Importing Cheap Labor Eliminates American IT Jobs

Immigration policy played an important part in the debate before and after the 2016 election.

The debate was focused on whether or not to protect undocumented aliens in the United States because they do “jobs Americans won’t do” – for example agriculture, food processing, and unskilled construction.

But no attention has been paid to protecting jobs Americans are doing from documented alien labor.

Despite the loss of +/- 200,000 US technology jobs, the United States Citizenship and Immigration Services (USCIS) proceeded to awarded 85,000 “temporary high skilled knowledge worker” non-immigrant visas (H1-B) to foreign contract worker firms and American technology firms — 85,000 direct competitors for the limited number of IT jobs available in 2016 and 2017.

Why are we not Employing American Workers?

The phenomenon is not new. Computer World estimates that at least 776,000 tech workers have entered the United States to directly compete with American workers between 2007 and 2017.

For the last few years, the majority of these visas (65,000 annually) went to India-based contract labor (outsourcing) firms. The firms, in turn, hire BA graduates from Indian colleges and universities to fill the visas.

The advanced degree quota for H1-B visas (20,000 annually) go to high technology companies — Facebook, Apple, Google, Microsoft and Intel, to name just a few.

In addition, H1-B visas are issued to American college and universities above the annual quota stipulated by Congress.

While, at the same time, the National Institutes of Health spends $11 million a year to help US citizen Ph.D. graduates in STEM to find alternative careers. There are not enough jobs for all the Ph.D. graduates USA universities produce.

Solution: Hire a Made-in-America Worker

The H1-B visa program poses a direct threat to US technology workers – both present and future – as the numbers of these workers have continued to grow despite a general weakening of demand for IT workers in the United States.

In recent years more and more high profile American companies have fired entire departments of American workers and hired H1-B replacements.

  • Southern California Edison
  • Northeast Utilities
  • Toys R Us
  • Disney Company
  • University of California San Francisco Medical Center
  • Too many more to name

In all of these situations, the American workers were required to train their replacements as a condition of receiving their severance pay!

Many of the displaced workers had 10, 15 or 20 years of service to the firms that dismissed them in the name of profits.

Turn-off the Spigot

Despite extensive investigation and numerous hearings before Congressional Committees no action has been taken to correct the abuses of the H1-B program.

Currently there are three bills pending. One in the Senate and two in the House, including one authored by Silicon Valley representative Zoe Lofgren which would require H1-B employers to pay 150 to 200 percent of the current prevailing wage for that job classification – a move that would bring the program back to its original intent. Once, again, the H1-B visa would be reserved for the rare, unusual and uniquely skilled job creator.

In addition, the Trump Administration has issued an Executive Order to “study” the problem but did so without turning off the spigot.

Exactly the opposite should be done.

There is a practice from an earlier time in information technology that applies to the current H1-B situation.

Before every executive had a laptop with a company performance dashboard in the middle of his/her desk, IT departments used to produce volumes of paper reports. Periodically, the queue of reports had to be “cleared” to reduce wasted paper and reduce labor costs.

The IT Department would simply stop printing all the reports one Friday evening and wait to hear on Monday who called and asked for their report. If no one asked for a specific report by the following Friday, it was discontinued.

Instead of waiting for Congress – which has shown no appetite to touch anything related to immigration this year – let’s just turn-off the spigot by Executive Order.

Don’t hold a lottery to award the 85,000 2017 H1-B visas and see if any labor shortage occurs – if any company mounts a court challenge in the name of shareholder profits.

It is more likely that the result would more be more jobs and better wages for American technology workers.

Public Option is Part of Fix for America’s Broken Health Care System

In the aftermath of the latest Republican House of Representatives’ attempt to “repeal and replace Obamacare” two things are certain.

  1. Health care is an entitlement due to all American citizens and a smaller group of legal non-citizens.
  2. Health care costs too much for too many people.

Quinnipiaq polling found only 17 percent of people approved of the Republican health care bill after hearing Congressional Budget Office projections that 14 to 24 million Americans might lose their health care coverage if the American Health Care Act became law.

Only eight percent of respondents supported just repealing Obamacare without replacing it.

But more than 50 percent want significant changes to the program.  Changes that will reduce cost – the cost of insurance and the underlying cost of health care.

Americans Reject Government-Run Health Insurance

It is an axiom of American politics that Americans reject a public health care option.

I don’t know whether to be worried or amused that members of Congress do not recognize the USA has a defacto public option?

Rhetoric to the contrary: 49.6 percent of the American people get their health care paid for by a government-run insurance program. The dictionary definition of a public option!

