Real American Solutions

Eating Healthy Costs Less!

2012-06-01T07:00:00.000-07:00

When I walk through the grocery store and look at the choices and prices, I am puzzled about the widely held belief that it costs more to eat healthy. This has been the accepted explanation as to why poor people tend to eat a less healthy diet. True, it’s more expensive to buy the foods that promote themselves as extra healthy, and often aren’t worth the price difference: organics, vitamin- and mineral-enriched foods and bottled water (often drawn from someone else's public water supply); but good old fruits, vegetables and sugar-free cereals always seem reasonably priced. Not only that, but they are healthier than convenience foods that are easier to prepare, but often contain added sodium for flavor.

Now I have found the explanation of why foods that are good for you are perceived to be more expensive. This new information published by the USDA tells a different story. It really is not more expensive. Previous studies compared the relative cost to get the same number of calories, not on the basis of weight or serving size. In a society where we are warned about the level of obesity and its rate of increase, does it make sense to try to duplicate the same number of calories? Still, those who published the original findings are sticking to their claims. Is a cup of coffee and a donut really cheaper for breakfast than a bowl of raisin bran with non-fat milk? From a per-calorie standpoint, it may be, but then you have to spend more on an artificial fiber additive later in the day and pop a vitamin supplement to make up the difference.

According to the USDA there is no reason other than a hurried lifestyle and poor choices to explain why most people don’t eat healthier. Add another reason, that people have developed a taste for the less healthy food. In most cases though, changes can be made without a financial impact. When I pick up lunch at Subway, a sandwich on whole wheat bread costs exactly the same as any of the others.

Bottom line, it sounds like the poor dietary choices throughout our society are much more a matter of behavior than a matter of economics – just as I would have guessed.

Facebook, Greed and Responsibility

2012-05-28T07:00:00.000-07:00

On May 18 Facebook held its initial public stock offering (IPO). By the following Tuesday, the value of the stock had fallen from $38 per share to $31 per share, a loss of 18%. This was accompanied by rumors that an analyst from Morgan Stanley, one of the underwriters, had shared a new, less optimistic analysis with only a limited number of clients; it was not shared with the general public.

The news broke a couple of days later that three investors were suing Morgan Stanley and Facebook. One interviewed in this article is a professor at Florida Atlantic University. He describes IPOs as tricky but adds, "this one had a lot of glamour, had a lot of interest. It has a lot of users. I thought it'd be a pretty good investment." So he used his E*TRADE account to buy 1800 shares and potentially lost a lot of money. (It isn’t lost until he sells the stock.)

News of a lawsuit always strikes me as a good place to look for evidence of lapses in personal responsibility, the desire to blame your problems on another and not as the consequences of your own behavior. This one made it easy. Here is a college professor, an educated man. He did not fall off the last turnip truck and fall prey to evil conmen. He understood and admitted that IPOs are tricky. He understood what he was investing in. It’s not like Facebook’s business model is some kind of mystery. News reports prior to the IPO were filled with questions about how Facebook was going to increase its profitability to justify the price and how overvalued the stock was in terms of its current price-earnings ratio. In addition, no one twisted his arm or tried to talk him into it. E*TRADE, after all is an on-line, discount broker where representatives don’t call with the latest stock tips trying to pressure you to buy. But he decided to plunk down over $77,000 (plus the small commission) on the basis that it would be a good investment because it “had a lot of glamour, had a lot of interest...[and] a lot of users.” When results came in a few days later, he was disappointed and upset.

When it comes to the stock market, I distinguish between investors and traders. Investors are in it for the long term, making investments and riding them out. Traders look for a short-term profit – think “day trader.” The above are not the actions of an investor. Interest, glamor and popularity have nothing to do with the long-term performance of a company or its stock. People who were lured in on this premise are victims of their own desire to make a quick buck or to get in on the ground floor of a possibly high-flying stock.

Investing is based on risk/reward. Those who expected a big reward without the corresponding risk were being naïve or greedy and became victims of their own mindset. Responsible individuals take credit for their successes but also their mistakes. They don’t try to shift the blame, legally or otherwise.

Disclosure: I'm confident (but not thrilled) that I do own shares of Facebook and JP Morgan Chase, but only through a Total US Stock Market Index mutual fund that owns shares of every public company, not through individual stock purchases.

Perspective/Critical Thinking – What’s the Difference?

2012-05-25T07:00:00.000-07:00

A week ago I presented outrageous magazine covers as an example how marketers and the media try to use slip-ups in perspective against us. On Friday I discussed earthing to show how we must be more skeptical, practice critical thinking. Is there really a distinction? Both perspective and critical thinking errors seem to result from acting based on emotional responses – thinking with our hearts rather than with our heads.

Although they are similar and can sometimes overlap, there are differences. When you make a poor spending decision, it could be the result of poor perspective, buying something you don’t really need, acting contrary to your core values or not maintaining a sense of moderation. Likewise poor spending decisions may result from inadequate critical thinking, buying something based on imaginary benefits or on a sales pitch that is logically flawed.

Those with poor perspective arrive at a store to battle, sometimes physically, over the limited edition footwear, yoga pants, smartphone or latest videogame. I recently saw an advertisement recommending that you buy the new videogame at midnight and then call in sick to work the next day. Being among the first to have a particular game is more important than having a job in a down economy? Sitting out all night for tickets to see your favorite performer ranks higher than spending that time and money on more important things? Are our actions consistent with what we really value or say we value? Do we have a sense of gratitude – appreciation for what we have rather than constantly longing for what we lack?

Those who fail in critical thinking spend money in pursuit of unproven products. I listed energy wristbands (on January 13, 2012) in this category but also include anything that claims to be better merely because it is labeled as green, all natural, organic, pure, chemical-free or other such term. My faith in Americans is challenged when I read an article about the government fining the Skechers Company for misleading people by claiming their shoes would magically make them slimmer or improve their muscle tone. Seriously, people were deceived? When I was young, PF Fliers claimed that they would make me run my fastest and jump my highest, but even at ten years old I knew they were just trying to sell shoes!

Perspective relates to poor assumptions about what is important or what we need vs. what we want. Critical thinking relates to lack of adequate reflection or to being insufficiently skeptical. Both lead to foolish choices, one from impulse and the other from naiveté, wishful thinking, or gullibility.

Earthing - Keep Your Feet on the Ground

2012-05-21T07:00:00.000-07:00

When I read about this last week, I could only think, “Where has people’s critical thinking gone? Earthing, proclaimed as “the greatest health discovery ever” and “right up there with the discovery of penicillin,” is the practice of walking outside barefoot or in some other way increasing contact with the earth to allow us to absorb free electrons from the earth’s surface leading to improved health. There is a detailed explanation of how this works along with – you guessed it! – lots of endorsements.

