Monthly Archives: November 2010

Computer Face Off

Posted on November 30, 2010 | Leave a comment

“Why is it drug addicts and computer aficionados are both called users?”

          ~Clifford Stoll

I have been proud to be a geek since my days in high school.  While that placed limits on my social life, I’ve always believed that dates with homecoming queens and cheerleaders are overated.  So instead of learning to be smooth with the ladies, I spent my time learning to wield a soldering iron with only occasional burns.   It was only natural that when personal computers became available I lusted over pictures of the Atari and the Imsai, which I could not afford.  Over time other options appeared and I jumped at the chance to assemble a Cosmac Elf when it showed up in Popular Electronics magazine in the 1970’s. 

I believe I’ve been responsible with regard to computers.  I’ve tried to meet their environmental requirements and lovingly fed them the latest utility programs to keep them operating at their peak.  While there were some peripherals I couldn’t afford, I tried to be open minded and at least consider them.  With such devotion you’d think that I’d deserve some modicum of respect from computers.  Or at least some grudging tolerance.  After all they get to stay in my home, consume my power and make my office 5 degrees warmer than the rest of the house during the summer.

But sadly, this is not the case.  Like Siegfried & Roy’s tiger, my computers have turned on me without provocation at the worst possible moments.  In fact, they’re more like a teenage child.  They don’t listen, they mope and they’re just plain contrary.

As computers have advanced, I’ve not always been the first to upgrade but I’ve made sure that my computers have not had to do without.  “It’ll make them better,” I tell myself.  “They need this!”

The computers don’t appreciate this loyalty.  My circa 1979 Radio Shack TRS-80 would load a word processing program so I could begin writing in a matter of a few seconds.  My ultra-fast, quad core, 64 bit, dual exhaust, positraction system running Windows 7 64 bit Ultimate sits there and churns forever from the time I hit the switch until I see the log-on screen.  This does not mean I can start to work, it merely means I can log on.

So I enter entering my user name and password and go to get a cup of coffee.  I don’t mean to the kitchen to merely pour coffee from the pot.  I have enough time to find a coffee plant, compare notes with Juan Valdez, wait for the beans to be at the peak of their ripeness, gather the beans, roast them, grind them and then make coffee.  Then I’m able to start work.

Two months ago my printer died, so I replaced it with an ink jet that scans, prints and accepts wireless connections to the computers around the house.

Or not.

After repeated attempts I was not able to activate the wireless connectivity.  Figuring that my firewall program may have been protecting me from my own printer, I gave up.  Shortly thereafter (after having a good laugh at my expense, I’m sure) the wireless feature started spontaneously working.  The printer and I had reached a state of mutual co-existence.

Or not.

“This is not a ‘Happy Printer’ ink cartridge,” it proclaimed.  I pressed [OK] on the printer’s panel.

“Happy Printers warranty does not cover damage due to the use of anyone else’s ink.”  Again I pressed [OK].  It was like the horses in Harry Potter that brought the students from Beaubaton’s to Hogwarts for the Tri-wizard Championship. “My horses only drink single malt whiskey!”

Burdened by the illusion that I was in control, I installed a system that I have used in the past in which the ink cartridges are connected to small tanks of ink so that cartridges don’t have to be changed every three pages.  The printer decided this was absolutely intolerable, and like a classic vampire (as opposed to the currently in vogue teenage ones) sucked the ink out of the system faster than bonuses flying out of a bank receiving federal bail out funds.

I began to frantically look for the ink leak before it ran down the stand and all over the carpet.  No ink.  I opened the printer and poked around with paper towels.  A few drops and no more.  There was sufficient ink on the cartridges so that when I removed them my fingers looked like they had lost a fight with the Sunday funnies, but no evidence as to where the rest of the ink was.

I believe that there is only one possible explanation.  On the other side of the universe is my anti-matter counterpart.  He’s looking at his new printer in disbelief as large quantities of ink pour out from it.  I believe this because I also believe that he ends up with all the odd socks that disappear from my dryer.  In any case I realized that I cannot win against a device that has intergalactic and parallel universe powers.  I capitulated.

Yesterday I got a phone call about a job interview, so I sat down to print a copy of my resume for tomorrow’s meeting.   In today’s job market it’s expected that a resume be tweaked for each possible employer.  I noticed a few changes that I needed to make, and began to edit.

Nothing.  I pressed the keys again.  Now every 3rd or 4th letter would print.  I rebooted the computer – and when the login screen came up I couldn’t type my password.  I rebooted again.  Using the mouse I ran utility programs to correct registry errors.  I connected an old beat-up keyboard and was able to get to the manufacturer’s site to download the latest drivers and software.  I still ended up with:

“Te qqqqqqck brooooon fx jpd ovvvr t lzy doog”

With the alternate keyboard, I wrote an e-mail to the manufacturer asking for help.  Suddenly the keyboard started working.  I’m guessing I had successfully executed the cyber equivalent of telling its parents.

So if you’ll excuse me, I need to go and print that resume.

“To err is human.  To really foul up you need a computer.”

          ~ Unknown

 

Copyright 2010 SF Nowak All Rights Reserved

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Posted in Technology, Uncategorized

Hope

Posted on November 29, 2010 | Leave a comment

“There’s a statistical theory that if you gave a million monkeys typewriters and set them to work, they’d eventually come up with the complete works of Shakespeare. Thanks to the Internet, we now know this isn’t true.”

                                                                              ~Ian Hart

When I was in my twenties Jimmy, a friend of mine and I would banter about pseudo-intellectual topics.  As a nurse he would claim that chemistry was the only true science and physics merely the rules.  As a Radiologic Technologist I naturally had to take the contrary position and defend physics as being the ultimate.  This ridiculous interchange was great fun even though it required a lot of mental effort to counter the factoids manufactured by the other and keep such a meaningless dialogue going.  However, as we worked side by side in a high stress environment in a teaching hospital this helped us keep things light.