Consider the facts.

There are 47.2 million Americans on Medicare.

More than 70 million Americans are covered by Medicaid through a variety of programs that have been added over the last half century.

  • Medicaid covers about 40% of all children in the United States
  • Medicaid pays for about 50% of maternity expenses in the United States
  • Medicaid pays for 2/3 of nursing home expenses in the United States

The Veterans Administration claims 8.9 million health care plan participants.

The Bureau of Indian Affairs provides health care for approximately 2.2 million American Indians and Eskimos who live on traditional native lands.

The United States military insures +/- 14 million uniformed active duty and retired service members and their families.

The Obamacare private health insurance exchanges subsidizes premiums for 11 million Americans without employer based health insurance who are not eligible for either Medicare or Medicaid.

Approximately 4.8 million federal employees including civil service, executive and legislative branches and the courts participate in the federal government (employer) health insurance program

Add it all up — 154.8 million Americans get their health insurance from the federal government at a cost of +/- $2 trillion (about 64% of all health spending in the United States).

Embrace Reality with Public Option

What if Congress seized on the opportunity instead of railing against “government intrusion into health care”? They could turn the USA public option into a benefit instead of a financial sink hole with a bad reputation – an excuse for the escalating cost of care in America.

Let’s start with a new piece of legislation that all Americans without a law degree can understand:

A public option health insurance program open to everyone from age 0 to 64 years not covered by private employer health insurance. The plan would cover all currently mandated Essential Health Care Benefits.

To succeed Congress must remove the “Medicaid stigma”— the broad public perception that Medicaid is health care for only the poorest people delivered by less skilled personnel in substandard facilities. The insured cannot be embarrassed to “show their card”!

The new product must appeal to the 11 million who are currently insured under Obamacare exchanges and to some portion of the remaining 23 million Americans in the private insurance market. People must be willing to pay out-of-their-pocket to belong to the program.

This alternative begins with assuring prompt access to current-in-industry standard treatment in first class facilities – for example, Kaiser, Humana, Cleveland Clinics, and Sutter Hospitals – probably operating only as health maintenance organizations.

Congress should “guarantee” the plan offers best-in-class care options by enrolling themselves, their families and their staffs in the new public option.

The public option must be a good enough product to compete as one of the choices for Federal employees and their families.

Access to a public option health insurance card could bring the nation’s 8.9 million veterans improved care in their home communities.

How to Create a Realistic Funding Source: Follow the Money

A new and realistic funding source must be a cornerstone of the new legislation — fair to all, affordable and paid for now and into the future (not adding to the national debt).

There’d be some savings to be recouped into the public option funding pool from existing government activities:

  • Collapsing the five or six government insurance bureaucracies into a single department.
  • Eliminating the Obamacare guaranteed profits to private insurers.
  • Claims processing through Centers for Medicare and Medicaid Services (CMS) at .84 cents a claim

There would be new funds earned from premiums paid by insured – based on income.

But these savings and premium payments would not come close to paying for the subsidized care of close to one-third of Americans = +/- $1 trillion/year

Every American has to know where the $1 trillion is coming from, how it will be collected, and how it will be spent.

Since the 1980s there has been a shift in our economy from production (30%) to consumption (70%).

Fewer good paying manufacturing and other semi-skilled jobs have swelled the rolls of Medicaid and reduced the role of employer-paid insurance.

Logically, then, the new source of revenue to pay for public option health care (even to continue to pay for Obamacare and Medicaid) must come from the consumption side of the ledger – taxes paid by the ultimate consumer.

Take a Small Step First

Congressional Republicans should acknowledge reality — pass legislation authorizing the development of a public option health insurance program effective January 1,2019.

Force Democrats – who have long argued for a public option — to “come to the table” leading to lasting, bi-partisan legislation.

Establish a budget line item and allow tax reform legislation to move forward.

Provide certainty to the current health insurance market and warn against unjustified 2018 insurance premium increases.

Encourage the health care industry, fearing further regulation, to come to the table with alternatives to ever escalating health care costs.

Isn’t that the bottom-line for all Americans?

Firearms Transaction Record

Honor Orlando with One Small Step toward Unity of Purpose

After I turn off the lights each night, I repeat the basic prayer of my faith followed by a brief, extemporaneous chat with God. It was just after 1 AM Sunday morning when I asked God to do what he can to achieve peace on earth.

At that very moment the largest mass shooting in the history of the United States was taking place across the country.

How can it be that 49 people were murdered in an Orlando, Florida, night club? How can it be that 53 people who went out for a good time on Saturday night – ended up fighting for their lives in Orlando hospitals on Sunday?

