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Friday, March 18, 2016

Evacuation Day... Boston, March 17th, 1776

St Patrick's Day, in Boston...

It is likely little known that Boston has two celebrations on March 17th each year... on the one hand, they celebrate the Irish... and the other they celebrate the Evacuation of the British... they call it Evacuation Day. In 1775, the British had blockaded the Boston Harbor... it was a troublesome time, around the American Revolution.

There were the British in the harbor trying to starve the Americans into submission. They were having nothing of it, and plotted to move canon into place on the hills overlooking the harbor... that was laden with the British blockade of ships. While this had all transpired over many battles, and eleven months... it was on March 17th, 1776 that the British realized that the Americans had, using subterfuge, successfully moved canon from the captured Fort Ticonderoga into place, and they were sitting ducks in the harbor. The British, on the first tide and favorable winds, retreated to Halifax... just another in many ties Boston has with Halifax, Nova Scotia.

So, the Irish celebrate not only St. Paddy's Day... but a veritable expulsion of the British that they appropriately name "Evacuation Day".

Double-Double-Triple, too sweet...

On Thursday this week I was in Boston on business. We arrived at our downtown meeting place, at the corner of Berkeley and Boylston Streets… that is about 300 yards from the finish line of the Boston Marathon.

We were early for our meeting, and it was St. Patrick’s Day. Boston is a most exciting city, on the 17th of March each year… a great parade takes place to celebrate the greatness of Irish Pride… we decided to walk a little toward the Starbucks on the corner. It was a beautiful day, mid-60’s… lots of people around… "coffee"? "Of course"!

We entered Starbucks… it was the first we had been in that didn’t have a seating area… just a narrow storefront, about six baristas, working steadily, to keep up with the 15 or so deep line up… it seemed not to move, but people were coming in and going out…

As we headed to the end of the line… we noticed a sign on the cash registers… hand- scribed… it said… credit and debit cards won’t work todayjust cash and Starbucks cards.
We arrived at the end of the line, followed by three young people, a lad and two lassies… clearly celebrating St. Patrick’s Day, wearing the green… they were excitedly discussing the payment signs… apparently, they always paid with their debit cards… and didn’t have enough cash to have the double-double-triple ‘too sweet what-evers’ that they wanted. 

I was mentally calculating if I had enough cash to gift them their coffees... but not fast  enough...

They had quickly realized that it would be at least five minutes before getting to the front of the line, and the cash register… they discussed "how long would it take to download the Starbucks app"?… "up-load their debit or credit information"… "pay for their treats"… of course… less than the time to get to the front of the line in a Starbucks… so they did! And happily they had changed from a cash to a debit, to a membership card society...

Life has changed!

When we later met with our business associates, we told the story... to support our thesis of changes coming, in retail medicine… how easily the young 'in green' people had adapted to the new reality in Starbucks… 

One colleague indicated that daily, he takes the Green line train on the MBTA into the city… when he has to change from the Green to the Red line at the Commons Interchange, he goes on his iPhone Starbucks app... orders and pays-for his regular double-double from the Boylston and Berkely Streets Starbucks… five minutes later, he comes up out of the Red Line subway station , conveniently in front of the coffee shop, picks up his double-double (without lining up), and walks across the intersection to his 20th floor office… 

Life has changed not only for the young people… we elders, too... our lives have changed!

This is but a small discussion of how things all around us are changing… are we ready?

No.... Better Get Ready...

Monday, March 7, 2016

What is acceptable production in Mexico... NAFTA

Recently I listened to the Donald, Bernie and others trumpeting about heroin in New England and how it was coming from Mexico. I thought it was coming through Mexico from Colombia... so I went looking for evidence of error... it is me that is wrong.

Colombia has reduced its heroin production and is down to about 2 metric tonnes of the stuff... from nearly 20... in the past ten years. Mexico on the other hand has replaced the Colombia production, and then some... this is a quote...

In contrast, opium poppy cultivation in Mexico remains high, and Mexico continues as the primary supplier of heroin to the United States.  Estimated cultivation of opium poppy reached 10,500 hectares in 2012, with an estimated pure potential production of 26 metric tons.

My disappointment runs deeply. I don't understand how a country with all the upside it has, can allow such an internal issue to exist. All they have to do is take the army in and wipe out the fields... not doing so makes one wonder about the leadership of the country... and perhaps, whether some of what the Donald is saying (although too bombastically) is correct. I suspect Donald would use Agent Orange on the fields, given his penchant for the spectacular.

The quote above is from The White House Office of National Drug Control Policy, and is written under the Seal of The President of the United States of America. Can one imagine what it must be like to be President Obama negotiating with the President of the United Mexican States, while knowing that the latter is fueling an American nation-wide epidemic, about immigration or NAFTA?  I don't understand how the USA can negotiate anything else, before ensuring that the manufacturing of Heroin is ended, before the other products manufactured in Mexico are allowed into the USA. 

I 2014 the estimate had become  about double that of 2012... it is growing larger! This during a period in which there was a concerted war by Mexico, on the cartels and drug trafficking. So, after writing and reading this discussion, I wonder "what is the answer?" Treat people well, treat people poorly... use a carrot, use a stick... care, don't care... what is the answer?

I don't think it has anything to do with immigration or the election. I think it has to do with helping the President of Mexico understand the difference between exports, and how one could impact the other.



Wednesday, March 2, 2016

What portion of $60 billion do we want to re-allocate...

Some research on annual healthcare costs, and where the money goes...

This is part of my series to document that individuals actually have more control on national healthcare costs than the government, insurance companies or politicians. There is a lot of evidence of this…

For example, in a January 10th, 2013 article in Forbes Entrepreneurs, Michael Bell wrote his reaction to data from Dr. Susan Dale Block of Bringham and Women’s Hospital in Boston. He wrote “It seems that no matter how much money you use during that last year/month (of a person’s life), if the person is sick enough, the effort makes things worse”.

We know that 30% of all Medicare costs (equal to about $175 billion) are spent in the last year of Medicare patients’ lives… and about 1/3rd of that in the last month (about $60 billion).

It is a relatively simple algorithm to state that ‘if’ a patient is very sick with end stage cancer, 'then' keep the patient comfortable; do not treat to extend life. By doing this, the Medicare system either saves a large portion of $60 billion, or uses it to ‘save’ lives. I am not suggesting that the decision be made without the patient’s knowledge; the decision is the patient’s. The obligation here is for the medical profession to ensure the patient is knowledgeable of her situation, and be allowed to choose.

We are all going to die. If we internalize knowledge about treatment, outcome, costs and so on, it is a simple leap to a better end. Should the motivation be to save money… likely not… that’s too hot. But just the knowledge that when we spend more, we likely “make things worse” should be enough.

Generally, people who know they are going to die, don’t want to go through excessive pain to live an extra day(s). It is also important for loved ones to understand the facts, and not get in the way. Is it a moral and ethical issue… only for the individuals involved? Perhaps, the rest of us, and the medical profession c/should stand aside.

How do we start the discussion and make this happen. It is a financial ethics issue, too.




Blueknowser

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Grad. Saint Mary's University, 1975, got into the medical device business initially in sales, then various management positions up to president, all in Medical Devices. I prefer therapy products over diagnostic, but they are all fun, and in a way have defined my life. I have now evolved, with help from my 35 year partner Lynnda with whom I now share every hour. I am into staying healthy, photography, kayaking, bicycling, gardening and two books a week. I wish I had gotten to this stage earlier!