Data Security: Can It Be Politically Correct?

The relationship between data security and its degree of political correctness probably seems a little curious.  However, that relationship may be critical to seriously reducing hacking, viruses and other negative aspects of an insecure data network environment.

As I read, too often, about hackers, cyber-warfare and digital vandalism, I am reminded of the emperor’s new clothes:  surely some small child will eventually exclaim, “He has no clothes!”  But, alas, no child has yet noticed, and we go on, day by day, each of us praying silently that it is not our turn to be the winner of Shirley Jackson’s Lottery.

This passive attitude is not new in human history.  Before modern science and the invention of vaccines, prayer was the only action we could take to prevent contracting the plague, smallpox or other deadly diseases.  There is undoubtedly a very long list of large and small disasters which we simply accepted for years as unavoidable.  So waiting for an inevitable encounter with the hacker trolls isn’t new, from a historical perspective.

Surely there must be a better way!

SECURITY 101

We know a lot more about data security principles and practices than might be guessed from observing present circumstances.  We know that we have to consider physical, technical and procedural measures.  Physical includes tangible things such as padlocks, strong doors and the like.  Technical includes alarm systems, computer hardware and software features, cryptography, and so forth.  Procedural involves passwords (changed often), regular audits of the locked doors and the hardware / software safeguards, backing up of data off-site, etc.  When the physical, technical and procedural measures work together the way they’re supposed to, the bad guys have to work much harder.

Computer hardware and software is at the front line of data security. The computer processors must include instructions for protecting memory (both store and fetch operations) and for protecting access to the small number of powerful privileged instructions, which are designed for use by only the operating system or control program.  The Intel architecture design (and its “me-too” competitors) used for a very large number of small computer processors today incorporates essential security features, as does every (or almost every) large and small computer processor available today.

But if genuine security is as simple as it seems, why are we still vulnerable?   If you don’t physically engage the lock on your door, the quality of the lock and strength of the door are moot.  If a bank should decide that an existing greenhouse could be the vault for its new branch location, you might wonder if enough add-ons could ever make that vault secure.  If the computer operating systems or control programs do not fully utilize the built-in security features of the processors, how could we expect secure networks and systems?

How did we arrive at what seems such an indefensible position? Two curious facts from the paradigm shift represented by the change from steam locomotives to diesel electric locomotives give us a clue.   None of the companies which developed and produced the diesel electrics had ever been in the locomotive business; and none of the companies which produced steam locomotives ever started producing diesel electric locomotives.

DATA SECURITY LORE AND HISTORY

The large mainframe computers, which preceded microcomputers, had (and still have today) very stable, reliable and secure operating systems and networks.  Unfortunately for all of us, little of that existing body of security knowledge, architecture and experience crossed the gap into the world of personal computers.

Way back when, AT&T’s Bell Labs and Western Electric divisions were the preeminent designers and manufacturers of telephone switching computers.  To help streamline the integration of rapidly-arriving new solid state electronics technology into communications switching computers, Bell Labs computer scientists developed the C programming language to help speed up the programming (as contrasted with low-level assembly language).  A related follow-on was the control program, Unix.  Because the world of telephone-switching computers was absolutely internal to the AT&T network and the Bell Telephone companies, the Unix software architecture design did not include the robust features now considered necessary for security.

A good corporate citizen, Bell Labs provided the source code for Unix essentially free to colleges all over the U. S.  Therefore, to most computer science students the Unix design was their familiar model—security deficiencies and all.  As an expected follow-on, Unix-like control programs became the norm for the growing population of small computers and the microcomputers we call “personal computers” today.

Another unfortunate (for security, that is) aspect of computer networking was the design criteria for the U. S. Department of Defense’s Advanced Research Projects Administration Network, ARPANET.  The intent of this network was to facilitate communications between the scientists who were working worldwide on DOD unclassified projects.  Because these projects were pure research (not applied research) and therefore unclassified, the decision was made to dispense with the hassle of normal DOD security precautions.  Because only accredited scientists working on existing contracts were provided with network connections, there was very little fear of mischief making.

But a funny thing happened on the way to network:  ARPANET became the basis for what we now call the Internet.  Adding the essential security  to a wide-open network has been somewhat analogous to adding security to the original non-secure Unix control program.

MORE LORE THAN HISTORY

From this point, we phase into more lore than history.  What we know is the result of informal conversations with individuals who worked in the various computer and communications disciplines during the extremely rapid growth of personal computing and networking.  In short, this information is comprised of leaks, inadvertent or intentional, by the principals involved.

Personal computers were being sold several years before International Business Machines finally developed a general personal computer product.  But there is no argument that IBM’s entry into the general personal computing arena was what really accelerated the phenomenal growth of the PC, its associated support businesses, and the Internet.

IBM had actually been successfully building and selling personal computers for some number of years to the scientific and engineering niche market (what we might call “engineering workstations” today).  Other divisions of IBM also had extensive experience in microprocessor design, manufacture and programming.  However, this wealth of expertise and experience unfortunately caused, or contributed to, decision paralysis:  which division should be assigned the new general personal computer project?  Failing to make a real decision, IBM formed a small independent business unit to create the PC product.

It’s easy to be a Monday morning quarterback, and there were a number of questionable decisions made by this independent business unit.  Two of those were significant in setting the path to the insecure data environment in which we find ourselves today.  First, the business unit chose a microprocessor supplier that didn’t really have a product that met the unit’s requirements; second, the business unit made a microprocessor control program supplier decision, which even today seems bizarre.  The hardware manufacturer subsequently worked diligently to improve its product, and it has little or no security shortcomings today.  Unfortunately, it does not appear that the same can be said of the control program supplier.

DATA SECURITY GOING FORWARD

The Wham-O¹ marketing strategy has proven to be very successful.  However, the use of that strategy for computer control programs and software does not appear to have good results for consumers and users of that software.  We all want new bells and whistles (“the sizzle sells the steak”) but most of us, given a choice, would put reliability, maintainability and security way ahead of new features.

But we have not been given that choice.  Insiders tell us that an essentially complete redesign (and recoding) would be required in order to have architected, built-in, state-of-the-art security features in the Unix-like microprocessor control programs or operating systems used in small computers today.  Those insiders also tell us that such an extreme redesign would be quite expensive and that there is no business case for such a project today.

