The Future of Wearables is More than Devices

In its February trends snapshot, Blueshift Research found that 40% of Americans made no change over the last six months when it came to living habits such as diet, exercise, sleep etc., up six points from a year ago.

The “no change” group is where I was over the last several decades despite periodically committing to do better.

Unfortunately, nearly 17% responded to the survey that their living habits had actually worsened, 3.1% significantly so over the six month span since this trend was last measured.

The good news is that during that same span 43% of us felt they had improved their living habits, 7% significantly.  A 2008 study calculated that “inactivity” costs the U.S. $76 billion in healthcare spending.

So I often wonder what finally made me shift gears 19 months ago after years of resolutions and wasted gym memberships.

Was it finally finding a spiritual connection while walking each morning?

Was it having a significant other to do that with, which has been expanded to include weight conditioning twice a week?

Was it using a fitness tracker and a linked app to track the caloric content of various foods I was eating?

Was it being confronted by a tiny belly roll when a portrait was hung to honor three of us just before I retired?

Was it that first sign of a film like build up in one of my carotid arteries?

Intrigued, I’ve been trying to reverse engineer what made me finally get serious.

It is not as though my doctor hadn’t been cautionary for several years about normalizing the level of triglycerides levels in my blood.

I always see the waiting room at the clinic where I get annual physicals full of people who are in much worse shape than I was and seemingly oblivious to the inappropriateness of yoga pants or having to lean over to see their shoes..

Medicare is now going to start holding doctors accountable for patient changes by calibrating what they are paid to outcomes.  But I am not sure how much more they can do to cajole each of us into accepting personal responsibility for our health.

Two years ago, a Pew Study found that 45% of U.S. adults are dealing with at least one chronic health condition but 7-in-10 overall keep track of a health indicator including 19% who have no chronic conditions.

But only a fifth use technological devices such as wearables with nearly half doing so only in their head.

Last year’s report by Endeavor Partners found that 1-in-10 adult Americans owned a fitness tracker, 1-in-4 between the ages of 25 and 34.  Unfortunately, more than half no longer use it and a third stopped using it within six months.

Key for sustainable use, according to the report, are 3 behavioral factors: habit formation, social motivation and goal reinforcement along with 6 other factors such as utility, design, fit, out of the box experience etc.

Fitbit, the one I have used since early 2010 when it came out, appeared to score highest overall among the eight different fitness “wearables” measured in the report.

Juniper Research projects that use of fitness devices and wearables will triple by 2018.  Some analysts project these devices will reach 48% market penetration worldwide by then.

A new Pew study shows that 64% of Americans now own Smartphones, double the proportion from just four years ago.  Smartphones have also rapidly become the means by which low income and disadvantaged Americans go online.

More than 60% of Smartphone owners use their phones to get health information, 57% to do online banking, 43% to look up job information and 30% to take a class or get educational content.

Making outdoor billboard advertising even more obsolete, more than 67% of smartphone owners use their phone for turn-by-turn navigation while driving, 32% do so frequently, compared to less than 1% of Americans who still rely on a billboard.

But wearables such as those for fitness and health are set to make “interruption” advertising such as billboards even more obsolete, according to PwC.

They will accelerate even faster the rapid transition to interest-based, content marketing but only when relevant and needed now.

Studies have shown that the three-decade decline in the effectiveness of traditional advertising has reached a negative return on investment overall.

Fitness and wellness apps are on track to more than sextuple by next year from what they were in 2010.  But a report issued last year by PwC shows plenty of reasons that businesses and organizations will soon get involved, too.

Already, 70% of consumers “say they would wear employer-provided wearable devices streaming anonymous data to a pool in exchange for a break on their insurance premiums” something that will obviously catch the attention of insurers in Obamacare exchanges.

The World Health Organization recommends that people get 30 active minutes a day.  A premium feature of the device I wear shows on a bell curve where I fall compared to men my age and weight as well as other demographics overall.

Telling is that at 30 “very” active minutes on average per day, I am in the 89th percentile for my group, or over 185% of the median. For many weeks I average over 40, over 300% of the median.

This means that, unfortunately, I am in the top 11% and regularly in the top 3%.

The center of that bell curve is only 6 “very” active minutes.  Even scarier is that I am 400% over the median for many of those people waiting in my doctor’s office.

People are nearly twice as likely to purchase and use fitness bands and smart watches if employers pay for them.  But the future of wearables goes beyond fitness.

More than half of the adults in the survey agree that automated facial recognition will replace the need to remember names, 56% say life expectancy will increase an average of 10 years and 46% believe wearables will decrease obesity.

But wearables, even for fitness, are rapidly moving beyond devices.  A report yesterday by KUED notedthat consumers are already moving to biometric clothing such as Hexoskin which report metrics beyond those done by devices.

Another by Athos is designed to help with weight and flexibility training.  Analysts project that sales of fitness device wearables will soon plateau or go down due to the overlap between smart wristbands and smart or sports watches.

But sales of smart garments such as Athos are projected to grow to 26 million units next year, up 2,600 times what they were in 2013 and more than two and a half times what they will be this year.

It will be interesting to see if they have a sustained impact on the overall health outcomes for Americans.

Food for Thought

Reading a new McKinsey analysis of the most effective ways to fight obesity made me remember that if it weren’t for an inability to metabolize sugar, I would probably be struggling with a weight problem, if not on my way up the first wrung of obesity.

The study quantifies the effectiveness of interventions including areas of personal responsibility as well as education and environmental factors such as labeling, portion control and subsidies and taxes, all of which have spawned a huge “sugar” lobby.

I first felt the hypoglycemic reaction that my body has to the levels of sugar in foods, mostly added, when I was 11 years old, going on 12 and weighed about 84 pounds on a 4’8” frame.

But it wasn’t fully diagnosed for another ten years when by that time I touched the scales at 150 pounds and nudging 6 foot tall.

I descended from a long line of “white food” eaters on both sides, who when they weren’t drawn to sweets and foods that quickly convert to sugar such as mashed potatoes, macaroni and milk, corn, fruit salad laced with whipped cream and bread, even bread and milk.

