Category: Random Thoughts

Got Spam?

If you’ve got an email account, chances are you have received some spam — unsolicited commercial email — over the years. In fact, in February of 2004, over 90% of all email sent was spam. This figure is rising, despite the fact that the United States has a nice new anti-spamming law on the books. Indeed, over half of all spam is proudly made in the USA.

Of course it is an annoyance to delete all the unwanted offers for mortgages, debt consolidation, “herbal viagra”, and other stuff you don’t want. Of course office workers collectively spend many hours doing the same at work — time they could be spending doing actual work. Spam costs money by using bandwidth and storage space that could be used for much more important things. Nobody feels this more than ISPs, who unwillingly transmit gigabytes of spam each and every day.

Spam prevention as we know it usually relies on blacklists of servers known to send spam. This technique works acceptably for most users, but depends on a continually upgraded list combating continually moving spammers. An alternate technique, sometimes used alongside a blacklist, is the algorithmic approach. In this method, a smart program looks at your email, analyses it, compares it to known spam, and decides how likely it is to be spam. The program might take the liberty of routing suspected spam directly to your “deleted items” folder. This carries the risk of accidentally deleting something important.

Part of the problem is that spam is very cheap to send. All it takes is one person to submit a credit card number, and the day is profitable. Another part of the problem fighting spam is the anonymous nature of the internet. It’s easy to be nobody, or anybody. You might get spam with a “forged header” that makes it look like it came from somebody famous, somebody you know, maybe even from yourself.

The next wave of spam control, we are told, will be about identifying senders. This will make it possible to prosecute spammers who break the law. This will also open the door to charging spammers. A Microsoft solution to this problem is expected tomorrow.

The “caller ID” paradigm of spam prevention is doomed before it begins. First, the vast majority of them do not verify that someone is John Doe, they verify that someone is at John Doe’s computer. This same flaw plagued the much protested security features of the Pentium 3 chip some years ago. This distinction is critically important. Not only might somebody else be at the computer, the computer might be under the control of a virus. You knew viruses could use email to send themselves to all your contacts, but maybe you didn’t know that a virus can use your computer to send spam. In fact, some experts think as much as 30% of spam is sent by “zombie-bot” virus infected computers. There you have it, the reason most computer security experts consider spam and virus control related.

There is another reason that “being at your computer means being you” will not control spam. It doesn’t allow for the possibility that you might not be at your computer, sending mail from your email client. Anyone who uses a web-mail client, anybody who must use email remotely, anybody who uses the “send this link to a friend” feature of a website may find themselves shut out of a “caller ID” model of spam filtering. Although some sites that run web-based email services appear to be sensitive to that, most people forget that there are many reasons you and your computer are not the same thing.

There is one sure way to keep spam and viruses off your computer. Unplug it.

I have said before that “Insurance makes things cost more,” and that “Tort reform is not the same thing as damage caps.” These facts are still true, and you are welcome to see my arguments in the archives. Today, I would like to focus on the Medical Malpractice Crisis. In short, yes there is a crisis, no simply capping non-economic damages will not make it go away.

There is definitely a crisis, make no mistake. Malpractice insurance rates are going up by double-digit percentages — as much as 82% in one case — in many places. Because insurance is regulated at the state level, the actual figures vary wildly from state to state. Doctors are not in a position to pass their added expense on to their patients. In some states, things are worse than in others. According to the AMA, about 19 states (almost 40% of all states) are in “crisis.” The AMA prescription for the crisis is caps on non-economic damages. Republicans agree. Mostly, anyway.

There is anecdotal evidence that doctors in some areas are closing practices, limiting the scope of their practice, leaving the state, retiring early, or making do without malpractice insurance at all. According to these tales, there is a particular problem with specialists, such as Obstetricians and Neurosurgeons. This evidence may or may not stand up to objective scrutiny.

One thing many people do not understand is that the malpractice insurance your doctor carries has limits, just like your auto, renters, or homeowners insurance does. In many places, the standard policy has limits of $1 Million per incident and $3 Million per year. In theory, anything over those limits awarded to a plaintiff must be paid out of the doctor’s pocket. In real life, this is not really the case. Perhaps more defendants (such as the doctor’s partners or a nice deep-pocketed hospital) have their insurance tapped. Or rather than spend years in appeals, a settlement is reached.

