Monday, August 22, 2016

trying to be present

It's not easy to take a picture of a 78 degree day with wind in the leaves. Or the pleasure it gave me when I took a minute to appreciate it. 

I am a very future oriented person, so I spend most of my time in my head thinking about what's next, what's next. It's a useful trait sometimes - it helps me plug along toward long term goals. It's a problem when the future goals become unclear, or don't seem to be tenable for some reason. 

I am not good at appreciating the moment. Even this moment. Even as I was appreciating it, I began thinking about how to process it into a picture and a blog post. See. That's how my hamster wheel brain works. 

But I did appreciate it, in and of itself, for a minute or two before my system 2 took over again. I'd like to get better at that. Because life is the sum of all the seconds and minutes. And if you aren't there when they are happening, what was the point?

Wednesday, August 17, 2016

Why shocked at manipulative Aetna pullout?

Aetna, one of the largest remaining health insurers was seeking to merge with Huaman, another of the remaining large health insurers, and after the DOJ moved to block the merger, Aetna announced it would withdraw from the ACA exchanges, leaving many exchanges without an insurer to sell plans.

Many observers are connecting the dots - Aetna is punishing the Obama administration for not supporting the merger by not supporting the ACA-created exchanges - and those observers are shocked. Here's an example from the Huffington Post:

But just last month, in a letter to the Department of Justice, Aetna CEO Mark Bertolini said the two issues were closely linked. In fact, he made a clear threat: If President Barack Obama’s administration refused to allow the merger to proceed, he wrote, Aetna would be in worse financial position and would have to withdraw from most of its Obamacare markets, and quite likely all of them.
Here's from Bloomberg:

Aetna and Humana may also be willing to play hardball, putting their participation in Obamacare in play. The Justice Department said Thursday that part of its reasoning was to preserve competition in the Affordable Care Act’s marketplaces for individual insurance.
Less than an hour later, Humana put out a statement announcing it would no longer sell plans in eight of the 19 states where it has been offering Obamacare plans. Humana CEO Bruce Broussard said the retreat was already in the works and not prompted by the DOJ announcement.

The ACA represents a massive manipulation of the healthcare market by the federal government. The federal government pre-ACA was already funding more than half of the revenues at the average hospital, but with the ACA it stepped up its game and added more layers, more regulations, and twisted the incentives even more. The bottom line is, the more the federal government becomes a player in an industry, any industry, whether that's healthcare, finance and banking, education, etc., the more valuable and more important it becomes to manipulate the politicians and regulators that make the decisions in the federal government. The source of profit becomes not how well you can serve customers and provide innovative, valuable solutions to their problems, the source of profit becomes how can you manipulate the government in such a way as to direct more revenue to your coffers and away from competitors'.

This is basic Public Choice reasoning.

If the government performs the role of enforcing property rights and contracts and doesn't try to direct particular outcomes, competition will primarily be between entities trying to serve customers. When the government enters the market place with the intent of directing particular outcomes, it becomes profitable for entities to try to not only serve the government's interests, but to manipulate the outcomes the government attempts to direct economic action toward. This is what lobbyists do. And this is what brings big money into politics.

Aetna's behavior is perfectly logical, and by creating the ACA, we collectively asked for this kind of behavior. If you want money out of politics, minimize the amount of economic value that political action generates. It's really that simple.

Wednesday, July 20, 2016

the best camera is the one you have with you

"The best camera is the one you have with you" is an old photographer's saying. What it means is, you don't need a fancy camera to do photography. Just do it with whatever you have.

Yesterday I took my daughter and a friend to visit Boston. We started at Faneuil Hall, and then they decided they wanted to visit the New England Aquarium. I have been to the Aquarium many times and wasn't really in the mood yesterday, so I walked them over,

then decided to go exploring.

Unfortunately, since I wasn't sure about the agenda, and my walk was sort of a spontaneous development, I didn't bring my regular camera along.  All I had was my iPhone.

And that's why I mention the above quote. I had a camera. Not the camera I wanted, but a camera nonetheless. With it's very wide angle, it has some limitations, but the image quality is amazing, and once you understand the effects of the wide angle, you can work with it to make interesting compositions. It doesn't hurt to have a few apps that let you do fun stuff like selective color. I made this with the app MobileMonet, which I think costs a couple of bucks in the Apple app store. Well worth it for making painting-like images, which I enjoy some of the time.

So I went roaming along the shoreline of the Harbor, looking for interesting images to make. 

There's something about the seedy side of things, the underbelly, that always draws my eye. This was an interesting composition, with the trashcans in the middle and the reflection of the harbor in the windows bracketing them. 

The North End, the historically Italian district of Boston is right near the Aquarium, so I went roaming through that neighborhood. Although I consider myself originally from the Boston area, I haven't spent all that much time in Boston proper. It was great to do some wandering.

And of course if you are in the North End, you have to eat. I wound up taking the girls to a cannoli at the Gelateri & Cannoli Factory. Amazing, made to order cannoli. 

What could have been a long couple of hours by myself turned into a visual adventure. I processed all these images on my phone, either using the onboard software, or MobileMonet. 

Are these the best images I have ever taken? No. But some of them are pretty cool. And I had a great time engaging with the scenery. 

We are all walking around with these remarkable cameras with powerful processing software. There is no excuse not to engage the creative side of our brains. The camera is for more than taking selfies and family pics. Its a great way to engage your brain in a different way. And it trains you to take in the beauty around you. Like the Nike commercial says, Just Do It. No excuses. 

