The Walmart healthcare memo: You DO need to read the original

A few weeks ago there was a brief furor about the leak of a confidential "memorandum" that was presented to the board of directors of Walmart -- America's largest employer and one of our wealthiest corporations. The news coverage was pretty fluffly and it passed quickly with nary a ripple.

Recently, however, I read a summary in a trade newspaper written for family physicians. That coverage was more intriguing, it suggested the Walmart memo had very broad implications for workers and health care providers. Reading that coverage I speculated that Walmart was merely transferring the well developed risk selection techniques used by managed care entities to the employer setting. (Payors do not develop and market their "wellness" and "alternative medicine" programs for noble reasons -- these programs help them select for healthy customers who don't use expensive resources.)

I decided I'd blog on this, but I needed something to link to. Looking for a link, I came across the actual memo. (Link is to a Google search rather than memo source, I don't employ the lawyers of the New York Times.)

I read the memo. Wow. The newspaper coverage was truly awful.

This "memorandum" is a 27 page white paper prepared by McKinsey (famously ruthless consulting company) and 16 highly compensated Walmart employees for the board of directors of one of America's largest companies. There's not much dissembling, though there are a few euphemisms. It was written for an audience that probably dislikes euphemisms, and is so removed from the "associates" that it can think about them the way a farmer thinks about their valued cattle.

The memo is not particularly cruel, but it's dispassionate and ruthless. It's also very well done. If you receive healthcare in America, you should read it. Did you realize that the feared coverage expense is not the employee, and not the employee's children, but rather the employee's spouse? Yes, that's obvious in retrospect, but it never occurred to me.

Did you know that the economic advantage of Walmart's 'defined contribution' plans (aka 'medical savings accounts', health savings account, employee driven healthcare) is not the global cost savings, but rather that they're a better deal for employees with healthy spouses? (So that overall the benefit biases the workforce towards employees with healthier spouses?)

I'm not done with the memo. There's a lot there that I may yet comment on. Read it yourself. I recommend starting with the last 3 pages.

Don't imagine this is in any way unique to Walmart -- they're merely slightly ahead of the curve. This document is "free" consulting for every employer in America, and anyone who works with McKinsey will receive the same advice.

Personally, I think this is a great thing. The inexorable engine of capitalism will force all but the healthy and the genetically gifted out of employment and out of heatlhcare coverage. Sometime in the next decade, sooner than I'd anticipated, this will lead to a political revolt, and we will get to the place the world has been heading for over the past twenty years:

• Second tier health coverage for the entire population that includes medications and procedures whose R&D cost has been fully recovered (depreciated). This second tier system will use less costly health care workers and will be extensively industrialized. Medicare, the VA system, the Indian Health Service, and Medicaid will go away.
  
• Lexus care for the wealthiest 10-20% of the population. This will include life-extending technologies who's R&D costs have not yet been fully recovered. Black market versions of these technologies will be available illegally in India, China, and Thailand.
  

Amazon pricing weirdness -- Digital Rebel XT

This is weird. I'd heard Amazon plays some odd games with their prices. They sell the extremely popular Canon Digital Rebel XT in two versions, with and without lens. To see prices you need to add the items to one's cart. I added both. The version WITH the lens is $5.00 cheaper than the version without the lens.

Canon Digital Rebel XT 8MP Digital SLR Camera (Body Only - Black) - Canon
Usually ships in 24 hours
$829.94

Canon Digital Rebel XT 8MP Digital SLR Camera with EF-S 18-55mm f3.5-5.6 Lens (Black) - Canon
Usually ships in 24 hours
$824.99

So is this a goof, or some diabolical scheme?

The price for the camera WITH the lens is very competitive with the slightly seedy but not criminal vendors like 'ibuydigital.com'.

Update 11/19: Amazon just jumped the price of the lens camera to $899. So either it was a goof or I'm being punished :-). Next time that happens, I'm buying it!

How to Fund a Startup by Paul Graham

Thinking of starting your own business(es)? You need to read Paul Graham. Or so I say, never having started a real business (yet).

If you doubt the advice, however, start with this one: How to Fund a Startup

God bless the plague

Fafblog! is in good form as he tackles the alleged antipathy of christian fundamentalists towards the cervical cancer vaccine. Brilliant and ripping.