But back to the million dollars. Let’s imagine that a 40 year old man in killed through medical negligence. First, lets look at the real damages. He made $50,000 last year, and planned to work until he was 65 (yes, that’s ambitious planning these days). That means if he worked 25 years for $50,000 — never got another raise — there are real damages of $1.25 Million before we even calculate the cost of his funeral. The insurance company has already reached the limits of what they will pay, regardless of what might be awarded for “pain and suffering.” In fact, it turns out that “only a handful” of cases exceed $1 Million verdicts. According to the National Practitioners Data Bank, the average payout of a doctor to a patient was $135,000. This figure likely averages in out-of-court settlements, which account for 96% of all cases.

To say that mega-verdicts have anything to do with rising malpractice rates is disingenuous. To say that capping non-economic damages will fix malpractice rates is doubly so. Non-economic damages account for 24% of the money spent on malpractice; more than any other single category, but not by much.

Critics who say that damage caps work normally point to California as their poster child. The truth is that California’s MICRA statute is just one part of an elaborate insurance reform and cost control scheme. It is furthermore worth noting that “California’s medical malpractice disputes are settled 23 percent faster.”

Proponents of damage caps prefer that you not look at Nevada. In 2002, they passed damage caps. That year, 7 doctors came to Las Vegas to practice medicine, an area that sees 5000 new residents every month. Despite passing damage caps, malpractice rates have still risen double-digits for 2004. Further reforms of the reform propose limiting lawyers fees, telling the jury when insurance paid for treatment (that would be “most of the time”), allowing payment of verdicts over time, and some shuffling of percentage of liability. I am at a loss for how most of this stuff is supposed to help. It is ironic that Nevada’s Senator Harry Reid is co-sponsoring a bill to bring damage caps to the nation.

One of the problems with Nevada’s reforms is that it abolished a medical review panel. Before, many cases could be dismissed as frivolous by a panel of actual doctors — whom one must assume are competent and impartial. Not surprisingly, the number of malpractice suits has risen. Now, everybody is entitled to his day in court, and this is costing everyone a lot of money. It can cost tens of thousands of dollars just to get to the point where a judge can decide to dismiss a frivolous suit, or take a clearly uninvolved party out of a suit.

Oh, and those legal fees are usually paid by the malpractice insurance carrier. It might take only one frivolous and quickly dismissed case against a family practitioner to obliterate the premium he paid. For reference, in West Virginia 29% of malpractice cases were dismissed in the last decade. Nationally, 70% of cases are closed with no money changing hands — except of course among the lawyers.

As if that is not bad enough, it turns out that the majority of malpractice complaints are against 1-5% of doctors. The figure varies by state. Some of this may well be “personality issues,” but the fact remains that as much as 80% of malpractice claims could be eliminated by getting “Dr. Nick” the heck out of the hospital.

Getting the malpractice crisis in hand will really impact health care costs by less than 1% according to the Congressional Budget Office. Others say that reduced “defensive medicine” such as unnecessary tests will help bring costs down. However, it may very soon impact the availability of healthcare in general. That would be bad. Here are some options we might consider instead of liability caps:

Insurance reform. Insurance needs to be reformed in many ways, all across the nation. We can start with re-mutualizing insurance companies (so no money is funneled off as profits), or setting up state insurance pools for high-risk groups.

Medical malpractice review boards. These impartial medical/legal experts would be the equivalent of a grand jury, determining whether there is sufficient evidence for a malpractice case to make it to trial. If they see the same doctor over and over, they should have the authority to open an investigation into his competence. For that matter, if they dismiss cases by the same lawyer over and over, they should turn him over to the local Bar Association for review.

More arbitration, fewer trials. Utah is considering this approach. There are pros and cons, of course, but it will be interesting to see how it works out.

Remember, sometimes bad things happen. Not everything has to be somebody’s fault. Does it?

On the lighter side, I thought you would enjoy this image.