How many times have I repeated that endorsements or wonderful stories are not proof of effectiveness nor is selling supposed remedies as ancient wisdom, old knowledge rediscovered, or the unlocking of some secret? When I read this, several questions immediately came to mind. Why are the earth’s electrons any different from other free electrons? Why did our ancient ancestors who had more contact with the earth have a much shorter life expectancy? Why don’t our doctors tell us to walk outside barefoot more often – some kind of conspiracy to withhold the information or are they just tired of giving tetanus shots? If electrons from the earth enter a body so easily, why can’t you slowly drain a flashlight battery by holding both ends between your fingers? Where is the research?

I actually did find some research. Here is one paper describing a particular study. It had 12 participants. The researchers grounded their beds and measured cortisol levels as well as participant reports of pain, stress and sleep dysfunction. This seems like pretty shabby experimental design. How were the 12 chosen? Such a small sample size limits the statistical validity. Where was the control group and “double-blind" setup to guard against placebo effect? Self-reporting is prone to error. This isn’t even in the same league as FDA requirements for any approved treatment. It’s almost like getting 12 people together for an endorsement party. Other studies are cited, but to what end? Their website lists 13 bullet point benefits and implies that it's just the tip of the iceberg. Snake oil, anyone?

The disclaimer on the site is most telling: “Products and information on this site are not intended to diagnose, treat, cure, or prevent any disease.” Of course not, that would probably be illegal. (I don't doubt their sincerity, since everyone just walking around barefoot would fit their theory and not profit them a dime. but sincerity is never proof of validity.) In any case, they strongly imply throughout that health benefits abound while making it easy to order their $60 mats, $200 kits and $300 bed sheets.

One hundred dollars here, one hundred dollars there – it all adds up -- and a non-skeptical, non-critical thinking society then finds itself wondering how can I afford to retire or why am I part of a $1 trillion college debt crisis?

Hype on the Newsstand

2012-05-18T07:00:00.000-07:00

You can’t judge a book by its cover, the old saying goes; this could be a motto for the dimension of perspective. External appearances should count for less than the true quality found within, whether it be a book, a person or a product.

Apparently this saying is not only old, but is becoming obsolete. Just Google “appearance discrimination” and you will learn about how better looking people are more likely to get a job, tend to be paid more, and even get lighter sentences in court. When people review the same book or article accompanied by false pictures of the author, one more attractive than the other, the picture alone sways their opinion of how interesting and well written it is.

This type of error, judging on appearances is not new. Surely it’s partly genetic and has been around forever. The problem is that the lure of a pretty face, fancy packaging or slick advertising often leaves us with a product we don’t need and a feeling of regret along with the resultant consequences of another poor decision. To compound the problem, artists and advertisers have found that shocking or controversial images arouse our curiosity in a similar way.

This issue comes to mind this week as Time and Newsweek seem to be engaged in a contest over which can have the most controversial or outrageous cover. Regardless of the actual cover designs or messages, what does this tell us about our society? Have we become so numb to the ordinary hype and overall noise in our lives that it’s necessary to continually up the ante? This is not an isolated example. So many marketers and media outlets, not just magazines, overwhelm us with warnings, outrageous claims and overall edginess just to get us to tune them in and prefer their product over others. Where does it all end?

It ends when we start exercising more perspective, looking for the substance and real value, not being drawn in by the hype, the outrageous, the superficial or by the controversial just for the sake of controversy.

Obesity Epidemic and the Food Police

2012-05-14T07:00:00.000-07:00

One week ago I wrote about correlation and how it can go wrong by assuming a relationship between two outcomes that may not be valid. An example given was the common occurrence of both gum disease and heart problems in the same person, which turn out to be not necessarily related as cause and effect.

There is a similar danger with extrapolation, taking a set of data for some time period and projecting it into the future to predict changes. Extrapolation can be very tricky and is often misleading when all factors are not accounted for or are poorly understood. One example was given in my comments on climate change (April 27, 2012) where one of the main proponents now says that perhaps he overstated his case. (Interestingly, he says he would not have changed his original prediction because that’s the kind of hyperbole that sells books.) As another quick example consider recent warnings about five-dollar gasoline for this summer that have now been revised downward. Extrapolation can be dangerous.

Early last week all the news agencies and networks blasted us with dire predictions by the Centers for Disease Control and Prevention (CDC) that the obesity epidemic continues and that 42% of Americans will be obese by 2030. There are several reasons not to panic. First, this is just another extrapolation, and we know how unreliable they can be. Second, it’s something that can be controlled through behavior, but not everyone agrees about that.

There are many examples available of how people can change their behavior and successfully lose weight (including a reality TV show). Here is an interview with a British actress from last summer. Pauline Quirke was grossly overweight. The article refers to her weight in stone (abbreviated st, which equals 14 pounds) so I’ll do the conversion. In early 2011 she weighed 272 pounds but lost around 100 pounds at the time of the article and is aiming to lose another 20 – and keep it off. Her motivation came from having a hip replacement before she was 50 years old and not wanting another. Regardless of motivation, it’s possible to lose weight and keep it off. If enough Americans are determined to do it, we can make liars of the CDC and be better off for it.

More disturbing though is this article that followed near the middle of last week asserting that it’s not our fault, that we can’t do anything about it. We are victims of the society and the way our culture has developed. People have been told about diet and exercise for years; so various parties have given up on voluntary behavior change, instead considering a bunch of heavy-handed political solutions involving, among other things, taxes, tax incentives and more regulations and requirements for schools. Can you see how these ideas become a direct attack on our freedom? I guarantee that this will happen (and has happened in the past) each time we don’t take responsibility. If we don’t fix it ourselves, others will step in with their mandates, programs and artificial incentives, excusing this outside interference as being in the interest of public health. The choice is clear on this and so many other issues - start doing for ourselves or have "help" inflicted on us.

This Really Works!

2012-05-11T07:00:00.000-07:00

This is my 100^th blog – 2 per week for 50 weeks. In each I have discussed the direction of the country by relating our problems to faulty behavior in the five key categories. Recently I noticed a couple of articles reinforcing this belief.

On December 30, I wrote “Build a Fence” arguing that the approach to illegal immigration was not to spend a lot of money trying to wall it off, but to find ways to lower incentives for people to come to the US illegally. In April I find an article about the drop in illegal immigration tied to a less vibrant economy and to stricter enforcement, two things that lower the incentive. (There was no mention of having a better fence.)