To my mom, who was a great cook having learned from her mother-in-law, even oatmeal wasn’t right without a layer of sugar across the top.  Maybe it is little wonder that my parents struggled with weight and sought comfort from these foods their entire lives.

Actually, our weight and happiness are on opposite “u” curves during our lives, one with the u bending upward and the other bending downward, but looking at how sugar affects the brain, they seem related.

Our relationship with food is apparently linked to both.

One of the interesting findings in the McKinsey analysis is that obesity is a condition shared now by 30% of the global population.  It is projected to increase to 41% by 2030, but already has the same economic drag as tobacco and armed conflict.

It is far more costly than alcoholism, for instance.

The interventions McKinsey finds most effective can lower obesity by 20% within a five year period when deployed together.

Portion control and reformulation of foods have the greatest impact followed by limiting access to high calorie foods, weight management programs and parental and school education.

A high-sugar tax can also play a role.

In the United States, obesity is the second most significant social burden.

In 1750, sugar consumption was about 3-4 kg or less per person.  It took off in the United States in the late 1800s and then skyrocketed about the time I was born.

About the time I retired five years ago, Americans were powering down 28 kg of “added” sugar alone or about 60 pounds per person.

The obesity epidemic is no surprise.

Normal weight, according to the McKinsey study means keeping the body mass index below 25.  My doctor tries to get me to stay below 19.  Overweight is between 25 and 29.

Obesity comes in three stages beginning at 30% and ranging to more than 40.

Those of us who are overweight push medical costs up 31%, and obesity, depending on the level, pushes costs up anywhere from 58% to 86%.  Click here for the latest pie chart showing where America’s $2.9 trillion health dollars go.

I’ve learned to limit my intake of added sugar to between 6 and 9 grams (about two teaspoons) per day and stay away from foods naturally high in sugar.

Still I am not deprived.  My diet averages around 30-40 grams a day.

One of the advantages to logging my meals, often vetting them in advance using an app called myfitnesspal, is being far more aware of foods high in sugar.

Whenever we eat breakfast at Bob Evans, I like the Border Scramble, substituting a fruit plate instead of potatoes and without bread.

But even without the fruit, that dish has 7 grams of sugar.  The fruit plate has another 13.  Way over my threshold and even with the protein involved risking where, for me anyway,a hypoglycemic reaction would kick in.

My sweet tooth is fed by two glasses of wine with dinner - only red - and on the more “minerally” side.  Each glass has only 1.8 grams of sugar each but is much weightier in calories overall.

But the apple a day I snack on later has 11 grams which is possibly why even when I was young, I learned to eat this fruit as my dessert after dinner, a time of day when any adverse reaction would occur only while I am asleep.

Also being certain to drink two quarts of water a day on top of the water in about 60 oz. of coffee is crucial in my case.  But my point is that even religiously avoiding foods with added sugar, I get a lot in my diet.

Obesity increases in countries along with prosperity.  In in the U.S., the CDC finds it at the same levels for men regardless of income level but in women it affects 42% of low income vs. 29% at high income levels.

This may give finger-waggers more ammunition to lecture the poor about personal responsibility, but it is clear the correlation is to only being able to afford or easily access unhealthy foods and eating leftovers while caregiving, I suspect.

This is another reason that making certain low income people have healthcare insurance is smart.  When it comes to healthcare costs we’re in this together when it comes to our pocketbook regardless of partisan leanings or feelings of superiority.

So whenever someone asks for the mashed potatoes to be passed during holiday meals, we need to be aware of just how incredibly powerful the “white food” lobby is in this country and give thanks if we are less impacted, but less judgmental of those who are.

New research shows that it is more than with fitness and caloric diary apps that smartphones are impacting the way we buy food.  A study shows that 79% of women alone now use their smartphones in stores.

Of those, 35% do it in grocery stores alone, 23% to check barcodes to learn more about products than may be revealed on labels.  By the way, the same percentage use GPS via smartphones to find the store greatly reducing any tiny remnant of rationale remaining for billboards.

I suspect, without my reactive hypersensitivity to blood sugar level, I would be among those judged.  I love mashed potatoes and not just because I’m from Idaho where it is patriotic or because “red states” are more prone to obesity.

Retirement agrees with me.  Although I seem to be getting shorter, I also dropped about 25 pounds (intentionally) over the past six months, more a credit to walking daily and cutting calories, not just a diet low in refined carbohydrates (smile.)

Now for some comic relief about the determination of the sugar lobby, click here to see John Oliver propose that all food labeling regarding sugar added be put in terms of “circus peanuts” (which have 5 grams each.)

Actually, a Gallup poll showing what Americans spent on average for this past Thanksgiving week reveals that it certainly isn’t peanuts nor is it just on food.

Happy Holidays!

Recovered Sounds

I first began to notice hearing loss in my early to mid-50s when it became obvious that I could only hear some voices on the telephone if I held it to my right ear.  Then I noticed it again one day when I leaned against a pillow while watching a movie.

I went to an ear specialist a few years later but sooner than most.  On average, people wait ten years to be tested.

The test detected mild to moderate loss in one ear and mild to severe in the other depending on the range.  But because the loss was asymmetrical, the issue soon became whether any tumor could be detected.

Typically hearing loss is symmetrical.

I was so relieved when there turned out not to be a tumor that I didn’t do much about the hearing itself.  We inherit various anomalies.  For instance, while it doesn’t affect my eyesight, my optical nerves have an irregular shape.

During my annual check up this year, my primary care doctor suggested I have my hearing retested now that it has been six or seven years.

I did, and fortunately the audiologist had access to the previous test for comparison.  While there had been little change, this time she explained hearing aids to me.

I now have two fine tuned to the levels and range of loss in each ear.  What made the decision easier was learning that researchers now know that when you can’t hear, your brain’s auditory cortex atrophies from lack of exercise.