Jimmy’s other philosophical belief regarded that which separated us from the lower species.  It was neither logic nor an opposable thumb that gave us a preferred position in creation.  It was the fact that we had tape and the monkeys did not.  Oh, they might get a roll here or there, but that wasn’t sufficient to empower them.  But if they had access to the virtually limitless supply of tape that we enjoy, Jim would postulate, they’d knock us off the top rung of the evolutionary ladder.

Aware of my responsibility to speak for the opposing viewpoint, I did not directly attack the role of tape.  Instead I pointed out that his position was untenable because the monkeys already had a better position than humans.  They spent their days eating, sleeping, scratching and having sex while we worked, paid taxes, stood in lines and filled out forms.

The other day, some 30+ years later, I found myself thinking about Jim’s quasi-philosophical theory.  I asked myself, “What DOES separate us from the other species?” 

I know that we are aware that there is a future.  I don’t know if anyone has, or even can determine if this is true of animals.  Knowing that there is a future is important, but alone is not complete.  Because we know there will be a tomorrow we can also have hope.  Hope, the ability to believe that things will get better has personal as well as theological implications.  From a practical standpoint it gets us through the rough times and incentivizes us to plan for a better tomorrow.  We cannot guarantee that we will be around for that tomorrow, but there will be a tomorrow.  Sometimes that is enough.

Hope is by its very nature optimistic.  It gives us the reason to try things, sometimes a “Leap of Faith” is equally based on hope.  It provides a bridge between yesterday and tomorrow.  It links reality with aspirations; between what is and what we dream can be.

Theologically hope is one of the three divine virtues, along with faith and charity (love).

So I believe it is Hope that separates humans from all other species on this planet.

And, sorry Jim, it’s better than tape.

“Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: You don’t give up. “

                                            ~ Anne Lamott

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Posted in Philosophy, Uncategorized

Tell Me a Story

Posted on November 28, 2010 | Leave a comment

“The skill of writing is to create a context in which other people can think.”

                                                                  ~ Edwin Schlossberg

 Writing is the act of converting a thought in the writer’s mind to a more or less similar thought in the readers’ minds.  Due to the influence of electronic media it no longer is looked at as putting words down on paper, which is beneficial.  For too long the focus has been on the words and not the meaning. 

While words are necessary they too often detract from the message when they should convey it.  Too often writing is an exercise in trying to impress others with the vocabulary of the author.  This is particularly true if the topic is a technical one.  Currently computer types are most guilty of this.  Like ancient tomes written by magicians for other magicians, many technical documents are written to be understood only by the inner circle of high priests who have the key to the language. 

While a document may be written to persuade, to instruct, to express an emotion or to elicit a response it is almost always possible to engage the reader.  The easiest way to do this is to tell a good story.

Now how can there be a story in a scientific journal or a technical manual?  It may take some small effort, but it is possible.  Look at Cliff Stoll’s The Cuckoo’s Egg, a book about computer hackers that could have been dry as toast but instead reads like a thriller.  Even in a scientific journal an article can be written using a format such as:

  1. Here’s what we expected
  2. Here’s what we tried
  3. Here’s what happened
  4. Here’s what we learned

Why not elicit a response from the reader of “Wow! You discovered something!  That’s great!”?

History is all about great stories.  For hundreds of years people would sit around the fire or in the public house and entreat an elder to, “Tell us about El Cid!” or King David, Charlemagne, Joan of Arc or whomever.  These were exciting tales replete with blood, sweat & tears.  There was good vs. evil – all the raw materials to thrill us, but as time went on we became educated.  We decided that as an academic pursuit history should be treated more seriously.  We took the story out (especially those embarrassing human traits) and focused instead on the facts and dates.

“William the Conqueror won the Battle of Hastings in 1066 and became the first Norman king of England” is what we’re taught today. B-O-R-I-N-G!

On the other hand, think about this. William bested Harold the Second.  It’s hard, regardless of the facts, to get too excited about a threat from anyone named Harold.  And it wasn’t Harold the Great or Harold the Terrible.  It wasn’t even the first Harold, but Harold the Hand-Me-Down! Oh, and by the way, Harold had just returned from war, was exhausted and had disbanded his army.

Somehow William the Conqueror doesn’t seem quite as overpowering a figure.  Shrewd, perhaps, but the tactics were closer to those of a bully than those of a great hero.  More of William “I’ll Kick You When You’re Down.” 

Here’s another example.

In Virginia history you can’t spit (figuratively speaking) without hitting either a Randolph or a Lee.   Many of the Lees made great contributions to this nation, but most Americans only know of Robert E. Lee.  Robert E. Lee was married to Mary Anna Randolph Custis, great granddaughter of Martha Washington.  (I warned you there’d be a Randolph connection.)  Her father had built a beautiful home overlooking Washington, DC in which they were married and which they later called home. 

When the South seceded, Colonel Lee was offered command of the Union Army by President Lincoln but after taking time to reflect he realized that he could not bring himself to bear arms against his home state of Virginia.  He instead fought for the confederacy and eventually was named General-In-Chief of the Southern Army.  During the war his home was seized by the Union and it was used as village for freed Black slaves and as a graveyard.  The plan was to bury those Union soldiers who died in Virginia as a result of Lee’s orders at his home.  The Lees never returned after the war.

Of course, Lee’s former home has now become one of our most sacred sites, Arlington National Cemetery. 

That’s history, AND a great story.

“Read history, works of truth, not novels and romances.”

               ~ Robert E. Lee’s oft’ repeated advice to his children.

Copyright 2010 SF Nowak All Rights Reserved

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Posted in Uncategorized

A Perspective on Perspective

Posted on November 27, 2010 | Leave a comment

“Chaos is a name for any order that produces confusion in our minds.”

