I’m Just a (North Carolina) Bill

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Many of us of a certain age learned most of what we know about government and grammar from Schoolhouse Rock. Unfortunately there isn't a Schoolhouse Rock piece about the process the North Carolina legislature goes through to draft a new law, but thanks to a guest piece in the Greensboro News & Record's Sunday opinion section we do have a fairly understandable overview provided by Louis Panzer, the executive director of North Carolina 811:

For those of you unfamiliar with the process, here is the flow in a nutshell: A bill is drafted by a team of research analysts and then introduced in either the House or the Senate. This requires sponsors who carry the language through the chambers, explaining the nuances and seeking votes to approve and move to the next level.

Each bill requires three readings in the chamber it originated in. During this process, a bill may be sent to a committee. Once the bill leaves the original chamber, it “crosses over” to the other for another round of three readings and more potential committee attention. Each time this happens, there is an opportunity for amendments. In some cases, the amendments adopted by one chamber are rejected by the original chamber. Then more modifications might have to be made. When a bill finally receives the governor’s signature, it becomes law.

Sounds simple right? Well, let's just say that the process truly resembles the proverbial sausage making and is rarely as simple as it sounds.
As for law making at the federal level, I'll leave the explanation to our friends at Schoolhouse Rocks:
*Note: This is a crosspost of an item I wrote for work*

Everyday Barrier

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The following was found on Sasha Dichter's blog and is something that might be a great exercise for all of us. Why? So we can walk a mile in someone else's shoes:

It reminded me of a day I spent over the winter, an exercise called “everyday barriers” that all Acumen staff participate in.  It’s something the Acumen Fellows undertake as part of their training.  Like our Fellows, each Acumen New York staff member came to work and then left everything in the office except for $5 in cash and a round trip Metrocard.  We were to spend the day in New York City and come back with suggestions for how to improve public services.  It’s an exercise in what we call “moral imagination,” cultivating the ability to walk a mile in someone else’s shoes, and to see problems from a new perspective.

Having talked to Acumen Fellows who had participated in this activity in the past, I recalled profound stories of connection, as well Fellows gaining a much deeper understanding of the challenges of being a poor person in New York City.  I recall a Fellow telling a story of a woman who walked everywhere with a giant box filled with papers – they were all of her identification, phone bills, records, etc. because the woman had gotten sick of getting to the front of a long line only to be told that she didn’t have the right paperwork.  Fellows experienced what was and was not working well in the provision of New York city public services, and the day served as a jumping off point for discussions about identity, empathy, and social change.

To me the most surprising part of the exercise came right at the beginning.  After about an hour of walking, feeling pretty relaxed, I started to feel a bit hungry and thirsty, and it hit me that it was 9:30am and I had 8 hours to spend in the city on a cold day with nowhere to go and almost no money in my pocket.   While part of my plan was to go to new neighborhoods, suddenly the very familiar parts of the city started to feel different.   The glass windows of a coffee shop or a high-end clothing store felt like they had “keep out” signs flashing at me with my empty pockets, big parka and heavy boots.  The transformation in my experience of something as simple as walking down the street in an upscale neighborhood was profound and shocking.  How could a shift happen so quickly?  I bought an apple for 50 cents and trudged on, making my way to a church (where the music was uplifting), a homeless shelter (for lunch), and then taking a massive trek (that turned out to be a wild goose chase) to an employment center in Queens, with a lot of time in the NYC subway noticing how everyone except for me was in an iPod / newspaper / book bubble.  Time passed differently, and most of New York City felt like it was for someone other than me.

 

The True Cost of Flying

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Just about anyone who has flown at all over the last few years will tell you that the data on flight delays highlighted in this Freakonomics post is not at all shocking:

The cost of air travel is going up, and airlines are counting on us not to notice.

I’m not talking about airfares, which have actually declined in real terms over the past decade, despite inching up in the past few years. And I don’t mean the ancillary fees to check a bag, check in at the airport, speak to a live agent, or pick your seat, though these, too, are going up. Instead, I’m talking about the cost of delays and schedule disruptions that waste travelers’ time and force them to travel earlier to their destinations or risk missing important meetings and events. ..

Researchers at MIT and George Mason University estimate that delayed and canceled flights imposed on passengers an aggregate delay of 28,500 years in 2007. The cost of these delays, and of risk-averting behavior like traveling early to destinations, was estimated at $15.3 billion, a startling number that accounts for the opportunity cost of time but doesn’t measure the consequences of missing critical appointments like weddings or job interviews.