Apparently your brain “stores” sounds and noises for up to three years but then begins to shed them.  Just as at birth, every human on earth is born with recognition of sounds in every language, but we begin to shed them based on what we hear our parents use when speaking.

That may also be why some people who learn to speak English very well can still be difficult to understand, especially when they speak very fast.  It is because they are still using sounds and cadence common in their mother tongue but unfamiliar in English.

When your hearing is amplified with aids not only do you hear sounds you had been gradually missing, but this then also improves perception and memory because that part of your brain is being exercised again.

A study published this year found that in 2,000 test subjects, all of whom were over age 70, those with hearing loss also developed cognitive impairment much earlier than those without hearing loss.

But this is one area where even under the Affordable Care Act, the health system still discriminates.  Hearing aids are rarely covered by insurance.

I’m only 65, but why wait?  I don’t feel old and I don’t think old.  An AARP survey published this year of people who ranged between 40 and 90 years old found, on average, that both men and women agree that “old” is age 70 for a man.

Amusingly, men thought women were “old” at 68 but women thought they were not “old” until age 75.  People in their 40s thought a person was old at 63, but by their 50s the threshold rose to 68 and in their 60s it had increased to 73.

In each age group those who felt that growing older was easier than they thought, that they had more energy than they expected for their age and that physical health did not hold them back were all highest for people in their 60s and 70s.

Anyway, the hearing aids I have now are each calibrated to the range and degree of loss in each ear.  I’d prefer it that you don’t stare in my ears the next time you see me (smile.)

Mine are the kind that fit over the back of the ear.  They are the color of my hair which I have always worn back and down over the tops of my ears.

They even have Bluetooth so that without disturbing others I can watch television or listen to streaming music or take a phone call in a noisy room.  Some movie and performing arts theaters are set up so I could pick up the sound through my aids if I chose.

DPAC where I live offers headphones, but I’ve never had trouble hearing there.  I haven’t been to a performance since being outfitted with aids, though.  The facility is looking at technological trends and plans to incorporate what makes sense in a few years.

I have a gizmo I carry in my pocket that, if needed, allows me to turn the hearing aids up or down, but I’ve never needed to.  I can also mute background noise if it is making it hard to converse with people next to me.

I just realized that I can even mute everything if I don’t like what someone is saying or “reinventing the wheel.”  (smile.)

For several reasons it took a day or two to get used to them.  The essential tremor I’ve had since childhood made learning to put them in fun.

It doesn’t take long at all to get used to having the buds in your ears but I am often startled at being able to hear something again and to accurately detect the direction from which the sound came.

On cross country road trips I sometimes found the GPS voice giving directions wasn’t loud enough or the volume on the radio hadn’t seemed to adjust automatically.

Now I know that the voice giving directions also shifts to the speaker closest to my left where I have the most hearing loss.  I also realize now that my English bulldog, Mugsy, pants very loudly.

I have also had to learn to adjust my whisper because I hear things differently now.

Life it good.  Always has been and now I am living even more of it.

The $7 Billion Cheeseburger

Nearly two-thirds (63%) of spending on public benefits goes to working families, according to a study released last week by researchers at the University of California and the University of Illinois.  These families make up 73% of enrollments in these safety net programs.

Working families are defined as those where at least one member is working.  While probably unintended, low wage industries are shoving costs off on to government, which is one of the rationales behind passage of the Affordable Care Act.

A high proportion of these low wage workers - a whopping 87% - do not receive health benefits.

In the case of fast food giants, more than half of their front-line workers, including the 28% fortunate enough to get 40 hours of work a week, are enrolled in one or more public assistance programs.

This is twice as much compared to 1-in-4 Americans nationwide.

This amounts to a $7 billion taxpayer subsidy each year for fast food businesses alone.  The proportion of Americans in low wage jobs has ballooned to 4-in-10 nationwide, according to another study.

Yet another recent study of U.S. food policy shows that “…huge subsidies are lavished on crops that become the ingredients for highly processed foods — including “junk” foods,” and other high margin staples in the fast food business model.

The result is a significant part of the $11 trillion diet-related heath issues and lost productivity is pushed off on taxpayers and higher premiums for those lucky enough to have health insurance.

Another report finds that the agriculture subsidy per taxpayer supports just over half an apple compared to 20 Twinkies, a junk food favorite where 17 of the 37 ingredients are taxpayer subsidized elements directly related to obesity, which burdens the economy with $150 billion in hidden costs annually.

Fast food giants and suppliers also make up 1-in-4 of the top 100 businesses keeping outdoor billboards on life support ever since use by tobacco companies were outlawed.

There is now an established link between prevalence of outdoor billboards and obesity.  And billboards themselves require the sacrifice of trees and vegetation, robbing taxpayers of not only these publicly owned assets but their public health benefits, such as screening noise and particulates as well as purifying air and storm run off of pollutants.

All of this amounts to a public subsidy of an unsustainable business model that relies on subsidized ingredients paying workers as little as possible while letting taxpayers pick up the costs.

Recently, it was estimated that for fast food companies to pay a livable wage it would require adding only 68 cents to a popular hamburger, but economists countered that to please investors, the companies would most likely just trim labor costs.

The not so veiled threat is that if required to do the right thing, they would hire fewer people, cut hours and push even more costs off onto the general public and taxpayers.  It is not unlike the hubristic mentality that just ripped $24 billion out of the economy in 16 days.

This is the same threat some of these businesses make about the Affordable Care Act and the requirement for health insurance to lower the burden on taxpayers.

I’ve personally sat on legislative committees for two state restaurant associations.  I’ve learned that there are many good people who want to do the right thing in these types of businesses but they are shouted down by small cadres of condescending extremists all too aware that they can’t go it alone or less honorable competitors would cut them to pieces.

So this is where the free market breaks down because it rarely requires full-cost accounting.  The minimum wage today is much lower than in 1955 when adjusted for inflation.  We’re paying for the cost of subsidized burgers and fries whether we like it or not, whether we realize it or not.