Perhaps you remember about a month ago, when the World Health Organization came out with guidelines for tackling what is turning out to be a global obesity epidemic. They said nothing less radical than too much sugar is bad for humans. Representatives of the Bush Administration quickly objected to this (emphasis mine): “The Bush administration, which receives millions in funding from the sugar industry, argues there is little robust evidence to show that drinking sugary drinks or eating too much sugar is a direct cause of obesity. It particularly opposes a recommendation that just 10 per cent of people’s energy intake should come from added sugar. The US has a 25 per cent guideline. Thompson’s representative… will be Bill Steiger, godson of George Bush Sr. He will argue there is no evidence that selling junk food to children increases overweight. [sic]”

The sugar industry has become a political linebacker, set to tackle any politician or scientist that dares speak ill of it, let alone attempt to rein it in. This means they have a two-front war for profits to wage.

The dietary front is only half the story. I have said before that every weight loss diet that works involves drastically if not completely eliminating refined sugars from your life, in the context of reducing total calories. Other experts agree that too much sugar, including too much corn syrup, is not good for you. Even the most rabid of high-carb low-fat proponents must concede this point. However, to listen to this commentator, sugar is great for you: the article is long on out of context quotes such as “Yes, even our “children benefit from eating some sugar,” says Ellyn Satter, a childhood weight specialist and clinical therapist…” and not-cited research by unknown researchers who “have found that added sugars and sodas – like other high-calorie, low-nutrient dense foods – are unrelated to weight. Consumption is high among all kids. In fact, the skinniest teens actually drink the most sodas, and the fattest drink the most sugar-free ones.” Did you notice that even her cited expert said “some” sugar is beneficial? I smell an agenda.

The other battlefront for Big Sugar is world trade, where they are in the process of winning two big skirmishes. The Central American Free Trade Agreement (CAFTA) is only going to allow 110,000 additional tons of sugar to be imported tariff free into the United States in return for opening Central American markets to American rice. Doesn’t sound like much of a free trade agreement, does it?

The other Big Win for Big Sugar is in a trade pact with Australia. Now, please keep in mind that Australian sugar producers are not faring as well as their American cousins. Last month the Australians made it clear that if the Americans wanted a Free Trade deal, it would have to include sugar. American Big Sugar made it clear that it had better not. Alas, the article is premium content, but The Economist had this to say in their February 14, 2004 print issue:

The deal has once again underscored the clout of the American sugar lobby — scattered across America from the powerful interests of Florida, a key electoral state for Mr. Bush in November, to the beet growers of North Dakota. The industry and its executives are among the biggest donors to congressmen and to the president. The sugar quotas they favour mean Americans pay around three times the world-market price. The inclusion of tiny concessions to cane growers in five Central American countries, in the recently negotiated Central American Free Trade Agreement, is one reason why that pack is guaranteed a rocky ride through Congress.

Not only does Big Sugar effectively own enough congressmen to possibly scuttle an international trade deal, they are doing everything in their power to suck money out of your wallet.

But day after day
The show must go on,
And time slipped away
Before you could build any castles in Spain…
The chance had gone by.

With nothing to say
And no one to say it to,
Nothing has changed.
You still got it all to do,
Surely you know.
The chance has gone by…

(Excerpted lyrics from “Day After Day (the Show Must Go On)” by A. Parsons and E. Woolfson (The Alan Parsons Project), from the album I, Robot. Song copyright 1976 American Woolfson, Inc. (BMI))

Don’t let this happen to you. It’s one thing to wake up one morning and say “Well, I guess I will never be Queen of England and I will never be an Astronaut.” It’s another thing to wake up one morning and realize that all the things you wanted to do with your life just haven’t happened, and that you have nobody to blame but yourself.

Do yourself a favor. Take 5 minutes out of your busy day to write down some things you would like to do with your life. Don’t think too hard about it, don’t rationalize any of it, and don’t spend too much time on it. We both know you have other stuff you have to do today. Fold up the piece of paper and don’t think about it again until tomorrow.

Tomorrow, take another 5 minutes with that bit of paper. Sort the items into Short Term Goals (“Christmas in Florida” or “Give money to [name of charity]”), Medium Term Goals (“Earn Black Belt”), Long Term Goals (“Own chain of Pizza Parlors”), and Impossible Dreams (“Win Lottery”). Remember that one person’s perfectly reasonable Long Term Goal might be another person’s Impossible Dream. Just because I will never win an Oscar doesn’t mean you shouldn’t try to do so yourself. In an ideal world, there should be some goals for each of the areas of your life: professional goals, relationship goals, personal growth and spirituality goals, you get the picture.

