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On Life In The Modern World, Or, What If Jesus Was An HMO? September 30, 2009

Those among us who are familiar with the Bible will recall that Jesus Christ himself was an active member of the health care community as he travelled about the Holy Land.

It is reported that he practiced within multiple medical specialties, and his works as both an ophthalmologist and a neurologist are recounted within the verses of the Gospels.

But what if Jesus had been practicing medicine in the therapeutic environment we’re familiar with today?

In today’s conversation we’ll be tagging along with Jesus as he takes a few calls at his HMO’s Customer Care Center—and by the time we get done you should be able to bring a whole new take to those discussions you‘ve been having about why reform matters.

“…a blind man, Bartimaeus…was sitting by the roadside begging. When he heard that it was Jesus of Nazareth, he began to shout, “Jesus, Son of David, have mercy on me!”

…Jesus stopped and said, “Call him.”

So they called to the blind man, “Cheer up! On your feet! He’s calling you.”

Throwing his cloak aside, he jumped to his feet and came to Jesus. “What do you want me to do for you?” Jesus asked him. The blind man said, “Rabbi, I want to see.”

“Go,” said Jesus, “your faith has healed you.” Immediately he received his sight…”

Mark 10:45-52

“Thank you for calling Customer Care. This is Jesus. How may I help you?”

“Hi, I was recently treated by you in Jericho for blindness—“

“Can I get your account number, sir?”

“J32-21515”

“Oh, yes. Is this Bartimaeus?”

“Yes it is.”

“So what can I do for you today?”

“Well, I went to check my mail, and I found a bill from you for 42,554 shekels for the eye treatment, and I don’t understand why you want me to pay this bill.”

“Well, give me a second while I look that up…ahhh, OK, I understand what happened. You see, I did perform the eye treatment, but your policy requires you to be referred by your Primary Care Physician for any specialist treatment and pre-approved by someone here at Customer Care before we can be liable for any costs of care, and the computer says that you didn’t do any of that first…so, I apologize, but we won’t be able to make any adjustments to this account.

Is there anything else I can do for you today, Bartimaeus?”

“Well, how am I supposed to pay this bill? I don’t have this kind of money. Can’t you perform a miracle or something to help me out here?”

“Well, sir, I can’t do that, but what I can do is transfer you to our Collections Department, who can help you make payment arrangements…”

Needless to say, the call went downhill from there.

“Here a great number of disabled people used to lie—the blind, the lame, the paralyzed…

One who was there had been an invalid for thirty-eight years.

When Jesus saw him lying there and learned that he had been in this condition for a long time, he asked him, “Do you want to get well?”

“Sir,” the invalid replied, “I have no one to help me into the pool when the water is stirred. While I am trying to get in, someone else goes down ahead of me.”

Then Jesus said to him, “Get up! Pick up your mat and walk.” At once the man was cured; he picked up his mat and walked…”

John 5:3-8

“…so you say you were lame and I made you walk, and now you’re getting calls from a collections agency that wants to garnish your ass?”

“Yes, Jesus, that’s correct.”

“Well, it says here that that back in Tishri of 12 AD you had severe boils and lesions, which is a preexisting condition. Now when I asked you if you wanted to get well you never disclosed any of this, and I don’t see it anywhere in your application packet, either.

Your policy requires you to inform us of any medical treatments you received before you became a policyholder, and because you failed to make a true and complete statement in your application we have to reject this claim.

I really do apologize, but we won’t be able to make any adjustments to this account.”

“To the elders among you, I appeal as a fellow elder, a witness of Christ’s sufferings and one who also will share in the glory to be revealed:

Be shepherds of God’s flock that is under your care, serving as overseers—not because you must, but because you are willing, as God wants you to be; not greedy for money, but eager to serve; not lording it over those entrusted to you, but being examples to the flock.

And when the Chief Shepherd appears, you will receive the crown of glory that will never fade away.”

1 Peter 5:1-4

“We didn’t know what to expect when he came here, but in just a few months Jesus has shown us what can happen when the Son of God is a Customer Care Representative.

His average call volumes are more than double those of any other rep, and when you listen to him take calls…well, when you hear him tell someone that they won’t be getting their benefits…it’s almost like he has some divine power over the customers or something, and that’s why today I’ve gathered you together to announce that Jesus is going to be transferred from the call center to the Executive Training Program.