The low wage, taxpayer subsidy is not unique to fast food businesses, that’s just where I have the most familiarity having worked for forty years in visitor centric cultural and economic development.

Similarly, a report updated last spring found that in another segment of the tourism sector, a typical 300-employee Wal-Mart Superstore shifts more than $5,815 per employee onto taxpayers each year or a total of between $1 million and $1.7 million in corporate subsidy per store.

The tourism sector cannot make excuses by pointing just to how many employed there are students.  Nearly 7-in-10 frontline fast food workers are not in school and are single or married adults with and without children.  Two-thirds rely on that income as an essential component of family income.

In my opinion this status quo isn’t working.  We need to experiment with things like requiring health insurance and a livable wage rather than pushing costs off on taxpayers where anti-government types want to “drown it in a bathtub” as a way of controlling costs.

The “drowning” metaphor is horrible when people’s lives are at stake. It is also bad for business.  I’d rather start paying the “real” costs of things even if it takes a while to get things right.

If you missed it, the reports cited are linked where noted in the text.

Don’t take my word, click through and read for yourself, maybe while eating at a fast food business.  Look in the faces of the people serving you and ask yourself if you would pay a little extra at the counter so they can make a livable wage.

Reflect on the fact that more than 7-in-10 are women, more than 2-in-5 are minorities.  Only 13% receive health benefits through their employer compared to 59% of workforce as a whole.

You’re paying hidden costs in taxes anyway.  Isn’t it time for the free market to incorporate a triple-line approach to cost-benefit analysis?

Seeking To Understand a Puzzle

At least one “gamer” agrees with the Speaker of the House of Representatives that the strategy by a small cadre of his members is not a game.  Instead, it’s a puzzle.

Negotiating in a political sense has always been the work of moderates, but the problem today,  according to Pew Research, may be that the majority of moderates are Democrats or swing Independents such as me.

This breakdown is based on how people identify themselves in surveys.

Moderate doesn’t mean squishy as those on the right mean when they use it as a pejorative.  To adapt a description used by Micah Sifry, co-founder of Personal Democracy Media, I prefer to think of moderate as being willing “to find a way forward.”

An analysis posted on “Third Way” found that on average over the past thirty years, nearly half of American voters have been moderates, close to the proportion of conservatives and liberals combined.

This probably means the mayor of Blount County, Tennessee took a moderate position last week.  Blount County lies on the Tennessee side between Knoxville and the Great Smoky National Park, due west across the amazing national treasure from Asheville, NC.

Last Friday, the mayor sent a request to the Federal Government, which was shut down, not by a majority of lawmakers but by a very few using parliamentary maneuvers, asking if the county could pay on its own to reopen the national park, a key part of the economy there.

That’s one way forward.

The four House members representing districts along the Tennessee-North Carolina line that dissects the Great Smoky Mountains are among the 18% of the House of Representatives responsible for the shut-down strategy.

I didn’t vote for any of them, nor did the overwhelming majority of Americans, and thus is the flaw in the “representative” form of democracy.  Due to partisan redistricting, those in that tiny group feel ensured re-election and thus willing to put a proverbial gun to the nation’s head.

A fascinating study released this month provides a glimpse into the mindset of not only this estranged minority but the political party that harbors them.  It notes that Republican moderates (1-in-4) want no part of the small group responsible for the shut-down, but they also don’t want to be ostracized as “illegitimate.”

Worse, word is they are blackmailed with threats from within their party to unseat them.  Many are speaking out anyway.

This means that while those holding the nation hostage demand negotiation the Republican moderates likely to pursue a way forward are reluctant to be at their table, robbing Democrats of those who would truly negotiate.

Ostensibly this is all about the Affordable Care Act, and the story this small group tells themselves, but that claim is largely symbolic.  Ironically, many of those creating the shutdown in hopes of defunding the program represent parts of the ten states with the worst healthcare.

These folks seem to be telling themselves a story that the Act is a conspiracy to expand government and ensure Democratic majorities by expanding Medicaid.  Ah, attributing motive is one way fuel confrontations.

This worry has repeatedly proven unfounded since the 1930s.

But an analysis for Wall Street investors notes that Medicaid actually plays a very small role, not to mention the Affordable Care Act is based on a Republican idea.  True, but half of Republicans according to the recent study are either Evangelicals or Tea Party partisans.

According to experts quoted in the report, the real problem is that the private insurance provided by employers and relied upon by 65% of Americans is no longer sufficient.

“All of the ten states with the lowest overall health insurance coverage rates had among the lowest rates of employer provided insurance.”

I wonder if Republicans actually understand this but oppose it because, as the study notes, many have convinced themselves that Affordable Care will become another way Democrats build up constituencies, ones they tell themselves are grounded on dependencies.

There is a kernel of truth about the issue of dependencies and safety nets, but I believe, deep down, if they have actually studied the Affordable Care Act they understand it is truly an attempt to control hidden healthcare costs.

The costs from leaving so many Americans uninsured are ultimately shifted onto taxpayers as well as increasing premiums for those who have insurance, something no longer sustainable.  It isn’t a problem resolved by “shoulds,” it is simply a business issue.

No, there must be much more to the hostage taking debacle.  But one thing is for sure, telling stories and attributing motive which in turn creates a lack of trust are at its foundation.

Years of research into organizational and individual behavior has shown this is usually at the basis of all confrontations.

I know from experience, it is nearly impossible to negotiate with people who are telling themselves stories.  I am also pretty good at telling myself stories and attributing motive.

A way to understand the current dilemma is to view it through the Doonesbury lens on a state where the hostage takers are now in control of all three branches of government, such as North Carolina.

Then, apparently “negotiation” suddenly becomes a one way street.

I want to believe those holding a gun to the nation’s head are well meaning but regardless of intent, I keep remembering that the first time this was done, we ended up embedding slavery in the U.S. Constitution.

The Far Greater Burden of Hidden Taxes

The earliest coverage for health services in the U.S. was established for seamen by the federal government in 1798.  It was a compulsory payroll deduction, something I learned about while representing small businesses on a task force in Durham only a couple of years before I retired .