Personally I suspect the Christian fundamentalists aren't really going to fight this vaccine. Firstly I don't think they're really that sick, and secondly Rove wouldn't let them.

In a dark corner of a secure underground Google parking garage ...

Is the key to world domination ...

PBS | I, Cringely . November 17, 2005 - Paper War

...The probable answer lies in one of Google's underground parking garages in Mountain View. There, in a secret area off-limits even to regular GoogleFolk, is a shipping container. But it isn't just any shipping container. This shipping container is a prototype data center. Google hired a pair of very bright industrial designers to figure out how to cram the greatest number of CPUs, the most storage, memory and power support into a 20- or 40-foot box. We're talking about 5000 Opteron processors and 3.5 petabytes of disk storage that can be dropped-off overnight by a tractor-trailer rig. The idea is to plant one of these puppies anywhere Google owns access to fiber, basically turning the entire Internet into a giant processing and storage grid.

While Google could put these containers anywhere, it makes the most sense to place them at Internet peering points, of which there are about 300 worldwide.

Two years ago Google had one data center. Today they are reported to have 64. Two years from now, they will have 300-plus. The advantage to having so many data centers goes beyond simple redundancy and fault tolerance. They get Google closer to users, reducing latency. They offer inter-datacenter communication and load-balancing using that no-longer-dark fiber Google owns. But most especially, they offer super-high bandwidth connections at all peering ISPs at little or no incremental cost to Google.

Where some other outfit might put a router, Google is putting an entire data center, and the results are profound...

Cringely claims next week's essay will fill in the rest of the tale. I'm waiting to hear about two things: 1. How will Google manage identity and ownership for GoogleBase data and 2. When does Google become the world's biggest private bank?

Schneier: the real SONY DRM story is the failure of McAfee, Symantec and Microsoft to catch it

Schneier, the deity of computer security, doesn't think SONY's malign incompetence is the real story. Rather, the real story is that the big name spyware antiviral software companies missed this intrusion.

Dang. I didn't think of that.

Schneier is right. We pay our XP taxes to Symantec and their kin every year -- and they blew it. Completely. Either they knew this was going on and didn't bother to tell us, or they missed it entirely. Both explanations are damning.

So, sure, boycott SONY. But also look to swith away from Symantec, Microsoft, and McAfee. They've disgraced themselves. F-Secure and Sysinternals, by contrast, deserve new attention. The next time my Norton Tax comes due, I'll switch to F-Secure Home instead.

SONY - "My God, what a fiasco".

SONY's spyware installation catastrophe has moved from merely "jumping the shark" into mad hilarity ...

Good Morning Silicon Valley: Let's see -- Secret installation? Check. Hidden changes? Check. Security breach? Check. Dangerous uninstall? Check. Now what was ... oh, yeah. Stolen code? Check.

...Looks like Sony's little sojourn to the ninth circle of PR hell isn't quite over yet. A pair of programmers who disassembled Sony's now infamous rootkit Digital Rights Management scheme, have found code that appears to have been plagiarized from VideoLAN, an open source media player distributed under the GNU General Public License. Worse, the code in question was written by "DVD" Jon Lech Johansen, author of a number of DRM-busting programs.

My God, what a fiasco...

Emphases mine.

It truly beggars belief. SONY may yet rival the stark raving incompetence of the Bush administration. I can't believe the CEO of SONY Music is still employed; in the SONY of the 1960s he would have died an honorable self-inflicted death by now. How are they ever going to keep track of all the lawsuits pouring in?

Combining PubMed RSS feeds with Bloglines to conveniently survey new developments

A Medlogs entry pointed me to an interesting new PubMed [1] feature -- syndication!

(1) Run your search in PubMed.
(2) Select RSS Feed from the Send to menu.
(3) Click Create Feed and copy the XML icon into your RSS Reader.

I of course had to try this out. Years ago I embedded (now broken) search links in web pages, but one runs into the notification problem. It's very boring to keep clicking on a link and finding nothing has happened. Syndication is a vastly better model.

I tested this out an old search I've long been interested in: the genetics of berry aneurysms and screening for subarachnoid hemorrhage. I logged into PubMed and set up a search, then followed the directions above; I limited the search to Bloglines, my syndication (RSS, Atom) web client, and added this URL as a feed to a new folder called "PubMed searches" (you can copy this URL and try this in your favorite feed client yourself.)