On April 20, I wrote “Healthcare Cost” enumerating at least 8 reasons for the rise in costs and elaborating on two of them. One was the variation in services among providers and pure, somewhat arbitrary pricing differences. I argued that the system must be more akin to an automobile check up where you know what to expect and get a cost estimate as opposed to the current system of somewhat secretive negotiations between care providers and your insurance. The following week, the headline from AP was: Medical sticker shocks: ‘No method to the madness’ telling how the system was broken and that there was no explanation of vastly different costs for the same basic medical procedure.

I am getting to these solutions not because of any particular genius on my part (though I’d like to think so), but because the model I am using works. Behavior has consequences, and individual behavior accumulates leading to societal consequences. Look at what you don’t like about America and trace it back to faulty decisions and detrimental actions and habits of our society in the five dimensions: discipline, understanding the economic cycle, critical thinking, perspective and responsibility. If we want to find solutions we will look for them not from the government or other big institutions, but here in individual behavior and posted on these pages twice each week. So tell your friends, tell your enemies, spread the word!

Critical Thinking - Understanding Correlation

2012-05-07T07:00:00.000-07:00

No, this is not a statistics lesson, but here are a couple of examples to help better explain what is often falsely implied or misrepresented in the news.

Both articles happen to be about gum disease. The first tells that the nearly-century-old belief that gum disease causes heart problems has been overturned. “[T]here is no conclusive evidence that gum disease causes heart attacks and strokes, or that treating gum disease will improve heart disease…” They don’t know yet why the two frequently occur together. It could very well be that some unhealthy habits or lifestyle choices cause both. When two events or conditions happen together, that’s not the end of the story. The next step is to understand how and why A causes B or B causes A. Perhaps they have a common cause. Perhaps it’s just a statistical fluke. In this case they admit that they don’t know why and are spreading the news in an attempt to correct the earlier erroneous conclusion.

The second article is about a correlation between obesity and gum disease. Studies indicate that obese people have twice the likelihood of losing their teeth due to periodontal disease. The fifth paragraph begins, “Why might this be? The researchers speculate…” You see, the correlation does not mean causation. They must find a link, explaining why they vary together and showing how one causes the other. Until they do, it is unfair, possibly dishonest, to make a cause-effect connection.

So when the news media, a politician or an advertiser presents you with evidence that two things frequently occur at the same time or that they vary together, don't immediately buy the argument that the two are related. Ask for more information. How are they related? What is the mechanism that makes one cause the other? People trying to make their case often skip this step deeming it unnecessary, but they are wrong to do so.

Healthcare and Behavior

2012-05-04T07:00:00.000-07:00

The topic of healthcare costs is so large that it takes many short essays to even scratch the surface. On Monday, April 16, 2012, I listed 8 categories – reasons for higher healthcare costs that should be addressed to solve the problem. These were explained further on that date and at other times including on the following Friday, April 20. I did, however, leave out one very important point, that a major influence on healthcare costs is how well we take care of ourselves – yes, individual behavior.

This was reinforced as I read in the past few days articles about: 13,000 newborns needing additional hospitalization because they are born addicted to painkillers; more teens requiring drugs for obesity-related diabetes; and almost half the people treated in emergency rooms being under the influence of drugs or alcohol.

Remember, I have argued on several other occasions that the solutions to our problems, our ability to overcome the so-called crises challenging our society, come not from big government programs or from punishing the big, evil corporations, but from adopting more positive behavior in one or more of the five key dimensions. Applying this same approach to the problem of rising healthcare costs we see that improved behavior in responsibility and discipline goes a long way toward solving it. Take responsibility for our health and then do something about it.

Remember back on August 5, 2011, I pointed out that all legitimate health advice we receive from the media can be reduced to a few basic habits, but we see them over and over presented as “news.” Likewise reports about preventing or lessening the impact of many diseases include the same advice: eat right, stay active, get enough rest, quit smoking, drink alcohol in moderation, avoid soft drinks and snack food, etc. It’s not rocket science. By taking individual responsibility, we improve our own health, reducing overall healthcare spending. And reducing the demand for anything usually has a favorable effect on price.

Another recent article about more people walking shows that we are off to a good start. We can do it and don’t have to wait for any new programs or laws.

Mad Cow Disease

2012-04-30T07:00:00.000-07:00

Mad Cow Disease is in the news again after authorities detected it in one dairy cow in California. A recent article points out how the beef industry reacted quickly to calm any possible panic. I described the potential for this kind of panic in my discussion of Global Warming (April 27, 2012) and called for moderation in our response to such news. This article points out that the rapid response to the mad cow “crisis” was motivated by lessons learned from the pink slime commotion (April 2, 2012) resulting in a public outcry and loss of jobs because the industry misjudged the impact of media reporting on consumer behavior.

Another interesting article appeared immediately following the announcement. It was intended to calm people – admirable but unusual for the news media – but it was in a subscription-only format on the Internet so I can’t provide a link. The reporter asked for comments from experts at a large university in the Midwest. The director of the animal disease diagnostic lab said, “This was one isolated cow in California… It was a dairy cow, but studies have shown that BSE isn't transmitted in milk… [T]his case poses no risk to people or other cattle.” A professor of agricultural economics emphasized that it was an isolated cow that did not move into the food supply, and added, “I believe it will not have any lasting impact [on the market] unless they find more cows or other animals, or there is enough media attention that somehow motivates groups in the United States to say that U.S. beef is not safe.”

I call attention to the last part of the comment. Have we become a nation of cattle ourselves - or antelope peacefully grazing on the plain until the least sound of a twig breaking or a rustle of trees sends us into a stampede? It appears that the moderation that comes from perspective is so lacking that honest people who run legitimate businesses providing valued service to society must always be on guard lest a fiery news headline or the ranting of a well-meaning, but misinformed celebrity shuts them down. This can only happen when the public behaves with a knee-jerk reaction to every new announcement. This is not behavior strong in perspective, and it does not serve us well in the long term.

Climate Change

2012-04-27T07:00:00.000-07:00

In case you haven’t been paying attention, climate change is the current name for global warming. I think it’s a good idea to remind people about the fact that the climate is changing. The climate is always changing. As the Buddha reminds us: Everything changes, nothing remains without change. Now here is an article about an admitted global warming alarmist changing his mind about the urgency of the problem. He says that his predictions were too extreme, but the last sentence of the article is very instructive where he says: If he had rightly been more cautious, it would have spoiled his book.

