Buddhist Marketer

Journal Entry

415 Grand; Bedroom

I feel like I am moving out before I really lived here, as if I am packing up and moving along before the story here is complete.

I love these periwinkle walls, the white lamps glowing off them, the hum of the orange bookshelves behind.

The sound of children squealing through a water sprinkler beneath; the sound of a helicopter above.

I miss all this, already.

It is hard to believe that one year ago I sat here and worked on linear algebra.

—–

I wonder if Bea feels this way.  As if she is moving out before she really lived.

Don’t Be Shy

Choices, Choices

The Epistemology Of Blogging

ThinkBuddha.org’s Will Buckingham shared his thoughts about “The epistemology of blogging”, a topic on Australia’s ABC National Radio show The Philospher’s Zone.  His thoughts:

I don’t think that seeing blogging only in the light of the mainstream media is really a useful way of understanding what role blogs play in the way that we deal collectively with knowledge, or what passes for knowledge…  Because – to return to the question of whether we are ‘epistemically better off’ thanks to blogs – I suspect that this kind of writing without authority is epistemically extremely valuable, because what it does is it demands of the reader a certain critical intelligence that can be obscured by the pantomime of authority, and in doing so, it opens up a space for the kinds of naive questions that are often unasked between the narrow lines of close, well-referenced arguments. It is not so much a matter of possessing knowledge as it is of exploring in dialogue with others the processes of knowing, or of coming-to-know. And if this is not social epistemology in action, then I don’t know what is.

I rather like this line of thinking.  And you?

Leslie Snyder Plays Vagina Card

The Rape Shield Law is egregious and should be overturned, yet Leslie Crocker “Vagina Card” Snyder is using it as a primary selling point in her campaign for DA.

As a woman, I loathe being marketed down to, as if all of my decisions are based on the fact that I have a vagina.  Grumble. I find this kind of messaging to be condescending, frankly, so when I received the first, the second, and then the third direct mail pieces from the Leslie Crocker Snyder for District Attorney campaign, I was annoyed.

Why?  Here are some of the large font, bold face phases on her marketing materials:

• A TRAILBLAZER FOR WOMEN
• A Record of Leadership on Our Issues
• A LANDMARK JUDGE FOR MANHATTAN WOMEN
• 35 YEARS PROTECTING MANHATTAN WOMEN
• co-authored New York’s first Rape Shield Law

It’s this last one that I find particularly vomit-rocious.  Here’s the bullet in full, bolding theirs:

Leslie co-authored New York’s first Rape Shield Law to stop defense attorneys from attacking rape victims on the witness stand.

Oh, really?  Is that what the Rape Shield Law does?  You mean it doesn’t result in a jury not being able to see the full extent of evidence for themselves and make a reasoned, informed conclusion based on the full facts at hand?  It doesn’t prevent defense attorneys from fully defending their clients?  It doesn’t patronize members of a jury and assume that they’re too stupid to determine when an alleged victim’s sexual past is or is not relevant to the guilt of the accused?

That’s crap!  The Rape Shield Law is egregious and should be overturned, yet Leslie Crocker “Vagina Card” Snyder is using it as a primary selling point in her campaign for DA!  Really?!?

Let’s be honest; times have changed and it’s no longer assumed that just because you wear a short skirt some dude has the right to have his way with you.  I understand that there may have been a time and a place for special protections for alleged victims, but you don’t have to be a former member of the Duke lacrosse team to wonder if laws like this remove the disincentive for women to simply cry “rape”.

“Oh, but prosecutors don’t press charges unless there’s like, lots of evidence and stuff,” you might say.  A reasonable assertion, to be sure; when I was sexually assaulted in college the DA in New Haven did not feel the evidence resulted in a strong enough case.  I agreed with his decision then and I agree with his decision now.  But the Duke example well illustrates that politics played a key role in the DA’s decision to proceed with the case; he was gunnin’ for office and, taking a note from the Chuck Schumer playbook, loved seeing his face on TV.

Bottom lines?

• The Rape Shield Law may have been necessary when date rape was seen as the fault of the chick in short-shorts, but those days are long gone
• It assumes that jurors are idiots and cannot decide when an alleged victim’s sexual past is relevant for the case before them
• It removes a disincentive for women to simply cry “rape”

The Rape Shield Law is a crock of shit, yet the shrill retired Judge Leslie Crocker Snyder is using it as a crown jewel in her run for District Attorney.  That alone would be annoying to me, but for her to wrap it into a broader message of “I’m a Woman; You’re a Woman — Elect Me!” is jejune beyond words.