On my first view I got 41 hits. After reviewing those the list was empty (as it should be), but as literature emerges that list should refresh. One wonders how the PubMed server will handle the transactional burden, since these unique searches may not scale well to thousands or millions of users. For now, however, the PubMed RSS and Bloglines combination is the neatest thing I've seen in this domain since Grateful Med.

If you'd like to see how this looks, without doing all of the above work, visit the public view of my bloglines list and click on the PubMed folder. It is very cool. You can also see the searches on my (hidden) blogroll page.

I guess I'll have to update that old, old, page of mine. (11/17/05 - I did. The page was over 6 years old.)

[1] Old dogs remember MEDLINE, MEDLARS, Grateful Med, etc. Really old dogs even remember the vast printed volumes of Index Medicus, and using early terminals to send query strings to Bethesda. Creak, creak ...

Interesting alterantive to mass quarantine -- focus on the high-risk super spreaders ...

Scientific American has a brief note on a fascinating topic. I did some simulation work during my last degree (10 years past now!) and I suspect the simulation community has been exploring this for awhile. Public health, of course, has been thinking about this since 'Typhoid Mary'; more recently one sociable male flight attendant was once considered to have been a sort of "super spreader" early in the HIV epidemic.

It turns out computer modeling of epidemics suggests an alternative strategy to mass quarantine:

Science & Technology at Scientific American.com: Study Assesses Impact of "Superspreaders" of Disease

... There are two ways for a population to protect itself: either everyone can act to reduce their chance of transmission--for example, by staying at home, which can throttle a country’s economy--or authorities can identify those most likely to be superspreaders, and focus their vaccination and isolation efforts on them. --Kaspar Mossman

In Minnesota we have recent experience with a young Amish child who is, due to an immune defect, a "super spreader" of polio [1]. The concept of "super spreader" has thus been in the news here. I suspect the simulation study is looking at more subtle super spreaders however.

If we do find reasonable tests to identify super spreaders, we would be well advised to think about compensating them for the inconveniences (or worse) a selective quarantine would create. As a way to manage the coming wave of epidemics [2], however, this is well worth researching.

[1] The combination of "super spreader", Polio, and unvaccinated community is potentially explosive, but fortunately our republican governor has not quite finished dismantling Minnesota's still excellent public health infrastructure.

[2] As humanity simultaneously travels more, congregates more, expands into Africa, and reproduces more, we become an ever richer petri dish for novel infections.

iPod over all -- 10/10 on Amazon

Amazon.com: Early Adopters - computers list has an iPod in each of the top 10 slots.

The audio and video list has in each of its top 10 slots ... iPods.

I think Amazon only sells 10 varieties of iPod.

That's astonishing.

Gordon's Tech: Replicate the experience of 19th century phone service

Gordon's Tech: Replicate the experience of 19th century phone service: "Thanks to the miracle of modern technology, one can combine Skype VOIP, a modern laptop, a wireless LAN and a USB full duplex speakerphone to recreate the turn of the (prior) century experience of yelling 'HELLLLOOOO, CAN YOU HEAR ME??'."

A quick preview on the next thing to blow your world apart

Do it yourself. Almost. ... Dan's Data provides a quick update on the state of the art in 3 dimensional "printing". As in download the specs, run the illegal hacking software, and print yourself an anonymous encrypted cell phone. Ok, so we're not quite there yet. Soon though.

Alvin Toffler didn't know the half of it. (Or did he? Read the wikipedia article ...)

All your bases belong to Google: the beginning of the end

The net shook this morning as Google dropped the hammer:

Official Google Blog: First Base

Right now, there are two ways to submit data items to Google Base. Individuals and small website owners can use an interactive user interface; larger organizations and sites can use the bulk uploads option to send us content using standard XML formats.

Rather than impose specific schemas and structures on the world, Google Base suggests attributes and item types based on popularity, which you can use to define and attach your own labels and attributes to each data item. Then searchers can find information more quickly and effectively by using these labels and attributes to refine their queries on the experimental version of Google Base search.

This beta version of Google Base is another small step toward our goal, creating an online database of easily searchable, structured information...

Meanwhile, in Redmond, insiders are dumping their shares ...

