.

Their final resting place is not in the tomb or in some foreign field. It is in the hearts and minds of those they loved and died for. It is in the hearts and minds of anyone whoever had the privilege of standing in front of the Tomb of the Unknowns and reflecting on the sacrifice of those interred there and throughout the grounds.

There is another Tomb of the Unknowns in Arlington that most people never see. It looks remarkably like the one that is guarded around the clock. A little southwest of the Mansion's front door, it was the first grave in the cemetery placed there to prevent the Lee family from re-inhabiting the house after the Civil War.

If memory serves and it does, there are just over two thousand men interred in this vault a little smaller then the one well known. They were recovered from the battles of Bull Run after the war. I was always amazed that in this grave were both Union and Confederate troops. Likely, some were related even if on different sides of the conflict.

They all thought God was on their side and died for what were no doubt, deeply held beliefs. Or maybe some were just swept up in the events of the day and died just trying to survive without really understanding the issues that brought them to war. Unwilling hero's led to untimely deaths by the failure of their leaders to resolve their differences short of a war they could have avoided.

I do not get war. Living so close to Arlington and spending so much time there really played a huge part in my feelings about a lot of things. It was a wonderful place to watch people. The tourists going through Arlington House or Lee's Mansion were always somber and respectful. The mourners in their grief were soulful, sad and despondent. The soldier's at their duty and even the grounds people digging and filling graves and beautifying the grounds added to the majesty and mystery of a place that epitomizes the futility of war.

To them a nine-year-old boy on a bike was invisible. To me it was a place of incredible pageantry and a kaleidoscope of human interaction and emotion. It was a place to escape to and spend a soft summer day or night reading or just observing nature, human and natural.

It is a place where any leader contemplating war as a solution should spend enough time to soak up some understanding of the consequences. It a place of not only peace and tranquility but shattered lives and dreams. It is a place of orphans and widows, of futility and despair. It is a place of courage and grace, of heroics and hero's. It is a place of questions and if one listens carefully, of answers in the heart.

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G M Bankruptcy

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Well, General Motors has achieved another milestone on its way back to the future. The black hole of arrogance, greed and cowardice has pulled the once iconic American company into the bankruptcy abyss. As a former Chevrolet dealership general and executive manager, I have some insight based on that experience. The future of GM is hard to prognosticate. However, if history is any indicator, this company has little chance at long-term viability if they do not seize this opportunity and start over with a clean sheet of paper.

During WW II, a gentleman named W Edward Deming Ph. D., helped American manufactures transition from peacetime production of their products to a wartime footing. Production of the material and equipment needed to fight the war was critical and Dr Deming’s contribution helped the transition. It is a well-known and documented story that prominently features Rosie the Riveter but not Dr. Deming. In fact, though he was instrumental in transforming the industrial production capability during the war and instituted quality control concepts that ensured the armed services got high quality material with which to wage the war, he was little known in the US.

After the war, the demand for American products increased dramatically. Efforts at quality control were sacrificed on the alter of higher volume and profit. Managerial focus drifted toward short term results as opposed to long-term viability. With the stock price driving everything, poor quality control and management was inevitable. Then Dr Deming was called to Japan.

He went over in 1947 to assist in preparing for the Japanese census that was to take place in 1951. The Japanese Union of Scientist and Engineers invited him to teach them statistical process control and concepts of quality. He willingly complied and in the summer of 1950 lectured extensively on these subjects. His message was simple. Constant quality improvement will reduce cost, improve productivity and market share. The Japanese took his message to heart and commenced to create a huge demand for their products over the following decades. American manufacturers were not listening, including the big three automakers.

There are two stories that exemplify our refusal to embrace quality. One is about a picture I saw in a book about Deming in the early seventies when I first started selling vehicles. The title and author escape me but the picture is indelibly imprinted in my memory. In the picture, Deming is holding the piston of a Mitsubishi truck in one hand and the piston of an American truck in the other. The caption quotes his saying that one is a finely crafted piece of precision steel and the other looks like the jawbone of an ass.

The other story is about Ford Motor Company’s solicitation of Dr Deming’s help. Finally, in 1981 while their sales were falling precipitously they turned to him for assistance. The company lost some three billion dollars between 1979 and 1982. By 1986, their profits had exceeded General Motors and the change in the management culture and new emphasis on quality was attributed to Dr Deming.
He stressed that better management techniques along with quality improvement were necessary to restore long-term viability. His philosophy and teachings are widely available if not widely accepted in this country. I recommend them to GM’s new board of directors, the auto advisory council appointed by President Obama and the management of GM.