  ~George Santayana

Perspective is seeing things in the proper proportion.  In real life and in representations of reality such as photographs and drawings we perceive things farther away as smaller.  Our brain discerns the difference and we tend not to confuse the fact that a person is far and not believe that the person is physically miniscule.  However, there is a philosophical component to this perspective.  Threats that are either very far away or physically small represent less of a danger than something that is actually large or actually near – or worse, both.

So today, the world seems once again at the brink of disaster as North Korea escalates its rhetoric after an exchange of artillery fire with South Korea.  Here is a nuclear capable enemy with virtually nothing to lose and who is believed to have the missile capacity to reach portions of the United States as well as South Korea, Japan, etc.

However, the defining disaster around here today is that when I brought in the artificial Christmas tree from the storage shed it had become a mouse’s home.  This not only meant a certain amount of filth and contamination that placed this tree irreversibly below my wife’s limits for toleration, but also that the mice, doing what mice do had chewed through parts of the tree.  Since this is one of those trees that has the lights permanently affixed, there is a high degree of probability with a relatively low margin of error that the mice had chewed through one or more of the wires.

Somehow bringing this potential carrier of plague as well as a fire risk into the house is not an option.  At seven foot the risk is both large and near.

So both physically and philosophically I need to address the problem of the tree and go tomorrow to find a replacement.  On the other hand, the issues affecting North Korea are very far away.

From your perspective this may seem strange, but from mine it makes perfect sense.  Funny, isn’t it?

“There’s always an Arquillian Battle Cruiser, or a Corillian Death Ray, or an intergalactic plague that is about to wipe out all life on this miserable little planet, and the only way these people can get on with their happy lives is that they DO NOT KNOW ABOUT IT!”

~Kay in Men In Black

 Copyright 2010 SF Nowak All Rights Reserved

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Posted in Philosophy, Uncategorized

Thoughts on Jobhunting

Posted on November 26, 2010 | Leave a comment

“If opportunity doesn’t knock, build a door.”
                                                                                        ~ Milton Berle

 Although I’d love to be writing full-time, I traditionally have a day job.  Today, I’m semi-retired, sort of, kind of.  Much of my life has been spent in the world of healthcare, but for nearly 30 years I was also in the Navy Reserve.  In 2005 I was recalled to active duty and I guess I did something right so they kept me around.  The family ended up here, which was great, of course, and now that my time with the Navy is done I’m in job-hunt-mode.

Did I ever mention that I have a terrible sense of timing?

Job hunting is a story that is too long and too fraught with danger but which hopefully will have a happy ending.  Part of this is due to what I call the “Dichotomy of Self Experience.”  Everything needs a fancy title. 

On the one hand, as I adjust my resume for a particular prospect I need to focus on and point out all of the good stuff.  Why, out of all the candidates, I’m the one they should choose.  However I find it difficult to write “I’m great because…”  However, if this is what is required to catch a prospective employers’ attention there is no choice.  One trick I use is to pretend that I’m wearing my writer’s hat and being paid to write about someone else.  It seems easier to be more objective about other people.

On the other hand, I also need to be cognizant of anything that might raise a question with a prospective employer.  This requires a focus on all the areas in which I am less than perfect.  If looking for the good is difficult, looking for the warts is even less fun.

To make it more challenging, there’s a ballet to job hunting, and it’s necessary to keep in step.  In many companies the object is not to look through the resumes to find the best candidate, but to take a stack of resumes and reduce it to a manageable number.  The few that make it are then sent to next level. 

The first filter for the resumes is often done by a computer.  It is programmed to look for certain key words that match the job description.  Theoretically this helps find a good match.  Clever job hunters soon realized that computers could read things people can’t.  They look through the job description and highlight what they think are the key words, and type a list of them at the end of the resume.  Just change the font color to white and the font size to 1 and no human will notice.

Of course prospective employers can just set up the resume screening computer to “Select All” and change font size and color.  I’ve often wondered – do the people who have hidden key words get points for being creative, or lose points for being sneaky.  If someone knows, I’d love to hear from you.

If you make it past the computers, you then have to impress a human who only has a few minutes to devote to each resume.  Thank goodness I didn’t have to make a positive impression on my wife under the same criteria.  The best I can do is just be honest (which is doable) and succinct (which is much harder.)

Resume styles change just like fashion; hemlines are up, and chronological resumes are in style.  Hemlines are down, and something else is the preferred style.  Should you use special paper?  All these things change frequently and it’s a challenge keeping up.  Nevertheless it’s critical to use the format and parameters that are expected today.  I’ve heard career experts recommend a certain style and then seen comments from Human Resource folks saying why they hate that same style.

So the bottom line is that job hunting is one of those experiences that does not rate high on my fun-meter.  Maybe I’ll find something more interesting to write about tomorrow.

 “Choose a job you love, and you will never have to work a day in your life.”
                                                                                         ~ Confucius

Copyright 2010 SF Nowak All Rights Reserved

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Posted in Business, Uncategorized

Thoughts on Thanksgiving

Posted on November 25, 2010 | Leave a comment

“Thanksgiving dinners take eighteen hours to prepare.  They are consumed in twelve minutes.  Half-times take twelve minutes.  This is not coincidence.”  ~Erma Bombeck

Thanksgiving as a holiday is a wondrous event.  Into one day we are able to cram parades, welcome Santa Claus, line up for the start of the sprint called “Black Friday” and the marathon called “Shopping Days Before Christmas.”  Families may travel many miles in order to be together. Great efforts are undertaken to prepare a feast that exceeds anything else throughout the year.  After partaking of such a sumptuous repast our eyelids droop and we blame the tryptophan in the turkey for making us drowsy.  And then, of course there’s football.

Some of us may try to inject a more serious aspect into the holiday and focus on the first Thanksgiving.  Of course our perspective is a bit skewed such that a Norman Rockwell painting pales by comparison.  There are the Pilgrims, of course, somewhere up in New England with buckles on their hats, and Native Americans, and turkey.  They celebrated the harvest, white man and red man and families, together.  But beyond that, the historical facts seem a little vague (must be the tryptophan.)