There are a few things to learn here. People in all walks of life are often motivated financially by such things as book sales and the need for funding of their research. This causes them to express their opinions more forcefully. Among other places, it is particularly evident in attention-getting news headlines. In the face of these pronouncements we must keep a cool head. Strong behavior in the area of perspective is characterized by moderation.

What ever happened to the hole in the ozone layer that people, especially NASA – think funding -- were so worried about twenty or so years ago? When we stopped spraying the wrong chemicals into the air, it started to close up. Now some scientists are worried that this may add to global warming!

How do they explain that some of the glaciers in Asian mountains are getting thicker? Well, they don’t. In that case they admit that they don’t really understand the situation well enough. They are just guessing.

Just as we should expect more from advertisers, politicians and the news media, all of whom have a stake in our believing what they say, we must hold our scientists more accountable to fully justify their claims and be willing to debate those with a contrary point of view. Whenever you hear any of these people stooping to name-calling, you know it's time to be skeptical of their claims and moderate in your reactions.

Psychic Healing

2012-04-23T07:00:00.000-07:00

In February a Colorado woman was accused of stealing nearly $300,000 from clients and ordered to serve five years in prison and to pay restitution. According to testimony, she told her clients that she needed their cash to draw out the bad energy and needed to check their credit cards to see how frequently the number 6 appeared. She kept the cash and used the credit cards at local department stores. She was found guilty on 14 counts of fraud and 2 of tax evasion.

Imagine how desperate people must be to consult a psychic healer to help them solve their problems! Despite articles like this one, and many others besides, that show psychic healing as well as other so-called psychic abilities are unsupported by scientific theory or actual results, Americans still pursue this as an avenue of relief. In this case they were lucky and may get some of their money back.

Is it fair to paint all psychics with the same brush, labeling them all frauds? Perhaps not, I’m sure some sincerely believe in the abilities they claim. Still, James Randi, magician and debunker of things psychic, has for many years offered a $1 million prize to anyone who can demonstrate true psychic powers under controlled conditions. He has gotten few takers and no winners. Yet police sometimes call in psychics to help solve crimes. If they don’t, they risk being accused by victims or their families of not doing “everything possible.”

Back in 1996 a nine-year-old girl for a science project devised a method of testing the validity of therapeutic touch, an “energy medicine” which claims to promote healing and reduce pain and anxiety when therapists move their hands over a patient to manipulate his or her “energy field.” The girl contacted 21 experienced practitioners, sat them behind a screen and asked them which of their hands was experiencing the energy field from her hand. Their success in detecting the energy field was no better than random guessing. Results of this experiment were written up in the Journal of the American Medical Association. Yet the State of California awards continuing education credits to nurses who learn this technique and “an American Hospital survey conducted in 2005 noted that about 30% of 1400 responding hospitals offered [and presumably charge for] therapeutic touch.”

What we see here are further examples of uncritical acceptance of alternative practices based on anecdotal evidence rather than scientific testing. This seems to be the trend. We are encouraged to be open-minded, but there is a difference between being open-minded and foolish when it comes to our health and how we spend our money in general.

Healthcare - Billing Nightmares

2012-04-20T07:00:00.000-07:00

Last time I listed eight issues that must be addressed to bring down and control the cost of healthcare. I discussed the problems of over testing and the inconsistency in content and pricing of services. Both are compounded by the lack of openness built into our current system.

Another problem with the healthcare delivery system comes under the heading of records and billing. The records side has gotten some attention lately with politicians rightly calling for a move to electronic medical records. The cost would be around $100 billion, but savings is estimated at $200 to $300 billion per year. This is a topic in itself, but here is one source for more information. Unfortunately, progress seems to be slow with no apparent "champion" for the cause.

Another problem that most of us have experienced is caused by a lack of a centralized billing system. If you have a major procedure, the paperwork involved is unbelievable. You get no meaningful information from the providers until they submit it to your insurance company. Then you get an explanation of benefits (EOB) from the insurance. An EOB has four numbers: what the provider billed, what the bill really is (due to insurance negotiations), what they will pay and what you owe. (Why doctors and hospitals bill one amount but are willing to accept less is interesting.) Later you get billed for what you owe.

Even for a simple visit you may receive two or three EOBs, but for a major procedure you receive a long series of EOBs and bills over time. They just seem to keep coming. You get them based on each provider, even some you don't recall ever seeing. Months go by. When you think you have seen the last one, another arrives in the mail. It’s so confusing that many people, even very organized people, just pay the bills as they arrive trusting that the insurance company and the medical offices have not made mistakes. This is the opposite of being a “smart shopper” but since you have no estimate to begin with and no clear idea of prices (as mentioned last time), what choice do you have? The concept of general contractor is foreign to healthcare providers leaving us to fend for ourselves, fighting through an avalanche of paperwork.

Some of this might be solved if our doctors referred to us as customers rather than as patients, but the role of insurance coming between the provider and us makes them the primary payer and isolates us from any meaningful information regarding negotiation or pricing. (This gets back to the initial issue of insurance design.)

In summary, I have shown in the last two installments that controlling healthcare cost is a lot more than providing insurance for everyone. The entire system is out of whack and needs attention. Without that attention, we may be able to afford our regular visits or emergencies, but the continued inefficiencies will come back to haunt us in the form of higher taxes, higher premiums, lower wages (to offset employer costs) and higher prices for nearly everything we buy - all to cover the continuing upward cost spiral. There is no magic money tree to cover this. It will come back to us in the end.

Healthcare Costs

2012-04-16T07:00:00.000-07:00

I commented last time that when politicians talk about healthcare, they are really talking about health insurance, a related but different subject. Just because you can pay for it with insurance, does not make it less costly. It just shifts around the financial burden, and as I pointed out earlier, that tends to raise rather than lower the overall cost. (Is it a coincidence that some of our worst crises are in areas of deepest government involvement: housing prices, healthcare costs, college costs?) So let’s apply some critical thinking to the issue.

I propose that there are at least eight reasons for high healthcare cost – few of which are in the news.

· Insurance Design: This was addressed here on August 25, 2011. You don’t make something cheaper by helping people pay for it. As long as insurance companies play an intermediary role, separating the provider from the customer, there will continue to be a cost problem.
· Innovation: This was addressed on September 12, 2011 and January 27, 2012. New medical technology and treatments save more lives and make recovery times faster, but they don’t come cheap. We need to understand that we can’t get 2012 medicine for 1970 prices.
· Lack of open competition: More on this below
· Over-testing: Also covered today.
· Billing and coordination issues: This was touched upon on January 2, 2012 and will be elaborated on next time.
· Regulations and Restrictions: Insurance laws vary by state. One consequence is variation in the permission for people with less training, nurses or physician’s assistants for example, to perform certain basic functions reducing the cost and freeing doctors to handle the more complex cases. More on this later.
· Liability: The cost of malpractice insurance is passed along. It’s not the doctors or insurance companies who ultimately pay. These costs eventually find their way back to us. More on this later.
Fraud: This goes without saying, but accounts for about $180 billion a year.