This final restructuring of all the restructurings GM has been through will be extremely painful for a myriad of people. The terminated employees of both GM and its affected vendors and their family’s will pay a heavy price. Stockholders and bondholders stand to lose their investments. Dealers and their employees, vendors and the communities they serve will suffer as much as anyone will. Those needing assistance through this transition will be turning to state and local agencies that are struggling with increased demand for their services and reduced revenues.

Government intervention is a seemingly two-edged sword. If it works all the naysayers will be denying they ever thought it would fail. If it does not work, the current recession will look like a kindergarten tea party compared to the catastrophic financial consequences to follow. As it is, interest rates are likely to increase at least for the short term based on investor caution created by the way the bondholders were placed behind the unions in this case. Changing the rules midstream does nothing for investor confidence and until the results are in, they will be cautious.

I hope that the management will take advantage of this opportunity to completely reinvent GM in a progressive and well thought out manner. There are numerous product strategies, distribution-channeling strategies, marketing strategies and long-term opportunities created by the negation of unbearable legacy cost. If they come out of this with the same old mindset, they are doomed to failure.

The old GM failed because it was poorly managed for a long time. The new GM needs to learn from that history and embrace a management style that values long-term gain over short-term stock performance. They need to make partners of their employees, vendors and potential customers. They need to embrace quality as never before. They can do it. We want them to do it. No one in his or her right mind wants this chance to recreate GM to fail. We will be watching and hoping that the management team just does it.

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The Cairo Speech

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After only one reading, I am amazed at the difference in this president and most others. He really gets it. He understands that the globe on which we live will not sustain institutional hatred or bigotry. The distance from the front of this boat, we are all passengers in, to the rear is too short. What effects one ultimately affects all of us. Everybody needs to be bailing or paddling. What cannot be tolerated is a few trying to disadvantage the many. There is no room for thieves, murders or bullies, except in the water.

Obama reminds me of Teddy Roosevelt when he was governor of New York. He had participated in some infighting with some party bosses. Mr. Thomas Platt in particular, was trying to obstruct a political appointment. He threatened to ruin Roosevelt if he did not acquiesce. Roosevelt held his ground and prevailed. Later when recounting the incident to a friend in a letter he wrote “I have always been fond of the West African proverb: "Speak softly and carry a big stick; you will go far.” It seems that President Obama has mastered speaking softly and I hope he can follow through with the big stick when it is required.
It strikes me that the President is an inherently honest man. He speaks from the heart and is not afraid to utter hard truths. Unlike most politicians, he seems to value the ability of truth to promote his agenda and beliefs. I detect no dissembling or attempts to manipulate the truth. He calls it like it is. That in and of itself is a refreshing change from the historical norm.
I am impressed that he really understands better then most the nobility of the American dream. That dream is first about liberty and equality for all. It is about a place where many can stand together to implement those ideas for all. Then secondly, it is about the opportunity to achieve the level of prosperity your effort entitles you too. Without the first part, the second part is merely a function of repression.
He also espouses something that I have always believed. Decent people all over the world want the same things for themselves and their families. They want peace and prosperity, some say as to how they are governed, health care for themselves and their children, education and the chance to improve the future and the ability to worship according to their own conscience. They abhor war and human depravity just as all right thinking people do. They would rather live in peace with their neighbors then lose everything in meaningless conflict where there are no winners.
I think he reached a good balance between the olive branch and the sword. He did not apologize for Afghanistan or our intention to protect our allies or ourselves. He called the Islamic countries to task for ignoring their duty to their own peoples prosperity. He reached out an open hand in peace and friendship and called for all to cooperate in making this a better world. It was a magnificent gesture and I believe he meant every word.
There will be many who disagree. The right wing talking heads will accuse him of pandering and socialism again. There will be conjecture as to which Washington area mosque he is sneaking out to in the middle of the night. On the other hand, there will be Islamic extremist who will say he does not mean it or as long as he supports Israel, it is meaningless. Some people are not happy unless the glass is half-empty. They would rather fight over what is left of their hate then join hands and search for more water. Those people will eventually destroy themselves or force us to do it for them. Unfortunately, they will make many others miserable in the process.
Life is often a series of self-fulfilling prophecies. We fashion our existence either purposefully or through lack of purpose. Generally, the more we do for others the more we accomplish for ourselves. The more we reach out our hands in peace, to give a hand up to those less fortunate, the better the future for us all. If we wander aimlessly without purpose, we endanger ourselves and threaten others. We come to feel entitled to those things we neglect to earn on our own. You are only entitled to freedom if you are willing to die for it. You are only entitled to food and shelter if you are willing to work for it.
Those unable to work or contribute due to physical or mental defect are the rightful responsibility of us all and we should accord them more sustenance and dignity then we do. Those unwilling to work or contribute should be thrown out of the boat and have no claim on the rest of us. The difficulty of course is in knowing the difference between the two to a moral certainty. Well, I dissemble and am getting way off track.
In closing, I am proud of this President. He strikes me as a good and moral man worthy of the great office he holds. I do not by any means think him perfect but still a much better man for the job then what we could have had. He gets it.