I have not studied the first Thanksgiving in any great historical detail, but these were real people who had worked hard to try to scratch a living out of the soil.  They had not been dealt the best of hands.  If memory serves right, the Pilgrims left England planning on landing in Virginia, but were blown off course.  I’ve read that they built seven times more tombs than huts.  It would have been understandable if they were more in the mood for a pity party than to be thankful.  Maybe that’s what causes us to connect with them and this holiday. 

We all know the old saying that an optimist sees a glass as half full while a pessimist sees it as half empty.  In fact is they’re both right.  That’s what a realist sees.  But merely seeing something realistically means nothing without precipitating an action.

It was rough for the Pilgrims, but they had enough determination to succeed or literally die trying.  Their realistic assessment was that they were still alive and their settlement, while shaken, was progressing.  This was no mean feat.  Jamestown had failed; Roanoke flat out disappeared.  So far the Pilgrims were ahead of the curve.

But they neither felt sorry for what they had endured nor did they sit back and pat themselves on the back.  They would have had reasonable justification to take credit and pride in their hard work.  Instead, they made a conscious effort to count what they had as blessings and give thanks for them.  This was not the type of thanks that occurs after someone passes the salt.  Instead it was a heartfelt and enthusiastic outpouring of emotion and resolve.  I believe that by assessing their situation, acknowledging what they had and being thankful for it fed the desire to not only move to the next level but to succeed overall.  Perhaps it was the emotional equivalent of a rocket at the edge of space as it sheds its first stage and fires the engines of the second stage. 

So this Thanksgiving I am going to stop and focus on how grateful I am for what I have – for my faith, my family, my home and the fact that I can take food and warmth for granted.  Then I am going to work to improve myself in those areas and look for ways that I can share the blessings I have.

I wish every one of you a Happy Thanksgiving.  I hope that you can enjoy the day and the company of your loved ones. 

A special thank you to our men and women in uniform, especially those deployed.  DFAC (Dining Facility) food tastes like DFAC food even on Thanksgiving.  The difference is that today some dignitary will show up and take over what could have been a well-deserved day off.  Oooh-rah and Hooah, guys and gals.

 

“Not what we say about our blessings, but how we use them, is our true measure of our thanksgiving.”

                                                                   ~ W.T. Purkiser

Copyright 2010 SF Nowak All Rights Reserved

 
 W. T. Purkiser quotes

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Posted in Uncategorized

My Blog on Blogging

Posted on November 24, 2010 | Leave a comment

“The heart and soul of blogging is the individual and/or the group of individuals opining on the fly and responding post-haste to one and all.”

                                                                                                ~ Michael Conniff

 

Let’s talk about blogging while I’m still an inexperienced novice wandering through the medium.  It’s the blogging and not the writing that makes it different since I’ve actually written before.  In fact that story is probably worth telling.

Way back in the early days of personal computers, I had bought my first computer by mail.  It was actually a plastic bag of parts and a circuit board and when competed had a whopping (hold on, please) 256 BYTES (not kilobytes, megabytes or gigabytes, BYTES) of memory.  It was programmable in hexadecimal, and could be expanded to a whopping 8 kilobytes of memory, connected to a mechanical teletype and its programs saved on cassette tape.  There was a booklet available for this computer, back before there were many computer magazines or real personal computer books, and I was so impressed I wrote a thank you note to the author.  He suggested that if I really liked it, I should write a review and submit it to one of the three (3) computer magazines for publication.  I figured, what the heck, and did just that.

Seeing my name in print emboldened me, and about a year later, as the first computer magazines began to hit the mainstream (Dr. Dobbs Journal, Byte & Kilobaud) I wrote an article about how I had used a computer with my oldest daughter who is profoundly handicapped.  I figured that with a published article I had reached the zenith, but two things happened.  The first was I received (are you ready for this?) a form letter looking for books for the computer Book of the Month Club by Tab Books.  The mailing gave a list of possible topics, one of which was pocket computers.  Now this was before PDAs, BlackBerrys or such – in those days there were a few computers that could accept tiny programs written in BASIC (Beginners’ All-purpose Symbolic Instruction Code) that actually fit in a large pocket.  I expressed my interest, they accepted, we had a contract, and I found myself staring at a tremendously large stack of blank white paper.

I began to work on the book, albeit slowly.  I took the advance and bought a Squire (by Fender) electric guitar and practice amplifier.  The guitar gave me something to amuse and challenge me whenever I hit writers’ block.  In retrospect, I think I claimed writers’ block whenever possible.  I don’t know if this was due to a desire to learn to play the guitar or an adult version of wiaitng until the last minute to write a term paper.

During this same time my day job was managing a Radiology Department in a hospital.  One day I received a phone call from Rick Martinez who told me that he had heard I did some writing and would I be interested in writing for a new magazine called Administrative Radiology?  I wrote a serious article or two, and then, spurred on by this success I pushed to write a satire column based in a fictional hospital called “Pandemonium General.” 

Bottom line is I finished the book.  Several people bought it and I wrote both occasional serious articles and a monthly satire column for 18 years for “Administrative Radiology.”  Later, I also wrote a monthly column for “73, Amateur Radio Today.”

Now that I’ve dragged you through all that, the question remains, “How does this compare to blogging?”

So far, I’m not quite sure.  When writing for a published magazine I had an editor and he or she would make changes to help the article flow better.  As a blogger, it’s just you and me.  On the other hand, when I write something today, you read it today – not months later.  The other part that is very different is that when I wrote for the radiology journal, I knew it was healthcare managers to whom I should aim the article since they were the most likely readers.  Likewise for the ham radio magazine or the computer book.  With a blog, it’s an open door to everyone; I can either try to write to please everyone, or just write as I always have and hope the people who like that style stop by.  If I were a good enough writer to please everyone, I’d be writing exciting stories to be turned into blockbuster movies.  So I guess that means I’ll just write as well as I can and hope it’s thought provoking or entertaining.