The group was noodling how to minimize the impact that people without health insurance have on those who do (prior to passage of the Affordable Healthcare Act), and it included Durham hospital administrators, medical associations, universities, local officials and others.

A study conducted in 2009 by the actuarial consultant Milliman quantified that people without healthcare coverage (often ranging to 1 in 3 Americans) are shifting a hidden tax on to those who do.

This amounted to $1000 per family and nearly $400 per individual because the costs of uncompensated care are shifted on to those with insurance through increased premiums, or on to businesses if they are covered at work.

By now, this tax-like shift was projected to increase by a third.  This above and beyond the fact that in the U.S. we overtly spend more tax dollars on healthcare than countries with universal coverage, many times more.

We only publicly provide care for mostly “poor people, old people and congress people” and we still spend 58% more per capita in public dollars on healthcare than countries with universal coverage and that doesn’t even count the hidden tax.

If you find yourself wondering why, watch the rest of this fact-checked video by the hilarious author John Green as part of his Question Tuesday series.  As the Upworthy post by Adam Mordecai notes, it will blow your mind in just the first five sentences, that is for those still open enough to watch or even read this far.

Until the 1930s most health insurance only protected workers from disability due to accidents or lost wages should they fall sick.  Companies in mining, lumber and railroads, however, experimented with plans that covered medical services in the 1870s and 1880s beginning in the Pacific Northwest.

Spurred by the Great Depression, healthcare insurance as we know it today evolved in the 1930s.  By 1940, a little less than 10% of Americans were covered.  But spurred again by WWII, by 1950, two years after I was born, 50% of Americans had some form of healthcare insurance.

Unlike soon-to-be required healthcare insurance, compulsory auto insurance wasn’t organized by the federal government but it too, was modeled after one passed in Massachusetts in 1925 and enacted in 1927.

It took nearly 30 years before another state followed suit. In 1957, North Carolina, where I live, became the third state to require car insurance.  Until the 1970s, a majority of states required only proof of financial responsibility, something still done in Virginia.

If a driver can’t provide poof they can pay any liabilities, they can either buy a bond or pay a fee, the proceeds of which are distributed to insurance companies to offset the hidden tax uninsured drivers place on the system.

The first car insurance policy was sold in Ohio in 1897, but it took a while to sort out whether auto accidents would instead be resolved in court like Torts.

In the beginning, insurance companies opposed legislation to make even financial responsibility mandatory for automobile drivers.  Reading the arguments back then seems very much like listening to conservatives today when they “diss” health insurance requirements as “Obamacare.”

Studies show that 1-in-7 drivers in the U.S. are still uninsured today, ranging from 4% in Massachusetts to 28% in Mississippi, including 14% in North Carolina.  These uninsured drivers shift a hidden “tax” onto the premiums of insured drivers that amounted to $10.8 million in 2007.

It sure doesn’t appear that handing that on a state by state basis has worked for car insurance either.

When I read that the CEO of Papa John’s estimated that meeting the requirements of the Affordable Healthcare Act could possibly raise the cost of a pizza by 15-20 to cents, it sounded like an excellent trade off to me.

That is peanuts compared to what leaving Americans uninsured does to my premiums.

Visitor-related businesses have been very slow to provide healthcare insurance to employees, often by keeping employees part time.  Sixty percent of restaurant employees are part-time, one third of which, according to studies, are using those jobs to further their education.

Last month, Rick Newman, a financial bloggers, quoted Victor Fernandez of People Report, an HR consultant that publishes benchmarks and forecasts for restaurants as saying about the Affordable Healthcare Act:

“If it works as it’s supposed to, we’ll probably see a happier, more engaged workplace.The law will provide some good benefits compared to what people have now.”

A recent survey by PwC found that the majority of private companies are already in compliance with the new healthcare insurance law and a very small percentage of those who aren’t cited affordability as an issue.

For many decades now businesses have understood the value of a healthy workforce.  Most also understand that plugging loopholes and avoiding the shift of hidden costs is just good business.

An $11 Trillion Diet Deficit Hawks Can Munch On

A friend and I have recently started walking an additional 12-15 miles a week up and down the many hills in my neighborhood in Durham, North Carolina.  Coupled with eating out half as much, it not only feels great but researchers note it should be expanding my hippocampus.

This is the part of the brain thought to be the central processing area for memory and learning which gets a workout during the 6 or so hours a day I spend researching and writing essays to post on this blog.

At the risk of offending my Tea Party friends who still can’t seem to come to grips with the fact that health insurance is not only for their benefit but to prevent uninsured costs from being shifted on to other people, I recommend a report published last month entitled The $11 Trillion Reward.

That is how much would be saved each year if Americans just increased their consumption of fruits and vegetables and yes, it would ultimately lower the deficit.  No, I don’t just mean those living in Red States which tend toward higher rates of obesity.

I was only saved from the genetic tendency toward being overweight by the fact that doctors discovered in my early 20s that I can’t metabolize sugar very well, including refined carbohydrates.

If they didn’t make me sick, I’d still be binging on my mom’s homemade cinnamon rolls and a big bag of glazed Spudnuts.

But all my life I’ve eaten way too much red meat, not just because I grew up on a cattle ranch, but because a high-protein diet suits me.  But recently I began to substitute poultry or fish four or more times a week.  I know, not very Idahoan.

The report is not only about quantifying savings if Americans increased our individual fruit and vegetable daily intake on average by 1/12 cups of fruit and a mere cup of vegetable, although just that change would save 127,261 lives a year and public savings of $54 billion a year in medical costs.

The scientists and public policy experts who authored the report include proposals for overhauling our entire public farm and food assistance policies by things like:

• Recalibrating programs to increase R & D and production of fruits and vegetables by shifting incentives to help diversify growers and gearing them to local markets.

 

• Grants to spur greater availability of farmers markets and grocery stores in low-income neighborhoods including moving “helping hand” food programs to more healthy choices.

Don’t go all “nanny state.”