Indeed, on a business trip to San Diego this past June I ended up missing my connections in both directions and spending the night in Dallas both times. The trip out was a weather issue so the airline just rebooked me for a flight the next morning and I was on my own to find accomodations. The trip back was a mechanical issue and the airline paid for a night at a Dallas hotel. Both times I missed appointments becuase of the delayed flights and missed connections. Sadly, I think this is becoming more and more common. The data would seem to back this feeling up:

Airlines are increasingly consolidating service at the nation’s largest airports, according to areport this summer from MIT. Meanwhile, the number of large hubs has declined from 20 to 10, even as the number of flights channeled into large hubs has grown 75 percent.

This means an ever-larger share of passengers must make connections in an ever-fewer number of airports, including those in the most congested airspace in the country. If weather, security, or accidents halt or slow operations at one of those airports, effects can reverberate throughout the system, as late-arriving aircraft delay flights downstream elsewhere around the country. United passengers should find this particularly alarming as five of the airline’s hubs rank among the six worst airports in the country for on-time departures.

 

Free Job Advice for Youngsters

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Here's a blog post from Jessica Gottlieb with some great job advice for Millenials, including:

  • Your first job will probably be a crappy job. Don’t wait until you’re 20-something to have that first job. Working is good for you, even when it’s not fun. 
  • No one owes you a job, you’re replaceable so it’s up to you to be better than everyone else (this advice holds true until you’re 75 or so)
  • If you work in a service industry tips should feel like silver and gold raindrops. No one is obligated to give them to you. Customers can sniff out entitlement.

To this I'll add:

  • Be on time.
  • Watch your language. Not just cursing, but grammar. You don't necessarily need to know when to use "who" or "whom", but at least know that you shouldn't say "I'm doing good" when you're asked how you're doing.
  • Dress appropriately and accept that it is perfectly reasonable for your boss to define what is appropriate.
  • Use a firm handshake when you greet people, but don't try to break their knuckles. Also, unless someone's your friend don't give them a hug/bro-hug.
  • This is for guys: shave every day even if you don't think you need it. Believe me, you do. If you have a beard, keep it trimmed and shave where appropriate every day.
  • Flirt at your own risk. It can backfire on you in a big way.

There's plenty more where that came from; things I was once taught and that have never really changed.

Side note: you millenials are exactly where we Generation X/Y, Baby Boomers were at your age. The generations that preceded us thought we were slackers/losers/lost causes too.

Who Says a Colon Exploration Should Take Two Hours?

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The Washington Post has a story on the 'secretive panel' of doctors who come up with the pricing on all medical procedures:

Unknown to most, a single committee of the AMA, the chief lobbying group for physicians, meets confidentially every year to come up with values for most of the services a doctor performs.

Those values are required under federal law to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors.

But the AMA’s estimates of the time involved in many procedures are exaggerated, sometimes by as much as 100 percent, according to an analysis of doctors’ time, as well as interviews and reviews of medical journals.

If the time estimates are to be believed, some doctors would have to be averaging more than 24 hours a day to perform all of the procedures that they are reporting. This volume of work does not mean these doctors are doing anything wrong. They are just getting paid at the rates set by the government, under the guidance of the AMA.

So, who's surprised by this? And it gets better:

To determine how long a procedure takes, the AMA relies on surveys of doctors conducted by the associations representing specialists and primary care physicians. The doctors who fill out the surveys are informed that the reason for the survey is to set pay. Increasingly, the survey estimates have been found so improbable that the AMA has had to significantly lower them, according to federal documents…

In the late 1980s and early ’90s, the United States called on a group at Harvard University to develop a more deliberate system for paying doctors.

What they came up with, basically, is the current point system. Every procedure is assigned a number of points — called “relative value units” — based on the work involved, the staff and supplies, and a smaller portion for malpractice insurance…

This point system is critical in U.S. health-care economics because it doesn’t just rule Medicare payments. Roughly four out of five insurance companies use the point system for the basis of their own physician fees, according to the AMA. The private insurers typically pay somewhat more per point than does Medicare.

Once the system developed by the Harvard researchers was initiated, however, the Medicare system faced a critical problem: As medicine evolved, the point system had to be updated. Who could do that?

The AMA offered to do the work for free.

Has no one heard of the fox in the hen house? Sheesh. It's one thing for the doctors' groups to be consulted – they should be – but to drive the entire process? That's absurd.

Race as a Distraction

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In college, way back in the dark ages of the 1980s, I had a roommate from Scotland who was intrigued with the racial discord he observed in America. To him it made no sense that people would hate each other based on their race, but of course it made total sense to him that the Catholics and Protestants back in Scotland were in a constant state of discord. He'd say, and I'm paraphrasing here, "Why do you Americans hate each other for what you are? At least in Scotland we hate each other for what we choose to believe."

Whenever race comes up as a topic I think about those words. Indeed, it's totally illogical for us to hate one another for something we have no control over. In fact it's probably the most absurd reason for people to hate and distrust each other. On the other hand, probably the most logical reason for any group of people to dislike another is if one group has disproportionately more of anything – wealth, food, opportunity, etc. – than the other, particularly if the group with less feels that the other group has gotten it off of their backs.