The first subject not previously addressed is lack of open competition. Open competition tends to keep prices low. Look at those medical services not routinely covered by insurance, such as laser eye surgery to correct vision. Over the years providers of these services have found ways to reduce the price while simultaneously improving results. In the broader medical field, however, such open competition is hampered by confusion/inconsistency about service components and secrecy about pricing. Both can be traced back to the role of insurance companies as intermediary.

Insurance companies deal directly with the doctors and hospitals, negotiating rates and conditions in isolation from us, the users. If we move to a high deductible plan we are told to be “smart shoppers” for medical services, but we get little information. Providers charge different prices for the same service and include different components as they judge appropriate.

If you see three different doctors for something as basic as a routine physical, you will have three different experiences. You certainly will be weighed and have your blood pressure taken, but whether you leave a urine sample, whether you have blood drawn (at appointment time or beforehand), what the lab tests for and reports on, even whether an electrocardiogram is administered depends on the office. I know, having moved lately and seen three doctors for initial examinations in the last 5 years. You really don’t know what to expect. Here is one of several articles talking about those inconsistencies.

So if you don’t know what you are going to get, how do you know what it will cost? Doctors don’t post prices. And if you don’t know what it will cost, how can you be a smart shopper? Here is an article about the variation in costs related both to the variation in services and also to pure pricing differences. At one point it says, “…consumers don't even ask about price because they're getting the service for ‘free,’ but also because doctor's offices don't list prices.” Getting any service for free, an insurance design problem, provides no incentive to shop around.

Contrast this with getting a service checkup for a car. You take the car in and know what they will do. You even sign a contract for the work that gives the exact price or an estimate for larger repairs. If anything additional is discovered, they must explain it to you and get permission. A current ad on TV shows how you can choose from three levels of routine service, what they include and what they cost. They do this because they know their competition is giving you pretty much the same information, and that customers who are surprised generally go elsewhere. If doctors and hospitals followed the same business model as vision correction and car repairs, it is certain that the cost of healthcare would fall. Estimates of the savings to the system are between $84 and $178 billion, annually.

The second topic for today, over testing, is directly related to the lack of consistency and also adds to the price. Fortunately, the American Board of Internal Medicine Foundation is leading a campaign to educate providers and the public about unnecessary medical tests, gathering fact sheets from seventeen medical organizations. Each group will spotlight five tests for further investigation. This is another high ticket item, between $158 and $226 billion. "Consumer Reports has reported what a critical issue overuse is to consumers. A 2010 reader survey of nearly 1200 healthy 40- to 60-year-old men and women, with no known heart disease, risk factors, or symptoms, showed that 44% had received screening tests for heart disease rated by Consumer Reports as very unlikely or unlikely to have benefits that outweigh the risks."

As you can see, the effort to control healthcare costs is far different from providing more insurance as we know it. Many changes are needed, but those mentioned here emphasize the need to instill more consistency and a more competitive environment into the entire system.

Words Revisited

2012-04-13T07:00:00.003-07:00

Recall how on October 3, 2011 I wrote about how advertisers try to get us to change our vocabulary. I’m not talking about political correctness. Rather, this is an attempt to change the way we think, to make certain products or activities seem more attractive. Examples included realtors, seemingly successful in changing the word houses to homes, which sounds much warmer, friendlier and more personal; and car dealers, somewhat less successful in rebranding used cars as previously owned. Here are a few more examples that I noticed over the past six months.

One example is the use of expressions gaming and gambling. Basically, gaming is legal, gambling is not, but they are really the same activity, risking money to win more. When it happens at a casino or takes the form of a lottery run by the state, it’s called gaming and it’s OK. If it’s an office football pool, it’s gambling and not OK.

Ironically, in the 10x10 matrix used in the office pool, you pay $1 for a 1 in 100 chance to win $100. In a pick-3 type state lottery, you pay $1 for a 1 in 1000 chance to win $500. The office pool is a smarter bet by a factor of two, in fact the probability of winning is superior to any legalized game!

Another advertising ploy is to label products as “chemical-free,” supposedly meaning safe or pure. The concept of chemical-free is an impossibility, since all matter from stars to mother’s milk is made from either a single chemical element or chemical compound or some mixture of both. Yet many cleaning items, for example, make ample use of this expression.

Critical thinkers know that when you go back to the dictionary definitions, we all live in houses, use chemicals for good and bad purposes, and gamble whenever we place a bet to win money. They are not influenced by advertisers’ clever use of euphemistic or manipulative wording.

As long as we’re talking about words, also note that, in this campaign season, when you hear a politician mention healthcare in most cases he is really talking about only insurance, not healthcare or the rising cost of healthcare. There is a big difference.

Disney Backs Down

2012-04-09T07:00:00.001-07:00

Walt Disney World is rethinking an exhibit on childhood obesity that was criticized for being insensitive. They used superheroes to demonstrate good habits with villains to show poor habits such as eating junk food and not exercising.

The primary objection came from an organization called the National Association to Advance Fat Acceptance (NAAFA). I went to their website to research their philosophy.

Their home page has a banner that reads: “Discrimination is Wrong.” That statement is totally incorrect. Illegal or irrational discrimination is wrong, but otherwise we discriminate every day, about the food we eat, the people we associate with, the television shows we choose to watch or skip, the kind of car we buy. The list goes on and on. Rational discrimination (or even sometimes emotional discrimination), choosing one thing or one brand over another, is a natural and important human activity. It’s the way we narrow options for decision making. I like chocolate and will sometimes make decisions to satisfy my preference, discriminating against other sweets or desserts. It’s not illegal and it’s not wrong – but so much for nit picking. There are more troubling things about this organization.

First, I agree with their basic premise that everyone should be treated with respect and dignity. Those who are otherwise fully qualified for a job should never be turned down on the basis of any non-job-related characteristic. That’s bad business and just plain stupid. Bullying in school for any reason is unacceptable. This ideal of respect for all is a noble mission.