This is simply about protecting innocent Americans from the hidden costs related to the actions of others.

Edmund Burke, considered the father of modern conservatism and a mentor to our founding fathers wrote that “whatever each man can separately do, without trespassing upon others, he has a right to do…”

I agree, and I suppose that means that anyone should be free to binge on whatever foods they wish, and businesses should be free to cater to those binges with junk.

But other Americans should not have to shoulder the costs of healthcare consequences of these binges or their binge enablers nor should my tax dollars be used to subsidize either the binging or the creating of the foods that are binged upon.

According to Joseph Thorndike, head of the Tax History Project and author of a book published this year entitled Their Fair Share: Taxing the Rich in the Age of FDR:

The original Tea Party “was a protest not against taxes but against tax loopholes.”

Shifting costs onto innocent Americans because you are too stubborn to have health insurance or to eat what is good for you, is a huge tax loophole.

An Even Bigger Drag On Productivity

For me a career in community-destination marketing, a visitor-centric form of economic development, required the perfect blend of traits and interests such as altruism, historical context, passion, strategic thinking, innovation, growth orientation and community.

A day doesn’t go by during my retirement, however, that I’m not embarrassed by the apparent selfishness, insensitivity, self-centeredness and stinginess of some of the businesses who are among the primary beneficiaries of my former profession.

A recent example is the news coverage of some comments a week ago attributed to the CEO of Papa John’s, a publically traded business he founded in 1985.

A complete reading of the article shows that he is threatening to cut employee hours as a dodge around healthcare reform out of one side of his mouth, he’s whining at the same time about the increased costs he estimates that the healthcare overhaul will add.

Then, out of the other side of his mouth, he undermines that argument by saying that everyone will be required to have health insurance and businesses such as his will merely pass the costs along to society with the hidden costs of healthcare the reform is designed to curb.

The same was true in the mid-1920s when vehicle liability insurance was first made compulsory (something that also began in Massachusetts) and was initially opposed by many conservatives including business owners and leaders for many of the same reasons they oppose healthcare reform today.

A pizza delivery business such as Papa John’s is filled with the kinds of “hidden” costs that businesses themselves create and pass on to customers.  In Papa John’s case this include a nearly$3 dollar fee which is now added after an purchase is made and tacked on to the bill as if it were, but it is, in fact, used in part to cover commercial liability insurance for drivers using their own cars.

Fortunately, more and more businesses in various sub-segments of the tourism sector are stepping forward to pay a living wage, and to provide benefits such as health insurance and even acknowledging, as a Marriott official did recently, that paying even targeted taxes, when  levied in a timely fashion and used in part to help businesses thrive, do not hurt business.

A drag on society and the economy that is at least as debilitating as healthcare costs is the cost of childcare.  As illustrated in the excellent infographic created by Column Five Media and shown in this blog, in many states such as North Carolina, where I live, the annual cost of childcare is more than the average annual tuition at a public university.

Nothing hurts both business productivity and upward mobility than the cost of childcare.  It is also an issue at the core of any hope of improving student achievement and better preparing future generations for a global economy.

Making childcare universally available, accessible and affordable is an investment America can no longer overlook.  It is also one business owners and leaders can champion and shape as a direct impact on productivity and the bottom line.

This is an area where I hope that tourism sector businesses, which overwhelmingly require shift-work, can finally step forward and show leadership as so many have in the areas of brand simplicity, customer loyalty and innovation!

A Strategic Overhaul for North Carolina Marketing

In 1995 I was honored when I was nominated by my state for an appointment as a Presidential delegate to the White House Conference on Travel and Tourism, but it is clear today, some 17 years later, that many other attendees did not take notes.

One of the clear outcomes of that ground-breaking conference was an understanding that tourism isn’t an industry, never has been, never will be. It is, instead, a sector of 6 or 7 different industries.  When I got back to Durham and the community-destination marketing organization where I was an executive until several years ago, we flipped that switch immediately.

Seventeen years later, you can use someone’s reference to tourism as a sector vs. an industry to quickly determine how strategic they are.  Of course, being thought of as a strategic thinker is something almost everyone seeks but lamentably few qualify as such despite the best efforts to teach it in leading-edge programs today such as Appalachian State University’s Hospitality and Tourism Degree Program.

It is more a mindset than a matter of smarts and the difference is more than semantic.  Anyone who has flipped the switch from viewing tourism as an industry to a sector of industries is more likely able to take the long view of leadership which in the words of Dr. Roger B. Porter, a Harvard professor and classmate two years ahead of me at BYU means they:

“…are more concerned with investing in the future than in immediate gratification, and they value dynamism, change, and innovation over security and stability.”

North Carolina Governor-elect Pat McCrory has an opportunity to overhaul state government the way Governor Bill Umstead did in the early 1950s and nowhere more so than in travel and tourism and the way the state is marketed overall.

Like Umstead, a Durham native, who embedded the development of Research Triangle Park in his overhaul, which after his untimely death happened to be carved into Durham pinelands and the launch of what would become North Carolina’s transition into a powerhouse for research and development, especially in healthcare, McCrory has the opportunity to set the tone for North Carolina’s marketing for the next 50 years.

In the late 1950s, North Carolina’s approach to both development and  environmental conservation were fused into one department.  Similar to how these two forces have become under separate agencies, today the state’s marketing has become much too fragmented with many divisions and departments trying their hand at marketing with little or no strategic coordination with the state’s destination marketing agency.

A more strategic, forward approach to marketing the state won’t be a replica of what McCrory saw in Charlotte when he was Mayor.  They have done some novel things there but it is still essentially old-school, facility-driven community-destination marketing, the way it was practiced in the late 1960s and early 1970s.

At its core, destination marketing, regardless of whether it is for a community or a state, is about promoting a the destination as a whole.  As a destination, the State of North Carolina has had some remarkable leadership over the years, but those leaders’ hands have been tied by a mix of old-schoolers in the tourism sector and fragmentation within state government.