That's why the new data about the true nature of poverty in America, and the plight of working class whites in particular, should scare the bejeezus out of this country's power structure. Once all of the poor and struggling working class folks from every race realize they have more in common with each other than with the wealthy of their own race they will form a formidable body to deal with. From the article linked above:

As nonwhites approach a numerical majority in the U.S., one question is how public programs to lift the disadvantaged should be best focused — on the affirmative action that historically has tried to eliminate the racial barriers seen as the major impediment to economic equality, or simply on improving socioeconomic status for all, regardless of race.

Hardship is particularly growing among whites, based on several measures. Pessimism among that racial group about their families' economic futures has climbed to the highest point since at least 1987. In the most recent AP-GfK poll, 63 percent of whites called the economy "poor."…

While racial and ethnic minorities are more likely to live in poverty, race disparities in the poverty rate have narrowed substantially since the 1970s, census data show. Economic insecurity among whites also is more pervasive than is shown in the government's poverty data, engulfing more than 76 percent of white adults by the time they turn 60, according to a new economic gauge being published next year by the Oxford University Press.

There's another important societal component contributing to the economic struggle of millions of individuals in this country, and it's one we need to deal with head on: the breakdown of the traditional family. Again from the article:

–For the first time since 1975, the number of white single-mother households living in poverty with children surpassed or equaled black ones in the past decade, spurred by job losses and faster rates of out-of-wedlock births among whites. White single-mother families in poverty stood at nearly 1.5 million in 2011, comparable to the number for blacks. Hispanic single-mother families in poverty trailed at 1.2 million…

Marriage rates are in decline across all races, and the number of white mother-headed households living in poverty has risen to the level of black ones.

As a man who has been happily married for a long time I'm obviously a fan of the family structure. However, whenever the topic of single parent homes comes up for public debate we get pulled into the moral/religious rabbit hole and never address the economics of single parenthood. Why do we insist on approaching this problem from a moral standpoint, haranguing young men and women about their sinfulness and almost guaranteeing they'll tune us out, and not instead concentrate on developing societal structures that will help deal with a very real problem? I'm not smart enough to have a solution here, but it doesn't take a rocket science to realize that the answer is not browbeating people back into church and insisting that they live they way great-Grandma and Grandpa did. 

Our leaders, whether in industry or government, need to begin to deal with the reality that is portrayed in this new data or our country will soon be in even deeper doo-doo. They can no longer hide from the reality that our middle class is disappearing and that our "land of opportunity" could quickly become an empty slogan if they don't change things, and fast.

Uber Teens

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Uber is a service that allows you to use an app on your smartphone to book a ride with a car service. Right now the service is available in several large cities around the country so it's not currently relevant here in small-city North Carolina, but the reason it hit my radar is a blog post a mom wrote about why she signed her teenage daughter up for the service. An excerpt:

When I met the Push Girls last year I noted that four of the five women I met were in wheelchairs because of car accidents. The accidents were all excessive speed or alcohol fueled. If a smart phone app can get my child home without risking dangerous driving conditions I’d be a fool to not use it.

Parents of teens: I’m going to ask you to do something we should all do at least once a day. I want you to be still and quiet and try to remember being 14 or even 17. Now put yourself at your friend’s house and their parents have just left. All of a sudden 5 other kids appear and they’re thinking about drinking a beer and smoking some pot. What does the 14 year old you do?

The only answer I have is that I know the 14 year old you doesn’t call Mommy for a ride home.

Now imagine the same scenario. The 14 year old you pulls out a smart phone (it’s probably already out) and texts for a town car. 14 year old you can hop into the back seat of a limo and get home. My credit card information is already stored in the app, no money changes hands and your private driver gets you home.

Boom. Done. Decision made.

That logic is pretty sound to me. In our household we have a similar rule in that any of our kids can call us for a ride and not risk getting in trouble. Sure we'll have a talk about it the next day and we'll push to make sure they avoid getting themselves in similar situations in the future, but I'd rather get a 12:30 a.m. phone call asking for a ride than risk having them hop in a car with an inexperienced driver who may or may not be inebriated. Still, how many kids actually believe their parents won't come down on them like a ton of bricks if they call for a ride in the middle of the night? Not many, which is why I like the idea of a kid having a tool at their disposal that can help them do the right thing.

There's another part of the blog post that was really horrifying to me as a father and it's about teen girls dealing with other dads who play grab-ass:

Then Laurie and I started talking about why every kid should have Uber on their phone and when we got to the part about being a teenager and on occasion not wanting to get into a car with a Dad who plays grab-ass the new Dad looked at us with horror in his eyes. Even though 100% of the adult women at the party sort of nodded and knew what that felt like I was all, “Oh but times have changed. I’m sure it will never be an issue.”