But they go on to say: “This discrimination [against fat people] occurs despite evidence that 95 to 98 percent of diets fail over five years…” Assuming that diets fail at that rate, is it time to give up? It’s not constructive or responsible for people to declare themselves victims. Diets fail precisely because they are diets. They entail following a certain course until the problem is fixed, and then folks go back to old habits. What if we treated oral hygiene the same way? We would wait until we got a toothache and then brush and floss like crazy and start keeping dentist appointments. When the toothache went away we would go back to neglecting our teeth and then scratch our heads wondering why problems recurred. Diets fail because they are short-term solutions. The NAAFA solution would be to have government regulate “and closely monitor and control all aspects of the $58 billion+ diet industry” and to ban them from advertising on TV, apparently because they don't work or give false hope. I say, don't blame the diet; take responsibility.

From the statistics on the failure of dieting they conclude, “Our thin-obsessed society firmly believes that fat people are at fault for their size.” Well, with the exception of valid medical problems, they probably are. And the valid medical problems are likely no more common than they were 60 years ago when obesity in the US was far lower than it is today. So the question is, do we let people off the hook for a preventable problem? Do we call it an addiction, call for “acceptance” and become enablers, or do we try to support them in their effort to lose weight? As a comparison, how do we treat smokers? People addicted to tobacco and have tried and failed over years to quit seem to be treated the opposite. Since the behavior is bad for their health and general welfare, society takes every opportunity to warn them of the dangers and urge, sometimes nag, them to quit. They are charged higher health insurance premiums and laws limit the places where smoking is permitted. Yet you don’t hear an uproar over smoker discrimination. You don’t hear calls for “acceptance.”

Let’s try this approach with children graduating from high school who cannot read. These young people have behaved in a way that will negatively affect their overall welfare for the rest of their lives. It is preventable in most cases. Do we decide that it could be a medical issue, dyslexia, and excuse it, or do we support and encourage them to change? Is having high school graduates who can't read acceptable because it adds to diversity in our society? Ridiculous!

The change model, presented last time, shows that change does not occur unless there is some discomfort or dissatisfaction with the status quo. The more we try to make people comfortable, even proud of any behavior or lifestyle, the less likely they will be to change to a healthier, more positive one.

Bottom line, I have a problem with the NAAFA, not because they are caring people, but because they promote excuse, apology and rationalization over responsibility, an approach that guarantees no solution, but rather a continuation of people putting themselves in danger of a myriad of physical and medical complications related to obesity. Presented as a service, it is actually a disservice to both the individuals it claims to support and to society as a whole.

Changing Direction for Improvement

2012-04-06T07:00:00.007-07:00

I mentioned the change process on December 12, 2011, but I’ll give more details today to tie that theory to the subject of these blogs.*

Change happens only when there is sufficient discomfort, dissatisfaction with the status quo. If I’m happy with the way things are going, I have no incentive to change and will resist. My attitude will be, “If it ain’t broke, don’t fix it!”

With dissatisfaction comes a demand for change. Then someone must present a solution consisting of three factors: a model, a plan and a cost.

The model says, “Here’s where we would like to be.” Contrasted with the current state, the model or desired state will yield better results.

The plan then outlines steps to get there.

Finally consider the cost. If a solution is too expensive, a new one must be found.

One simplified example is planning a vacation:

1. Discomfort = you do not want to spend a vacation sitting at home; it’s not exciting enough or restful enough or fun.

2. Model = pick a destination and timeframe that will satisfy the needs identified in step one: theme park, beach, cruise, spa, golf resort, etc.

3. Plan = pick dates, decide whether to drive or fly, make reservations, etc.

4. Cost = check the budget to make sure you can afford it, otherwise you must modify the plan.

The approach to improving America is the same. For the past 30 years survey after survey has shown dissatisfaction by the majority of Americans with “the direction of the country.” The 2008 presidential campaign played on this dissatisfaction with a theme of “hope and change,” but recent survey results are unchanged. It seems there is sufficient dissatisfaction but still no clear model or plan (and the cost keeps going up!).

This blog is about a model and a plan that works. For over 10 months I have shown how real American solutions are based on our personal behavior in five key dimensions. Our behavior is the primary source of most problems. Individual consequences accumulate into societal woes. With almost 90 examples as background, I trust you are beginning to recognize in the news and in your own experience other examples of behaviors that fit into these dimensions. More positive behaviors yield better consequences; no change in behavior yields what we have now, or worse.

The plan is to recognize these behaviors and start to eliminate destructive ones in favor of positive ones. The sum of individual behaviors and their consequences build to societal consequences, i.e., our national problems and crises. When we persuade a “critical mass” of citizens – not everyone, but enough to make a difference – we will begin to change the direction of America. This is the desired state, more positive consequences and fewer crises, with people depending on themselves (not government or big business) to bring about the improvement. (If we can’t achieve that critical mass, it means not enough people care enough to change, and we should expect more of the same.)

Surprisingly cost is not a factor. It costs nothing to eat less and exercise more (discipline). It costs less to forego the latest fad item - be it a fancier car, tennis shoes, designer fashions or the latest phone - to appreciate what we have and not always be grasping for more (perspective). It costs less not to throw away money on unproven medical cures (critical thinking). It costs nothing to admit and take ownership of our errors and problems and teach our kids to do the same (responsibility). We support wiser and less wasteful decisions by recognizing that you don't get something for nothing, that there is no magic (government or corporate) source of free money (understanding the economic cycle). Look at all the examples in previous blogs. None requires an investment beyond improved behavior in those five key dimensions and doing so leads to happier individuals and a better overall America!

*Change discussion was adopted in part from my book, No-Secrets Leadership.

Pink Slime

2012-04-02T07:00:00.020-07:00

One of the principles of the behavioral approach is to address the behavior and not the person. This automatically eliminates the acceptability of insults, name-calling and other personal attacks so common in our political process. Addressing behavior replaces those destructive and often erroneous activities with attempts to solve problems with relevant facts and intelligent debate.

Now we get the case of “pink slime,” a derogatory term used to refer to, and gather support against, a beef product that has been in our food supply for years with no ill effects. Why do people stoop to such name-calling? Either they have no valid arguments or they are trying to catch us up in an emotional reaction to promote their particular cause (or as this news article calls it, a crusade). And who thinks about the jobs lost? Why are people who speak out against waste in other areas silent on this issue? How can Kroger and the others offer twenty different kinds of dishwashing soap but not offer a simple choice to those who are not swayed by these scare tactics and want to buy the same kind of ground beef, less expensive and less fatty, that they have been buying for the last 20 years?