A first order of any strategic realignment in this state must recognize and adapt to the reality that over the past thirty years it has been the marketing agencies of North Carolina’s cities and counties, working in collaboration, that have collectively driven nearly 80% of the state’s tourism growth.

McCrory is in a position to generate synergistic realignment of the paradigm in North Carolina state government, just the way Governor Umstead did with the state’s approach to economic development 60 years ago.  Fortunate for North Carolina and especially Durham, a McKinsey Global Institute Report last year entitled An economy that works: Job creation and America’s Future, two of the three most potent sectors for job growth will be healthcare and tourism.

According to the report, the tourism sector alone, reported to be the nation’s fifth largest employment sector, is projected to generate one in seven jobs over the next decade, adding to sub-segments such as the 1.9 million in arts, entertainment and recreation and more than 11 million combined in sub-segments of foodservice and accommodations.

Ironically, soon-to-be Governor McCrory will need to look no further than the state constitution for an overarching strategy to guide any strategic overhaul of North Carolina’s marketing.  By a vote of more than 7 to 1, in 1972 North Carolinians embedded an oft-ignored constitutional amendment that reads in part:

“It shall be the policy of this State to conserve and protect its lands and waters for the benefit of all its citizenry, and to this end it shall be a proper function of the State of North Carolina and its political subdivisions to acquire and preserve park, recreational, and scenic areas, to control and limit the pollution of our air and water, to control excessive noise, and in every other appropriate way to preserve as a part of the common heritage of this State its forests, wetlands, estuaries, beaches, historical sites, openlands, and places of beauty.”

Unfortunately, the following year responsibilities for economic development and environmental resource protection were segregated, leading to desecrations such as the recent legislative give-away of roadside beauty to out-of-state billboard companies, something McCrory lamented during the campaign.

North Carolinians have a very deep love for their state and its incredible and unique sense-of-place.  They deserve an overarching strategic direction for the state that puts the protection of its sense-of-place at the top of any list of development priorities, just as the state constitution requires.

Election rhetoric aside, no one has a proven track record of doing this more than Governor-elect McCrory!

Robo-Decisions

There are good reasons we have a "representative" democracy. If we wanted robo-decisions, it would be easy enough to turn everything over to polling computers and do away with elected officials altogether. As much as I value scientific, generalizable public opinion polling, I say we stick with a representative form of decision making.

Republicans bent on repeal of healthcare reform are driving an agenda that represents only 26% of Americans (page 2) and less than half of the just-more-than-a-third who affiliate with their Party.

But, of course, they weren't elected to just represent Republicans or those who support repeal of healthcare reform.

They represent everyone in their districts and states, even those who choose not to vote at all. They definitely don’t just represent bully-pundits or lobbyists or anonymous corporate campaign donors either.

Representative democracy requires conversations, informed by reading, analysis, thoughtful discourse plus courage and open minds.

The AP-GfK poll referenced above which was conducted a week ago on healthcare reform also shows overwhelming support for nearly every element of the reform enacted last year with less than a third opposed to the most unpopular element, a requirement for virtually all Americans to carry healthcare insurance.

By the way, the largest group of Americans who want the act changed, more than 4 out of 10, want the reform to do even more to change the healthcare system.

Given the amount of misinformation and distortion about healthcare reform, it is astonishing that anyone at all favors any of it.

Suppose there were a way to let the 1 in 3 who object to the requirement to carry insurance to completely opt-out on the condition that they or their families never run up even the most indirect or hidden costs to the system.

That just isn’t possible. It would be like saying one is never use streets or roadways or the monetary system or to breathe unpolluted air.

A free society doesn't come free. It comes with responsibilities. And those responsibilities must be carried by everyone. No one gets to pick and choose. No one gets a free ride.

Raise A Pint of Guinness to Jim!

I don’t even know if he drinks beer but if he does I’ll explain why it could very well be Guinness Stout. I am so proud of Jim Wilkerson and Duke University and Durham. While the bellyaching of so many enterprises makes me want to ask if “they would like to have some ‘whine’ with that cheese,” Jim is showing how to do the right thing.

As the head of Duke Stores, Jim pitched in lend DCVB a hand when I worked there, but I never met him in person or got to know him. I knew he has been a national proponent of better working conditions in factories around the world devoted to producing goods for sale in the US.

He also worked hard in coalition with Duke students to ensure that none of the products sold in Duke Stores were produced in overseas manufacturing operations employing child labor.

Jim had a breakthrough last year when he led an effort to open the first apparel factory in a foreign country to pay a “living wage”. He received a nice write up in The Durham News this week.

His observation quoted in the article epitomizes values in Durham’s overarching brand, "I've never seen more motivated, productive and appreciative group of workers in my life." Durham’s a very caring community.

I’ve never been a beer drinker. I learned during high school that even one drop reacts unpleasantly with my digestive system. I know now that it wasn’t the alcohol nor was it the stern silence of the stare I got from the top of the stairs from my father when I got home.

But I ‘m a big fan of at least one beer in particular after reading Stephen Mansfield’s 300 page book The Search for God and Guinness – A Biography of the Beer That Changed The World published just 12 or so weeks ago. It doesn’t have much to do with beer, really! Now don’t go all evangelical on me. The author is a former pastor, Christian speaker and I think he’s probably Republican. He’s written on both the spiritual journey of President Obama, whom he admires but did not support during the campaign and more recently Sarah Palin. So stick with me a minute.

I worked in part on behalf of truly small businesses for nearly 40 years. I know how they struggle and I think that they will be inspired by this book enough to shout down the rhetoric of the corporate-fueled anti-healthcare reform trying to manipulate them to lobby for repeal of the healthcare insurance reform act enacted last year.

Guinness was founded in 1759 in Ireland, just the year after one of my ancestors, James McCrory was born there. The company’s founding family had an uncanny grasp of how an economy functions. They understood the concept that good consumers are healthy consumers and live in clean communities and need time with family and what is given, goes around and what goes around, comes back around.