The biggest appeal in deciding to blog was the chance to see people interact.  My hope is to plant a seed of thought and watch others help it grow.  It’s an opportunity to brainstorm with the whole world.  In traditional brainstorming, someone in the room throws out an idea.  Someone else may say, “That’s the dumbest thing I ever heard, but if you turned it this way, it would work.” It’s a positive experience for all involved and no one takes offense at having their idea changed.  My goal is to make this blog is like brainstorming – with a heck of a lot more participants..

Setting up the blog was far more intimidating in thought than in actuality.  Once I actually got started it fell into place fairly easily.  Having said that, I have no doubt that I’ve left pieces unattended that may come back and bite me later.  If so, I’ll be happy to share with anyone who’s interested.  In the meantime, I’m sure there’s a good laugh or two at  my expense coming up.

By blogging I’m looking for others who like to share thoughts and the thinking experience.  I know there are a whole lot of us who are looking for a place to share ideas.  Here’s the place.

“Writing is a socially acceptable form of schizophrenia.”

                                                                                                         ~E.L. Doctorow

Copyright 2010 SF Nowak All rights Reserved

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Posted in Blog, Uncategorized, Writing

The Hospital Business Model

Posted on November 23, 2010 | Leave a comment

“A hospital bed is  a parked taxi with the meter running.”

                                                                    – Groucho Marx

Most businesses, whether they provide products or services, operate along fairly similar lines.  The business determines that the market desires more of a product (and for this essay that will mean services as well) and has the means to pay for it.  The business then does what is necessary to provide such a product, lets potential customers know that the product is available (marketing); the product is priced in a manner that is acceptable to customers and so that it provides a profit for the business.  If after the transaction the customer is satisfied, efforts are focused on retaining that customer for future sales.  If the customer is not satisfied and the customer’s expectations were reasonable, the company tries to make things right (repair, replace or refund).  If the customer’s expectations were unreasonable, a refund will still probably occur, but the business probably writes off that customer.

Hospitals, on the other hand, operate on a completely different business model, and I propose that the business model is what has created many of the current problems and driven the desire to reform healthcare.

  1. Few people truly desire what a hospital has to offer. 
  2. When dealing with most businesses, the customer normally has reasonable information as to what the product will cost.  Hospitals, in most cases, cannot tell in advance what the price will be.
  3. In most business transactions the customer and the business negotiate what is being purchased.  In hospitals various other forces such as physicians and insurance companies impact these terms and conditions.
  4. In most businesses the customer pays for the product.  In healthcare a third party often pays for a significant part of the product.
  5. In most businesses if the customer is unhappy, the seller attempts to correct the problem at minimal or no charge to the customer.  If a mistake is made in a hospital it is common that the customer will be expected to bear the cost of correcting the mistake.

Let’s examine each of these in more detail. 

  1. Few of us want to be in a hospital for any reason.  There are exceptions such as those desiring cosmetic surgery and expectant mothers, but most of us prefer to avoid an encounter with the hospital.
  2. Hospitals charge for virtually every item, and horror stories of exorbitant charges for common products like aspirin or Band-Aids are common.  There are two issues; first, the hospital cannot predict exactly what will be consumed to address your medical requirements.  Almost all are determined by a physician, and physician practice is not standardized.  Two patients presenting with the same symptoms and different doctors may be treated by radically different methods.  One may be treated medically, another surgically.  Second, even if there is an attempt to standardize how physicians treat patients, each patient is different.  One patient may require more time in the operating room or may be allergic or nonresponsive to a certain drug when compared to another patient.  These can radically affect the treatment and therefore the price.
  3. Physicians are, in most cases, independent of the hospital.  Some of this may be changing under the current healthcare reform, but that is yet to be determined.  Some of this is intentional while some is caused by regulations intended to maintain checks and balances to protect patients and payors. Currently most physicians in private practice are accorded privileges to practice in a hospital by the Medical Staff.  The Medical Staff is similar to a corporate entity and is responsible for ensuring physicians are appropriately qualified to practice in that hospital.  While the Medical Staff normally reports to the same Board of Directors (or similar entity) as the Hospital Administrator, the physicians are not employed by the hospital.  However, in their practice at the hospital, they determine what procedures, treatments, medications, etc. the patient receives.   This can make it difficult for the hospital (which pays for the supplies and drugs) to control costs.

Insurance companies are also influential and can specify a formulary for pharmacy or certain vendors for other products.  If supplies or medications not within these parameters are used, the reimbursement may be at a lower level.  Some of these costs may be shifted to the patient.

  1. Insurance companies or other third-party payors such as a government agency in the case of Medicaid and Medicare have two other areas of influence.  The first is that there is cost shifting.  This means that a certain procedure, such as ultrasound exam, may be paid at a level well above its cost.  On the other hand certain very expensive services such as a Burn Unit or the Emergency Department may be paid well below costs.  The hospital has no choice but to rely on the payment for one type of service to offset the loss in others.  In other industries a company can close unprofitable product lines, but in healthcare this is not possible.  The second quirk is that third party payors have traditionally demanded discounts.  Over time the prices that hospitals publish have been adjusted to allow for a realistic reimbursement after providing such a discount.  Occasionally this leads to a bizarre and blatantly unfair situation.  Two people have a procedure – let’s use an MRI as an example.  One has insurance and the hospital has to complete paperwork and wait months for payment.  The other pays cash at the time of service and because there is no discount, may be charged significantly more (50 – 150%).  This makes little sense as the hospital does not have to incur the costs for submitting claims and incurs no carrying costs due to delayed payment.
  2. When a surgical case has a complication, and the patient returns, it has been common for the physicians involved in the correction and the hospital to charge for the corrective action.  Unlike taking a car back to the mechanic until the problem gets fixed, each encounter is billed separately.  Medicare has begun limiting those cases that qualify for a second payment, but this problem is not yet fixed.  In some instances it’s clear cut – say a surgical sponge or instrument was left in a patient and surgery is required to remove it.  However, a patient returning with the same symptoms could be experiencing a subsequent occurrence of a particular problem rather than suffering the result of an error.  We often find it difficult to accept that some diseases and conditions cannot be cured and repeat procedures are necessary.

