I had lunch with a pediatric specialist in a field that doesn't have a lot of procedures, and so like those of us in primary care, is relatively poorly paid. She is currently employed by the Sutter Health Foundation.
She makes pretty good money there. Sutter is rolling in cash, being a corporation based on a hospital system that has a very powerful position, little reason to economize, and is a price giver rather than a price taker with insurance companies. This specialist bills an unholy amount for office appointments and gets paid accordingly, because the contracts that Sutter extracts from payers are, well, rich. So she makes money.
But, are the patients well served, and is she well served? As in many corporations, the staff are not directly responsible to the doctors. She can still be seeing patients and if it's lunch time, adios! A patient became unresponsive in the waiting room and luckily someone brought this to the doctor's attention and she could administer to him, because the staff had vacated the premises for lunch.
If she wants a chair to sit in - a chair! - it has to go through innumerable levels for authorization, if the site administrator deigns to send the request in. Administrators tell her where her office will be without asking her first. They just tell her, they don't care about her. Administrators come and go, no one caring very much. It's corporate and it's large.
I am currently looking for an Administrator at Bayside and our headhunter has told me several times that she understands, I started this practice and it's my baby. Well, sure, I thought. But now it really hits me what she meant. When she searches for a corporate client, it's much less serious business. The level of performance matches the level of caring. Good enough is really good enough. Me, I really care.
In capitalism, the theory is that competitors with superior efficiency and customer satisfaction should rule the roost. But look how that isn't true here. The market really isn't working. Sutter gets big contracts and makes big money, pays the doctor probably more than I can - I'm hopeful that maybe I can match, but it will be hard - and it sure ain't because of efficiency or customer service. It's market power, pure and simple.
And why market power? It's partly because of size - Blue Cross needs to contract with Sutter or close up shop in Northern California. But I'm wondering if it's also because of like liking like. Big corporations seem to like each other. The minions get together and they are in it together. So they scratch each others back? Is corporate medicine what they are both most comfortable with?
Corporations, administrators. It reminds me when I worked for government. People would talk about "government," and said that it was inherently unresponsive and rather evil. When I was on the inside, I looked around and saw what people did, and I thought they weren't capable of much, and/or they didn't care. The few who got something done took themselves off in a corner with a few other good people and actually got good things done. Management to good effect was scarce. I always thought, yes, the structure allows them to do this, but then, they are the ones who did it. If they were more ethical and less immature and self-indulgent, they could do the right thing. If they cared. I guess I still feel the same way. But now I also think, that's the way people are. It's really a shame.
Budd Shenkin
Sunday, June 27, 2010
Monday, June 7, 2010
Missing Old Times
I thought time was supposed to dull missing departed people. So I thought. I was always touched when we still had the San Francisco Examiner and each Christmas publisher Randy Hearst published a long poem of his father’s on the editorial page, about the renewal of life, and how water rolls down to the sea and returns as rain. Then he said that he missed his father and he always would. I hadn’t lost my father yet, but I was forewarned.
My father died in December, 2007 – he missed the big financial meltdown, he missed Obama, he missed a much-wanted great grandchild. And I miss him. It isn’t getting any better. I kinda knew I idolized him when he was alive, and fought against him, but it’s just gotten worse since he left us.
I think about how we used to be. I remember when I was in high school, and when I was away at college and knew my parents were there, even when I called home reluctantly on Sunday night – no cell phones, he kinda missed that, too, he was too old when they came – and my Mom and my Dad were on the phones and I said some of my courses were hard, and Dad said, “Well, it’s long distance, so, ….”
And my Mom said, “Henry! He needs you!”
And then my Dad said, “Well, everyone knows that math and science are the hardest.”
I hadn’t even known that I needed him. I never thought I did before. Just knew that I needed to please him or I’d feel crappy. Not that I ever did displease him, so far as I knew. Displease my mother, that seemed easier. I still remember the call; it must have helped, I’m sure it did. Nothing had been particularly hard before, I guess. Except mechanical drawing, and I could always just spend more time on that. But in college we were steaming ahead.
And I remember sitting with my parents and with Betty Jane Lipshutz from up the street, whose daughter Margie was friends with my sisters. Who was it on the TV? It must have been the Beatles, because Elvis came on Ed Sullivan when I was in high school, and this must have been later, when I was older. It doesn’t matter. I just remember they were watching the old 21-inch black and white TV in my parents bedroom, and we heard them screaming, like girls were supposed to do, probably a replay of the bobby soxers. And the parents looked at each other and laughed.
Why does that make me cry? I just don’t know. I do know I miss them.
My first play was Our Town. I was in 7th grade and played Wally Webb, Emily’s little brother. My whole family came to see my one line, “Aw, Mom, by 10 o’clock I have to know all about Canada!” Wrung every emotional note out of it I could. Emily gets to go back and look at the past, against the advice of the Stage Manager. Don’t do it, he says. Oh, but I want to, says Emily.
I can see why. I can imagine myself there right now, just like Emily. I look down on the parents, on me, and I want to say, I’m right here! I love you all! You were so wonderful! Can you hear me?
I love Thornton Wilder. It’s just what I want to say. I can see us all, I really can – and I’m not stoned. True, I’m listening to Beatles music and 50’s music and 60’s music, but I’m not stoned, really I’m not.
Time is such a pisser. We just can’t beat it. I hope they knew how much I would appreciate them, how much I loved them. I know they loved me. And I just realized a couple of days ago how young they were. My Dad was 26 when I was born, my Mom I guess just shy of 24. So when I was 20, they were just 46 and 44, already had 4 kids whom they had sent to private school until we moved to Lower Merion, a summer house down the shore (who knew that “down the shore” was a localism?), a succession of cars, etc. Rock and roll had just come and no one knew how to treasure it yet. No one knew Mad Magazine was a classic. No one knew we’d be flying on jets, listening to IPods, and the world would be getting less dangerous from H-bombs but more dangerous from terrorism. No one knew that the US would get better and better. Now we know. Too late, man! That doesn’t help them now! They couldn’t plan on that, and now they’re fucking dead!
All we have is the present, but I sure miss the past, and I miss my mommy and daddy.