To give you just a “sip” from the book, Guinness regularly paid wages 10%-20% above the levels of the time and by the 1920’s the company was already providing unheard of benefits to workers, even by today’s standards. They didn’t dismiss them as entitlements, they granted them as “the right thing to do” and trusted the company would still be the beneficiary in the long run.

Here is a sample of what Guinness provided its workforce way back in the 1920s:

• Full medical and dental care
• Massage services
• Reading Rooms
• Subsidized meals
• A fully funded pension
• Funeral expenses
• Educational benefits
• Sports and fitness facilities
• Free lectures and concerts

source: The Search for Guinness And God – A Biography of the Beer That Changed the World

Under Guinness family leadership until 1986, the company also had an extraordinary sense of the importance of “place” and reinvested heavily into historic preservation, again just because it was “good business.” Today, nearly 2 billion pints of Guinness are consumed worldwide each year and it is arguably one of the most recognized brands anywhere on the planet.

Then, as today, it pays to do the right thing. Just ask Jim Wilkerson.

How Appearance Is Related To Healthcare Insurance

I fully understand how Americans can fail to grasp healthcare insurance reform and yet show up in polls so positive about the components.

I’ve watched officials do it for years with “appearance.”  Ask if overall community appearance is a priority (polls show it is for residents) and officials will often say “no” and imply it is just not substantive when we have so many “real” problems.

Ask then if they think public health or crime reduction or economic development or clean air and water or community confidence or longer lasting streets or wayfinding are important and unless they are brain-dead, they typically sing a different tune.

The problem is a failure to think strategically.  From a tactical or “little picture” viewpoint, it is easy to dismiss things like “appearance” or “health insurance reform.”

That’s why we need more not fewer, elected officials who can and will do more than look down at their feet.  We need folks who can and will solve problems strategically, using “big picture,” over-arching approaches and solutions that focus energy on resolving  numerous problems at once.

We need more officials who can stand up to special interests whether it is behind-closed-door lobbying by millionaires and their sycophants or thirty angry people in orange shirts showing up at meetings about an isolated issue. We need more officials who think strategically about what’s fair and equitable to the community overall.

That’s why “appearance” is so important to 9 out of every 10 residents…they viscerally grasp that a well-kept community is:

• A well run community,
• A more healthy community,
• A community with less crime,
• A community that is appealing to talented, creative people and the businesses that pursue them,
• An easier to get-around, more productive community,
• A community that is better able to market to visitors and lessen our tax burden with the revenue they generate.

Typically though, it isn’t the officials who can’t or won’t think “strategically.”  The problem starts with “US.”  “We” fixate officials on crises…pet projects, or obsessing about isolated aspects rather than holistic solutions to overall issues.

This in turn feeds the cycle of news coverage all too preoccupied with anecdotes vs. data, fads vs. trends, demanding quick, simplistic solutions to complex problems, obsessing with whiners or momentary winners and losers or the crisis of the day or hour or minute.

So everybody jumping up and down with signs and simplistic bumper-sticker dismissives or hammering thoughtlessly on listservs or seeing red because someone told you to and marching robotically to the polls – – these all symbolize our malady of short-sightedness and they’re all examples of how we do not see the forest for the trees.

The first step to improved government is to accept that “we’re” the problem, we’re the reason we have short sighted officials….we’re the contributors to the very things we fear and the perpetuation of problems.

Keep Polluting, Uhhhh…Just Because We Can?

I’ve been reading a lot of people including scientists voicing opinions on the other side of the pollution issue.  Typically, these are well thought out opposing or mitigating arguments about global warming.  It is good to know both sides of the issue.

I read in last week’s issue of Newsweek a fact-filled column by conservative and very dry-witted commentator George Will providing compelling evidence that, as in the past, the predictions about running out of oil may be too conservative.

His column is well worth reading…but yup, I got the impression he’s arguing that liberals are too conservative when it comes to global warming.  At least that was my inference.

These opposing arguments including Will’s provide some fascinating details to inform the overall discussion but  they appear to be saying we should continue polluting because…we can?   Uhhh, that we should continue to be over reliant on oil…because we can, regardless of the problems inherent on burning it as fuel?

I understand market forces play a role but I also keep hoping that somewhere in the conservative or libertarian (ultra-conservative) world there are some think-tankers trying to make arguments for something other than just sitting tight with the status quo while nit-picking at efforts to make a better world!

Are they out there?  Tell me where and I’d love to read or see their stuff.  I just don’t see the logic in continuing to pollute a planet and be over reliant on a particular source of energy…just because we can.

Tea Partier Reveal Makes Perfect Case For Health Insurance Reform!

Okay, I get it now. Supporters of tea party candidate for U.S. Senate in Kentucky have clarified that he only opposes “victimless crimes” like riding a motorcycle without a helmet.

Uhhh Really!

How on earth can anyone believe that there will be no victims when someone is killed riding without a helmet…?

• Can they really think his or her family isn’t victimized by the rider’s untimely and unnecessary death? No hidden social security disability or other publicly funded services will be drained?

• Can they guarantee that no one else as a passenger or in other vehicles is hurt during the accident involving a reckless driver without a helmet?

• Can they guarantee that everyone who doesn’t wear a helmet is still smart enough to carry health insurance?

• And even if rider has insurance, can they can guarantee that a fatality won’t arbitrarily drive up everyone else’s health and vehicle insurance rates?

• Or if they do or don’t have insurance can it be guaranteed that absolutely no hidden public costs will be expended on emergency response, hospital emergency rooms, investigating officers, claims adjusters or clean up after the fatality?

I get it that by nature people resist being required to do something even when it is a no-brainer (pardon the expression) but this guy just made the case for both helmet laws and healthcare insurance reform.

We all value our freedom…but freedom comes with responsibilities especially when others may even remotely be forced to pick up the costs for our actions.

Wearing a stupid helmet and carrying insurance isn’t a surrender of freedom…it is doing the minimum to mitigate actions for which someone else or the public-at-large may be forced to pick up hidden costs.

No one lives in a vacuum, not ultra conservatives, not libertarians, not tea partiers, not even Republicans. No one!