Tuesday, July 12, 2016

thoughts on "How Google Works"

So first off, I really enjoyed How Google Works. There's a lot of good stuff about corporate culture at the 30,000 foot level, bu the authors also bring it down to the 50ft level as well with some suggestions about how to run meetings, how to do recruiting, etc.

I wrote some about the talent management aspects in this post on my other blog.

There's a certain breezy confidence in this book that all companies could run this way. I couldn't help thinking as I read the book that all this works really well when you have a high growth industry with a lot of margin, as Peter Thiel talks about in his book Zero to One. In healthcare delivery, we don't see that same kind of flexibility. At least I don't see it. Given the heavy handed regulation of the industry, it's much more difficult to be innovative. Schmidt and Rosenberg give lots of examples where Googlers take their 20% time and develop new products that lead to new revenue streams. When the government provides 50% or more of your revenue, and that revenue is tightly tied to specific actions and codes, it's challenging to develop new products because the demand is so rigid. The demand is further made rigid by the 3rd party payment system.

Oddly enough, Google faces a similar situation where users are not customers. This is an interesting comparison between healthcare delivery and Google. Most of Google's revenue comes from advertising - in particular when companies pay to have their sponsored links show up at the top of your search. So while you are the user, and Google wants you to have a good experience, you are not the customer. Googles customers are advertisers.
At Google, our users are the people who use our products, while our customers are the companies that buy our advertising and license our technology. There are rarely conflicts between the two, but when there are, our bias is toward the user. It has to be this way, regardless of your industry. (How Google Works, p. 216)
Who are a hospital's customers? Insurance companies (Mediare/Medicaid at 50% plus, as I said, as well as private insurers). Hopefully insurance companies and their insured members have aligned incentives, but that is inevitably not so, and there are a slew of economic forces behind that, including behavior facts like moral hazard.

If a hospital comes up with an innovative initiative that might be of value to its users (patients), it is hard to monetize that initiative because the customers (insurers) are boxed in.

So innovation is primarily focused on reducing costs and improving operational effectiveness. Good things in and of themselves, but they are not the kind of revenue enhancing innovations that Google regularly pursues.

Saturday, July 9, 2016

existential crisis just barely averted by microwave smores

smores - after

smores - before

getting touchy feely in the woods

college woods

I went for a walk in College Woods yesterday with Marley, as I try to do a couple times each week.

college woods

As usual, I brought along the camera to see what I could see.

Bringing the camera puts me in a different mind set than when I am just out walking. I become more aware of my visual surroundings. There is nothing stopping me from trying to be more aware when I am walking without the camera, but the camera gives me sustained purpose.

Usually I do not venture off the trail (though Marley goes zooming back and forth and all around once we are far enough into the woods that I feel safe letting her off the leash). Also, I usually don't touch anything while I am in the woods. I don't arrange my subjects - my goal is to see the composition as it is, not create a composition that was not there. College Woods is not a delicate ecosystem - it is a community trail - so touching things would really be OK within reason.

college woods

And so I was walking along and thinking about compositions got to really paying attention to the varieties of bark on the trees. This tree had bark that looked like scales. I kept thinking the scales looked like they had been made out of clay, with someone's thumb prints on them.

college woods

This tree's bark made me think of puzzle pieces - some sort of mechanistic rendition.

There were a few others. And they were so textured, I broke with my usual rule and touched them. I closed my eyes to really absorb the tactile experience, like a blind man would. Smooth, rough, jagged, rounded.

There are of course many other trees with many other barks in these woods. These are just a couple samples.

college woods selfie

I love these woods. All year round I love walking through them. They constantly change and yield new experiences. Sometimes it is the woods that change; sometimes it is me.

Tuesday, July 5, 2016

Wagon Hill, Emery Farms - Exploring home


I drove back and forth down Rt. 4 last year every day when I was staying with my father and drove past a sign for "Wagon Hill Farm" (and also past the hill with the wagon on it - hence the name) and never once stopped to check it out.

Wagon Hill Farm is owned by the town of Durham where I now live. It's a 139 acre property with hiking trails, a community garden, and... a beach!

The amazing thing is that there are gems like this in every community. By gems, I mean little properties like this, museums owned by non-profits, or local businesses.

After we left Wagon Hill, I suggested we check out another place I had been driving by and wondering about, but had never bothered to stop at, a farm stand belonging to Emery Farms. The Emery Farm market is almost directly across Rt. 4 from Wagon Hill, so we just cruised over there in the spirit of exploration. It was a fairly typical farm stand with plants for sale and some local produce. They have a huge blueberry orchard (is that the right term?) where you can pick your own blueberries. Not sure what else they have - we'll have to return and do a little more research. They did have a small petting zoo with a few donkeys, goats, and chickens.


We bought some plants, not so much because we needed them but to give a little support to the business. I'm not a big believer in the local food movement. But I like having quaint things like farm stands around me. The only way to make those things economically viable is to patronize them. So we bought the plants more as a tip for producing something we like - the quaint farm stand - than the fact that we needed plants. If I needed plants, I would probably just go to Home Depot or Walmart and pick up a bunch.

Anyway, off the soap box - Emery Farm was another nice find. We'll go back just to be nostalgic, and maybe to pick some blueberries - though ours are starting to ripen now.

It was a nice adventure. You don't have to travel far to travel. There's always a lot to see if you open your mind to it.