There’s one other unintended consequence of this.  If a mistake is made and not corrected the patient has a valid reason to seek damages.  The practice of not     “making it right” may be a key contributor to the current level of malpractice lawsuits.

The key point is that the business model being used in healthcare is not sustainable.  A new model in which cause and effect or more closely tied is long overdue.  The healthcare industry operates under significant regulation imposed by bureaucracies at the federal, state, local and industry level.  These need to be streamlined while simultaneously maintaining the protections for patients. This will be difficult since bureaucracies were created to address problems and are loath to give up control lest that problem recur.

We need to admit that people need healthcare rather than want it.  We need to accept that healthcare is a unique industry.  Then we need to design a business model that provides a reasonable amount of care for a reasonable price.

 ”Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.” 
                                                                                             - Redd Foxx 

Copyright 2010 SF Nowak All rights reserved.

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Posted in Business, Healthcare, Uncategorized

Whose Taxes Should Be Raised?

Posted on November 22, 2010 | Leave a comment

 “The only difference between death and taxes is that death doesn’t get worse every time Congress meets.”

Will Rogers

Today’s topic is everyone’s favorite – TAXES.  With a new Congress on its way to Washington DC, there’s a lot of discussion about taxes, particularly about letting tax cuts enacted during President G.W. Bush’s administration expire.  The main point of dissension is whether the richest Americans should continue to enjoy reduced taxes.

There are two key issues here.  The first is how we perceive rich people.  From the end of the Second World War until about 2000 most middle class Americans seemed to identify to a certain extent with the rich.  There was a kinship based on “If I work hard, or invent something exciting, I too can be rich.”  It’s not that the middle class had a lot in common with the rich – we, the middle class just believed that the gulf between them and us was not insurmountable.  In recent years, though, the rich have seemed to accumulate wealth at a prodigious rate while the people who actually make products and provide services have been at status quo.

We no longer view ourselves as having much in common with the wealthy.  To rub salt in the wound, as the nation has suffered in the current economic crisis, the efforts to mitigate the financial crisis seem focused on helping the rich more than helping the rest of society.  Our perception of the rich has taken a decided downturn. 

The second issue is how the proposed increase in taxes for the rich would affect the overall economy.

If I were a rich person….

(Sorry I got distracted for a minute.  I’ll try to stay focused.)

If I were a rich person and my tax rate were low, what would I do with the money that did not go to pay taxes?  As I see it, there are only two choices.  I could spend it or I could invest it.

If I spent it, the store where I shopped would pay their wholesaler, their employees and their other expenses.  Even if the product were actually manufactured overseas, there would be Americans getting paid for unloading the ship, transporting it to the store, manning the cash register, etc.  Each of these Americans would then use that money to purchase what they needed, particularly food, utilities, etc. again involving other Americans in the chain. That would seem to be good for the economy.

If I didn’t spend it, what would I do with it? Let’s accept that most rich people don’t stuff large denomination bills into their mattresses.  A good, comfortable mattress is hard enough to find, so messing it up with lumpy currency would not make sense.  So, I’d invest it, of course, either through a bank or stocks and bonds, etc.  The money that I invested would then be available to businesses or individuals.  Businesses might use the money to expand their facilities, and individuals might be able to buy a car or maybe even (gasp) a house.  Once again, wouldn’t that help the economy recover?  I suppose you could use these as arguments to support keeping tax rates low for everyone regardless of income.

But this may not be just about tax rates.  Instead it might be about more fundamental issues, such as Americans’ basic expectation of fairness.  I sense that the middle class is subliminally dealing with a more fundamental issue than taxes, and the wealthy appear to be oblivious.

The middle class has continued to believe that the common good is critically important.  On the other hand, there have been egregious examples of the wealthiest Americans putting themselves above the common good.   I personally find no way to justify a company being so at risk that they need a government loan just to survive turning around and paying employees exorbitant bonuses.  I find it even harder to accept that an executive who is fired for nearly destroying a company is paid more money in severance than I and all my neighbors combined will see in our lifetimes. 

Since I provided some arguments to permit the wealthy to continue to enjoy reduced taxes, I offer the following marketing campaign to support increasing taxes on the wealthiest Americans. 

“None of us want to raise taxes on anyone.  However, while most of us have suffered through this downturn in the economy, others have prospered.  Among those who have prospered are those worked for the very companies that we, the taxpayers propped up.  If we return the tax to its previous rate – not increase it, just return it to where it was – it would ensure that the Wall Street and Mortgage Bankers, the Investment Wizards and the Corporate Executives who ruined our economy and received government bailouts will have to pay taxes on their multimillions in bonuses and severance packages.”

I think that just might play well with many people.

“The only difference between a tax man and a taxidermist is that the taxidermist leaves the skin.”