CY VANCE FOR DA!

A More Accurate Portrait

Screw corporate sales videos.  I’m using this as my sales pitch for my team’s marketing solutions.

A film by Todd Sokolove.

Thought-Provoking Health Care Article

I read an article in the Atlantic recently (How American Health Care Killed My Father by David Goldhill) that made me think more deeply about my mandatory universal coverage POV.  Now, I have Googlefights in my brain regarding this “debate”, because I enjoy free markets when applied where markets make sense (allocation of scarce resources) but I also don’t think that health care is a zone of scarcity.  Good health can be abundant if we let it be so.

Plus, I’m biased:  my older sister has been sick for the past twenty-five years, and I just don’t think it’s fair to make someone with an illness they’ve had since the age of nine to eat shit and die.  I don’t want to live in the kind of society where we cross our fingers and hope that local charities will help out; the people in my hometown made it clear that they felt Rahnee’s illness was a function of the racial mixing my parents got up to.  And if we would just accept Jesus as our lord and savio(u)r!

So this was the mindset I — a self-professed libertarian pragmaternalist — had going in to reading this article.  Ready?

America has built a health-care system with incentives that inexorably generate terrible and perverse results.  Incentives that emphasize health care over any aspect of health and well-being.  That emphasize treatment over prevention.  That disguise true costs … and discourage transparent competition based on price or quality.  That result in a generational pyramid scheme rather than sustainable financing.  And that — most important — remove consumers from our irreplaceable role as the ultimate ensurer of value.

These points made my “I want to study incentive structures and I like free markets” thoughts hum.  They also reminded me of a point that Ashton Kutcher made on Real Time with Billy Mah this past week (I, for one, am curious about how Ashton having an arguably less-healthy brother has shaped him — but I project …) — that the system is encouraged to keep people addicted to pills to mitigate the poor health that’s caused by the fact that they’re eating too much meat and not getting outside often enough.  To quote Ashton:

Instead of promoting this healthcare plan that seems a lot more like a sick-care-plan, why don’t we promote wellness within the system?

Unfortunately the article never gets around to delineating specifics regarding how the author’s proposal would fix this aspect of the health care shit-storm, but there is a general bone thrown in that direction (more in a bit).

The author is against the current bill:

Fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system — insurance-based, employment-centered, administratively complex… Unless we fix the problems at the foundation of our health system — largely problems of incentives — our reforms won’t do much good, and may do harm.

He also points out that health insurance is not health care, which makes me wonder if that’s the “health insurance is not a right” angle that some of my less flexible libertarian friends support.  [NB:  boldface emphasis mine, throughout.]

Employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago…  We all believe we need comprehensive health insurance because the cost of care — even routine care — appears too high to bear on our own.  But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense...

For every two doctors in the U.S., there is now one health-insurance employee…  In 2006, it cost almost $500 per person just to administer health insurance.  Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else — by ourselves.

This all is making a lot of sense to me, I think as I read.

His section on “The Moral-Hazard Economy” is worth reading in its entirety, so I won’t anger the copyright gods by snipping it all here.  However I will type the best sentence from each paragraph into one giant, ellipsis filled blockquote:

Society’s excess cost from health insurance’s administrative expense pales next to the damage caused by “moral hazard” — the tendency we all have to change our behavior, becoming spendthrifts and otherwise taking less care with our decisions, when someone else is covering the costs…  The key message [of medical ads on TV, which note that the product or treatment is eligible for Medicare or private-insurance reimbursement]: you can benefit from this product and pass the bill on to someone else…  Combine these two features of the system [that someone else will be paying for most or all of your bill when you walk into a doctor's office, and that most physicians benefit financially from ordering tests, etc.] with a third — the informational advantage that extensive training has given physicians over their patients, and the authority that advantage confers — and you have a system where physicians can, to some extent, generate demand at will…  In our current system, physician supply often begets patient demand…

Moral hazard has fostered an accidental collusion between providers benefiting from higher costs and patients who don’t fully bear them..  The average insured American and the average uninsured American spend very similar amounts of their own money on health care each year — $654 and $583, respectively.  But they spend wildly different amounts of other people’s money – $3,809 and $1,103, respectively.

The author’s bottom line:  health-care demand is an artificial construct jacked up in no small part by the current clusterf*** of incentives to jack said health-care demand up, up, and away.