Budd Shenkin
My father died in December, 2007 – he missed the big financial meltdown, he missed Obama, he missed a much-wanted great grandchild. And I miss him. It isn’t getting any better. I kinda knew I idolized him when he was alive, and fought against him, but it’s just gotten worse since he left us.
I think about how we used to be. I remember when I was in high school, and when I was away at college and knew my parents were there, even when I called home reluctantly on Sunday night – no cell phones, he kinda missed that, too, he was too old when they came – and my Mom and my Dad were on the phones and I said some of my courses were hard, and Dad said, “Well, it’s long distance, so, ….”
And my Mom said, “Henry! He needs you!”
And then my Dad said, “Well, everyone knows that math and science are the hardest.”
I hadn’t even known that I needed him. I never thought I did before. Just knew that I needed to please him or I’d feel crappy. Not that I ever did displease him, so far as I knew. Displease my mother, that seemed easier. I still remember the call; it must have helped, I’m sure it did. Nothing had been particularly hard before, I guess. Except mechanical drawing, and I could always just spend more time on that. But in college we were steaming ahead.
And I remember sitting with my parents and with Betty Jane Lipshutz from up the street, whose daughter Margie was friends with my sisters. Who was it on the TV? It must have been the Beatles, because Elvis came on Ed Sullivan when I was in high school, and this must have been later, when I was older. It doesn’t matter. I just remember they were watching the old 21-inch black and white TV in my parents bedroom, and we heard them screaming, like girls were supposed to do, probably a replay of the bobby soxers. And the parents looked at each other and laughed.
Why does that make me cry? I just don’t know. I do know I miss them.
My first play was Our Town. I was in 7th grade and played Wally Webb, Emily’s little brother. My whole family came to see my one line, “Aw, Mom, by 10 o’clock I have to know all about Canada!” Wrung every emotional note out of it I could. Emily gets to go back and look at the past, against the advice of the Stage Manager. Don’t do it, he says. Oh, but I want to, says Emily.
I can see why. I can imagine myself there right now, just like Emily. I look down on the parents, on me, and I want to say, I’m right here! I love you all! You were so wonderful! Can you hear me?
I love Thornton Wilder. It’s just what I want to say. I can see us all, I really can – and I’m not stoned. True, I’m listening to Beatles music and 50’s music and 60’s music, but I’m not stoned, really I’m not.
Time is such a pisser. We just can’t beat it. I hope they knew how much I would appreciate them, how much I loved them. I know they loved me. And I just realized a couple of days ago how young they were. My Dad was 26 when I was born, my Mom I guess just shy of 24. So when I was 20, they were just 46 and 44, already had 4 kids whom they had sent to private school until we moved to Lower Merion, a summer house down the shore (who knew that “down the shore” was a localism?), a succession of cars, etc. Rock and roll had just come and no one knew how to treasure it yet. No one knew Mad Magazine was a classic. No one knew we’d be flying on jets, listening to IPods, and the world would be getting less dangerous from H-bombs but more dangerous from terrorism. No one knew that the US would get better and better. Now we know. Too late, man! That doesn’t help them now! They couldn’t plan on that, and now they’re fucking dead!
All we have is the present, but I sure miss the past, and I miss my mommy and daddy.
Budd Shenkin
Sunday, June 6, 2010
Health Care Evolution as Seen From the Bottom
We know that the money in health care is going to the hospitals. If you are half-decently managed and you have a half-decent payor mix, you will be making a lot of money. Non-profit has no meaning in health care; it was shown long ago that for-profit and voluntary hospitals act equivalently. The money they make goes for very handsome executive salaries and retained earning to be spent on system development. “System development” for hospitals can mean more and more technology. It can also mean buying up doctors and controlling the field, vertical integration.
Here’s what this process can look like on the ground. There is a voluntary hospital in Pleasanton called ValleyCare. The CEO is a firebrand named Marcy Feit, who began life as a nurse, but who has now been in Pleasanton for over a decade and is very well entrenched. She decided a couple of years ago to construct a Foundation. In other states the hospitals simply hire doctors; in California it is illegal for non-doctors to hire doctors, so instead there are Foundations, which are non-profit entities governed by Boards, which are essentially run by the hospitals that establish the foundations.
In forming the Foundation, Marcy and her aides identified a primary care doctor well-schooled in previous medical care wars, John Yee, to head the group, and I understand he is being paid $1.5 million over three years to be Medical Director. Between these two and some others, they rule the Foundation without opposition. Their view seems to be that anyone who hasn’t joined the Foundation is the enemy.
Two pediatric practices were approached about joining the Foundation on what they judged were unfavorable terms, so they declined. Outraged, Marcy vowed to hire pediatricians on her own, which she proceeded to do, and hired all the obstetricians practicing at ValleyCare, and ordered the obstetricians to refer exclusively to the newly hired pediatricians. It was essentially a got-out-of-town verdict for practices that had been there for 30 years and who had done much to build the hospital’s pediatric program.
Marcy and her associates, I understand, are insisting that most prominent Medical Staff positions be held by Foundation members, although so far the staff as a whole has managed to remain independent. They sought to vote democratically for their member on the hospital Board, but their nominees were disqualified by Marcy and a Foundation doctor appointed.
There are two large radiology groups in the East Bay, one of which holds the ValleyCare contract. Marcy informed the group holding the contract that if they wished to continue to do so, they would be required to discharge two of their radiologists there, both competent and very long standing members of the staff, whom she judged disloyal. The group is now in a condition similar to Google in China – important market, but mindful of their ethics. Not easy.
It’s an interesting story, and an extreme. But to my mind the ValleyCare situation highlights the forces in medicine as they are being played out currently. It’s hard to know how it will play out, but if people are interested, I’ll keep you posted.
Budd Shenkin
Here’s what this process can look like on the ground. There is a voluntary hospital in Pleasanton called ValleyCare. The CEO is a firebrand named Marcy Feit, who began life as a nurse, but who has now been in Pleasanton for over a decade and is very well entrenched. She decided a couple of years ago to construct a Foundation. In other states the hospitals simply hire doctors; in California it is illegal for non-doctors to hire doctors, so instead there are Foundations, which are non-profit entities governed by Boards, which are essentially run by the hospitals that establish the foundations.