Additionally, because Jesus did not adjust a single claim in favor of a customer for the last three months we’re also giving him the “Employee of the Quarter” award, which means he gets three days off with pay that he can take anytime he wants, a check for $500, and, of course, Jesus gets to use the parking space right by the front door for his Hummer.

We expect really great things from Jesus in the future, and while we will miss Him here at Customer Care I think we can safely say that with Jesus running the show this company is going to remain profitable for decades to come.”

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On Improbable Realities, Part One, Or, “I Want A Jet Car With Frickin’ Lasers…” September 23, 2009

When it comes to getting around, Americans love to consider the question of “what if…?”

As a result, our cars have evolved into “land yachts”, our trucks have become “monster trucks”, and the desire to drag our living spaces around with us has morphed into converted busses with rooms that pop out of the side, a Mini-Cooper hidden under the master bedroom floor, and self-tracking satellite dishes that fight for space on the roof with air conditioning equipment.

And for more than a few of us, “what if…?” has even extended to “what if my car…was a jet car?”

In today’s improbable reality I’m here to tell you that Chrysler engineers asked that exact same question, for roughly a quarter of a century, and as a result they actually designed and deployed seven generations of cars with jet engines—and they came darn close to putting the eighth-generation design on sale to the general public.

It’s a story of pocket protectors and slide rules and offices full of guys who look a bit like Drew Carey…but as we’ll see in Part Two, it may also be a story of technology that couldn’t be perfected “back then”, but could be reborn in our own times.

As so often happens, a bit of “setting up” is needed, and to get this story going we need to discuss exactly how jets—particularly gas turbines—work.

In the case of an automotive engine, the idea is that air is drawn into the engine, that air is compressed, fuel is added, and the air/fuel mixture is then set on fire with a spark plug. This rapidly heats the mixture, it expands, and the energy created by that expansion is used to turn a turbine (a variation on a fan) which is connected to the driveshaft that eventually turns the wheels.

Some aircraft and helicopter engines also use this design to turn propellers, but the majority of aircraft jet engines force the expanding air/fuel mixture out the back of the engine in the form of “thrust” that, to put it as simply as possible, “make airplane go fast”.

From an engineering point of view, there are a lot of advantages to a turbine engine.

In contrast to a design that requires pistons and valves and a crankshaft and a cooling system and a system for oil distribution, turbine engines have very few moving parts, are cheaper to manufacture, and require a relatively small amount of maintenance. They also have very long service lives compared to piston engines.

Beyond that, turbines start right up on very cold days. Because jets output lots of heat you never have to wait for the jet car’s heater to “warm up”, and they can burn virtually any combustible liquid or volatile gas as fuel.

Vibration is very low, and you get 100% of available torque at 0 rpm, which means you don’t have to “rev up” the engine to get the wheels to start turning (something that is also true of vehicles powered by electric motors).

“Eagles may soar, but weasels don’t get sucked into jet engines”

John Benfield

So that’s the why…now how about the “who did what when?”

1954, 1955, and 1956 saw Chrysler rolling out the first-generation CR-1 turbine engine. One vehicle was produced in each of those years; the ’55 version was designated the Plymouth Belvedere Sportone CR-1 Turbine Special. (The 1956 version of the same vehicle was rated at 100 horsepower and 13 MPG.)

By 1959 the CR-2 engine was in service, again only in “testbed” vehicles, and it had achieved ratings of 200 horsepower and, after a 1,200 mile demonstration run from Detroit to Princeton, New Jersey, a far more respectable 18 MPG.

Operating these vehicles had taught Chrysler a few things about the disadvantages of turbine designs:

–the gases that come out the back of the car are really, really hot (temperatures can climb above 1000 degrees F.).

–after you put your foot on the gas, there is an annoying delay before the turbines (and the wheels) start spinning faster.

–because you’re basically dumping fuel into the combustion chamber, fuel economy sucks.

–the CR-1 and CR-2 engines did not offer “engine braking”, which means there would be extra wear and tear on the brakes at the wheels, and, because the driver would be constantly “riding” the brakes, increased potential for a heat-related braking system failure.

An engine was coming along that would address these problems, and in 1961 it was dropped into the visually stunning TurboFlite, which looked like a cross between two famous automotive avians: an early 1960s T-Bird and a late 1960s Plymouth Superbird. This Chrysler-designed and Ghia-built car even featured a clear “bubble” canopy that lifted up to allow passengers to get in and out.