Then the “other shoe dropped”. The killer who pledged allegiance to ISIS — was known to the FBI but still was able to buy a military-style assault rifle from a legitimate gun dealer.

Massacres Have One Common Denominator

Watching the breaking news, I was struck by the sounds recorded by law enforcement. The rat-a-tat-tat – the speed and the volume or shots fired.

It sounded like a Hollywood war movie!

It’s the same sound we heard in the videos of Fort Hood, Sandy Hook, Tucson, San Bernardino, Charleston, Aurora and a dozen other instances in the last 8 years.

There is a common denominator: A semi-automatic, military-style assault rifle (AR-15). We learned after Aurora that you can buy this type of weapon at Wal-Mart!

To the best of my knowledge there are no wars going on in Aurora!

Democrats could not resist the urge to politicize the tragedy. They took to the Floor of the House of Representatives shouting “Shame” at the Republican Majority. They ignored the fact they failed to pass any meaningful gun control legislation when they were in the majority in both the House and the Senate. This is an Election Year and gun control is a perpetual issue to rouse voters.

Not a Time for Typical Politics

When I work on a new strategic direction with a corporate client I start with the facts. Focusing on facts avoids inter-personal tensions and political agendas from side-tracking the discussion.

All the participants are focused externally – listening more than talking — until they all come to a consensus about what to do with those facts. It is a first step in building the trust necessary to take more significant, risky actions.

People are scared.

What they want are solutions not posturing.

Our leaders must avoid political finger pointing and focus instead on quiet conversation that allows the evidence to lead us to constructive consensus, which would build a new multi-pronged strategy to combat all forms of domestic terrorism.

It is a fact – based on ample evidence – federal gun purchase background checks do not work to make us safer. 80 percent of Americans agree they must be strengthened.

Background Checks Are Not Gun Control

Congress passing legislation to expand and strengthen background checks could be a confidence building step toward a new homeland security strategy.

They have the facts:

  • The Charleston massacre last year demonstrated that an arbitrary three day maximum waiting period is not long enough for a thorough FBI background check.
  • The Orlando killer had been under FBI surveillance for nearly a year (2013-14) as a suspected terrorist but was able to walk into a gun store and walk out with a military assault rifle – no questions asked.
  • The Department of Homeland Security maintains a “no-fly list” of potential terrorists to prevent the use of an airplane as a weapon of mass destruction but Congress has refused – so far –to make it illegal for these people to buy a gun.
  • This policy is in fact: Crazy in its contradiction!

Congress has had more than a dozen opportunities to debate this subject over the last seven years. It’s time to stop talking and listen to the American people!

Amend the background check legislation this week with a simple amendment to the law that honors the memory of those who died in Orlando – while they were just out living their lives.

  • Remove the 72 hour restriction from the background process. The FBI completes the background check when they have all the data required – no matter how long it takes.
  • Integrate FBI interview records and the “no-fly list” with FBI gun background check system.
  • If someone who has been interviewed or surveilled as a potential terrorist attempts to purchase a gun they should be flagged for an FBI interview before any action is taken on the gun purchase application.
  • Similarly, anyone on the “no-fly list” who applies to purchase a gun must be subject to FBI interview and further investigation before any action is taken on the gun purchase application.

This legislation would be a small, politically safe step for Congress. It would be a huge step forward toward building a national consensus on steps that can make our homeland and our homes more secure by following the evidence the FBI and the ATF are developing in Orlando and across the country.

To do less dishonors the lives lost!

Obamacare Wellness Exam

Obamacare Turns Wellness Exam into Dying Discussion

Last Monday I got up early, went to gym, did my cardio and took an hour long Pilates class. Then I had a shower and set off for my annual Wellness Exam. (One of those new mandated benefits of the Affordable Care Act [Obamacare] and/or Medicare).

It was a lovely bright blue summer morning, my first day free from a nine month project I had been managing for one of Silicon Valley’s elite technology companies. I was feeling really wonderful – until I got to Palo Medical Foundation.

The receptionist greeted me promptly and took my co-payment. Then she handed me a clipboard with a form attached.

Welcome to the Most Annoying Form on The Planet

It is legally required to be filled out annually by all of us who have reached a certain age.

I wonder if Hillary Clinton’s doctor or Nancy Pelosi’s doctor has the nerve to tell her the form is the law and she has to fill it out. I’m not as old as they are!

The first question asked if could bathe myself without assistance. It went downhill from there.

No, I am not depressed. At least I wasn’t until I walked into the clinic.