POLITICAL CORRECTNESS TO THE RESCUE!

One thing many of us observed over the past twenty or thirty years  is the power of political correctness.  Once an idea, a concept, or even a food item is accepted as politically correct, we can count on forty percent of our population to support it—irrespective of its degree of rationality or absurdity.  So our challenge is to convince a critical mass of citizens that secure computers and secure data networks are politically correct.

During the last few years of apartheid in South Africa many of us refused to buy South African products or invest in South African companies.  This was the politically correct thing to do; and we have numerous other examples of shunning companies and products which were not politically correct.

Surely if the word gets out, a number of us (possibly including the occasional enlightened government organization) will refuse to purchase computers of any type that are loaded with Microsoft Windows (or other Microsoft control program) until Microsoft produces a control program / operating system that is as secure as IBM’s “MVS Server Family” of operating systems.  (This is not a promotion for IBM’s software; it’s just that MVS is a good basis for security comparison).

Bill Gates is widely admired for his political correctness and for his philanthropy that supports politically correct endeavors.  If buyers avoid the Windows control program because of its lack of robust security, perhaps Mr. Gates will get the message that data insecurity is definitely not politically correct. I would hope that he then might use his still-important influence to convince Microsoft executive management that a secure operating system could indeed be a profitable project.

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¹The Wham-O Company is an admired and successful west coast company which has brought us, among other blockbuster products, the Hula Hoop and the Frisbee.  The Wham-O strategy has been to roll out an attractive product quickly, grab as much market share as possible, and utilize intensive marketing as the inevitable copycat products of competitors start arriving in the retail supply conduits.  It is likely that many companies have studied Wham-O’s techniques and adopted them for their own products.

Health Care Done Right

I wish our government could do a few things as well as Kentucky Fried Chicken does chicken (and biscuits, for that matter).  My qualifications for judging fried chicken are sparse, but genuine:  I grew up in the south, eating my grandmother’s fried chicken.  Recognizing the difficulties of doing things on the monumental scale that KFC does, I really believe they do chicken right.

It’s too bad the government can’t learn a little bit from KFC.  Government does a small number of highly focused things effectively.  At the local government level, fire and police protection is mostly adequate to excellent; at the national level, the military has kept us intact as a country for over 230 years.  But by and large, government does almost nothing well.

When it comes to health care, government has performed up to its mediocre-to-unacceptable reputation:  expensive, tons of bureaucratic details, unable to effectively combat overuse and fraud, etc.  The next chapter in health care, the so-called Health Care Reform (actually, a gratuitous solution to an undefined problem), is being mindlessly rushed toward becoming the Mother of all Government Disasters.  But its spectacular failure won’t be for lack of funding:  how about eight to sixteen times that of the Department of Defense?

We might imagine how Colonel Sanders, and the management teams of the subsequent KFC owners, would approach the task of making health care affordable, accessible and effective.  First, they would make sure they know what the goal is.  This sounds overly simple, but has anyone heard a single elected or appointed government official state a real goal, or endpoint, of health care reform?  The only defensible real goal (as yet not mentioned by Obama, Pelosi or Reid) is healthy Americans, substantially healthier than they are today!

We are not going to go from our current state of health to being as healthy as we can be in a short time.  It will take at least two generations; but we would be consistently improving all along the way!

First, we need to implement an ongoing healthy living initiative with the goal of assuring that everyone has the opportunity to learn all of the practical information that we have accumulated to date about health maintenance and disease prevention.  This initiative, involving public schools and universities, government health agencies, and private organizations from the health care community, can be implemented and maintained indefinitely for what amounts to pocket change, compared to the cost estimates for the currently envisioned “health care reform”.

A world-class, full-court-press health initiative can, on its own, significantly reduce health care costs as more and more Americans take heed.  This effort, unlike any of the “health care reforms” proposed to date, starts accruing health benefits and health care cost savings from day one.  This initiative is also essential to the long-term success of any genuine health care reform.

Second, the current health care system must be documented and defined, including its strong points, deficiencies and everything in between.  For example, medical schools failed to ramp up for an impending shortage of doctors:  why did that happen, and what are ways to prevent a recurrence?  This systems analysis will be a large and costly project, involving operations research problem-solvers, systems analysts, and experts from every public and private area of health care.  It would, of course, be broken down into multiple sub-projects in order to keep each segment within manageable size.   While this effort will be costly (although nowhere near the sums politicians are proposing for “reform”), it is the critical first step if we are going to have health care that is effective, accessible, and affordable by our families and by our country.  The health care system  analysis also provides the information necessary to make truly informed decisions on public sector / private sector responsibilities and authorities.

This approach has several advantages. Improvements can be recommended, approved and implemented as the various segments are completed. It would be expected that some elements could be started independently, while others will need to be coordinated with related segments.  Projected costs of the individual recommendations will be much more accurate than would have been possible with one giant “health care reform” unknown.

Third, we must eventually get around to open, honest and thorough discussion and debate of “entitlements”.  One entitlement, Social Security, is by far the largest item in the federal budget.  Another, Medicare, is the second largest item in the budget, far more expensive than the much-maligned Department of Defense (the fourth largest budget item, behind number three, Interest on the National Debt).  Unsustainable cost is the most immediate and most obvious concern about entitlements; but you will presently see the real problem that entitlement creates for effective health care.

Our Social Security program works exactly like the scheme Bernard Madoff pulled off; Social Security is also headed for the same collapse as Mr. Madoff’s little $65 billion, tragic fiasco.  Medicare, which was originally projected to reach a $15 billion per year cost by its 15^th year; actually reached that level by its third year, and the government has been scrambling ever since to try to keep it under control (by reducing provider reimbursements, thereby effectively rationing health care).  Also, the government has been unable to root out the intractable twenty-plus percent of fraud and waste from the Medicare and Medicaid programs.

The critical “entitlement” questions that need to be asked, studied, and debated are (1) “What is the obligation of each individual citizen?” and (2) “What is then the obligation of the government?”