The uproar about the coloring ingredient in Coke and Pepsi that I addressed on March 19 had a similar dynamic - get people all riled up to rally behind a cause or complaint based on poor or sometimes even deceptive evidence. The problem is that with social media it is now far easier to start a crusade or get people fired up about an issue using an emotional appeal. Before you know it governments are banning products or ingredients or companies that sell them are back-pedaling due to the bad press on Facebook or Twitter. Most consumers have little formal science education in such areas as human biology or experimental design, but they loudly express their “concerns” based on information from social media or the Internet. The masses are howling, the ringleaders are name calling, and we are moving closer and closer to a kind of mob rule where we end up paying the extra costs, enduring the unintended consequences, and having our free choice eroded.

In this fast moving society one subject does not stay in the news long, so the following week, "concerns" arose over the use of BPA in food packaging. At this rate we could be banning or otherwise losing access to 50 products a year based not on science but on public outcry!

Along similar lines this article tells about how old photos were intentionally used by the press to influence public perception in the Florida shooting case, which has sparked so many protests. The article suggests that this type of manipulation by selective presentation of pictures and videos has become common practice in the media. Another article sheds additional doubt on the accuracy and completeness of some news reports.

So my question is, when are we going to stop being influenced, frightened and manipulated, and start thinking for ourselves? One way leads to reasonable outcomes, the other to the consequences of chaotic, knee-jerk reactions to each new manufactured crisis or well-intentioned crusade.

Gas-saving Myths

2012-03-30T07:00:00.003-07:00

Since I began March with an explanation of critical thinking, I decided to end it with an example on the same subject.

I came across this article on Yahoo! Finance, and if you rarely click onto the links, this is one I definitely recommend taking a look at. It talks about four myths about saving gas, and with gas prices high and rising, saving gas is something of universal interest.

Beyond the fact that it’s good information, the reason I chose it is that it makes some good points about critical thinking. In the case of the first myth, it gives a good, logical explanation of why buying gas early in the morning makes little or no difference. From a critical thinking standpoint, logical explanations are far superior to celebrity endorsements or the testimony of a friend or relative, but are sometimes not good enough. The other three examples tell of tests or experiments performed to validate or disprove the beliefs. These provide an even stronger argument. Furthermore, the tests were done by reputable organizations with no direct stake in the outcomes – Popular Mechanics, Edmunds and Myth Busters. That makes their conclusions even more reliable.

There is a kind of critical thinking continuum, running from endorsements (little or no credibility) through explanations (better) and experiments (even better), ending with validated experiments, those that have been reviewed and duplicated. That is not to say endorsements are always wrong. Sometimes what trusted, experienced people tell you is perfectly true, but it depends on how they got their information. Sometimes experiments have flaws in design and give wrong information. In general though, the trustworthiness of information can be judged by the strength of the evidence and its position along this continuum. We would be wise to follow this rule of thumb when choosing products or lifestyles.

One more thing – don’t forget about the placebo effect. There are instances of people who have tried the magic magnets under the hood of their car or those expensive fuel additives and reported an increase in fuel mileage, unconscious of the fact that they were so excited about this new discovery that their driving habits changed as well. Stronger evidence that I’ve seen about such products show they are not a wise investment.

Truly Magic Buttons

2012-03-26T07:00:00.010-07:00

Seriously, I want to tell you about magic buttons. This may come as a shock to faithful readers who know that when faced with any product representing itself as magic, I usually respond with, “Apply some critical thinking!” But this is different. The magic buttons I refer to are the ones that turn off or change stations on your radio or television. The fact that there are such buttons should come as no surprise, but when I see how many people complain about being "offended" by something they heard or saw, I don’t think these buttons are used enough.

What brought this to mind is the latest minor controversy involving the Doonesbury comic strip commenting on Texas abortion sonogram debate (and subsequent letters to the editor). This is not the first time Doonesbury has tackled controversial subjects, and I know of one newspaper that thought it appropriate to move the strip to the editorial page long ago. Doonesbury appears in my local newspaper, although I seldom read it. I don’t have strong feelings about this particular subject, but the humor of Doonesbury just does not appeal to me, and I have better things to do with my time. There are other columns, as well as television and radio shows that fall into the same category. There’s no button on the newspaper, but no one is forcing me to read everything, so I pick and choose, making my own decision. Smart media executives eventually survey readers to find out what is popular and adjust accordingly. (For example, here's an article mentioning Oprah's use of survey information.) If I’m in the minority, which I often am, no adjustments will be made and I will just keep managing my own exposure using the off and channel-change buttons. I’ll choose to be discriminating rather than offended.

I take this course because I feel strongly about the First Amendment. All are free to express beliefs or state opinions no matter how outrageous. If people don’t agree they can tune them out or turn them off – or they can make calm, rational counterarguments. Eventually the worst will lose their support and platform. I’m patient. I can wait. (Impatience is a great enemy of perspective.)

What I can’t understand are those self-righteous types who make a big fuss and demand apologies, boycotts and retribution. Sometimes I agree with their point of view, sometimes I don’t; but I fail to see what gives them the right to dictate my choices based on their taste or morals. If something disturbs or offends them, let them use their magic buttons. If they think certain things are not appropriate for their children, let them get more involved in their children’s lives.

By the way, another magic button is the mute button on the TV remote. Used during commercials, it provides some nice quiet time, time to relax or converse with your family, and just ignore all the sales pitches. I use it frequently and recommend it.

Water, Water Everywhere...

2012-03-23T07:00:00.008-07:00

Last time I pointed out one example of the folly of trying to make everything in our lives totally pure and one-hundred-percent safe. Ironically, about the same time that California is requiring the removal of minute quantities of a coloring chemical from soft drinks, the rest of the world is striving to find reasonably safe drinking water for a significant number of people.

A recent news story from the BBC gives the details. Work led by the UN begun in 1990 has greatly reduced the number of people worldwide without access to safe drinking water, meeting their goal 3 years ahead of schedule. Still even today only 89% of the world population has access to a reliable source of clean water. Further along in the same article it mentions another major challenge, that less than half the people living in India have access to a toilet!

To me this helps with gratitude and perspective. How often do we take for granted such things as indoor plumbing? While some Americans buy bottled water at hundreds of times the cost, there are millions of people in the world who would celebrate the opportunity to drink the water we feel is only fit for washing cars or watering lawns. These reminders should give us reason to be appreciative and grateful for what we have and not so obsessed with what we wish for.

Coke and Pepsi Warnings

2012-03-19T07:00:00.009-07:00

One day I overheard a news item on the radio about using radiation to kill bacteria on vegetables. A colleague asked the rhetorical question, “Who would buy that?” I told her that I had done some reading on the subject recently and the irradiated vegetables were perfectly safe to eat. In fact those vegetables had been exposed to radiation for at least half of the time they were growing and couldn’t have grown without it. It’s called sunlight. But people don’t think of sunlight as radiation. They don’t consider radio and cellphone signals as radiation. Radiation is thought to be always bad and dangerous – no distinction is made between harmless and dangerous. That would take some critical thinking.