How far away?  He writes under “There’s No One Else To Pay The Bill” that:

• “Confiscating all the profits of all the famously greedy health-insurance companies … would pay for four days of health care for all Americans.”
• Adding “in the profits of the 10 biggest rapacious U.S. drug companies” pays for “another 7 days.”
• “Confiscating all the profits of all American companies, in every industry, wouldn’t cover even five months of our health-care expenses.”

He continues under “The Government Is Not Good At Cost Reduction” with a great illustration of jack-booted market inefficiencies that can crop up when optimization rules that serve the middle are broadly applied by a Kafkaesque central bureaucracy.  In a nutshell:

1. It takes a while for centralized bureaucracies to notice “market changes and resource misallocations, and then (sometimes subject to political considerations) issue additional regulations or change reimbursement rates to address each problem retrospectively.”  At which point the landscape has probably already shifted, yo.
2. So then you get situations like a total lack of geriatricians, which is a function of “Medicare’s current reimbursement system (which generally pays more to physicians who do lots of tests and procedures).”  If the market had its way, and seniors’ demand created geriatrician supply, the geriatrician paycheck would go up and send “a useful signal to medical-school students.”

His argument makes sense here, though I’d wager that the pay differential would need to be pretty handy to sway kids who want to be radiologists and anesthesiologists to become the doc who works with cranky old people.  Have you spent time with seniors?  They are opinionated and cranky.  Think Anittah Patrick.  In big diapers.  QED.

David continues with more information regarding the uncompetitive nature of the industry, and closes that section with the strongest paragraph in the entire piece:

The net effect of the endless layers of health-care regulation is to stifle competition in the classic economic sense. What we have instead is a noncompetitive system where services and reimbursement are negotiated above consumers’ heads by large private and government institutions.  And the primary goal of any large noncompetitive institution is not cost control or product innovation or customer service: it’s maintenance of the status quo.

He also points out in “The Strange Best of Health-Care Technology” with the help of an example of MRI machine over-purchasing that “technology is driving up the cost of health care for the same reason every other factor of care is driving up the cost — the absence of the forces that discipline and even drive down prices in the rest of our economy.”

Ouch.  Damning veritas!

David’s not done yet, folks.  In “Our Favored Hospitals” he asks aloud if hospitals stick hospital-wide operating costs into the Emergency Room bucket in order to inflate the size of their perceived charitable public good.  It’s a great point that calls into question the data point regarding emergency-room care as the most expensive form of treatment (at least partly, though my friend Cameron’s TV points re: universal healthcare certainly have merit as well).

Moving into “You Are Not The Customer”, David illustrates how difficult it is to get service pricing upfront from hospitals, clinics, and doctors’ offices.

Keeping prices opaque is one way medical institutions seek to avoid competition and thereby keep prices up.  And they get away with it in part because so few consumers pay directly for their own care — insurers, Medicare, and Medicaid are basically the whole game.  But without transparency on prices — and the related data on measurable outcomes — efforts to give the consumer more control over health care have failed, and always will…

It’s astonishingly difficult for consumers to find any health-care information that would enable them to make informed choices … so while every city has numerous guidebooks with reviews of schools, restaurants, and spas, the public is frequently deprived of the necessary data to choose hospitals and other providers.

Although as my friend Sheethal has noted, “I wonder if some would just choose poorly [even with full information] because they don’t want to pay now for something they cannot foresee will happen.”  Adds my friend Matt (a social psychologist who works in behavioral change):

People underweight any number of potential problems because they are not as psychologically “hot”. More people die in auto accidents than of cancer, but you don’t see people running marathons for auto safety, because cancer is long and slow and basically horrible as a death.  I’m not sure straight market choice is the answer there, Anittah. Consumer Reports is awesome, but it doesn’t reach everyone…what you want is smart, solid defaults, as chosen by either good HR or experts, then allowing advanced users to have personal choice to override if they have a special situation.

I suspect David would nod his head at Matt’s suggestion.  And in “A Way Forward”, he outlines his own reform prescription:  the government should support “consumers — by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care”.  He doesn’t state it, but my guess is he’d want said subsidy to appear more in the form of a health stamp (grocery stores charge the same for cheese wheels regardless of payment form).

He adds that

we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans — indeed, all Americans should be required to buy it — with fixed premiums based solely on age.

This, I like.  I’d go one further and add in some kind of preventive health coupon that encourages regular checkups and discourages waiting until that little boil turns into Jabba the Hut.