In forming the Foundation, Marcy and her aides identified a primary care doctor well-schooled in previous medical care wars, John Yee, to head the group, and I understand he is being paid $1.5 million over three years to be Medical Director. Between these two and some others, they rule the Foundation without opposition. Their view seems to be that anyone who hasn’t joined the Foundation is the enemy.
Two pediatric practices were approached about joining the Foundation on what they judged were unfavorable terms, so they declined. Outraged, Marcy vowed to hire pediatricians on her own, which she proceeded to do, and hired all the obstetricians practicing at ValleyCare, and ordered the obstetricians to refer exclusively to the newly hired pediatricians. It was essentially a got-out-of-town verdict for practices that had been there for 30 years and who had done much to build the hospital’s pediatric program.
Marcy and her associates, I understand, are insisting that most prominent Medical Staff positions be held by Foundation members, although so far the staff as a whole has managed to remain independent. They sought to vote democratically for their member on the hospital Board, but their nominees were disqualified by Marcy and a Foundation doctor appointed.
There are two large radiology groups in the East Bay, one of which holds the ValleyCare contract. Marcy informed the group holding the contract that if they wished to continue to do so, they would be required to discharge two of their radiologists there, both competent and very long standing members of the staff, whom she judged disloyal. The group is now in a condition similar to Google in China – important market, but mindful of their ethics. Not easy.
It’s an interesting story, and an extreme. But to my mind the ValleyCare situation highlights the forces in medicine as they are being played out currently. It’s hard to know how it will play out, but if people are interested, I’ll keep you posted.
Budd Shenkin
Sunday, May 23, 2010
Budd's Advice to the Democrats
It’s true – I am negative on the Democrats. But I wonder why. And I believe I’ve said a word or two about poor spending on the Stimulus Bill. I haven’t liked their timidity vis-à-vis the financial industry, and their obeisance to the powerful interests in health reform – nor the kowtow to clinics and nurses. When my friend Michael, returned from a year’s stint in the Defense Department, asked Ann and me how we felt about Obama last Monday night, I said I was disappointed. Why? Lack of apparent leadership, I said. Obama’s inexperience was showing.
But isn’t that terribly short-sighted of me? I thought that the Obama Administration should go for a lot of big goals simultaneously, and not scale down objectives and go one by one. They took my advice, and it has worked out. There has been a spate of articles in the last few days pointing out that the triumphs of Obama puts him in the league of FDR, LBJ, and Reagan for changes made and influence felt. That’s big league, and they are just talking about domestic policy, leaving out the important foreign policy advances such as nuclear reductions, temperature lowering with the Russians if not the Chinese.
Here is a typical quote from Steve Benen, reflecting on how voters tend to vote for and to vote against: “This year, the Democratic Party really hopes that it can benefit from both. On the one hand, they argue, Democratic policymakers have an impressive list of accomplishments, mirroring the platform they ran on -- economic recovery, health care reform, Wall Street reform, student loan overhaul, withdrawing troops from Iraq, restoring the nation's global stature, advances on civil rights, Lilly Ledbetter Fair Pay Act, expanded stem-cell research, new regulation of the credit card industry, new regulation of the tobacco industry, a national service bill, the most sweeping land-protection act in 15 years, etc. On the other hand, the Democratic argument goes, Republicans have moved sharply to the right, and generally act as if the GOP has gone stark raving mad.”
I said a couple of months ago that the Democrats needed to get past health care reform, and then make a very big deal about Wall Street reform, daring the Republicans to stick up for the plutocrats. They are doing that, but in their moderation, the Republicans are able to support it, and not take the bait. Hard to find sympathy for Lloyd Blankfein. So we’ll get some good law, not enough but something – and the problem is that it will not provide an electoral theme.
So, what is the Obama Administration to do? Again, I’ll go back to 1934. Everyone advised Roosevelt that the opposite party always loses seats at the midterm elections. They advised him not to risk his prestige in a lost cause. Roosevelt overruled them, set out aggressively to campaign hard and nationwide, and came up aces. Similarly now, with everyone expecting a Democratic debacle, what really does Obama have to lose? If anybody can make a case, he can.
It’s probably a question of timing. Right now, the Gulf Spill is the problem, and the Administration needs to come out heroes, if they can. Then in the fall, take the one item that the great Spill brings to the fore, energy policy (used to be climate policy, but that doesn’t sell.) Obama can say that his Administration has shown they can be successful, but more remains to be done. We can’t have any more oil spills. We need to completely reform the governmental part of it (the hapless Materials Division of Interior, or whatever it is, the sex and drugs haven), and institute strong incentives for alternative energy generation, and tax carbon.
There has to be more to the campaign, of course, and maybe this isn’t even the main part. But the tone and the energy needs to come forth, even if it seems like a risk. Not playing hard is the real risk.
Budd Shenkin
But isn’t that terribly short-sighted of me? I thought that the Obama Administration should go for a lot of big goals simultaneously, and not scale down objectives and go one by one. They took my advice, and it has worked out. There has been a spate of articles in the last few days pointing out that the triumphs of Obama puts him in the league of FDR, LBJ, and Reagan for changes made and influence felt. That’s big league, and they are just talking about domestic policy, leaving out the important foreign policy advances such as nuclear reductions, temperature lowering with the Russians if not the Chinese.
Here is a typical quote from Steve Benen, reflecting on how voters tend to vote for and to vote against: “This year, the Democratic Party really hopes that it can benefit from both. On the one hand, they argue, Democratic policymakers have an impressive list of accomplishments, mirroring the platform they ran on -- economic recovery, health care reform, Wall Street reform, student loan overhaul, withdrawing troops from Iraq, restoring the nation's global stature, advances on civil rights, Lilly Ledbetter Fair Pay Act, expanded stem-cell research, new regulation of the credit card industry, new regulation of the tobacco industry, a national service bill, the most sweeping land-protection act in 15 years, etc. On the other hand, the Democratic argument goes, Republicans have moved sharply to the right, and generally act as if the GOP has gone stark raving mad.”
I said a couple of months ago that the Democrats needed to get past health care reform, and then make a very big deal about Wall Street reform, daring the Republicans to stick up for the plutocrats. They are doing that, but in their moderation, the Republicans are able to support it, and not take the bait. Hard to find sympathy for Lloyd Blankfein. So we’ll get some good law, not enough but something – and the problem is that it will not provide an electoral theme.