Although cost, or cost-versus-worth, is the concern usually debated, the most serious entitlement problem is rarely, if ever, mentioned.  Most people are familiar with Descartes’ “I think, therefore I exist” (cogito ergo sum).  But in our entitlement era it has become “I exist, therefore I deserve”.  We can, and do, endlessly debate all the moral aspects of entitlements.  But the one thing we forget to ask is:  does our entitlement mindset actually create a barrier to accomplishing the intended benevolent result?

In the case of health care, “entitlement” creates the illusion that absolutely nothing is required of the individual.  But I seriously doubt that a single medical professional can be found who would agree that an ignorant, uncommunicative, uncooperative patient could truly benefit from his or her health care—irrespective of cost or accessibility.  While we have heard the word “accountability” in almost every utterance by the politicians in power, they are nonetheless extremely reluctant to ask individuals to take a serious interest in their own health.  It appears that the vote-attracting potential of entitlements precludes the advocating of personal responsibility, and it therefore also makes healthy Americans an unattainable goal.

Given the choice, I would prefer Kentucky Fried Chicken for my primary health care over any form of  “universal health care” that the political powers have proposed.  An added bonus might be a drumstick and a biscuit with honey at each doctor’s appointment.

Comrade Obama Debuts, President Obama Fades; Chairman Barak’s Little Red Book To Follow

Our pragmatist President dampened his deep-seated ideology for as long as necessary, or possibly as long as he could stand it.  Today President Obama’s ideology trumps his pragmatism and is completely unfettered.   The President’s proposed Fiscal Year 2010 budget reveals the Marxist initiatives that he reasonably believes the predominantly free-lunch Congress will readily accept.  Now there is freedom for  Hollywood socialists to celebrate, the Reverend Wright to smile again, and Black Liberation Theology believers to feel vindicated.  The rest of us now get to learn just how large the free-lunch fraction of our electorate is.

We have elected an intelligent, charismatic and well-educated man to lead the United States of America.  But it does not appear that he took any hard science courses, like physics or calculus, where the correct answers are not determined by opinion polls, ambiguous semantics or legal interpretations.

President Obama apparently believes that wealth just exists, like matter.  He must remember from grade-school science that matter can neither be created nor destroyed; it can only be transformed between phases.  Therefore, because wealth just exists and cannot be created, the President is poised to transform wealth from places he believes it should not exist, to places where he prefers for it to be.  We will not be surprised to hear the President tell us, “It’s just a simple matter of physics”.

As many predicted, the President’s idea of “Health Care Reform” turns out not to be any meaningful reform that would result in more effective health care delivery,  more efficient use of health care resources, or result in more healthy Americans.  In Obama semantics, “Health Care Reform” means only government-subsidized, government-regulated health care. There is no hint of actually defining the current health care system and its problems, no suggestion of  any healthy living initiatives, and no mention of health maintenance and disease prevention.

One hyper-expensive initiative, an education entitlement from birth through university (and law school?), does offer an intriguing bit of hope.  Much credible evidence indicates that our educational deficiencies are not caused so much by lack of affordability as by lack of believability.   A large percentage of parents, and consequently most of their children, simply do not believe in the value of education.   Over the last five decades very little progress has been made in opening the minds of these parents and students to the potential value or necessity of education in our world today.  Assuming there is some way to pay for the education entitlement,  it might have a beneficial effect of taking away the financial excuse commonly touted as the reason for our widespread ignorance.  Perhaps then the opinion leaders of the various communities within the U. S. might feel some obligation to encourage their constituents to believe that education is now  not only politically correct, but also necessary and valuable to them.

That tiny bit of hope buried in the education area of the FY 2010 budget may also lead our president to perform a personal education initiative for all of us.  There is precedent for a leader of millions to compile the rules for his subjects in a small book, preferably with red binding.   Although it might commonly be called “Chairman Barak’s Little Red Book,” with today’s technology it would likely be available online as well as in print.

The vast majority of us have never seen such a book, much less been able to read one.  But we might imagine the tone of its contents:

• “A spirit of cooperation is necessary; dissent will not be tolerated”.
• “You have a right to everything your government wants to give you”.
• “Read budgets line-by-line and expunge all waste and frivolous spending not favored by your Leader”.
• “Remember that those who have more than you are your enemy”.
• And so forth. . .

In the spirit of cooperation, all thinking Americans should send President Obama their favorite aphorisms as idea stimulaters for “Chairman Barak’s Little Red Book”.

Hugo Chavez: Eclipsed By Protege?

Hugo Chavez has made significant progress, in ten years moving Venezuela much of the way toward his vision of a perfectly-governed country.  But one of his proteges has made even faster progress in only a few weeks.  Could it be that Hugo has stimulated a bit of competition with one of his admirers?

In a previous post, “Political Change:  The Hugo Chavez Model”, I identified the three-step program that Hugo Chavez is implementing in Venezuela. I noted that his Step 2 had run into a temporary roadblock, although his Step 3 was being rolled out at a rapid pace.   As I predicted, Chavez came right back, better-prepared to make Step 2 happen; with his recent victory at the polls he is 85% of the way.  Presidential term limits have been voted out, and Hugo’s Step 2 goal of Presidente For Life is within sight.

Chavez has proven he is smart, ruthless and tenacious; and he is totally consumed with two major goals.  The first is to transform Venezuela into a classic Soviet-style Marxist / Leninist dictatorship.  The second is to transform his entire continent into the Union of South American Socialist Republics, with Venezuela as its controlling center.  His progress is accelerating.

But his protege has also proven to be very smart, devious, and capable of using the ruthless elected politicians as well as the shady characters in his administration.  Barak Obama has utilized political muscle and sheer personality to leverage the United States to the threshold of European-style Socialism in less than a month.  The government is presently engaged in nationalizing U. S. banks, just as Karl Marx prescribed in “Das Kapital”.  Fannie Mae and Freddie Mac are back to 100% government enterprises, and General Motors and Ford are getting their government marching orders.  Other efforts are under way to transfer management authority in private businesses to the federal government.

In addition, Obama has laid the foundation for his own Presidente For Life plan by the simple step of moving control of the U. S. Census into the White House.  Now his political party is within grasp of indefinite control, although Obama’s personal indefinite control will require a little more effort.