Yes, I live in a house with stairs. I run up and down them countless times every day.

Yes, I dispense my own medications – for allergies – because all native Californians are allergic to something. It’s in the air.

No, I have never accidently overdosed myself. In fact, I read the fine print that comes with the medication and take the pediatric dose because I don’t weight 100 pounds soaking wet. There’s nothing wrong with my reasoning!

Yes, I’ve filled out my Healthcare Directive. No, I don’t discuss it regularly with my son – he knows my wishes.

By The End of the Exam I Did Need Medication to Lower My Blood Pressure!

Not only did I have to fill out the questionnaire but the doctor then asked me all the same questions, again. The actual physical exam plus the laboratory blood draw took a total of 10 minutes. The argument about giving me the required referral to see my true primary doctor – allergy and immunology – took another 10 minutes.

The remaining 30 minutes of the exam had nothing to do with keeping me well, happy, productive and independent. Rather, the focus was on just the opposite – measuring the rate of my decline into Depression, Dementia and Death or as I like to call them – the 3 Ds.

One Size Fits All Government Mindset Taking Over Our Healthcare

It’s nothing personal – I had to remind myself – it’s the one size fits all mentality that pervades the bureaucracy at the Center of Medicare and Medicaid Services (CMS).

It’s a striking example of the outdated thinking that dominates Washington DC.

Today, more than 25 percent of 70 year olds are still in the work force – still paying Medicare taxes every pay period – active, vibrant, engaged and productive.

Any of the leading 2016 Presidential candidates would enter the White House already somewhere along the CMS 3Ds continuum– unless we elect Marco Rubio.

The logic behind the Wellness Exam is management of the four chronic disease conditions that cost the US health care system the most – diabetes, high blood pressure, obesity, and heart disease. The earlier these are identified the more effectively they can be managed – through lifestyle modification and, if necessary, medication – controlling the cost of care.

Put Patient at the Center of Healthcare

If health management is the focus of our modern healthcare system, doesn’t it make sense for the doctor to encourage my active and engaged life-style – maintaining my weight, blood pressure, blood sugar – rather than condescendingly telling me I am in denial?

It’s illogical, but the Federal government is incenting the doctor to focus everyone on preparing to die rather than to live.

They’re just following a basic tenet of modern politics – if you repeat a lie often enough it becomes the truth. Tell me I am in decline until I believe it and obligingly die.

I am a typical Baby Boomer – independent, grabbing the gusto. I’m not likely to return any time soon – unless I am sick or injured – adding rather than reducing the cost of my final care.

In the business world, when a policy or procedure is not customer friendly and may cost either customers or customer wallet share, we change it.

If the Centers for Medicare and Medicaid Services truly wanted to keep Baby Boomers well and productive they’d get the bureaucracy out of the exam room and let doctors and patients decide when and how often to focus on the inevitable questions that surround aging.

Photo Credit: Google Images

Nazi War Criminal

Congress Ignores Social Security Benefits Paid to Nazi War Criminals

I have a gallery of family photos on a shelf on the second floor landing of my home.

A picture that makes me smile every day is one of my father and my grown son sitting together in companionable silence — their profiles and expressions so familiar, so similar.

Craig was the first grandchild for my parents. It was a learning experience for all of us – one full of love, laughter and not always as much discipline as I felt warranted.

But I don’t think I fully appreciated the unique role a grandparent plays in a child’s life until I became a grandparent, myself.

I never had the pleasure of being spoiled by my grandparents. They died at Auschwitz in October,1942.

I know when and where they were murdered because the Nazis kept good records.

Nazi War Criminals Lived the Good Life in America

The American immigration authorities in the late 1940s and early 1950s didn’t check those records carefully enough. The Associated Press reports that as many as 10,000 Nazi party members and actual war criminals immigrated to the United States and became naturalized citizens during that period.

Some sightings of suspected Nazi war criminals by Holocaust survivors, who had also immigrated to the USA, brought a few of them into public view. As a result, the Justice Department established the Office of Special Investigations (OSI) to track down the most egregious criminals among them – by then fast becoming old men.

Over the years I’ve seen TV News reports or read newspaper stories about deportation proceedings, most particularly Jakob Denzinger, a notoriously cruel guard at Auschwitz. He had built a comfortable American life of entrepreneurship before the OSI came calling at his Ohio lakefront home.

Nazi War Criminals Still Collect Social Security Benefits

The name Denzinger stood out in an Associated Press (AP) investigative report this week which claimed nearly $2 million in Social Security benefits paid to a handful of Nazi war criminals after they were “outed” and stripped of their US citizenship.