The CR-2A engine featured fancy new engineering that dramatically reduced the acceleration delay and provided engine braking, and in 1962 one of the two Dodge Darts that was fitted with this engine was taken on a 3,000 mile national tour (New York City to Los Angeles) to introduce the concept to the public. (Two other cars, both Plymouth Furies, were also fitted with turbine engines that year.)

At this point we need to talk about the most unusual characteristic of this type of car: its singularly unique sound.

If you can imagine the sound of a Learjet taxiing several hundred feet away you might have a pretty good idea of—well, actually, you don’t have to imagine it if you don’t want to. You can hear it for yourself by watching the film produced by Chrysler to document that 1962 cross-country trip.

By 1963, a fourth-generation engine had deployed new technology that recycled heat from the exhaust to “preheat” the intake air. This dramatically reduced the exhaust temperature while making it easier to set the intake air on fire, which significantly increased both fuel economy and horsepower.

Other improvements further reduced “acceleration lag” and provided better engine performance while idling.

There is just too much story for one day, so we will stop right here and pick up the rest next time. Before we finish, a quick recap of where we’ve been, and a preview of where we’re going:

Chrysler, among other manufacturers, was experimenting with using jet engines to turn turbines; the idea being to replace the piston engines used in virtually every car built from that day until this with something better.

Four generations of engine had already been produced, many of the problems that were associated with the original design had been either partially remediated or fully resolved, and a significant effort was underway to introduce the idea of “jet cars” to the motoring public.

In Part Two, Chrysler puts a turbine car in the hands of 200 lucky families, we continue a history that may not be over yet—and in a most unexpected development, we’ll discover the common heritage that links the 1956 Ford Thunderbird, the 1961 Lincoln Continental, the 1964 Chrysler Corporation Turbine Car, and the 2009 Dodge Challenger.

So how about that? A decade-long story of history, engineering geekery, and conceptualism…and all of it presented in the form of useful objets d’art.

And in Part Two: lots more to come.

What’s not to love?

 

On Understanding Your Market, Or, Mr. Obama, We Need To Talk September 9, 2009

So it’s the day of the big speech, Mr. President, and we got trouble with a capital “T” right here in Health Care City.

What are you gonna do? Do we follow the traditional Democratic Party legislative process of passing…something…at any cost, assuming the entire time that the Left and the Netroots will “go along with the program”, or is there a risk that the calculus doesn’t work as well today as it did in 1994 and 1996?

Well, lucky for you, I’m a fake consultant, and I know a few things about your “target market”, so before you answer that question…we need to talk.

So the common sense approach to handling this situation is to make any deal required to get a bill passed, because otherwise your entire Presidency will be tagged as “strong on oratory but unable to govern”. Since the Far Left supports Democrats today and won’t be supporting the Republican Party under any circumstances, they’ll have no choice but to follow the “centrist” (read: “bluedog”) Democratic lead.

What you don’t want to do, common sense tells us, is demand that reform contain elements that simply are too tough to get through Congress. Insisting on a public option is absolutely out of the question, the new “preexisting conditions” requirements would be too onerous on the insurance companies—and requiring everyone to purchase insurance, with no public option competition at all to moderate the prices private insurers charge, and, for that matter, no guarantee of universal coverage, somehow makes perfect sense.

To mollify those who will object, we can hold out “triggers” as a compromise: in other words, Government says “hey, let’s wait a few years, and if the insurance companies still haven’t changed their ways…then we’ll do something.”

If you decide upon this approach, then the speech you want to give is to remind the Far Left and those pesky bloggers that political progress is incremental, you take what you can get, and that we can always come back later and make this whole stew of compromise better than what we propose to cook today.

While that’s a pretty good approach…most of the time…it won’t be this time.

There are two major reasons why, and, ironically, they’re both derived from your success in 2008.

Right off the bat, this strategy assumes the millions of new voters—and even more importantly, donors—that you attracted in 2008 are Democrats, and that, no matter what, they will continue to support Democrats. The problem is, they’re not….and they won’t.

Why? Because the vast majority of those new voters weren’t “redirected” from another Democratic candidate. Instead, they were “political non-participants” who had previously held no political affiliation whatsoever—and other than supporting you personally, the vast majority of those new voters have no long-term political affiliation now, other than, perhaps, “Progressive”.