Now, I will be honest. I had such a bit of paper. It sat in a side compartment in my purse for some years, forgotten. When I opened it and read it again, I realized I had accomplished much of what I had written down. By that time, most of the things I hadn’t accomplished didn’t matter to me anymore. Maybe the magic of writing such things down is that it forces you to admit what you really want in clear, concise words. Maybe it’s that writing it down is an automatic reminder.

If you really want to achieve, you will look at that list and figure out how to make those things happen. Break it down into manageable steps. Be realistic about what you can do, what you need help doing, and what you need to learn to do. Do you want to see the cherry blossoms in Japan? You’d better start by getting a passport, finding out when cherry blossom season is, and maybe learning a bit of Japanese. After that, all you need is time and money.

Don’t make excuses. This is what you want. You wrote it down. If there is something standing between you and your goal, find a way around it. Some obstacles will be insurmountable, most will not. Please, don’t let your life pass you by, one dreary routine laden day after another.

Or, Hello ShortWoman!

Today is the 30th Anniversary of the introduction of Hello Kitty, not to be confused with her actual birthday, which Sanrio insists is November 1. To commemorate the occasion, 30 lucky collectors will have the opportunity to purchase a 3 centimeter high platinum figure of the birthday kitty, adorned with 131 diamonds. The price is a mere 3 Million Yen.

Perhaps this sum is out of your budget. You can still purchase Hello Kitty trinkets ranging from $2 pens to toilet paper to sake sets to televisions. Or maybe you need a USB hub. Perhaps a $1000 Hello Kitty dress for the fashionable Hello Kitty fan in your life.

It is clear that Hello Kitty and Generation X have grown up together. What, you didn’t think this stuff was for little girls, did you? Indeed, you either love her or hate her but nobody can be ambivalent to that much cuteness.

This has helped Sanrio earn revenues of between a Half Billion and a Billion dollars annually, depending whose figures you like (and truth be told, exchange rates). She is a popular icon both in the United States and Japan, where there is even a theme park in her honor. Her rise is documented in the book, “Hello Kitty : The Remarkable Story of Sanrio and the Billion Dollar Feline Phenomenon.”

If you are looking for a more subdued way to honor Hello Kitty, preferably one that does not involve your purchase of something pink, you might check out the “Jump to Japan” exhibit at The Childrens Museum of Seattle. Press coverage here and here.

Last night, the President made his State of the Union speech before both houses of Congress. Among the ideas he put forth were increased money for school drug testing (a pricey logistical nightmare even before considering civil liberties issues), greater Federal student aid for those who take tougher courses (great idea, except for that exacerbating the gap between suburban and inner-city schools which have no advanced programs), and a Federal ban on the use of performance enhancing drugs by professional athletes (never mind that as a part-owner of a baseball team, Mr. Bush knows full well all the leagues have rules which do not require Federal intervention). I will leave it to others to point out the logical and practical issues of these and other issues mentioned by the esteemed Mr. Bush.

I would like to focus your attention on these passages if I may:

Our agenda for jobs and growth must help small business owners and employees with relief from needless federal regulation, and protect them from junk and frivolous lawsuits….

To protect the doctor-patient relationship, and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits…. By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America’s health care the best in the world.

It must seem odd that out of all the things said last night, I am focusing on 3 sentences. To be sure, there were intervening paragraphs, but make no mistake: these ideas are one and the same. Do you remember back in the early 90s, when “Health Care Reform” was discussed? Before the conversation went on too long, it was clear that the participants meant “health care insurance reform.” By the mid-90s, they meant little more than “HMO reform.” Another discussion is being fatally limited, as illustrated by the above 3 sentences.

Somehow, politicians and doctors both have gotten it into their heads that “tort reform” and “caps on non-economic damages” are the same thing. They are not. Tort reform is more than damage caps. It is both cynical and disingenuous to propose that a limit on the amount of money a doctor or business can lose in a court case will improve anything for the typical American. How can this be so? Let me count the ways.

1. Such a cap will not, contrary to AMA opinion, bring down liability insurance rates. When the AMA says that caps are “proven” tort reform, they are referring to California’s MICRA statute, which was enacted as part of a more comprehensive plan than a mere cap. Other states where they have enacted liability caps are still facing premium increases of 8-45%. Now, you don’t really think your doctor can afford to not raise prices when one of his largest non-employee expenses is out of control?