The initial version of Google Base is entirely public. Too bad, I'd have liked to create a private list of contact information for our cub scout troop. There doesn't appear to be any access restriction, it's very much designed to create public knowledge. Some of the templates they provide compete directly with Amazon, eBay, Craig's List and (above all) newspaper classifieds, but they've yet to provide commercial transaction services (that's next week). Other templates are for recipes, reference articles, course catalogs and other shared knowledge. It appears one can use XML structures to create one's own templates (vendors bidding for software projects?). The intersection between formally structured and emergent metadata is intriguing.

Elsewhere, Google writes "content providers who already have RSS feeds can easily submit their content to Google Base without requiring much additional work". This is the original vision of RDF metadata as first presented in Apple's mid-90s "Project X" and the more recent vision of the "Semantic Web".

Google Base is a component of potential web services. Google will use it, so will others.

Now we await the micro-commerce transaction system that will transform Google into a multinational financial powerhouse.

This is fun. Scary, but fun. A bit like inline skating downhill ...

The Economist is falling out of love with Bush

The Economist, a once great newspaper lately in decline, rediscovers some ghost of its historic spine. Emphases mine -- they do reveal a certain depth of feeling:

Torture | How to lose friends and alienate people | Economist.com

Nov 10th 2005
From The Economist print edition

The Bush administration's approach to torture beggars belief

THERE are many difficult trade-offs for any president when it comes to diplomacy and the fight against terrorism. Should you, for instance, support an ugly foreign regime because it is the enemy of a still uglier one? Should a superpower submit to the United Nations when it is not in its interests to do so? Amid this fog, you would imagine that George Bush would welcome an issue where America's position should be luminously clear—namely an amendment passed by Congress to ban American soldiers and spies from torturing prisoners. Indeed, after the disastrous stories of prisoner abuse in Abu Ghraib, Guantánamo Bay and Afghanistan, you might imagine that a shrewd president would have sponsored such a law himself to set the record straight.

But you would be wrong. This week saw the sad spectacle of an American president lamely trying to explain to the citizens of Panama that, yes, he would veto any such bill but, no, “We do not torture.” Meanwhile, Mr Bush's increasingly error-prone vice-president, Dick Cheney, has been across on Capitol Hill trying to bully senators to exclude America's spies from any torture ban. To add a note of farce to the tragedy, the administration has had to explain that the CIA is not torturing prisoners at its secret prisons in Asia and Eastern Europe—though of course it cannot confirm that such prisons exist.

... Although Mr Cheney has not had the guts to make his case in public, the argument that torture is sometimes justified is not a negligible one. Khalid Sheik Mohammed, presumed to be in one of the CIA's “black prisons”, is thought to have information about al-Qaeda's future plans. Surely it is vital to extract that information, no matter how? Some people think there should be a system of “torture warrants” for special cases. But where exactly should the line be drawn? And are the gains really so dramatic that it is worth breaking the taboo against civilised democracies condoning torture? For instance, Mr McCain argues that torture is nearly always useless as an interrogation technique, since under it people will say anything to their tormentors.

If the pragmatic gains in terms of information yielded are dubious, the loss to America in terms of public opinion are clear and horrifically large. Abu Ghraib was a gift to the insurgency in Iraq; Guantánamo Bay and its dubious military commissions, now being examined by the Supreme Court, have acted as recruiting sergeants for al-Qaeda around the world. In the cold war, America championed the Helsinki human-rights accords. This time, the world's most magnificent democracy is struggling against vile terrorists who thought nothing of slaughtering thousands of innocent civilians—and yet the administration has somehow contrived to turn America's own human-rights record into a subject of legitimate debate...

A diabolical use of Google Adwords

Dan, of Dan's Data fame, casually tosses this aside into a comment on strange Adwords adorning his site:

Dan's Data letters #154

Actually, of course, some people actually do click ads that contradict what a site is saying, and not always because they agree with the advertiser. If you're reading a page about how reprehensible anti-vaccination activists are, and find an ad-link at the bottom that says FREEMASONS USE VACCINES TO NEUTER CHRISTIAN KIDS, you might feel a strange urge to click it. Not only to revel in the craziness, but also to transfer some money from the crazies to the owner of the page on which the ad appeared.

Ooooohhh. That never occurred to me. I'm so naive. Heh, heh, heh ....