People also fear carcinogens. If it might cause cancer, regardless of the conditions or dosage level, it’s bad. But so many things have been shown to cause cancer (including good-old sunlight, by the way) that comedians joke about it. There are even substances that were once considered dangerous but have earned a reprieve. It seems you can hardly move without bumping into something that at one time or another wasn’t considered deadly.

Now we get a recent news article about a substance in Coke and Pepsi coloring being banned in California because it caused cancer in lab animals. Later in the article it states that humans would have to drink over one thousand cans per day to reach the dosage level given to the rodents. Of course, if you tried to drink that much in a day the amount of water would kill you long before you reached the danger point for developing cancer. (Yes, you can overdose on water!)

Perspective is about moderation, understanding that you can keep trying to make your food, your drink, your environment purer but you reach a point where an extra dollar of effort yields pennies in benefit, and finally a point where an extra dollar of effort yields no benefit at all. Yet there are still those with so little perspective and no understanding of science who insist that the water and the air are never clean enough. Then it’s left to politicians and judges, not scientists, to sort it out. And where do all these additional dollars come from? – you guessed it!

Bank Overdraft Fees

2012-03-16T07:00:00.022-07:00

Again, here is a subject we should be taking care of ourselves instead of expecting the government to fix. This article tells about an inquiry, not an investigation to uncover wrongdoing, by the Consumer Financial Protection Bureau into banking practices regarding overdraft fees.

I made the point back in July 2011 and again recently that the bankers are smarter than the government when it comes to business and finance. They react to new regulations with new policies or fees, forcing the government to come back later with more regulations. It’s a vicious cycle that adds no value to our lives or to the economy. In fact it often results only in our receiving another piece of mail with a multipage explanation of how the rules have changed - once again.

The fact is that most of these interventions for consumer protection involve situations that are directly under our control. If we act responsibly, we don’t need protection. This case of overdraft fees is a prime example. The fees become an issue only when someone writes a check or withdraws from an ATM more than is in the account. It’s addition and subtraction, but it doesn’t affect people because they can’t add or subtract. It affects them because they don’t keep their records current.

There are many excuses for slipping, but they are only excuses. When customers make an error, the banks take advantage. When this happens, there should be one of only two outcomes. Either the fees are high enough to cause a person to change behavior and keep better track, or they are not. A good analogy is running out of gas. You are stuck by the side of the road, costing you both time and money. It is the result of not paying attention to the fuel gauge. There is no question as to whose fault it is, and it is easily remedied in the future. This seldom happens to people a second or third time because they have learned from the experience to pay closer attention to the gauge.

Likewise overdraft fees should be no big deal! Yet the head of the bureau wonders: “how consumers are affected and how well they are able to anticipate and avoid paying late fees.” What a surprising statement! They are affected by having to pay fees that should cause them to change behavior, and they know exactly what behavior needs to change. To assume that people are incapable of solving this problem on their own seems arrogant and insulting. Citizens displaying responsible behavior, not government inquiries, effectively solves this problem with no more regulations or "protection" required.

More Americans Saving Tax Refunds

2012-03-12T07:00:00.008-07:00

Here is some good news for the future of our society. Yahoo! Finance reports that more Americans are planning to save at least part of their tax refunds than did so in the past nine years. Others plan to use their refund to pay down debt. Less than one-quarter expects to use it on splurge spending or a vacation. Another survey mentioned in the article found similar results.

People have been known to give one answer to a survey and act differently (see blog from October 7, 2011), but if this one turns out to be true, perhaps fewer people would be living on the edge, paycheck to paycheck, in danger of default. It’s good news not only for them, but for everyone.

Economic understanding about the flow of money tells us that when people are unable (or unwilling) to pay their legitimate debts - credit cards, auto loans, mortgages, or whatever - the rest of us must take up the slack. Banks adjust interest rates, penalties, fees and their willingness to approve loans to make up for the added risk posed by these deadbeats. The same reasoning applies to tax evaders who settle for “pennies on the dollar” or, for that matter, to shoplifters. Those losses don’t go away or come out of some mysterious pot of money or some magic insurance policy with no premiums. They are made up for out of your pocket and mine in the form of higher prices, premiums, taxes and fees.

So this expected increase in responsible behavior from some is good news for all. (This example shows how more positive behavior by individuals in any of the five key dimensions moves America as a whole in the right direction.)

Don't Listen To Me!

2012-03-09T07:00:00.005-08:00

As I walked through the mall a few weeks ago, it occurred to me that if everyone listened to me we would be in big trouble! If we all suddenly developed perspective, began living out our values that people are more important than things and suddenly stopped reacting to advertising hype and peer pressure, half the retail establishments would go out of business - and with them the jobs. The stock market would tank and with it our retirement investments – so many IRAs, 401(k)s and union pension funds.

What if we all started buying things because we needed them, not because someone else told us that we needed them? What if we stopped trying so hard to impress our friends and neighbors? How many shoe stores would one mall need? Would people rush to buy the latest electronic gadget the day it came out or fight over the latest athletic shoes or pay outrageously for fashions with a designer label or logo? Would we continue to buy four-dollar cups of fancy coffee? Instead would we have a nice bowl of cereal packed with fiber and vitamins in the morning and make ourselves a sandwich for lunch a few days a week, saving money and feeling healthier instead of living on a fast-food diet? Would we be willing to pay those high prices to watch millionaire athletes, actors or singers perform, camping outside the door for hours; or would we wait until the prices seemed more reasonable, more in perspective, forcing those entertainers and promoters to meet (rather than set) our expectations?

Think about it –how many of the 1% that the occupiers rail against were able to join the top1% because we met their price or kept their companies in business by buying stuff that we could have easily lived without? Whose spending drove the housing bubble, the Internet bubble and all the other bubbles that made someone else rich? How many people have basements and garages full of things they once “needed” but now rarely look at – and storage containers rented to accommodate the overflow?

But let’s not all get perspective at once! There are common folks out there whose jobs depend on Americans buying new cars every few years, stopping in for fast food and a cup of coffee, making a meal with our family a special event instead of a regular practice, preferring designer labels on everything they buy, putting appearance ahead of substance, and planning their lives around what others think of them. It’s OK if a few try this perspective thing, but let's not get carried away. If it spreads too far too fast, we are all doomed!