The only reason they voted for you in the first place was because you were out promoting that whole “change you can believe in” thing. They saw you on TV telling people that universal access to care “…is a moral responsibility and a right for our country…”, and saying you would:

“…set up a government plan that would allow people who otherwise don’t have health insurance because of a preexisting condition, like my mother had, or at least what the insurance said was a preexisting condition, let them get health insurance”.

At that same evening’s event (the Democratic Presidential Debate of January 31, 2008), they also saw you say this:

“…because my view is that the reason people don’t have health care… [w]hat they’re struggling with is they can’t afford the health care. And so I emphasize reducing costs. My belief is that if we make it affordable, if we provide subsidies to those who can’t afford it, they will buy it.

Senator Clinton…believes that we have to force people who don’t have health insurance to buy it. Otherwise, there will be a lot of people who don’t get it.

…I think that it is important for us to recognize that if, in fact, you are going to mandate the purchase of insurance and it’s not affordable, then there’s going to have to be some enforcement mechanism that the government uses. And they may charge people who already don’t have health care fines, or have to take it out of their paychecks. And that, I don’t think, is helping those without health insurance.”

The fact that you said all those things brings us to problem number two: if you don’t live up to your…exceptionally public…campaign promises, you’re gonna get YouTubed.

Forget about the Republicans. The Netroots will dig these quotes up in about two seconds—in multi-part harmony, I suspect—and all of a sudden, all those “new voters” who helped put you over the top last time, instead of seeing change they can believe in, are going to start seeing you as the “same old same old”…and if that happens, they won’t be voting Democratic again (or for anyone else, for that matter) for years to come.

And if they won’t vote for you…they most assuredly won’t be giving money to Democratic causes and candidates…including you in 2012.

You have to understand, it’s a question of trust. We want to believe that you’ll do the right thing, but we have been lied to for eight years straight…and we now fundamentally mistrust our elected representatives…including you.

Not all the news here, however, is bad news.

There is a way to turn all this to your advantage, and it basically involves “leapfrogging” the opposition.

Here’s what you do:

In the speech tonight, you look America in the eye and you tell us that you said all along that we must have a public option if we hope to control costs, you tell us that insurers can’t continue to “exclude” us out of insurance, and that universal coverage is, indeed, a moral obligation for our Nation—and a smart investment to boot.

Tell America that you will fight for them and against the special interests that are trying to hustle us once again. Most importantly—and this will be The Tough Part—tell us that a bad bill is a bill you won’t sign.

You have to tell America that if we don’t get it this year, we’ll have to come back next year and try again. And if we have to, the year after that, and the next, and the next.

You also get to remind America exactly what kind of methods Republicans were wiling to use to advance their position over this past month, and whose interests they’re representing when they do it.

To put it another way, you gave ‘em enough rope, and now it’s time for some noose-tightenin’.

The best part: not only does this approach lay to waste Republican opposition, it reels in the wavering Democrats—and it allows them to go home and tell their constituents that “Barack Obama and I are fighting for people and businesses and jobs while Republicans fight for fat cat insurance companies”.

If it’s done correctly, the 2010 midterms will be y’all’s to lose—but as I said earlier, if you are seen as selling a political product everyone’s seen far too many times before, the cost could be brutal…maybe even “President Palin” brutal.

We all have a busy day today, especially you, Mr. President, so let’s wrap it all up:

You made a lot of campaign promises about public options and universal coverage and ending exclusion abuses, and now it’s come time to make good.

A lot of the people who supported you didn’t do it because you’re a Democrat—and not because they are, either. If you don’t make good, you got a problem, and so do the Democrats, possibly for years to come.

YouTube was a fantastic tool for you and the seed of trouble for many Republicans in ’06 and ’08—but if you’re not careful, the tables will turn, and a lot of the people doing the turning will be to your left.

Do it right and you and the Democrats have a superb opportunity to pivot on the opposition and imprint the Democratic “brand” for a new generation of voters—and donors—and an aggressive approach tonight could be the opening salvo of a message barrage that either forces Republicans to become more moderate, or turns them into a crazier political movement that loses seats and Governors in 2010 and carries even fewer states in the 2012 Presidential than they did in 2008.

Screw it up, and even Tina Fey might not be able to save us from the wrath of “Palin/Gingrich 2012”.