Barak Obama’s true beliefs and goals are unknown (except possibly to a very small circle of trustworthy confidants).  Hugo Chavez has always been more open about his plans, more so than even Adolph Hitler was in “Mein Kampf”.  But Obama keeps his cards close to the vest.  He talks a lot, but he says almost nothing.  Therefore we are limited to observing recurring themes from his writings and speeches and to watching his political appointments and official actions.

One clue to Obama’s true beliefs may lie in his twenty years as a member of a church immersed in Black Liberation Theology, which is heavily-laced with Marxism.  Then we notice the recurring themes in his communications tend to incite class envy and to convince American workers that they are downtrodden.  In fact, most of his campaign speeches sound like extracts from Engels and Marx in “The Communist Manifesto”, wrapped up in idiomatically up-to-date, politically-correct adjectives.  Please note that this is not an accusation of plagiarism; it’s just an observation of the “look and feel” similarity.

Obama’s cabinet nominations, for the most part, can pass a Marxist credentials threshold test (his Secretary of Labor candidate seems especially strong in this regard).

It is therefore not unreasonable to deduce that Barak Obama’s least ambition is to turn the United States into a  European-style Socialist state,  like many of the U. N. member countries.  This would be in keeping with the Democratic Party outlook (except for that brief period during the Cold War when Socialism / Communism was not considered politically correct).  How far beyond European-style Socialism Obama intends to move the U. S. remains unfathomable.

That leads us to wonder if Hugo Chavez has considered the implications of his protege’s parallel progress.  The value of the United States as a villain and object for fear-mongering cannot be over-estimated; it has been Hugo’s best tool.  How well will it work with Venezuela’s lower classes when they figure out that North America is now completely socialist—from Canada, through the U. S., to Mexico?  What will happen when Venezuelans also notice that the workers’ paradises of  North America at present look a lot better than that of Hugo Chavez?

How will Hugo take it if some of his fellow Latin American dictators find a better star to follow, one in the hated Estados Unidos de Norteamerica?  But, worse, what if Barak Obama sees himself as the emerging Josef Stalin of the Union of North and South American Socialist States?  Hugo Chavez may want to seek psychiatric help right away, just in case.

Forget Health Care Reform!

In its scramble to pass as much federal legislation as fast as possible, Congress should completely ignore health care reform.  One reason, totally unrelated to the subject, is that hastily-conceived bills, rushed through at riot speed, provide an opportunity for the more devious members of congress to engage in very expensive targeted pork production.  One of my favorite examples, in the emergency economic stimulus bill, is funding for a high-speed train to carry gamblers between Los Angeles and Las Vegas.  Gambling is, of course, economically important to Las Vegas and Nevada; but few people outside of the Nevada congressional delegation believe that this should be addressed in a national emergency stimulus bill.

Besides congressional mischief, which is just a fact of life, there are at least four critical reasons why health care reform should not be addressed before the essential groundwork for it has been laid.

First, from what we see in the media on a daily basis it is apparent that the phrase  “Health Care Reform” is almost universally interpreted as a single-payer health care system.  Many envision a single-payer (U. S. Government) system  as a Medicare-like national health insurance program.  Others envision the single-payer system as a national health service like those of Canada or Great Britain.

But the requirement for a single-payer system, either insurance or actual health care delivery, is not the issue.  The real problem is that this “forgone conclusion” mindset strongly indicates that there is no accepted definition of the health care problem that we wish to solve.  The closest thing to a problem definition we have seen is the very general requirement for “affordable and accessible health care”.  We know from long experience that whenever government sets out to fix a problem that it does not understand, a disastrous outcome is inevitable.

We cannot fix what’s wrong with today’s health care by mindlessly accepting a gratuitous solution to an undefined problem.  We must first put forth the effort and cost to define our current health care system.  Then we can systematically go through each defined segment to ferret out and understand what problems exist.  Only then would we be prepared to develop solutions that could provide desired results.

Second, many or most Americans are not ready for health care reform.  Even without a detailed systems analysis, we can be pretty sure that what our citizens want is good health.  But it appears that too many of our fellow countrymen do not perceive that they have any individual responsibility for their own health; in their minds, their personal health is the responsibility of the doctors and the hospitals.

Medical experts have come to believe over the years that good health requires an active cooperation between patient and doctor.  Chronic disease accounts for about 80% of all health care costs, and a significant fraction of chronic disease is more the result of individual choices than of genetics or environmental factors.  Therefore doctor-patient cooperation is the critical element in disease prevention and health maintenance.

We have seen commendable progress in a number of health initiatives, most of which have been public and private cooperative efforts.  Among the better-known efforts are those to reduce smoking, prevent the spread of AIDS, and (more recently) head off obesity among our children.  What we need most is an expanded effort to educate Americans about healthy living.   An initiative by the combined forces of federal and state governments, including public schools and universities, could be implemented at an extremely modest cost (by today’s standards).

Third, all single-payer systems implemented in the world to date are, or eventually become, health care rationing systems.  This is true in Canada, Great Britain, Cuba, etc.

The first modern innovation in health care came about relatively recently:  the Health Maintenance Organization (HMO) pioneered by the Kaiser Permanente company.  Henry Kaiser was best known as a man who, by thinking outside the box, figured out a way to build cargo ships during World War II much more quickly than had ever been done before.  So it is not surprising that the first systems approach to making health care delivery a more effective process was in a Kaiser organization.

The Kaiser Permanente HMO worked well initially, and it became the model for future HMOs.  But fast-forward fifty years, and you find “HMO” is today a sort of epithet.  One bit of black humor reflects this:  “triage is the process of dividing patients into three groups—those with cash, those with health insurance, and those with HMO”.  The word is out, and now HMO is most peoples’ last choice for health insurance.

The reasons why national health services eventually become health care rationing mechanisms seem to be (1) the irresistibility of something-for-nothing and (2) the failure to comprehend the critical distinction between good health and health care.  The resultant over-use, and questionable-use, of the “free” system leads to a tidal wave of cost overruns.

We have actually seen an American example.  The Medicare system was projected to reach a cost of $15 billion per year by its fifteenth year; it actually reached that level in its third year.  Ever since, we have watched our government work diligently to reduce costs, by a means that more and more resembles rationing.

Fourth, Congress should suppress its desire to legislate for the sake of legislation because I said so.  (Actually, this reason is not 100% facetious.)