But Mr. Denzinger is not in a European prison. Germany declined to prosecute him and today he is living a comfortable life in Croatia. His retirement funded by a $1500 a month Social Security (SS) check – the very same SSI tax dollars withheld from your pay check every month. His son, a US citizen, claims he “earned” those benefits.

His benefits are not paid from some factious Social Security Trust Fund. Rather current recipients are paid from current year taxes withheld from pay checks.

Even though Mr. Denzinger and his fellow Nazi war criminals paid Social Security taxes while hiding in the United States, who can justify taxing you and I — the children and grandchildren of Nazi victims and the brave American soldiers who defeated their black-hearted ideology — to support these aged criminals in comfort?

The short answer is it’s the unelected, unaccountable, anonymous bureaucrats who are the real US governing power over our lives.

Because Nazi war crimes were not committed in the US, these men could not be prosecuted under US law. US policy became to remove them from the US with as little publicity as possible. This was accomplished by guaranteeing these criminals their Social Security benefits in exchange for their voluntary departure from the US.

Once they had landed in Europe their US citizenship was revoked. In almost every case, the European government declined to prosecute them.

The same Elena Kagan who now sits on the United States Supreme Court defended this policy on behalf of the Clinton Administration. She argued Immigration Courts might be reluctant to deport old and sick men – even if they were notorious war criminals who had entered the US fraudulently.

Better Late than Never Congress is Asking Questions

Congress had an opportunity to stop tax payer abuse 15 years ago but didn’t. The AP claims there was pressure from the OSI.

Hog wash – members were afraid of headlines claiming they’d stripped someone, anyone of their Social Security benefits.

Ending this monstrous abuse of taxpayers is urgent.

Thanks to the AP report, Rep. Carol Maloney (D-NY), member of the House Oversight and Reform Committee, is now asking questions and threatening hearings.

Congress must establish a working group and dedicate staff to thoroughly investigate how such the original objective – removing and punishing Nazi war criminals hiding in our midst – came to such a bad outcome. No whitewash, no hypotheticals, no politics – a deep analysis.

The lessons the American people and the members of Congress can learn about bureaucratic over-reach and inadequate Congressional and Executive oversight can be a catalyst for change far beyond this single scandal.

The findings have the potential to drastically change the balance of power between the people – through their elected representatives – and the unelected bureaucrats before whom we now cower.

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Homeless Vet

A Single Homeless Veteran Is an American Disgrace – 1.4 Million A National Shame

Yesterday I logged onto to buy a special pair of running shoes for my son. Before I had a chance to go to search window, Amazon presented me with offers to buy three recently or about to published books.

Amazon technology “remembered” that I had purchased the first two volumes of Ken Follett’s trilogy on twentieth century Europe. Volume three is going to be released in mid-October. I can’t wait – such great writing!

I bought all three books in less than 5 minutes.

The running shoes – I didn’t find them in my son’s size and the price was higher than expected. But I am certain that between now and Christmas, Amazon will shoot me an e-mail offer in his size – at a price I am willing to pay – delivered free in 48 hours.

That’s the power of customer focused business, fueled by solid but not extraordinary technology.

Veterans Administration Has NO Customer Focus

I take Amazon’s efficiency as much for granted as I do government inefficiency.

Still I was shocked by a front page story about a disabled Vietnam-era veteran in today’s San Jose Mercury News.

But I was just as surprised by the indifference David Reiss met inside the VA. Indifference that is deeply imbedded in the VA culture the VA sources quoted in the article didn’t even recognize that they were personally accountable to their fellow human being.

Dr. Abigail Wilson, Mr. Reiss’s VA Health Care surgeon complained how difficult it is to treat a seriously ill veteran who is living in an SUV. She said she “referred him to the Veterans Administration” but the VA disability pension, granted after a long delay, was not enough to pay for permanent housing. That’s yet another bureaucracy.

In the meantime, this veteran “lives” in the Regional Medical Center parking lot – to remain close to the Emergency Room!

America Owes Veterans a Roof over Their Heads

Vietnam era veterans were largely drafted – right out of high school.

For the last 40 years military volunteers were induced by promises of college and/or career.

After a series of wars and expeditions draftees and volunteers returned to civilian life with physical and psychological scars the rest of us cannot even imagine and, too often, without the job skills our economy values. Too many have ended up hopeless, drug-addicted, and homeless.

In 2009 Congress passed legislation aimed at ending veteran homelessness by – drumroll please – 2016!

I wonder where these self-satisfied, comfortably warm and air-conditioned representatives and VA bureaucrats thought these veterans would eat and sleep during the decade long effort.