So, what is the Obama Administration to do? Again, I’ll go back to 1934. Everyone advised Roosevelt that the opposite party always loses seats at the midterm elections. They advised him not to risk his prestige in a lost cause. Roosevelt overruled them, set out aggressively to campaign hard and nationwide, and came up aces. Similarly now, with everyone expecting a Democratic debacle, what really does Obama have to lose? If anybody can make a case, he can.
It’s probably a question of timing. Right now, the Gulf Spill is the problem, and the Administration needs to come out heroes, if they can. Then in the fall, take the one item that the great Spill brings to the fore, energy policy (used to be climate policy, but that doesn’t sell.) Obama can say that his Administration has shown they can be successful, but more remains to be done. We can’t have any more oil spills. We need to completely reform the governmental part of it (the hapless Materials Division of Interior, or whatever it is, the sex and drugs haven), and institute strong incentives for alternative energy generation, and tax carbon.
There has to be more to the campaign, of course, and maybe this isn’t even the main part. But the tone and the energy needs to come forth, even if it seems like a risk. Not playing hard is the real risk.
Budd Shenkin
Saturday, May 22, 2010
Spending ARRA Money
It’s pretty clear that the government needs to spend money to keep the economy going. That’s basic Keynesian counter-cyclical governmental action – buy when no one else is buying. That’s not the time to worry about the deficit (but at the same time one hopes that in better times the deficit will be worried about – ojàlà). So I’m for priming the pump, and I wish we had another round coming.
But, then, even I have my doubts. I haven’t seen any big exposés of the shovel-ready projects of the original ARRA legislation – where is William Proxmire’s Golden Fleece Award when we need it? It’s really strange, come to think of it, that the Republicans haven’t come out with sensational stories about multiple bridges to nowhere. I wonder why. Maybe it’s mutual respect for each other’s district spending.
So, in lieu of Proxmire, here are my own personal observations of how money is filtering down to be government-spent. Item #1 – two weeks ago we received a notice from our local Contra Costa County Health Department. They had a $1 million grant program that they themselves could not spend directly, but had to divvy up among others (if they could have spent it themselves, knowing that health department, believe me, they would have. A classic health department, bureaucracy and empire building.) Anyway, we were notified about this program with one day turnaround time required – they are not used to involving others in money spending, I guess.
This grant program was a mélange of rules. How to apply, what criteria to meet, how to measure, who would be eligible for what, etc. etc. Just the reason I don’t deal with governments. Half the value of the grant, if received, would have been spent (and not reimbursed) by time and effort filling out the damn grant application. So typical. Then reviewed by the huge brains in the health department.
And what was the object of this million dollars to be spent, and the time of application to be spent on unpaid work, and the time of bureaucratic efforts to conceive the project, make the rules, and review the applications and later the work? Get this. Spending all this money to find the hard to reach populations in Contra Costa County and immunize them against H1N1!! Jesus! Talk about a stupid objective! Where is the evidence that this is a worthwhile objective? Where is the evidence of how much money would be spent per shot delivered? Where is the evidence that this is worth anything at all, especially when so many regular people are declining the H1N1 shots for various reasons of their own? Do we think that H1N1 is that much of a threat now? Anyone there with experience in trying to wipe out smallpox or polio with the CDC worldwide, who would know how uninformed this choice of objective is on so many levels? Government!!!
OK, so that’s only a million dollars. Then a friend of Sara’s who works for the health department in Seattle was visiting last week. Now we’re talking $25 million. What are they looking to spend $25 million on? Tobacco and obesity. What are they going to do about tobacco and obesity? OK, tobacco public health campaigns have been effective, and I love the old ads that were so sarcastic and hardhitting, about the hard-bitten faux advertising guys plotting about how to make kids into cigarette addicts. They probably helped. And it’s true that tobacco is a huge public health problem. Although it’s also true that probably the most important element of the anti-tobacco crusade was the tax policy. But OK, I’ll give them this on tobacco – important objective and a somewhat proven track record. On the other hand, I doubt if this money is going to lead to much increased employment, except maybe for the health department people and some advertising agencies. Not exactly the people I would target to get this country going again.
But obesity? What the hell are they going to spend the obesity money on? There is no proven way to combat obesity. We don’t know anything about advertising about obesity – who and what are going to be the targets? No one knows anything that will work! Gym memberships? Lectures about fast food? Hit squads on fructose-rich corn syrup? General money for the health department personnel so they avoid layoffs? Personally, I’d rather see some Ben Shahn art commissioned – at least that leaves a trace. I smell another Golden Fleece, sorry to say.
Which leads us to taxes. By the grace of God, I am a highly taxed person. I don’t squawk much about taxes, but lots of people do. They might give lots of reasons for their discomfiture, both practical and theoretical, but I think it comes down to this – what are we getting for our tax money? Even if we are borrowing money now and these expenditures might not be coming directly from taxes yet, we still pay interest and we the people will have to pay it somehow sometime. What are we getting for it?
When the money goes out to health departments and they are told, “Spend it in a good cause,” I don’t buy that. Pea brains don’t do well in spending Other People’s Money (OPM). Large brains don’t even do so well. I look at these idiocies and say, why not fix the pot holes on I-880? It turns out that construction projects don’t have a very good multiplier effect in rocketing money around in the economy. But then I have to ask, does giving money to public health agencies and advertising agencies do better?
That's what I see and that's what other people see.
Anyone ever thought of subsidizing bloggers?
Budd Shenkin
But, then, even I have my doubts. I haven’t seen any big exposés of the shovel-ready projects of the original ARRA legislation – where is William Proxmire’s Golden Fleece Award when we need it? It’s really strange, come to think of it, that the Republicans haven’t come out with sensational stories about multiple bridges to nowhere. I wonder why. Maybe it’s mutual respect for each other’s district spending.
So, in lieu of Proxmire, here are my own personal observations of how money is filtering down to be government-spent. Item #1 – two weeks ago we received a notice from our local Contra Costa County Health Department. They had a $1 million grant program that they themselves could not spend directly, but had to divvy up among others (if they could have spent it themselves, knowing that health department, believe me, they would have. A classic health department, bureaucracy and empire building.) Anyway, we were notified about this program with one day turnaround time required – they are not used to involving others in money spending, I guess.