Insurance rates are more dependent on the investments of insurance companies than the claims they must pay. With interest rates this low, insurance companies have to raise rates. This is doubly true for publicly held insurance companies who must continually impress Wall Street. If you want lower insurance rates — not just liability, but home, life, health, and even auto insurance — re-mutualize insurance companies and hope Mr. Greenspan has to raise rates sooner rather than later.

2. Damage caps severely limit the rights of average Americans. Anybody can file a lawsuit, and that is truly a double edged sword. As one person put it, “Lawsuits by small people who’ve been injured by big companies is the one thing out there still protecting the little guy.”

Not only will damage caps harm the very people who have been most egregiously hurt through the negligence of others, they limit the ability of such people to obtain legal counsel. As long as lawyers can look forward to a percentage of the final take, there will of course be abuses. That problem is solved by looking at the way lawyers are paid, which is unlikely to happen inasmuch as most legislators are lawyers. Want to cut down truly frivolous lawsuits? Give every judge the authority to declare lawsuits frivolous and compel the plaintiff (or his attorney) to pick up everybody’s legal bill.

3. The much lambasted “mega-verdict” that damage caps seek to eliminate is a tool that juries need, and a tool that businesses need to fear. You don’t honestly think juries return such opinions because they just believe the victim deserves to be a millionaire, do you? They return such verdicts as a punishment to the defendant and a message to the defendant’s competitors: treat people this way and you will be crushed.

Fear of a large verdict actually helps the court system by encouraging out-of-court settlements. Interestingly enough, the poster child for tort reform is asbestos liability. Now, there is no debate that asbestiosis is really bad, but the business world feels that the lawsuits — now against the deepest available pockets — are out of hand. It is of course pure coincidence that Halliburton stands to gain from any tort reform that addresses asbestos.

4. Damage caps would be a boon for large corporations, but would still allow small businesses to be put out of business by lawsuits. Take, for example, the famous McDonalds Coffee Case. A $250,000 million damage cap is little more than a rounding error to a company the size of McDonalds, but it would put almost any corner diner you have ever eaten in out of business. Do you really want to send the message to America’s largest corporations, our largest polluters, our most abusive employers that they can do whatever they want, as long as they pay the $250,000 fine at the end of the trial?

I agree that we must take the Lotto mentality out of our civil courts, but damage caps are not the answer. Instead, make a large percentage of the non-economic damages payable directly to the jurisdiction of the court. The offender gets punished; the windfall is less motivating; and the city or state gets money they badly need. I can’t think of anything not to like about this plan.

Mr. Bush presents you, the voter and taxpayer, with a false “either-or”: either we enact damage caps or costs of everything will spiral out of control. Tort reform isn’t about keeping your family doctor delivering babies. It is about big business covering their assets.

Today, jury selection begins for the trial of domestic deity Martha Stewart. If you haven’t followed the case at all, this timeline provides a minimally adequate summary. If you have been living in Amish country or the Unabomber’s shack, and don’t know who Ms. Stewart is, this short biography says that she is a retired model, retired stockbroker, former caterer, newspaper columnist, author, and all-around expert on all things domestic. As many people love her as love to hate her in this role.

The short version of the saga is this: about 2 years ago, Ms. Stewart was very fortunate to sell almost a quarter million dollars of stock in a biotech company the day before the FDA announced their drug would not be approved. The stock of this company needless to say was down sharply on the news. The immediate question was lucky, or had “insider information.” Being a former stockbroker, she very well knew that insider trading is something that could get you in big trouble. Indeed, the former CEO of that biotech company is in jail for trading on insider information about his company. But Ms. Stewart is not being charged with insider trading; she is charged with “lying to investigators, obstructing justice and securities fraud.”

The real issue is what she said to investigators and to the public. Specifically, she told shareholders in her own company that she had done nothing wrong. Loud statements about how she did nothing wrong are now the ammunition against her in court. In the expert words of Eric Dezenhall, “The way to keep out of jail is to shut your mouth; the way to rescue your brand is to talk. She’s trying to do two things at the same time, and there’s no way you can do both brilliantly.”