Chrysler, GM and the Dealer Fiasco

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Chrysler and GM needed to pair their dealer count. Some of the dealers they got rid of needed to go. They were under performing in sales, service and customer satisfaction. Some were in markets that had too many dealers. Some did not fit the channeling guidelines of all models under one roof. Others were just not politically astute and had made the wrong person angry. Still others and perhaps the majority had done nothing wrong.

Family owned and operated stores serve most of the smaller markets. Many are second, third or even fourth generation operations. They provide some of the best paying jobs in their respective markets. They pay a higher amount of taxes then most other businesses. They pay sales tax on high-ticket items, inventory taxes on high value inventories, real estate taxes on large pieces of valuable property and so on ad infinitum.

They are among the pillars of their communities. They fund charities, community sports and other things that will now go begging. The loss of these classic small town enterprises will have devastating ripple effects across their communities. They were generally the largest advertiser in town. They bought oil, gasoline, tires and auto parts in large quantities. Many were large contributors to local churches, schools and hospitals. Their loss will be felt in many ways and by many people across their communities.

The big three have been trying to pare their dealer counts for years. The competition has been selling more vehicles out of fewer stores for some time. That has more to do with the quality of the product though then the quality of the dealer. That and the fact that the import manufactures have not diluted their sales per store by over dealering in the first place. State franchise laws have prevented, and rightly so, much of what Ford, Chrysler and GM have wanted to do. The bankruptcies’ made those laws mute though.

The Supreme Court refused to hear argument on behalf of the dismissed dealers. That is to be expected because federal bankruptcy law trumps state franchise law. There is a movement in congress to pass legislation to either slow or reverse the terminations. It is too early to tell what effect if any that will have, but it looks like too little too late for most of the Chrysler dealers. GM’s dealers do have an appeal process available to them and time will tell how that plays out.

Better management of Chrysler and GM., could have avoided this whole scenario. The management teams at all of the big three tend to have a short-term point of view driven primarily by the stock price. That has a lot to do, maybe everything to do, with the way top executives are compensated. Little good it has done them in recent years as the stock price slipped ever lower.

In their management, quality takes a back seat to artificial cost control. Union negotiations were handled like there was no tomorrow. Tough decisions were put off until it was too late to matter. Too much time and effort were put into incredibly complex customer satisfaction efforts; designed to make all customer issues, the dealers fault. Finally, way too much effort has gone into trying to change the distribution system. High quality products sell themselves regardless of the perceived problems in the distribution system. The horrifically poor management of these two American behemoths made the slaughter of their dealers a self-fulfilling prophecy.

Many of the dealers have questioned why, if they are profitable and have good customer satisfaction scores are they being terminated. They point out that their existence does not cost the manufacture anything. This is true. They pay for their vehicles, parts, co-op advertising and point of sale material. The dealers get nothing free. The manufacture has a holdback account on each dealer in case of default that they can apply to any delinquent amounts owed to them. To be terminated by letter or hearing it on the news like some did is unconscionable on the part of Chrysler and GM. These dealers deserve an answer to their questions if not full reinstatement.

When someone has to drive over a hundred miles to get a Chrysler or GM car serviced, or worse yet to buy one, you wonder. How long will it be before somebody’s nephew or friend gets an add point store in that market. Neither GM nor Chrysler will abandon all of these markets permanently. Some dealers in peripheral markets, closely adjacent to bigger stores in large markets, will be gone for good. Other markets though will be redealered at some point. It will be interesting to watch how long that will take and who will get the stores.

The real problem though is that all this pain and suffering is likely just delaying the inevitable. Regardless of any restructuring, debt elimination or infusions of taxpayer dollars the same management is in charge. Without an honest look at how they got where they are they are doomed to repeat the same mistakes. If they charge into the future, thinking the past was somebody else’s fault it will lead back to the past. If quality is not a priority and innovation a mandate then nothing changes. For the sake of the country and all the remaining stakeholders, I hope they get it right.

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