During the ten years I worked for a regional health insurance company (where I was responsible for data security and corporate business continuation / disaster recovery), I read a daily digest of health news the first thing every morning—25,000 or so in total.  I would mark articles that related to my duties, or just caught my interest, for later reading:  I have no idea how many thousands of hours of reading that amounted to in ten years.

Among my reading interests was the subject of disease prevention and health maintenance and its growing acceptance in the health care community (an ounce of prevention is worth a pound of cure?).  Early in my tenure I was meeting with the vice president I reported to and the executive vice president who was his boss.  The conversation touched on disease prevention and health maintenance, and I suggested that there were business opportunities in this area.  The executive vice president disagreed, noting that the company had not made earlier “wellness initiatives” profitable or popular with the employers who purchased health insurance for their workers.

But times changed, and before I left the company it was solidly into “wellness initiatives” demanded by those employer-customers.  One of the programs, diabetes education and management, turned out to be valuable for me when I was diagnosed with the Type 2 version of the disease.  (Should you have the interest, and the time, you might take a peek at several previous postings: “Healthcare Reform Lost Opportunity?”, “Health Care:  The Next Prohibition Amendment?”,  “Better Health, Lower Healthcare Costs”, and “Political Change:  The Healthcare Debate”.)

America’s Party Comes Out

In a previous post, America’s Political Party, I noted my family’s long association with the Democratic Party, dating back to Civil War days.  I described my father’s lifelong belief in the Party and in labor unions, and I speculated that he would be pleased to see the state of the Party today.  I also recommended that the Party bring its name up to date, both to reflect its principles, directions and goals, and to send a clear message to fellow members of the United Nations.

With the current financial crisis opportunity, it is understandable that President Obama, Speaker Pelosi and Senate Majority Leader Reid have been much too busy to handle routine housekeeping duties.  However, I believe that the name change would also help advance their legislative agenda.

It really is past time for the Democratic Party to come out of the closet.  I don’t mean this in the sense of gay and lesbian people taking the not inconsequential risk of going public with their sexual orientation status.  Gay people have been shunned like lepers; they have suffered discrimination in the workplace; and in too many cases they have had to fear for their very lives.  In contrast, Democrats have had only a trivial fear of the long-gone specter of McCarthyism.  Today, progressive Democrats need only summon up the courage of their convictions; they are free to openly and honestly explain and defend their political beliefs.

We now have a president who prides himself on his pragmatism but is willing to let his deep-seated ideology show through, in both his words and his actions.  He is supported by a solid Democratic majority in both houses, as well as by the leadership of each.  The president has also taken the bold step of moving control of the next census into the White House, thereby guaranteeing that Democratic majorities in both houses will continue to grow.  It is now apparent that the Party can define, pass and implement any and all legislation it desires.

Surely this is the perfect time and opportunity to bring the name of the Party up to date:  to reflect its true purpose and values, and to use the form of name most common in the world today.  The Democratic Socialist Union (DSU) Party is definitely ready to introduce its new name!  Imagine the thrill of people in U. N. member countries, seeing the appellations “Harry Reid (DSU, NV)” and “Nancy Pelosi (DSU, CA)”.

The recent Newsweek cover story, “We are All Socialists Now”, is both timely and prophetic.  The long-overdue Party name change will be well-received.

One immediate effect will be to hasten the departure of that small, irksome bunch of conservative Democrats, making room for more progressive members in future elections.  It may also help remaining dinosaurs to decide to retire.

A near-term international benefit will be better cooperation from Socialist states like Cuba and Venezuela.  President Obama has had good things to say about both (eg, Cuba’s health care and the feeling of hope among Venezuela’s lower classes).  The name change should help assure Hugo Chavez and the Castro brothers that Barak Obama is indeed of like mind and will be their good  friend.

In the slightly longer term, the day the the U. S. Constitution can be replaced with an up-to-date, progressive document is in sight.  Without question, the Democratic Socialist Union Party will leave an indelible mark on the United States.

Guantanamo: Obvious Solution Overlooked?

Closing the prison for unaffiliated combatants at the Guantanamo Naval Base does pose a serious problem:  what to do with the current inmates (and any that may be captured in the future).  The politicians—from both of the major parties—have not offered any suggestions that meet a common-sense test.  Nor have the reporter-commentators from the semi-rational media.  This absence of plans from any source gives us ordinary people an indication of the perceived seriousness of the problem.

Yes, the prisoners at “Gitmo” are different—probably far worse than most of the current residents of the federal super-max prison in Colorado.  Somewhere around 15 – 20% of those released from the Guantanamo facility to date have rather quickly returned to their terrorist activities in Iraq, Afghanistan and vicinity:  some to be recaptured, some to be killed in action, and a few to publish videos of their triumphant return to jihad.  No wonder there are public safety concerns.

We are reminded  frequently that although these captives may be worse than just rowdy boys, we must consider their “rights” (which opens up a distracting discussion of how to handle people who have no Geneva Convention status and no country, who deny all authority, and who obey nothing and no one).  Clearly, this is a difficult problem, made more difficult by its breadth and its distractions.

Now is the time to remember what world-class problem-solvers tell us:    often the most obvious solution is overlooked.  Sometimes this is caused by the cost or unpleasant aspects of the obvious answer.  At other times the best solution is ignored because it seems too simple.

When we release convicts by parole or by completion of sentence in the United States, we know from long experience that some fraction of those released will go back to commit other offenses.  Therefore we have learned to expect and to tolerate the small fraction of recidivism—fifteen, twenty percent or whatever—that our experience teaches us.  We should not be surprised to see the same small fraction of recidivism in released terrorists.  But a bonus is that so far they have gone back to their own base of operations, far from the U. S.

We should just release the remaining prisoners on their own recognizance in a location where they would have the best opportunity to become normal, productive residents.  The ideal location would be one where the citizens have displayed a high tolerance and a welcoming receptivity for people who have a different ethnicity, culture, language, color, or way of life. At their release they should be provided with somewhat more than we normally give paroled criminals released from our prisons, considering the circumstances of these particular parolees.