You would think some lawyer would have recommended she say nothing more than how she was looking forward to defending herself against “such ludicrous charges.” But the moral of the story — regardless of this media circus at taxpayer expense — is that the Fifth Amendment is good for you, and there is a reason the Miranda warning begins with “You have the right to remain silent.”

Don’t forget, tonight President Bush makes the State of the Union address. Before then, you might want to do some light reading. Try some of these interesting items.

Those of you who have been reading the ShortWoman for a while know what I think of the TSA, airline security, and the War on Terror.

Today we learn that the Government is still wanting to implement their traffic-light inspired traveler coding system. Remember, this system will only designate people for more security, not less. Furthermore, they estimate that as much as 2% of all fliers may be prevented from flying altogether — perhaps 5 or 10 people on each and every 747. Some analysts predict that this will mean the end of online ticket sales.

Airlines are not pleased about this. Their official concerns mirror those of the EFF, and involve issues like privacy, how the information will be used by the Government, and what happens after they are done with the data. Truth be told, they are probably also wary of the cost of the system, both in terms of implementation and lost travel revenues. In fact, they are proposing a “trusted traveler” system, where people can voluntarily submit a bunch of information to the government and get a “not a terrorist” card. It won’t work. Everyone still has to go through the metal detector, and all the luggage needs to be inspected. Besides, can anybody guarantee that William Krar or someone like him could not have gotten such a card? What about Tim McVeigh? Last week’s unknown hijacker, who foolishly tried to get a commuter jet to take him to Australia? How about the soldier who tried to take a land mine on an airplane last week?

I have said it many times: there will never be a “get out of the security line free” card.

The current flagging of travelers for additional scrutiny and the associated “Do Not Fly” list are already problematic. Two new cases illustrate my point. Even more recent than the Air France flight that was in an uproar because of passengers mistaken for international terrorists. The first involves a 6 year old girl who was placed on the CAPPS watchlist, singled out for additional screening, apparently because her mother had an expired drivers license. It remains to be seen whether this is a one time thing, or whether she will have to endure absurd scrutiny every time she flies for as long as the War on Terror takes — which is to say forever.

The second case involves the use of the Do Not Fly list to control members of certain political groups. That shouldn’t happen in the United States. We are not talking about groups like Hamas, or the IRA, or anybody else on the State Department’s official list of terrorist organizations, a list that reads like the Coliseum scene of Monty Python’s Life of Brian. We are talking about a political party that managed to drag down about 3% of the votes in the 2000 Presidential Elections.

Alas, this is not the only place where I feel the authorities have gone wildly overboard in the name of public safety.

New Years Eve was less than 2 weeks ago. I wasn’t the only one who decided to stay in. I was only mildly concerned about actual terrorist activity. After all, security was incredibly tight. In fact, in my mind that was part of the problem. Locally, there was almost a million dollars spent on New Years Eve security measures. That included things like military helicopters, rooftop snipers, and radiation sensors.

What would have happened if somebody made a mistake?

No really, the authorities mistook a 6 year old for a terrorist. Sometimes law enforcement officials and military officers make mistakes; mostly honest, sometimes nefarious. What if one of the snipers had a bad day, or a twitchy finger, or just thought he saw Osama with an almanac? What if one of the military craft decided that a passenger plane into McCarran Airport — practically walking distance from the Strip — had deviated from course too much for the gunner’s taste? What if somebody turned on a microwave too close to the radiation sensors?

I don’t care to live in a police state. I prefer to live someplace where the Bill of Rights is respected.

As the calendar ticks over into 2004, a plethora of interesing, trivial, important, annoying, and otherwise simply new things happen. For one thing, in the middle of cold and flu season just like every year, many Americans change private health plans. This is rarely a completely voluntary choice: either a decision was made by a pointy-haired boss, or the family made a decision balancing cost and benefits to change coverage back in an open enrollment period some months ago.

Families and pointy-haired bosses are not the only ones making hard decisions about health care. Doctors and clinics are making tough choices too. They too have to balance money and healthcare. Among other things, they must decide which health plans and insurance companies pay enough that they can afford to provide treatment.