This grant program was a mélange of rules. How to apply, what criteria to meet, how to measure, who would be eligible for what, etc. etc. Just the reason I don’t deal with governments. Half the value of the grant, if received, would have been spent (and not reimbursed) by time and effort filling out the damn grant application. So typical. Then reviewed by the huge brains in the health department.
And what was the object of this million dollars to be spent, and the time of application to be spent on unpaid work, and the time of bureaucratic efforts to conceive the project, make the rules, and review the applications and later the work? Get this. Spending all this money to find the hard to reach populations in Contra Costa County and immunize them against H1N1!! Jesus! Talk about a stupid objective! Where is the evidence that this is a worthwhile objective? Where is the evidence of how much money would be spent per shot delivered? Where is the evidence that this is worth anything at all, especially when so many regular people are declining the H1N1 shots for various reasons of their own? Do we think that H1N1 is that much of a threat now? Anyone there with experience in trying to wipe out smallpox or polio with the CDC worldwide, who would know how uninformed this choice of objective is on so many levels? Government!!!
OK, so that’s only a million dollars. Then a friend of Sara’s who works for the health department in Seattle was visiting last week. Now we’re talking $25 million. What are they looking to spend $25 million on? Tobacco and obesity. What are they going to do about tobacco and obesity? OK, tobacco public health campaigns have been effective, and I love the old ads that were so sarcastic and hardhitting, about the hard-bitten faux advertising guys plotting about how to make kids into cigarette addicts. They probably helped. And it’s true that tobacco is a huge public health problem. Although it’s also true that probably the most important element of the anti-tobacco crusade was the tax policy. But OK, I’ll give them this on tobacco – important objective and a somewhat proven track record. On the other hand, I doubt if this money is going to lead to much increased employment, except maybe for the health department people and some advertising agencies. Not exactly the people I would target to get this country going again.
But obesity? What the hell are they going to spend the obesity money on? There is no proven way to combat obesity. We don’t know anything about advertising about obesity – who and what are going to be the targets? No one knows anything that will work! Gym memberships? Lectures about fast food? Hit squads on fructose-rich corn syrup? General money for the health department personnel so they avoid layoffs? Personally, I’d rather see some Ben Shahn art commissioned – at least that leaves a trace. I smell another Golden Fleece, sorry to say.
Which leads us to taxes. By the grace of God, I am a highly taxed person. I don’t squawk much about taxes, but lots of people do. They might give lots of reasons for their discomfiture, both practical and theoretical, but I think it comes down to this – what are we getting for our tax money? Even if we are borrowing money now and these expenditures might not be coming directly from taxes yet, we still pay interest and we the people will have to pay it somehow sometime. What are we getting for it?
When the money goes out to health departments and they are told, “Spend it in a good cause,” I don’t buy that. Pea brains don’t do well in spending Other People’s Money (OPM). Large brains don’t even do so well. I look at these idiocies and say, why not fix the pot holes on I-880? It turns out that construction projects don’t have a very good multiplier effect in rocketing money around in the economy. But then I have to ask, does giving money to public health agencies and advertising agencies do better?
That's what I see and that's what other people see.
Anyone ever thought of subsidizing bloggers?
Budd Shenkin
Monday, May 17, 2010
Too much, too soon?
When a baby comes into the family, you start making priorities. As my friend John (Buzzard) Bernard said, before children, you could pretty much fit anything you wanted into your life. Especially if you were as talented as John Bernard. But kids are the killer.
Even when you are expecting a baby, the priorities change, for women more quickly than for men. Women have to change what they eat and drink. We don’t. Women have to learn to sleep on their back. Not me! Women worry about the health of the baby. Men worry about how to support the whole family financially. Everybody has to grow up.
You get a sense that this is the most important thing you have ever been entrusted with. If you disappointed your parents, that was too bad, but still you could say, hey, I’m the one who will really suffer. It’s my life! But with a baby, if you screw up, it’s not just you who suffers. So many people read baby books. Me, I tried to go back and read Jean-Jaques Rousseau’s Emile. Nuts, I know, but at least I was sensible enough not to get very far into it.
Then there’s life style. When Allie was born, I was determined that going out to dinner wasn’t going to be interrupted. Colic fixed that one pretty good. I thought, I would so like to life in another country for a while so the kids could be easily bilingual. Not at the top of everyone’s list, and it turned out that it wasn’t as easy as I thought. Allie’s first word was “Titta!”, which is Swedish, but that was about it as we moved back to the States to stay.
The rich and famous can have more temptations than we do, simply because they have the means. Daughters trotting around with Gucci, sons with Stingrays. Too much, too soon. A real hazard.
All of which brings us to my step-daughter Sara Buckelew, and her daughter, Lola Buckelew. Sara is a wonderful mother and Lola is just over three months old. Luckily, Lola is a very complacent but still very responsive baby, making everything easier. Sara can focus in on her own priorities for Lola.
Sara seems more reasonable that I was, which is probably not that hard to be. But, Sara is a baseball fan. Actually, more of an uber-fan. And Lola doesn’t have colic. As a result, Lola, at just over three months of age, has been to about six major league games already.
One of the things about baseball is its endless variety. They say that every time you go to the ballpark, if you are observant, you will see something you never saw before. Like this last Saturday at the Giants, Brian Wilson of the Giants faced Kazuo Matsui with two out in the ninth, bases full, Giants up 2-1. Fifteen pitches, about six of them strikes thrown one after the other as Matsui fouled them off, finally succumbing to a soft fly to left before a rapturous crowd, Fifteen pitches! And then yesterday, Sunday, it’s Wilson vs. Matsui again, two men on, two out, bottom of the ninth, Giants up 4-3, and it’s a strikeout. Pretty good! Baseball is a game to savor.
But, that’s just me, and I’ve been to hundreds of games. What about Lola?
Lola: three months old, six games. She has already seen the Giants’ Aubrey Huff hit an inside the park homer, saw the Yankees pull a triple play on the A’s, and then last week she saw Dallas Braden’s perfect game – perfect game! – for the A’s. Perfect game!