Mark Twain

Copyright 2010 S.F.  Nowak, All rights reserved

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Posted in Government, Taxes, Uncategorized, Wealthy

And the Winner Is…

Posted on November 21, 2010 | 2 Comments

“They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.”
- Attributed to Ben Franklin

There are a number of large, ugly and political topics in the news today. They are ugly, of course, because they are political, and because they are political they will be surrounded with rhetoric reduced to sound bites, and a lot of good old fashioned blithering.
One of these topics is the current situation with regard to the Transportation Security Administration and its enhanced inspections by either an imaging device or a thorough frisking by a TSA agent.
First, some of the factual issues. There are two types of enhanced imaging devices being deployed. Both produce an image that is essentially an electronic strip search. The more graphic type of imaging device uses low dose radiation and relies on backscatter. According to the TSA, this has been “deemed safe.” In my younger days I worked in medical radiology and know that many of the earliest medical practitioners suffered bad effects because the devices they used were assumed to be safe, but were not. Some of this was based on calculations that predicted a “maximum allowable dose” of radiation. This was when dealing with radiation was in its infancy so they made a guess and based the allowable dose on a fraction of the amount that would cause to turn skin red (erythema). It was later determined that this dose was way too high to be safe (but notice they called it allowable – not “safe”).
Sometimes things are deemed allowable or safe because we don’t know how the story ends – it’s only after years of experience with an entity that we are able to decide whether it’s safe or not. Early Radiologists, the physicians who specialize in radiology were the ones who inadvertently became the test subjects. As they got older, some radiologists lost fingers to cancer; I still remember one radiologist with whom I worked who, when chatting, would pull out his pocket knife and calmly whittle lesions off his hands. These ill effects were attributed to the Radiologists placing their hands into the x-ray field during fluoroscopy to manipulate a patient’s position. Fluoroscopy uses an x-ray beam to produce a live image on a screen, and early fluoroscopic units used many times higher amounts of x-radiation than would be allowed today. Educated professionals utilizing the data and scientific techniques available at the time did not believe there was significant risk.
One key factor about radiation exposure is that it is cumulative. Your body can be affected more or less by the sum of all the radiation you receive throughout your life.
The TSA scanners utilize back-scatter. Now I know just enough physics to be dangerous, but I was always taught that x-radiation cannot be reflected. It can pass through an object or it can be absorbed. Sometimes it is almost a combination of the two due to a principle called Compton’s effect. When ionizing radiation interacts with matter, it gives up some of its energy to the matter which results in a change of direction of the x-ray travel. The direction of change is more or less random and called secondary radiation or scatter. If the scatter has sufficient energy, when it interacts with other matter the process is repeated. Back scatter is the scatter that travels more or less in the direction from which the x-ray beam originated.
In the backscatter imaging devices it would appear that some amount of ionizing energy is interacting with the matter (i.e. the airline passenger). At the very least this cannot be expected to have an overall positive effect on these passengers, and may be detrimental.
The media have reported about intelligence sources in Saudi Arabia or Yemen who have identified terrorist efforts, and sometimes the terrorists themselves. Fortunately this has halted some terrorist efforts in the early stages. On the other hand, I’m not aware of terrorist efforts that have been foiled the TSA. While enforcement agencies do not like to tip their hand when they figure out what the bad guys are doing, things do leak out. One might expect a few strategic leaks about the TSA’s successes particularly while this issue is in the headlines.
Now to the philosophical aspects.
First, the TSA agents at the gate get their marching orders from the hierarchy of a government bureaucracy, so the poor schmuck at the checkpoint doesn’t have a lot of choice. Give the economy, would you make waves and possibly lose a steady paycheck, excellent benefits and a promising retirement? So let’s all agree that the front line TSA grunts are probably just as thrilled with this as travelers are.
And now the second and more important key philosophical point, which will involve some role playing. Let’s pretend that you and I are terrorists and that we hate America. Imagine us having this conversation.
Me: “We’ve attacked and destroyed their building yet the Americans have only become stronger. How can we possibly win against these people?”
You (and notice that I gave you all the good lines): “We develop a plan so that every American makes a complete fool of himself. Let’s make them so frightened that they WILLINGLY let the government take naked pictures of them and frisk them like common criminals. If we can make them grovel to such a pathetic level, we have surely won!”
Is it game, match and point for the bad guys? You tell me.

Copyright 2010 S.F. Nowak all rights reserved

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Posted in the Terrorists and you, TSA, Uncategorized

You’ve Got Mail

Posted on November 19, 2010 | Leave a comment

You’ve Got Mail

“We get letters, lots of letters, we get lots and lots of letters” 

                                            - Song from the Perry Como Show

Like most Americans, every day I follow the afternoon ritual and head out to the mailbox to see what treasures might lie therein.  Now, I’m old enough so that I remember when the mail was the primary means for communicating; the only readily available electronic media were telephone and telegraph, and their use was reserved for such events as a death in the family. 

But the daily mail was something special.  There were the great magazines such as Life & Look not to mention the Saturday Evening Post which traced its lineage back to Benjamin Franklin.  However, as a kid I lived for any package postmarked Battle Creek, Michigan.  Two box tops and 25 cents sent to a PO Box in that magic city would eventually yield a plastic treasure that I’d love for at least two days.  Letters were the norm in the mailbox, of course, with news from and about family and friends and everyone else who lived more than 15 miles away. 

There was “junk mail” back then, too, but we didn’t view it as such.  Catalogs came out infrequently and were such things as the Sears Christmas Toy Catalog.  When Thanksgiving approached, we began to look forward to it, and when it finally arrived it was immediately grabbed and passed among siblings until the pages fell out.  As a geek (before geeks were cool) I also loved the electronics catalogs from Allied, Lafayette, Heathkit & Olsen Electronics which stirred the imagination so that I dreamed of the things I could build.  These advertisements were not only welcomed, but they often took priority over the regular correspondence. 

It was a different time. 

The Post Office was a government service and the price for mailing items was set in a manner so that a letter to East Elbow, Iowa cost the same as one sent to a neighbor.  The philosophy was that every US citizen should have access to a postal system at a reasonable price. 

I guess you could say it was a simpler time.

Several things happened between then and now.  The Post Office became the US Postal Service, a pseudo-corporation with the expectation that it should be run like a business, efficiently as well as effectively.  Letters that cost 4 cents to mail escalated in price to a nickel, then double digits until it got to the point that many stamps had no value printed on them, just in case a rate increase was allowed – or not.  Alternatives such as FedEx began to appear which promised delivery by the following day, followed by the ultimate alternative, e-mail.