Many doctors are still in the business to serve others, but even they admit that they can’t afford to provide care below cost forever. A non-trivial number of doctors, like Susan Hershberg Adelman, MD, have determined that it is simply no longer possible to provide medical treatment the poor without joining them in poverty. Her figures citing that over a third of area hospitals have closed in the last 25 years is particularly damning inasmuch as Michigan prohibits for-profit hospitals: no money is being siphoned off to a corporate profit statement and an over-hefty CEO salary.

Reasons she states for closing her own practice include the fact that Medicaid in Michigan only pays 38% of the billed amount. Nor is this an unusual reimbursement figure. Try paying 38% of your bills and see what happens. She also cites high (and rising) malpractice insurance rates and the dreaded “unfunded government mandates.” You hear a lot about those unfunded mandates lately, not just in medicine, but in the costs of implementing DHS Code Orange and No Child Left Behind too. Although she does not mention stringent and sometimes contradictory regulations, that surely played a role too. She specifically does not see a single payer system as an answer because, “If we change to a single payer system, Washington no doubt will franchise it out to the same private insurers that state Medicaid programs contract with today.”

Ah, but some of you are asking why this matters. Record poverty levels, particularly among children, aren’t enough reason for you? How about the fact that long term unemployment is relegating even educated professionals into the ranks of the poor, the uninsured, and the underinsured? How sure are you that your family will not need Medicaid and a doctor like Dr. Adelman in the next 5 years?

American corporations might be able to get computers programmed and research done in India. However, we cannot outsource medical care to foreign nations. The time has come to seriously discuss how to balance “stemming the rise in health care expenditures” with “paying enough for medical care that it will still be available next year.”

‘Tis the season to be spending inordinate time and money at the local shopping center. Although I avail myself of online options whenever possible, there are just some things you have to step away from the computer and venture into the real world to obtain. I prefer to do this on a weekday, when crowds are light.

And this is how I came to be in a Sears store for the first time since their purchase of my favorite catalog and online retailer, Landsend.

Please keep in mind that although I was not in what anyone would call the very nicest of Sears stores, it was clearly remodeled sometime in the last 5 years. Furthermore, my visit was at 10:30 AM on a weekday morning: not a peak retail sales period, and close enough to the beginning of the day that there should still be evidence of the prior evening’s cleaning and straightening.

The store demonstrated a substantial degree of disarray.

The Landsend store-within-a-store concept is a great idea, but poorly implemented. As executed, it includes several racks of clothing within each section (Mens, Womens, Petites, etc.). Check the signage carefully, or it is hard to tell where the merchandise changes from Landsend to regular Sears inventory. Well, on second thought, maybe it isn’t. There were some very abrupt transitions: all cotton Landsend sweater twinsets next to fake fur trimmed cardigans, for example.

Stock was thin in general, particularly considering that we are in the first half of December. Only 4 of Landsend’s many colors of Mens mock turtleneck were available, and empty spots remained for other colors and sizes. Things looked very picked-over, as well. Folded shirts lay haphazardly on shelves instead of neatly stacked.

Finally, a visit to the Petites section confirmed my theory that I would have to do all my Landsend shopping far away from Sears. One of the things I love about Landsend is the availability of pants — and particularly jeans — in a wide array of inseams. I don’t call myself the ShortWoman for nothing. Although Sears appeared to have an adequate supply of petite jeans in assorted colors, including multiple non-blue hues, all were the 28″ inseam.

That’s like having a plus-size dress shop that only carries size 22.

It is my personal theory that part of Sears’s problem is the fact that a substantial number of managers end up being rotated around the country. The idea is that fresh blood will shake things up, that The New Guy Will Surely Turn This Store Around, that this prevents stores and regions from having a “this is the way we do it around here and to heck with corporate” attitude. In reality, this costs the company money in the form of moving expenses and lost productivity. The New Guy spends 6 months figuring out the market, his employees, and the peculiarities of his particular store, then maybe a year or so actually making things work. If he is lucky, he has staff that know what they are doing, so things run along pretty much as they always have with or without management.

Maybe all of this is part of the reason Wal-Mart, Target, and J.C. Penney have higher P/E ratios than Sears. My experience is part of why Sears is having declining sales at the same stores. Buying placement in a reality show is not going to make everything all better. Nor will placing hip-hop fashions next to Landsend and the existing ecclectic cast of fashion players. Their debatable online success aside, some are calling for radical change at Sears.

This has been my Sears experience. How about you?