In the United States, there are several locations which meet the criteria for release of these alien prisoners .  None is better than the northern California area around San Francisco represented by Congresswoman Nancy Pelosi.  The breadth and depth of the tolerance of these Californians is well known, and their support for the former terrorists would be all but guaranteed.

Each released person should be provided with a full complement of new clothing, of whatever type and style the individual desires.  Every one should be given $10,000 cash (for transportation to any location desired).  All released combatants should, of course, receive unemployment and health care benefits.   In addition, each should be provided with a package of hygiene, grooming, and other personal necessities.¹

In the warm and affirming  environment of the San Francisco area, it might be within the realm of possibility that every single one would become a welcome addition.

¹ Personal Necessities:  AK47; 250 rounds of ammunition;  10 hand grenades and  grenade launcher; and a choice of 3 anti-personnel mines, 2 Claymore  mines or a single 155mm artillery shell.

Healthcare Reform Lost Opportunity?

We can question the motives of politicians who constantly belabor real and perceived problems with health care affordability and accessibility.  We can disagree with many of the gratuitous solutions to the largely-undefined U. S. health care problems.  But almost everyone would agree that people who need health care and want health care should have help, help that leads towards good health.  However, that point of agreement, meritorious as it might be, may also make us vulnerable to accepting very low-probability “reform” proposals.  In fact, poorly designed health care reform plans might establish a new paradigm of government boondoggles; it would also likely result in a far worse problem than wasting a few trillion dollars.

The recent controversies surrounding the Troubled Assets Relief Program (TARP, or ” banking bailout” for the less politically-correct crowd) provide us with an advance warning of things to come.  As the astute Senator Everett Dirksen remarked, “a million here, a million there, and pretty soon you’re talking real money”.  But updated for our current situation, the phrase would more properly be “a trillion here, a trillion there, and…”.  Sometimes it’s difficult to remember that this is real money that Congress is dealing with.  But TARP, and its TARP-like cousins waiting in the corridor, are actually chicken feed.  Wait until we get a glimpse of  the real money numbers for health care reform!

The best thing for all of us to do would be to go through the exercise of personally developing our own estimate of the annual cost for health care reform—either a national health insurance program or a national health care delivery system (or both, for the psychologically-strong).  The easier cost estimate of the two is national health insurance; all the information you need is easily available in two web sites on the internet.

A rough estimate of national health insurance cost is as simple as scaling up the current cost of Medicare to cover everyone in the country.  The Medicare web site contains the number of people currently enrolled and the current annual cost of the program.  The Census Bureau web site contains up-to-date population figures.  Divide the (smaller) number of Medicare enrollees into the (larger) number of people now residing in the United States.  Then multiply the resulting quotient by the current annual cost of Medicare, and you have a useful (but very conservative) estimate of the cost of National Health Insurance.  The importance, and value to you, of your projected cost of national health insurance will be explained shortly.

If you are sufficiently ambitious, and willing to expend quite a bit more time and effort, a similar process would yield a very rough estimate for national health care delivery.  But your health insurance estimate will satisfy the important need you probably have not thought about.  Who can you believe and trust among the hordes of politicians, pundits and personalities out there, repeating their various reform mantras simultaneously?  How can you have any confidence that any of the projected cost estimates are even in the ballpark?

Your conservative estimate (conservative because Medicare today isn’t confronted with many prenatal, childbirth delivery, pediatric care, etc. claims) provides you a basis of comparison and a reasonableness check.  Also, you know it was developed honestly, using the most accurate information available.  It may be your best line of defense against spurious claims about the “affordable” health care reform proposals coming from the Washington elites.

But how does lost opportunity enter this discussion?  When Medicare was unveiled to us, the annual cost was estimated “to reach $15 billion in the fifteenth year of the program”.  In fact, it was up to fifteen billion dollars by the third year!  That alarming cost overrun set off a frenzy of cost-containment activity, working towards cutting claims expenses.  Eventually, the hastily-conceived private Medicare Supplement Insurance program was one of the somewhat-effective results that was not some form of rationing.   Based on history, and the government’s track record, a national health care reform today might well stumble and bumble its way into existence—at a cost beyond belief.  But cost is not the worst problem.  A politically created expedient to salve politicians’ consciences is likely to rob us of a real opportunity to achieve better health in our country!

The truth is, America is not ready for universal health care.  Until a vast majority of our citizens have learned the rudiments of healthy living, and how to apply them, we will not see the improved health and reduced cost the politicians are promising.

By way of example, you could give your 18 month old toddler a $30,000 Rolex watch so that he or she could know what time it is.  However, someone might diplomatically suggest that it would be better to wait until the toddler could tell time and could understand the obligations of caring for a fine timepiece.  American people undoubtedly want good health, which will not be an easy, automatic result of health care reform.  In fact, an unbelievably expensive “affordable” health care system combined with ubiquitous availability will not, in and of itself, yield the better health that we expect.

The government—federal, state, and local—is capable of implementing a healthy-living initiative, at a cost that would be trivial compared with the trillions being tossed around at present.  (Note the success of joint public / private initiatives to reduce smoking, prevent AIDS, etc.)  In fact, a number of experts from the medical community have estimated a reduction in national health care cost of up to 40% just from educating citizens in personal health care basics.

In the absence of such a world-class, full-court-press health education initiative preceding any universal health care implementation, the prospects for better health are dim.  Most likely, we would see widespread disillusionment and disappointment as the government took years of trial-and-error tweaking (and wasted trillions of dollars) trying to “fix” the system.  Meanwhile, we knew where we wanted to go all along:  to the point where we are healthy.  We may not like being given advice, but we are even unhappier if we are deprived of the opportunity to listen and learn.

America’s Most Common Serious Disease?

In the last fifty or sixty years the United States government has had a measure of success in eliminating or  reducing the incidence of certain targeted diseases.  In several instances the fight against diseases was conducted in cooperation with the governments of other countries, sometimes with assistance from the United Nations.  Among diseases targeted over the years are infantile paralysis (polio), smallpox, tuberculosis, malaria and aids.  But now there appears to be a groundswell of public clamoring for targeting yet another disease in the U. S.

This latest disease has sneaked up on us, only recently entering the general public consciousness.  But, as with some other epiphanies, awareness seems to be all that is needed to generate political demand.  The latest disease to be put up for government management and control is RDS, which many of us have never heard of.  We should, however, resist our first tendency to dismiss it as a trivial problem.  It turns out that to a growing number of individuals and organizations RDS must be the most important factor in their existence.