Apparently, the US Postal Service decided that personal correspondence was no longer going to support their operation.  The mail carrier still had to cover the entire route 6 days a week, so much of the expense of operating the postal service was a sunk cost – it would occur no matter what the Postal Service did.  The USPS decision was to focus on business customers, particularly in the area of advertising.  In other words, junk mail.  Since the letter carrier was coming to my (and your) mailbox anyway, they might as well encourage advertisers to use the Postal Service by offering cheap delivery of their advertisements.  They figured that if the business users pre-sorted everything by zip code and the pieces didn’t need to be canceled, the post office labor costs would be very low.

Now, in fairness, most business plans look different looking forward than they do looking back, so let’s give the Postal Service the benefit of the doubt.  However, these days, if my mailbox is any indication the majority of my weekly mail is junk mail.  Each day I dutifully go to the mailbox and retrieve its contents, sort it and drop most of it straight into the recycling bin.  One day I happened to be thinking about an argument I had heard on the radio about global warming.  I wondered, “If global warming is due to the carbon released by using fossil fuels – how much carbon is produced in our daily dose of junk mail?”  My perception, although I have never attempted to calculate it, is that it has to be significant.

Trees are cut and transported to the paper mill utilizing fossil fuels.  The wood is processed into paper.  The paper is then transported to a printing facility (as well as ink and other supplies.)  The printer utilizes energy to print and collate the materials and probably addresses and sorts the printed material.  This is then transported by fossil fuel using vehicles to the nearest post office, which delivers the materials to the neighborhood post office, and from there to each home.

If most of us then drop the material into the recycling, or worse, into the trash,  a truck then carries this material away to the recycling center or landfill.  The proverbial light bulb went off in my head.  How much of the carbon believed to contribute to global warming* could be eliminated by doing away with junk mail?  By encouraging junk mail is the US Government a major contributor to carbon emissions?  If so, could we take a major step toward correcting carbon emissions by eliminating the preferential pricing for junk mail?

Considering that most days the mail contains nothing, or almost nothing of value, I would have to say if the Postal Service eliminated junk mail I would be willing to accept some changes as well.  Here’s the  deal – I already receive most on my bills electronically (and pay them on-line as well) so I would be willing to have the postal service deliver my letters, cards, magazines and eBay packages on Monday, Wednesdays and Fridays.

Oh, and if I can get a Federal grant, I’ll figure out how to calculate the carbon savings and sell the carbon credits at a discount to some of our struggling manufacturers.  Maybe this way we’ll be able to get some of our jobs back from overseas.

* Regardless of your views on global warming, fouling one’s own nest never makes sense.

“Everybody talks about the weather, but nobody does anything about it.”
                         -attributed to Mark Twain

Copyright 2010 S.F. Nowak all rights reserved

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Posted in Solving Global Warming, Uncategorized

Sharing Thoughts

Posted on November 18, 2010 | 1 Comment

Sharing Thoughts

 

“Great minds discuss ideas; Average minds discuss events; Small minds discuss people”

 – Eleanor Roosevelt

In today’s society one need only turn on the television, pick up a magazine or check out the internet in order to see what’s being discussed about people and events.  I have caught myself madly surfing through 500 cable channels or desperately Googling the web in order to find something – anything – to interest me.  This often ends in frustration.

So, how do I find things that interest me?   I decided to explore ways to encourage the discussion of ideas.  I want to challenge myself and invite others into the discussion.  This type of interaction is a normal human function, whether carried out around the caveman’s campfire or in the public house.  Unfortunately, in our fast paced world, we often can’t fit this in.

Perhaps this is because as we specialized, our culture assigned this task to those in academia.  However, society has changed the fundamental role of educators  Some say that it changed from teaching people how to think, to teaching them what to think.  This was not done out of malice, but rather as an attempt to fix problems with the system.  After all, when people graduate from high school without the ability to read their diplomas, something is wrong.   Now we have methods in place that attempt to determine if the students in our school system have achieved the education we expect them to achieve.  While a great and noble concept, it begs the question, “And just how do you do that?”  The best we could come up with is to provide standardized tests comparing one student to the others.  On the surface, or perhaps I should say before actually implementing this it seemed logical and achievable, but there are problems.

The only way to standardize tests is to ask each student the same questions and compare their answers.  The easiest way to do this is to teach specifics to the students and then ask those students to regurgitate those statements.  For example:

Global warming is caused by what?

a)      Man releasing carbon into the atmosphere

b)      Changes in the levels of solar thermal energy reaching the earth

c)       Natural cycles of heating and cooling

d)      Various theories exist, but none have been proven

 

Depending upon who is grading this question, one of the choices will be deemed correct and the student who chooses the correct answer will be deemed to have satisfactorily learned the material.  Multiple choice and true and false questions allow for a digital view of education – two states, right or wrong. 

On the other hand, a question phrased as:

How can climate change be evaluated in a manner which predicts future climate with at least 70% accuracy?

Requires both knowledge and thought on the part of the individual answering the question, and the person determining whether the response is appropriate or not.  This is most definitely not as easy. 

However, in the giant scheme of things, wouldn’t it be more productive to not only teach about an issue such as global warming, but also plant the seeds for people to begin thinking about the issue with an open mind?  I suspect that a simple, obvious response to global climate issues will be just as effective as the simple, obvious standardized testing was to education.

So, like Don Quixote I’ve donned my armor and am off to joust with the windmill dragons by starting this.  A few guidelines, if you please:

  1. This is a forum for intelligent people.  I believe that intelligent people choose to comport themselves in an appropriate manner.
  2. I’ll write about whatever catches my interest on a particular day.  No doubt that means that some days you’ll be disappointed.  Hopefully on other days I’ll make up for it.
  3. On any given topic, the person with the best idea wins.

“This may be the beginning of a beautiful friendship.”

-          Rick Blaine in ‘Casablanca’

Copyright 2010 S.F. Nowak all rights reserved

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Posted in Philosophy, Uncategorized