He also teases into the idea of a new allied health professional that Matt suggests above with the “expert”:

we’d also probably see the rise of health-care agents — paid by, and responsible to, the consumer — to help choose providers and to act as advocates during long and complex care episodes.

I’d go one further and suggest that these agents could be engaged as the healthy lifestyle sherpas, advising on everything from nutrition to yoga to the evils of too much animal protein consumption.  Perhaps catastrophic premiums could be reduced if you have a sherpa — sort of how having The Club on your car lowers your auto insurance premiums.  Or, maybe this is what you can spend your health coupons on.  (I have to think this through more carefully, but in my mind there’s got to be a way to get Americans to adopt healthier lifestyles, and doctors never take a course on nutrition during medical school so they’re not necessarily going to push the nuts and berries…)

It’s a thoughtful, well-considered piece that made me switch my position.  Now?  I say:

• Dismantle employer-based health insurance plans
• Mandate catastrophic coverage for all
• Provide health coupons for those who cannot afford ongoing health maintenance
• Create incentives for healthy lifestyle choices
• Tax meats, especially the red kind

In essence:  make consumers pay for their own health care and the cost will decrease while the quality increases.

But, I’m sure this is not my final answer.

What say you?

No Longer Runnin’ Away

A few weeks ago, my iPod and I were caught in a sudden summer hailstorm on Brighton Beach; the wind powered sand into animate and inanimate crevices alike. So it was no shocker that when I tried to coax my Nike+iPod kit to start tracking my run this morning, I was told to insert the appropriate attachment. “But the attachment’s already in,” I wanted the Nike+ kit to realize. Darn sand.

Now how was I going to record my Summer Streets run? How would I know how long I’ve run? How would I know when to turn around? I considered heading back to the apartment to swap iPods. But then I realized how curious that line of thinking was – as if the run ceased to exist if some external party wasn’t tracking and measuring it (/me) via constructs like distance, time, and a calculation involving both.

Granted, it makes sense — for someone who still remembers trivia ranging from the elementary school record she set for fourth grade girls in the mile run (7:52) to her AP Calculus AB score sophomore year (5) — to think that nothing’s truly done if not mapped and noted by a dispassionate, objective, external entity. And, just last summer I wouldn’t have been able to pace myself without the help of a watch and an iPod voice announcing my current distance, time and rate. Was I pushing too hard? Had I gone too far? My internal voice was not yet to be trusted, but the robo-lady announcing my 8 and a half minute mile splits was proof that everything was going to be fine.

But today, I cranked up Asobi Seksu’s New Years and let my feet push into the pavement as my fellow New Yorkers pedaled and skateboarded and rollerbladed and walked all around me. Sandy iPod? Whatevs. I let myself run, not for more Nike+ data points, but simply to run. I slowed down when I felt like it. I sped up for an incline. I walked a few blocks.

I had a good time.

I’ve no idea how far I ran, have no idea what percentage I walked, have no idea how fast I went. I just know that the run felt good.

The numbers? I see now that they don’t matter, have maybe never mattered, especially insofar as experiencing deep joy is concerned. What the scoreboard says no longer has any correlation with the happiness I feel.

For sale:  one nike+ ipod kit.  Gently used.

Survey SEZ!

Take this survey without using an online dictionary, pretty please; it’s to help a nonprofit organization that I’m marketing strategerizing for.

xoxo

Click here if you are an awesome, generous, kind, and impossibly sexy human being.

Go Create Something

I want you to go create something.  Now. Because when W. H. Auden wrote, in In Memory of W. B. Yeats:

Time that is intolerant
Of the brave and innocent,
And indifferent in a week
To a beautiful physique,

Worships language and forgives
Everyone by whom it lives;
Pardons cowardice, conceit,
Lays its honors at their feet.

Time that with this strange excuse
Pardoned Kipling and his views,
And will pardon Paul Claudel
Pardons him for writing well.

what he really should have been writing was that all creators’ — not just writers’ — flaws are pardoned over time (suggests Ralph Caplan in Pantheon for a Flawed Species).

So go make something.  Create, design, enterprise.  Consider creativity realized as your permission slip to be an ass-hat.  Because in time, if you are productive enough, people will remember less your ass-hattery, and more your body of work (not to be confused with your banal-in-a-week beautiful physique).

Or at least, with so many embarrassing little videos in mind, history turning a blind eye to the flaws of the relentlessly creative is what I hope for.