So, I have to ask. Sara: Too much, too soon?
Budd Shenkin
Even when you are expecting a baby, the priorities change, for women more quickly than for men. Women have to change what they eat and drink. We don’t. Women have to learn to sleep on their back. Not me! Women worry about the health of the baby. Men worry about how to support the whole family financially. Everybody has to grow up.
You get a sense that this is the most important thing you have ever been entrusted with. If you disappointed your parents, that was too bad, but still you could say, hey, I’m the one who will really suffer. It’s my life! But with a baby, if you screw up, it’s not just you who suffers. So many people read baby books. Me, I tried to go back and read Jean-Jaques Rousseau’s Emile. Nuts, I know, but at least I was sensible enough not to get very far into it.
Then there’s life style. When Allie was born, I was determined that going out to dinner wasn’t going to be interrupted. Colic fixed that one pretty good. I thought, I would so like to life in another country for a while so the kids could be easily bilingual. Not at the top of everyone’s list, and it turned out that it wasn’t as easy as I thought. Allie’s first word was “Titta!”, which is Swedish, but that was about it as we moved back to the States to stay.
The rich and famous can have more temptations than we do, simply because they have the means. Daughters trotting around with Gucci, sons with Stingrays. Too much, too soon. A real hazard.
All of which brings us to my step-daughter Sara Buckelew, and her daughter, Lola Buckelew. Sara is a wonderful mother and Lola is just over three months old. Luckily, Lola is a very complacent but still very responsive baby, making everything easier. Sara can focus in on her own priorities for Lola.
Sara seems more reasonable that I was, which is probably not that hard to be. But, Sara is a baseball fan. Actually, more of an uber-fan. And Lola doesn’t have colic. As a result, Lola, at just over three months of age, has been to about six major league games already.
One of the things about baseball is its endless variety. They say that every time you go to the ballpark, if you are observant, you will see something you never saw before. Like this last Saturday at the Giants, Brian Wilson of the Giants faced Kazuo Matsui with two out in the ninth, bases full, Giants up 2-1. Fifteen pitches, about six of them strikes thrown one after the other as Matsui fouled them off, finally succumbing to a soft fly to left before a rapturous crowd, Fifteen pitches! And then yesterday, Sunday, it’s Wilson vs. Matsui again, two men on, two out, bottom of the ninth, Giants up 4-3, and it’s a strikeout. Pretty good! Baseball is a game to savor.
But, that’s just me, and I’ve been to hundreds of games. What about Lola?
Lola: three months old, six games. She has already seen the Giants’ Aubrey Huff hit an inside the park homer, saw the Yankees pull a triple play on the A’s, and then last week she saw Dallas Braden’s perfect game – perfect game! – for the A’s. Perfect game!
So, I have to ask. Sara: Too much, too soon?
Budd Shenkin
Tuesday, May 11, 2010
Another Thursday
It was a Thursday like any other Thursday. My day of long but productive and important meetings in our Dublin office. We have been operating for over a year now – indeed, for several years – without a well-functioning Administrator, and I have taken that role.
We met all morning, then I went over to ValleyCare Hospital for a Pediatrics Committee meeting, to consider once again how we can combat a hospital intent on using its capital to construct and run its own medical group, and put us out of business. There will be more and more of this – the hospitals have the money.
Then I visited our local Infinity dealer for a second time. My lease ran out on my Lexus GS 430 – four years and out. I lease so that I don’t run a car into the ground until it just breaks up, which means I’ve been driving a fairly crappy car for a long time, no matter how great it was at the start. I have to force myself to get going and make a new choice. I’m not a good chooser – I procrastinate. I think it’s pretty genetic. My son Allie is pretty much the same. I really don’t know if it makes economic sense for me to lease or buy – it’s too hard to figure out, and it can’t be all that different or it would be obvious. They get you coming and going no matter what you do. I guess.
So here I was with the salesman. Not a pushy guy, not a pushy agency. I drove the car around again and liked it, responded to the Joe the salesman that I was ready to buy real soon, saw his eyes light up, and I told him the way I bought my last car – figured out what I wanted and called around to dealerships until I found the best deal, which was $750 above invoice. Said I’d do the same thing this time. I thought I ought to get back to the office, but he said, “Want to come inside and see what we can do?” “OK,” I said, surprising myself.
So we were sitting in his cubicle and Joe checked with his manager – they are all so young! Short wiry guy with a little mustache and nice smile. I’m still getting used to being older and successful, being looked at with respect, I guess, but I’m always surprised not to find envy and resentment. I’m still surprised the way I’m treated with respect. And, to tell the truth, delighted. I’m always friendly back at them, and “a regular guy.” A strength. Why I don’t like to be in situations where I am inferior in some way. Not good with mentors. A weakness.
Strangely, Joe came back and said my offer was just fine with them. He said, my manager felt like dealing today. I figure, either they understood that my story about what I would do made sense, or the car had been sitting, or the invoice isn’t as valid as one would like, or they get manufacturer rebates. So what could I say? I had bought a car. Surprised myself, me, who dithers and channels my late father by second guessing myself. Joe asked if I wanted to take the car home tonight. Couldn’t wait for it that long, I said, the Sharks play at 6. “Go Sharks” came the cry from the salesman at the next cubicle. Such a friendly group. “He has season tickets,” said Joe.
I knew the next step in the familiar dance, visit the financial officer who would try to convince me to lease instead of buy. Another wiry guy, about my height, another guy with a small mustache. Started out the same way as the guy did four years ago when I switched from buy to lease, “Why do you want to buy a wasting asset?” “Why tie up your money?” I guess I reflected that I had danced this dance before, because he made a meta-comment – “I have to do this.” After all, it’s his job. Another low-key guy. And I wound up leasing, just like last time. He acted surprised that I had bought his argument rather than the car.
I think it was the meta-comment, the personal connection, the “Go Sharks” comment, the surprise that they simply accepted my offer, or the relief of actually having made a decision; it was something. But I’m a naturally gregarious guy, not overly shy, and - hey! - I’m a doctor. Maybe I was talking about my wife or my kids. So I must have said, “Are you married?”
He said, “No, I’m not.”