Part of the reason RDS has only lately begun to enter the public discourse is that so little is known of it.  There have been few, if any, rigorous scientific studies of the disease.  Yet it is much more widespread than we might have believed.  There is no known cure at present, and there is a wide variation in the therapies used to control it.  Even an unlikely folk remedy is reportedly used:  including a common bird (corvus brachyrhynchos) in the patient’s diet.  But the usual therapy is a short period of isolation, plenty of bed rest, and professional counseling.

Experts believe RDS has both genetic and environmental factors.  There is not much agreement on how contagious it is, but a lot of anecdotal evidence suggests that it can spread quickly through groups of people.  The disease has only one principal symptom; but a number of related factors or sub-symptoms have been recorded, including outbursts of rage.  In most cases the disease is episodic; some observers believe stress can trigger an episode. One of the more annoying aspects of RDS is the common inability of those afflicted to articulate this main symptom; undoubtedly that has led to many instances of misdiagnosis.  In cases where the disease has spread quickly, infecting most of the individuals in a group, it has left friends, families and health professionals mystified.

By all accounts, RDS is extremely painful to most of those infected.  Yet this has not been widely reported.  One possible reason is that the primary purpose, focus or mission of an afflicted group overshadows the misery of individuals in the group.  Usually it is only after completion of the groups’ purposes that mention of the RDS symptoms begin to leak out.

The recorded history of RDS is relatively short, but some researchers have recognized its main symptom in a number of historical accounts, some dating back hundreds of years.  Like a few other diseases, it was named after a victim rather than the person who first identified it.  This victim suffered from the disease for many years; his doctor subsequently named it the Rodney Dangerfield Syndrome, or RDS. Fortunately for all of us, Mr. Dangerfield described his painful symptom in some detail before he died.

The anecdotal evidence of the stress relationship to RDS episodes is abundent in this wind-down period following the national elections.  A few observers expressed an opinion that there is a correlation between the degree of partisanship of an individual and his or her likelihood of an RDS episode.  These observers have pointed out that it did not appear to make any difference whether the campaign was for an elective office or for a ballot initiative.

There is substantial disagreement as to whether the government can actually help in the fight against RDS.  The more pessimistic side points out that the government does almost nothing well, and that it might  aggravate the problem.  The more emotional side responds that it is worth the risk of getting the government involved because of the obvious degree of suffering.  Furthermore, the emotionalists point out that we all can see it first hand.

With all of today’s reporting channels—professional, amateur, network, cable, internet—we all have the opportunity to see the suffering of a number of RDS victims.  Although the disease usually runs true to form, with most of those afflicted unable to specifically tell us what hurts or where, there are numerous exceptions.  If you have ever seen a tape of Mr. Dangerfield describing his symptom and his pain, you will immediately recognize those sufferers when you see them in the media.  On several occasions while watching some poor victim comiserating, I could clearly visualize Rodney Dangerfield passionately saying “I get no respect”!

Better Health, Lower Healthcare Costs

There exists a growing number of credible doctors and medical research organizations who do not believe that declining health and increasing health care costs in our country are inevitable.  Nor do they agree that only a massive, hyper-expensive health initiative can dampen the trend.  In fact, they believe that it is mandatory that we apply current knowledge of disease prevention and health maintenance before any changes to our health care delivery can be effective.

Health news in the media today, and politicians’ pontifications,  focus only on health care cost and accessibility in this country.  But what U. S. citizens actually want is good health, not some particular  implementation of a health care system. If the question is asked in the correct manner, the vast majority of people will say that “health” means an absence of pain or other symptom of sickness. That’s a good enough definition of what result we are expecting; it’s a place to start looking for better health care which is also accessible and affordable.

First, who should be responsible for the health of an individual? The government? The health care providers? The health insurance industry? Actually, the only answer is: none of the above! The government,  the providers and the insurers each play a role, but every individual is and must be responsible for his or her health. Medical providers cannot assume responsibility for patients’ health; nor can the government, nor can the health insurers. The reason this is true is that individual choices have the greatest impact on disease prevention and health maintenance. Genetic factors and environmental factors (especially if unrecognized) beyond the control of the individual do impact health, but not nearly so much as individual choices and actions.

There are only two exceptions to the individual-responsibility truth: children and mentally challenged individuals. Parents are responsible for teaching their children the fundamentals of health and hygiene, beginning with the earliest steps such as washing hands and brushing teeth. Guardians of individuals who have limited mental capacity must similarly teach these people those health principles that they can comprehend and apply; beyond that point, health of these individuals will continue to be the responsibility of others.

But a little introspection is in order. Of course I want good health, and so do you! But is that all we are talking about when we agree that every individual must take charge? Not totally. What we all want is good personal health, plus good health for our spouses and our children, and across time good health for their families, and so on.

Second, except for assuming responsibility for one’s own health, the first and most important step forward in the quest for better health is education. I realize that this statement will cause most readers to turn elsewhere; but please humor me and read on to find out what I mean by “education”.

My personal “health education” frustrations come from attempting to learn about some newly-discovered diet, or trying to understand a serious health condition via the internet. Most diet books say either “trust me, this diet will work for you”, or they confront us with several chapters of confusing and /or boring rationalizations. Specific disease diagnosis and treatment therapy information available from the internet can be even worse; some articles appear to have medical school completion as a prerequisite for understanding the first sentence. But that’s not the kind of education I’m talking about.

All of us absolutely must know and apply the scientifically-accepted “rules of thumb” concerning disease prevention and health maintenance. These are the important health truths that civilization learned originally via long and painful trial-and-error, confirmed and understood through more recent scientific study:  not enough vitamin C in the diet causes scurvy and not enough vitamin D or calcium causes rickets; untreated drinking water is the usual source for several serious diseases; food left out too long at room temperature can result in food poisoning; failing to brush our teeth regularly and observe dental hygiene leads to unnecessary loss of teeth; just washing our hands is the most effective disease prevention; and so forth. Most of us already know more than we think we know.  However, we don’t always apply this knowledge routinely once we become independent adults, responsible for making our own way through life.  Worse yet, when we abandon the healthy habits our families may have imposed upon us as we grew up, we are unlikely to impart those desirable traits to our children.