A measure of the level of indifference facing US veterans is the elasticity in the number, itself. The VA estimated there are 57,800 homeless veterans daily in 2012. The Department of Housing and Urban Affairs put the number at 62,900 during the same period.

That’s a daily difference of 5100 – or 1.8 million days of veteran homelessness in a single year.

If that’s not an emergency, then what is?

Veterans Need an Advocate

In the 21st century the VA should be able to connect the dots – using either the veteran’s Social Security Number or Military Identification Number – to coordinate health care, disability, housing and other resources. But we’ve learned such simple automated coordination is impossible in today’s VA.

Lacking the tools to quickly connect the dots makes it tougher to solve the problem but not impossible.

The VA must urgently recruit a corps of Veteran Relationship Managers (VRM) to serve as personal advocates for each veteran. The advocate would work with local homeless aid organizations and law enforcement to identify veterans who need VA services. As well as soliciting referrals from VA Health Care and Claims Offices.

For each veteran, the advocate would use the various disconnected systems to gather and verify needed information, determine care and services required. The advocate would, then, use the same systems plus telephone calls, e-mail, confrontation of VA bureaucrats – whatever is needed to get a veteran services beginning in less than 90 days and stay with the veteran to “wellness”.

Veteran Relationship Managers can be recruited from demobilizing current military members. Their experience will give them empathy. Their ethos remains — we leave no man or woman behind on the battlefield.

Most importantly the modern veteran is characterized by a “can do” attitude. It’s that attitude that will give homeless, hopeless veterans a fresh grasp on life. It’s an attitude that must come to characterize the 21st century Veterans Administration.

Photo Credit: Huffington Post

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ACA Website

ACA Exchange = Shiny New Car Paint But There’s No Engine

The mainstream media is still reporting the Affordable Health Care (ACA) Exchange Website is not working well – when it works at all. Well, they’ve got it wrong. It’s not the website that isn’t working. It’s the very complicated software environment behind the website that’s dysfunctional. The website does not work because a significant portion of that software environment is not yet built or even designed – end to end.

ACA’s Bright Shiny Paint Job

A website is like the shiny bright paint job on a new car on the showroom floor. The paint attracts the buyer’s attention but it doesn’t drive the car.

What propels the shiny paint job down the road is a chassis, to which a body style can be attached, and a motor. The ACA chassis is the software architecture that is supposed to link the user, the government and insurance company systems together – the same way the chassis connects the axles and steering wheel to the driver.

When Ford or GM or BMW or Tesla, for example, build a new car they start with the chassis. Many body styles (and paint colors) can be built on a single chassis. The weight of the chassis and the associated body style determine the size engine that is needed to make the vehicle efficient and easy to drive.

In software the chassis is the systems or environmental architecture. The architecture is the super-superstructure to which each of the individual software modules are attached – for example, prove the identity of the applicant. The architecture also establishes the relationship between individual modules. For example, after establishing identity, the next module determines eligibility for subsidies and/or Medicaid. The software modules are grouped together to meet specific user needs – analogous to the auto body style. The modular relationships determine the type (and complexity) of software needed to make the whole thing work – the engine.

Oops, Engine Not Bolted To Chassis

The ACA Exchange website crashed on launch not because the shiny green user portal didn’t work but because the engine – the software – hadn’t been bolted securely to the chassis and fell off as soon as users “stepped on the gas”. In fact, we now know that the chassis has not yet been fully designed and consequently there really are no engine bolts.

For the past week, daily “cover their own backside” (“CYA”) leaks from both administration and Center for Medicare and Medicaid Services (CMS) officials have brought to light a troubling picture of political expediency, bureaucratic bungling and executive irresponsibility. The self-serving leaks have unveiled the truth.

At least 40 percent of the system has not yet been designed. OMG, beyond the shiny green paint – there isn’t even a complete design of the car – yet and White House officials knew it. The chassis is nothing more than a partial Plaster of Paris model –certainly not sturdy enough for any road test.

In the automobile design process there actually is a Plaster of Paris model of a proposed car. It is used by car manufacturers to secure bids from tool and die makers and other suppliers so that they can determine, at various points in the design process, the costs and challenges associated with the planned vehicle. It’s no different in the procurement of software (purchased systems) or software development.

If the Plaster of Paris model is incomplete, the tool and die maker can only tell the car manufacturer the hourly cost of labor and the cost of a ton of steel, not the wholesale cost of the car tooling. Similarly, in software development if the first task for the vendor will be to define the system, their bid must be limited to an hourly billing rate plus a specific percentage of that rate to cover miscellaneous development expenses.