So I said, naturally, “Are you a gay guy?” I mean, we were talking, why pussyfoot around?
So he said no, he wasn’t. “If you’re not married,” he said, “do you have to be gay?” He seemed a little surprised that I asked him.
“No, but it’s the Bay Area,” And I added, “You’re a good looking guy, so I figured you could be married if you wanted to be, so I was just wondering.”
He accepted that (I’m not above a little flattery.) So he said, “I’m not married, but I have a girl friend.”
I asked him how old he was and he said 49 – that’s about what he looked.. “How long have you been going together,” I asked.
“Five and a half years.”
“Wow, I said, that’s pretty long. Why don’t you marry her?”
He said, “Why do you think that?”
I said, “Well, if it’s been that long, and you love her and you think you’re getting a good deal with her, you just have to knock her down and marry her. Otherwise you don’t know what will happen. If you don’t think you’re getting a deal, if you think she’s the one getting a good deal, and you’re doing her a favor, then you probably need to find somebody else.”
Then I told him about Andre Agassi’s book, which I thought was terrific. “You know what happened?” I asked him. “Agassi thought Steffi Graff was terrific, admired her, even idolized her, so he tried to make a date with her.
“She said, ‘I have a boyfriend.’
“He said, ‘how long have you been going together?’
“She said, ‘Six and a half years.’
“He said, ‘That’s a long time. So long that it’s probably not going anywhere. Why not give me a try?’
“She did, and not too much longer, they were together, she was pregnant, and they were married.”
A pretty powerful story (and a great book.) So my new friend said, “There’s something you don’t know.”
“Ah!” I said. “What is it.”
“She’s married.”
“Yup, that explains it,” I said.
“And she’s Chinese.”
Well, that’s not unheard of. I wondered what was coming next.
He said, “You know, I think I’m telling you this because you’re a doctor.” And kind of shrugged.
“Yes,” I said, “it’s OK, I’ll treat it confidentially.”
So he continued: “She has a 16 year old son. They are traditional (!). They think a teenage son should be raised by a father and a mother. So she’s there in the day, but every night she comes over to my house and sleeps with me.”
Well, I thought this was an unusual solution to wanting to be traditional, but people do solve dilemmas in unusual ways.
Then he said, “I used to be married. We had a son. He was 13. Then one day he was with a bunch of kids and they were up in a tree. We found him up in that tree hanged by the neck. We don’t know how it happened.” He shrugged. He just shrugged.
I told him about Peter. Peter was 17 and on a trip with his school and they slept overnight in an open campground on the American River. In the middle of the night a 4,700 pound live oak tree fell in the midst of the group and crushed Peter’s abdomen. He lost a kidney, 18 inches of bowel, severed all the lateral processes of the lumbar spine, broke a hand, and was in the ICU for many days and in the hospital for 3 weeks, and went from 132 pounds to 112 pounds and months of rehab and recovery. He came back. He narrowly escaped paralysis and death. We were lucky. We were just lucky. My auto financial advisor wasn’t.
It was just about then I got call from Grant, our IT guy at Bayside. “Dr. Shenkin, are you coming back to the office today?”
I said, “Yeah, Grant, I figure I will, but I’m buying a car. What’s up?”
Grant giggled in wonder, “You’re buying a car??”
“Yeah, I just figured I would. What’s up?”
“Well,” Grant said, “I have a contract with ATT that we really should have signed today and sent in, and they are in the Central Time Zone.”
“Grant, it’s twelve minutes of four o’clock.”
“Yes, we have about twelve minutes. They’re waiting for it.”
“Grant, it’s just not going to happen today. I’ll be back there in about half an hour.”
So I signed the lease and shook hands with my friend, who I figured I would look up when I brought the car in for service (I had negotiated three free servicings), arranged to have the salesman deliver the car to our house on Friday night, drove back to the Dublin office reviewed the terms of the contract, thanked Grant for doing all the work of getting the price of revision of service down from the $150,000 that our three months and out Administrator had negotiated to a more manageable $2,750, but told Grant that we need to exert some leverage at this point to recoup some of the losses we had sustained in switching services, and getting a better deal on the monthly charges.
Grant said, “But it’s a time-limited offer!”
“That’s OK, Grant. You’ve done a great job. Now let’s hand it over to Flora. Don’t worry.”
On the way home Flora called me and said she had negotiated a $41,000 check to reimburse us for the ATT deficiencies. At the end of the day at home Flora emailed me that she had negotiated the monthly fee from what Grant wanted me to sign down by a third. Good job Flora.
Another Thursday come and gone. When I get my car serviced, I think I’ll drop by to visit the guys and say hello. The Sharks are still in it.
Budd Shenkin
We met all morning, then I went over to ValleyCare Hospital for a Pediatrics Committee meeting, to consider once again how we can combat a hospital intent on using its capital to construct and run its own medical group, and put us out of business. There will be more and more of this – the hospitals have the money.
Then I visited our local Infinity dealer for a second time. My lease ran out on my Lexus GS 430 – four years and out. I lease so that I don’t run a car into the ground until it just breaks up, which means I’ve been driving a fairly crappy car for a long time, no matter how great it was at the start. I have to force myself to get going and make a new choice. I’m not a good chooser – I procrastinate. I think it’s pretty genetic. My son Allie is pretty much the same. I really don’t know if it makes economic sense for me to lease or buy – it’s too hard to figure out, and it can’t be all that different or it would be obvious. They get you coming and going no matter what you do. I guess.
So here I was with the salesman. Not a pushy guy, not a pushy agency. I drove the car around again and liked it, responded to the Joe the salesman that I was ready to buy real soon, saw his eyes light up, and I told him the way I bought my last car – figured out what I wanted and called around to dealerships until I found the best deal, which was $750 above invoice. Said I’d do the same thing this time. I thought I ought to get back to the office, but he said, “Want to come inside and see what we can do?” “OK,” I said, surprising myself.
So we were sitting in his cubicle and Joe checked with his manager – they are all so young! Short wiry guy with a little mustache and nice smile. I’m still getting used to being older and successful, being looked at with respect, I guess, but I’m always surprised not to find envy and resentment. I’m still surprised the way I’m treated with respect. And, to tell the truth, delighted. I’m always friendly back at them, and “a regular guy.” A strength. Why I don’t like to be in situations where I am inferior in some way. Not good with mentors. A weakness.