For the record it's my opinion that while having a service like Uber to get my daughter out of harm's way at that moment would be a good thing, it would also be of utmost importance that she inform me of the offending father's actions and allow me to use another tool at my service: a large can of whoop-ass.

It’s a Start

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In the past I've written extensively about how frustrating our health care and health insurance systems are in the good ol' US of A.  As I see it one of the biggest obstacles to true health care reform in this country is the lack of transparency in the system, or in laymen's terms, the fact that you generally have no idea how bad you're screwed until well after you've received whatever treatment or service for which you visited the doctor.

That's why I was very interested in this piece at the Triad Business Journal's blog:

Passed last week in the waning days of this year's legislative session, the "Health Care Cost Reduction and Transparency Act of 2013" (House Bill 834) will create an online database of what hospitals are paid, on average, for the 100 treatments they perform most frequently. They'll also be reporting their costs for the 20 most common surgical procedures and 20 most common imaging procedures.

Take a case of pneumonia. N.C. consumers will now be able to go online and compare a variety of prices for that treatment. The database will tell them what Medicare pays for the treatment of pneumonia, what Medicaid pays and the average of what the five largest insurers in the state would pay the hospital.

Additionally, the database will offer up what the charge will be for a person with no insurance, and what the average price that the uninsured are able to negotiate with the hospital to pay.

That's a lot more info than is now available to N.C. consumers, though a clearer picture of what health care costs are in the state is still emerging.

This is what NC's attorney general had to say:

N.C. Attorney General Roy Cooper, who had advocated for several of the provisions included in the final transparency law,praised its passage.

“We recommend that consumers shop around for a good deal, but our health care system doesn’t make that easy to do,” Cooper said. “Giving consumers straightforward information on what medical services cost and what they owe will help them make better decisions about their health care.”

He's got that right, especially when you're talking about preventive or non-urgent care. Obviously if you're in an emergency situation the last thing you're going to think about is whether or not the hospital nearest to you is the cheapest, but when a consumer has time to think having accurate information is the most valuable tool at his disposal. 

What I hope we see in the very near future is an app on our phones that will be linked to a database of ALL medical procedures from all health systems. And while I'm dreaming I'd love to see our state have more viable health insurance options than the duopoly we currently "enjoy" in North Carolina.

Google (Re)Discovers the 19th Century

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An article over at the Chronicle of Higher Education looks at an interesting effect of Google's book digitization program:

Google Books is a kind of Victorian portal that takes me into a mare magnum of out-of-print authors, many of whom helped launch disciplines. Or who wrote essays, novels, and histories that did not transcend their time. Or who anonymously produced the paperwork of emerging bureaucracies, organizations, and businesses that, because printed, has been scanned and, because scanned, is now available.

I am not a scholar of the 19th century but have found its digitization to be one of the most fascinating new resource for understanding the centuries that precede it.

It is not by chance that the 19th century gave birth to projects such as the Oxford English Dictionary. The OED is the tip of an iceberg of genteel scholars, male and female, who had the time and resources to dig through vast mounds of material and make something of it. Those researchers lived in closer chronological proximity to their subjects than we do; they often worked amid the dimly lit bookshelves and attics of private homes. As a result, their experience of a historical subject captures a sense of intimacy that might otherwise be lost.

 

In Retrospect

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Over at Letters of Note is a great letter written in 1974 by an WWII veteran and pilot on his deathbed to his grandson:

But, in spite of what I've said, there is much, in life to enjoy – to relish. There is also much that can be done to make life worth while and living worth the "candle." There is a rich heritage of literature and music that awaits your investigation – it's there for the taking – in the libraries of the country and in the archives of the museums. There is poetry and prose – enough to fill all the hours you can spare to listen to them and more knowledge, on every conceivable subject, than you can assimilate in a lifetime. It's all there just waiting for you to ask for it or to seek it out. Don't overlook it or pass it up for less important or less meaningful pastimes.

Most important of all is ability to savor life, to taste of it in as many variances as you can – while you can. Life never looks so short as when you look back on it. Unfortunately you cannot do this until it has passed you by. So, as you go through life, don't overlook the "Lily in the Field," the newborn puppy, the fledgling bird – for they are as much (or more) of life as the tall buildings, the shiny automobiles and the possessions we tend to place so much importance upon. If you can do just this much – life will be more meaningful for you…

And my favorite paragraph, one that I would echo for my own children:

If I could package (with ribbon) those gifts that I would most like to give you, I would. But how do you package integrity, how do you wrap honesty, what kind of paper for a sense of humor, what ribbon for inquisitiveness?