Until the system has actually been defined, there can be no plan to develop it. No plan means no budget and no budget means no controls. That’s a software contract every vendor dreams of and is every client’s worst and unending nightmare.

ACA is a Shiny Green Edsel

An estimated $600 million dollars has been spent on the ACA Exchange to date. There’s still no end to end system designed or built. Absent strong executive guidance, detailed plan-to-complete and seasoned management, the ACA Exchange is a shiny green Edsel destined for the junk yard of failed government information technology projects. Except this time, it could take a significant part of the US economy along for the ride!!

As tax payers, we must insist that Congress freeze spending on the ACA Exchange, including so-called “fixes” at least until an end-to-end design is complete, new management and oversight team has been put in place, capable external contractors hired and zero-cost-overrun development and rollout milestones established. If you agree – call, write or forward this blog to your representative along with your own comments.

Photo Credit: Joe Raedle/Getty Images

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Children are not a Commodity

Ecosystem Turns Our Children Into Commodities

I went to a family picnic Sunday – sunshine, a sea breeze, hot dogs and hamburgers, laughing children playing with their cousins – even Despicable Me cupcakes, decorated with Twinkies© (sorry Michelle). It reminded me of my own childhood – a simpler time when Mom and Dad were the center of my universe.

That was a time before well-meaning “advocates”, government bureaucrats and Madison Avenue turned our children into commodities surrounded by an ecosystem that influences, encapsulates, isolates, and smothers them.

The child’s ecosystem is a community of interests that surround our children. While some of these interests may be well intentioned, collectively they’ve objectified our children. From public policy advocates, to a myriad of government agencies, the education system, academic researchers, plus toy makers, advertisers and marketers, all the way to entertainment producers; an ecosystem has grown up that collectively serves the needs of the adults involved rather than the children it surrounds.

From the early colonial period, American parents were responsible to nurture, protect and challenge their children. They expected their children to “climb the” social and financial “ladder” through education and industry. The Civil Rights movement of the 1960s exposed the ugly secrets of institutionalized or situational “separate but unequal” whether the result of race or poverty or both. The government needed to intervene. But rather than addressing only that subset of children, bureaucrats expanded those protections until they included all children. This unnecessary intervention eventually became a barrier to parental responsibility and choice.

Schools develop and administer curriculum, use test scores to develop academic labels for children and assign students to classes or student groupings – based on those labels – with little or no parental input. In my recent experience, the parents’ concerns about specific teachers shared on the playground were never communicated to school administrators. The parents feared their child may be retaliated against.

The government meets every failure of individual parents to act responsibly toward their children with a new and expensive program – health care, child nutrition, education special needs. Too often, where a problem could be solved with a tooth brush, bureaucrats employ a paint roller. The broad brush has actually encouraged an abdication of parental responsibility. I don’t think it’s just a coincidence that nearly half of children born in the United States last year were born out of wedlock. Government programs have become an accepted alternative to the nuclear family as the economic foundation of childhood.

In my mind, there is something really out of whack when the government requires parental consent for a 16 year old to apply for a driver’s license but not when that same child wants to abort a baby. Kids need certainty – a single standard of responsibility and accountability – to learn how to behave as adults.

If the exploitation of children by education and social welfare experts were not enough – Hollywood and Madison Avenue, equally, see our children as opportunities to maximize profits. There’s a children’s feature film almost every month loaded with product placements and supported by an infrastructure of merchandise. It’s no coincidence that toys or children’s cereals are on the store shelf at the child’s level! Even the most responsible and conscientious parent feels the pressure to indulge their child.

When I was young, kids dreamed of growing up to be a doctor, lawyer, a plumber – just like their dad – or a skilled athlete. Today kids aspire to become celebrities – just like they see on so-called “reality TV”.

I worry about the message our children get from television. Disney’s pre-teen and teen programs, for example, portray the parent(s) as either a buffoon, absent, or clueless.

Social media can be anti-social when it discourages genuine communication between children and parents. In my childhood, parents and children connected at the dinner table. We “checked in” to share the day’s events. The dinner table was where we asked questions and debated our parents’ answers. It’s where our personal and social values were developed.

I recently observed a family of five at an adjacent table at our neighborhood Red Robin Restaurant each texting on a separate device. There was no communication, no eye contact between the five family members. The parents were being “friends” to their kids instead of setting an example about the importance of communication in establishing meaningful human relationships.

Hillary Clinton suggested It Takes A Village to raise a child in modern America. I believe that we need to shrink the village down to a hamlet that puts parents and children together in the town square – just as it was for the first 200 years of American history.