Part of our departure from “the healthy fold” can be attributed to pharmaceutical company end-consumer advertising (“our pill will cure whatever ails you”) which leads to unreasonable medical expectations.  Another somewhat related part is the persistence of the long-discredited “binary theory” of medicine:  you are either sick or you are well, nothing in the middle.  Such a short-sighted view blinds us to the value and necessity of disease prevention and health maintenance.

Third, there are areas in which the government, the health care providers and the health insurance industry can be more effective in helping us to become a healthy nation.

Government does almost nothing well; but governments’ performance in one area seems to have escaped that generality.  The government—federal, state and local—can be effective in educating its citizens in specific, focused areas.  Look at the efforts to reduce smoking in the United States: in about 50 years adult smoking has been cut by half, and some progress has been made in reducing the number of new, younger smokers.  California has been the leader in reducing the overall incidence of smoking.  Another area in which both government agencies and private groups have had successful collaborations is in AIDS awareness campaigns.

The federal government, cooperating with and coordinating state and local efforts, is fully capable of implementing a world-class, full-court-press disease prevention and health maintenance (“healthy living”) initiative, at a negligible fraction of the cost of any universal health insurance or universal health care delivery system that has been visualized.  Such an initiative is, in fact, a mandatory prerequisite for any universal health care or health insurance plans to be effective.

That area we sometimes forget is a part of government—public schools and colleges—could be particularly effective in integrating disease prevention and health maintenance concepts and practices into the curriculum.  From preschool through university our educational system should provide the information that is essential for all students to be equipped to foster and maintain a healthy life.

However, the difficulty in prodding the government into a really effective health improvement program is the fact that politicians are extremely reluctant to vote for anything that will take longer than one or two election cycles.  I guess we voters are on the hook to somehow make the politicians believe we really want better health—not just for us, but for our children, grandchildren, great-grandchildren, and beyond.

Health care providers periodically take their turn as the whipping boy du jour for both the public and for pot-stirring politicians.  I am far from an apologist for the persistent problems in health care delivery, but I don’t believe the providers are really as bad as we perceive:  self-indulgent, uncaring and bloated with bureaucracy.  My biggest disappointment with the medical community is their passive willingness to let the politicians herd us down the wrong path toward a bleak and sparse pasture.

By and large, the health care industry is way ahead of most of us on disease prevention and health maintenance.  It is true that the current shortage of doctors was identified as a future problem, and that  little or nothing was done to head it off.  However, it seems likely that serious, preventable problems of this nature will recur only rarely.  The AMA (American Medical Association) health insurance reform initiative is another positive sign from the medical sector, although the current proposal still needs more work.

That brings us to the health insurance industry.  This segment of the insurance industry is not really the greedy predator portrayed by politicians who need a scapegoat for their demagoguery.  In fact, the health insurers have the largest financial stake in our being healthy:  healthy people file fewer and smaller claims for doctors, clinics, hospitals and pharmacies than their less-healthy countrymen.

One fact is not widely known—even to the AMA:  most families get their health insurance through the employer of a family member; and a significant percentage of all covered workers’ employers are self-insured.  That is, with a self-insured company the coverage limits, exclusions and benefits defined in the policy are established and controlled by the company.  Recognizable health insurance companies are usually contracted to maintain the policies and process claims for a small fee per transaction.  But the money in the account from which claims are paid is supplied by the employer company.  Clearly it is in the best interests of the employer, their claims processor, and their independent health insurance consultants to work very hard to provide the employees with the best bang for the buck.

Insurance companies support a growing number of “wellness” programs:  education and support for those suffering from chronic diseases, such as diabetes; programs for smoking cessation; classes and physical training for weight loss and fitness, etc.  Because 80% of all health care costs are due to chronic diseases, the wellness programs championed by health insurers can have a significant positive impact on both personal and national total health care costs.

Another little-known insurance industry effort is the statistical analysis of claims history to identify areas of excellence (or areas of deficiency) in the medical outcomes of patients treated at the various hospitals—diagnosis, therapy, time and cost, and resulting degree of cure or  effectiveness for the patient.  (Note:  this initiative, demanded by the companies who purchase health insurance services, has not been well received by the medical sector.  Although such studies have normally not extended down to the level of individual practitioner, they are nonetheless viewed as threatening).

Whether the health insurance is in the self-insured or underwritten category, the best business outcome for health insurers is healthy people.

Fourth, what can you and I do, right now (short of enrolling in medical school)?  We can pay attention as the fire-hose stream of health information streaks by on television, on the internet, and in daily, weekly and monthly publications.  Our goal is not to become experts or sink into a health obsession, but to be at least as knowledgeable about health as we are about the other common, everyday concerns.

We, the public in general,  can also take action.

1. Seriously review our health insurance situation:  competitive costs; coverage; and options.
2. If health insurance is beyond our means, locate all of the sources for free or low-cost medical care:   clinics for people who are not eligible for Medicaid but who don’t make enough money for regular insurance; free health screening sessions periodically offered at various locations (e.g., shopping malls); public health departments; teaching hospitals; etc.
3. Refresh our understanding of generic prescriptions; locate the most advantageous sources for medicine; and faithfully take the medicine our physicians have prescribed.
4. Assure we have all of our adult vaccinations (and make sure our children have theirs).
5. Actually use available health care providers for periodic (wellness) checkups.
6. Seriously review our diet while redoubling our resolve to eat healthy (and do what we can to combat the junk food tidal wave that engulfs our children).
7. Raise our priority for a regular aerobic exercise regimen—so that we actually will do exercise.
8. If we smoke, get the necessary help to quit; if we don’t, then don’t even think of trying or starting.
9. Don’t even visualize, much less do, recreational drug use—either prescription or illegal drugs.
10. Avoid all types of risky behavior (including bad driving habits), and take a defensive driving refresher course.

A number of credible sources have projected a 50% to 80% reduction in national health care costs if we could somehow convince a significant number of our citizens to take those ten steps.  It would be ineresting to see a projection of the total fiscal effect of having a population that is healthy, believes that it is healthy, and enjoys the benefits of good health.