Strangely, Joe came back and said my offer was just fine with them. He said, my manager felt like dealing today. I figure, either they understood that my story about what I would do made sense, or the car had been sitting, or the invoice isn’t as valid as one would like, or they get manufacturer rebates. So what could I say? I had bought a car. Surprised myself, me, who dithers and channels my late father by second guessing myself. Joe asked if I wanted to take the car home tonight. Couldn’t wait for it that long, I said, the Sharks play at 6. “Go Sharks” came the cry from the salesman at the next cubicle. Such a friendly group. “He has season tickets,” said Joe.
I knew the next step in the familiar dance, visit the financial officer who would try to convince me to lease instead of buy. Another wiry guy, about my height, another guy with a small mustache. Started out the same way as the guy did four years ago when I switched from buy to lease, “Why do you want to buy a wasting asset?” “Why tie up your money?” I guess I reflected that I had danced this dance before, because he made a meta-comment – “I have to do this.” After all, it’s his job. Another low-key guy. And I wound up leasing, just like last time. He acted surprised that I had bought his argument rather than the car.
I think it was the meta-comment, the personal connection, the “Go Sharks” comment, the surprise that they simply accepted my offer, or the relief of actually having made a decision; it was something. But I’m a naturally gregarious guy, not overly shy, and - hey! - I’m a doctor. Maybe I was talking about my wife or my kids. So I must have said, “Are you married?”
He said, “No, I’m not.”
So I said, naturally, “Are you a gay guy?” I mean, we were talking, why pussyfoot around?
So he said no, he wasn’t. “If you’re not married,” he said, “do you have to be gay?” He seemed a little surprised that I asked him.
“No, but it’s the Bay Area,” And I added, “You’re a good looking guy, so I figured you could be married if you wanted to be, so I was just wondering.”
He accepted that (I’m not above a little flattery.) So he said, “I’m not married, but I have a girl friend.”
I asked him how old he was and he said 49 – that’s about what he looked.. “How long have you been going together,” I asked.
“Five and a half years.”
“Wow, I said, that’s pretty long. Why don’t you marry her?”
He said, “Why do you think that?”
I said, “Well, if it’s been that long, and you love her and you think you’re getting a good deal with her, you just have to knock her down and marry her. Otherwise you don’t know what will happen. If you don’t think you’re getting a deal, if you think she’s the one getting a good deal, and you’re doing her a favor, then you probably need to find somebody else.”
Then I told him about Andre Agassi’s book, which I thought was terrific. “You know what happened?” I asked him. “Agassi thought Steffi Graff was terrific, admired her, even idolized her, so he tried to make a date with her.
“She said, ‘I have a boyfriend.’
“He said, ‘how long have you been going together?’
“She said, ‘Six and a half years.’
“He said, ‘That’s a long time. So long that it’s probably not going anywhere. Why not give me a try?’
“She did, and not too much longer, they were together, she was pregnant, and they were married.”
A pretty powerful story (and a great book.) So my new friend said, “There’s something you don’t know.”
“Ah!” I said. “What is it.”
“She’s married.”
“Yup, that explains it,” I said.
“And she’s Chinese.”
Well, that’s not unheard of. I wondered what was coming next.
He said, “You know, I think I’m telling you this because you’re a doctor.” And kind of shrugged.
“Yes,” I said, “it’s OK, I’ll treat it confidentially.”
So he continued: “She has a 16 year old son. They are traditional (!). They think a teenage son should be raised by a father and a mother. So she’s there in the day, but every night she comes over to my house and sleeps with me.”
Well, I thought this was an unusual solution to wanting to be traditional, but people do solve dilemmas in unusual ways.
Then he said, “I used to be married. We had a son. He was 13. Then one day he was with a bunch of kids and they were up in a tree. We found him up in that tree hanged by the neck. We don’t know how it happened.” He shrugged. He just shrugged.
I told him about Peter. Peter was 17 and on a trip with his school and they slept overnight in an open campground on the American River. In the middle of the night a 4,700 pound live oak tree fell in the midst of the group and crushed Peter’s abdomen. He lost a kidney, 18 inches of bowel, severed all the lateral processes of the lumbar spine, broke a hand, and was in the ICU for many days and in the hospital for 3 weeks, and went from 132 pounds to 112 pounds and months of rehab and recovery. He came back. He narrowly escaped paralysis and death. We were lucky. We were just lucky. My auto financial advisor wasn’t.
It was just about then I got call from Grant, our IT guy at Bayside. “Dr. Shenkin, are you coming back to the office today?”
I said, “Yeah, Grant, I figure I will, but I’m buying a car. What’s up?”
Grant giggled in wonder, “You’re buying a car??”
“Yeah, I just figured I would. What’s up?”
“Well,” Grant said, “I have a contract with ATT that we really should have signed today and sent in, and they are in the Central Time Zone.”
“Grant, it’s twelve minutes of four o’clock.”
“Yes, we have about twelve minutes. They’re waiting for it.”
“Grant, it’s just not going to happen today. I’ll be back there in about half an hour.”
So I signed the lease and shook hands with my friend, who I figured I would look up when I brought the car in for service (I had negotiated three free servicings), arranged to have the salesman deliver the car to our house on Friday night, drove back to the Dublin office reviewed the terms of the contract, thanked Grant for doing all the work of getting the price of revision of service down from the $150,000 that our three months and out Administrator had negotiated to a more manageable $2,750, but told Grant that we need to exert some leverage at this point to recoup some of the losses we had sustained in switching services, and getting a better deal on the monthly charges.
Grant said, “But it’s a time-limited offer!”
“That’s OK, Grant. You’ve done a great job. Now let’s hand it over to Flora. Don’t worry.”
On the way home Flora called me and said she had negotiated a $41,000 check to reimburse us for the ATT deficiencies. At the end of the day at home Flora emailed me that she had negotiated the monthly fee from what Grant wanted me to sign down by a third. Good job Flora.
Another Thursday come and gone. When I get my car serviced, I think I’ll drop by to visit the guys and say hello. The Sharks are still in it.
Budd Shenkin
Subscribe to:
Posts (Atom)