Child’s Eco-System – United States 2013

Photo Credit: Economists Journey to Life

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Government Plan For Patient-Centric Healthcare Reform Is Suspect

My primary care doctor spent half of our 20 minute appointment complaining that she has to waste too much of her time with each patient entering data into the computer. She became a doctor, she sighed, because she wanted to “help people live better, fuller, longer lives not to serve a machine”.

She needs-to-get-over-it! The computer in the exam room can facilitate scientific research that will help people live better, fuller, longer lives! That is, unless the science is co-opted by the government through the Institute for Patient-Centric Outcomes and the Independent Payment Advisory Board (IPAB) in 2015.

To illustrate the science – Kaiser has been trying to increase the number of patients who undergo routine colon cancer screening for 20 years. About 10 years ago, they migrated all of their patient health records onto a single, standardized computerized platform. I know, I wrote the business rationale.

For the first time, Kaiser could readily identify their entire 50 to 75 year old patient population and track test results over a decade. Researchers compared the effectiveness of screening colonoscopy to less invasive testing methods, both to determine diagnostic reliability and patient compliance. At the end of the decade, they had doubled the rate of patient participation and saved more lives through early detection.

This research technique is known as comparative effectiveness. Comparative effectiveness compares outcomes first on the basis of quality and compassionate care. Then, all things being equal, it considers comparative cost. In Kaiser’s case, it turned out the cost savings were significant.

It’s a technique well suited to Kaiser. Their patient population is large (8.9 million patients), diverse, stable, and in some cases includes a patient history over multiple decades – sometimes from pre-natal to birth through adulthood. This will allow future comparisons across generations to determine the impact of environment versus genetics, for example.

Now enter Obamacare. During the debate over the ACA some staffers apparently heard the term “comparative effectiveness research”, from an insurance industry lobbyist. Here, they thought, was a panacea for cost control and cost reduction.

Congress authorized $3.5 billion dollars to establish a Patient-Centered Outcomes Research Institute – under Centers for Medicare and Medicaid Services (CMS). The Institute is already identifying, funding and collecting comparative effectiveness studies from health care institutions around the country with the intent to establish national standardized diagnostic and treatment protocols.

Standardized and patient-centric – now there’s an oxymoron! Human beings are not shrink-wrappable! For example, standard basal temperature of a healthy adult is 98.6 degrees. But I am a healthy adult whose basal temperature is 97.6 – always has been. Under a standard reimbursement protocol, an emergency room might not be reimbursed for treating me for fever until I reached the standard of 103, instead of the more appropriate 102, even if that resulted in harm to me.

The same legislation established the Independent Payment Advisory Board (IPAB). The board, unelected and unaccountable, will begin to make Medicare coverage decisions in 2015 justified by comparative effectiveness studies collected by the Institute.  Medicare coverage decisions are usually quickly adopted by Medicaid and private insurers.

Congress stipulated that cost should not be considered in determining the relative effectiveness of test or treatment options. But I’m a bit too familiar with the difference between legislation and regulatory interpretation to take that stipulation seriously. ACA was an 1100 page bill that has spawned 100,000 pages of regulations and they are not done writing, yet!

If better treatment and higher patient satisfaction were REALLY Congress’ altruistic objective, the Institute would have been established as part of the National Institutes for Health (NIH). NIH is “the nation’s medical research agency – supporting scientific studies that turn discovery into health”. The NIH already regularly sponsors comparative research with private health care systems – i.e. Kaiser, Mayo etc. At best, the Patient-Centric Institute is a $3.5 billion duplication of effort. At worst, parallel efforts may lead to conflicting results adding confusion where clarity is the objective.

In the America I imagine, our national objective would be to reduce the cost of health care through unbiased scientific research — extending the limits of our knowledge instead of constraining the study to comparisons between known options. Sometimes research generates new drugs, new therapies, and new medical devices and sometimes it proves that less treatment is more helpful. The last is, in fact, the most patient-centric of medical choices.

Meanwhile, I am starting to worry about what penalty the IPAB will assess for being allergic to aspirin. It is, according to many comparative research studies, the best, low-cost preventative miracle drug against cancer, heart disease and arthritis – just not for me!

If you agree with this blog, please forward it to your representatives with your own comments.

Photo Credit: Health Allianze

  • It is up to YOU

    Get Involved

    In the coming weeks, will do what our Presidential Candidates and other politicians are not - throw out some positive and plausible ideas to "right the ship of state".

    Ideas you can ask candidates about during the Fall Campaign.