With the (surprising) election of Donald Trump as America’s next president, I’ve been asked by quite a few folks what this might mean for the Patient Protection and Affordable Care Act, especially as it relates to individual health insurance. It’s been more than seven months since I posted anything in this blog (been busy launching a couple of companies), but I thought I’d use this space to provide my perspective. For the impatient among you, that answer is: either a complete disaster or some modest fixes that actually improve the ACA. Dramatic, but non-lethal, changes are unlikely. As for the details: Trump’s call to repeal and replace the ACA was core to his campaign. His official health care reform platform promised to:

1. Repeal Obamacare in its entirety.
2. Permit the sale of health insurance across state lines.
3. Allow individuals to fully deduct their health insurance premiums.
4. Promote health savings accounts (HSAs).
5. Require all healthcare providers to publish their pricing.
6. Provide block grants to states for Medicaid expenses.
7. Remove barriers that delay the introduction of new drugs.

Some of these ideas, such as promoting HSAs and increasing pricing transparency, have merit. Some, like enabling carriers to sell across state lines, are nonsensical for several reasons I have described previously. None offer much solace to the 20 million-plus consumers in danger of losing their individual coverage if the ACA is repealed. Trump and his Republican allies in Congress will need to do more. See also: What Trump Means for Workplace Wellness I hesitate to predict how Trump will lead as president, but he seems to be  a “big picture guy” who leaves details to others. So let’s assume he lets Congress take the lead on repeal and replace. In December 2015, Republicans in Congress passed legislation aimed at gutting the ACA. President Obama vetoed the bill, but its major provisions are instructive:

1. Repeal the federal government’s authority to run healthcare exchanges.
2. Eliminate premium subsidies available to individuals purchasing through the exchange.
3. Eliminate penalties on individuals for not buying coverage and employers who failed to offer their workers health insurance.

Combined with Trump’s campaign promises, these elements of the Republicans’ repeal-and-replace legislation give a glimpse to the starting point of GOP-style healthcare reform. Add House Speaker Paul Ryan’s call earlier this year for high-risk pools, and the hazy outlines of a possible reform package begin to emerge. Given Trump’s commitment to start the repeal-and-replace process on the first day of his administration and Senate Majority Leader Mitch McConnell’s statement after the election that getting rid of the ACA was “pretty high on our agenda,” healthcare reform is coming — and soon. Whether the result will be an outright, actual repeal of President Obama’s signature legislative accomplishment is no sure thing. Supporters of the ACA are already vowing to defend the law. And while Republicans will hold majorities in both chambers of the new Congress, they are a long way from having 60 votes in the Senate. And that’s problematic. Senate filibuster rules require 60 votes to cut off debate and allow legislation to come to a vote. This means the most powerful person in Washington on healthcare reform may not be President Trump, Speaker Ryan or Senator McConnell, but the senator needed for that all-important 60th vote. Yes, the first through 59th supporters are important, but their support means little if a 60th vote is not found. As a result, the 60th senator can have a tremendous impact on the final language in the bill simply by offering (implicitly or explicitly) a favorable vote in exchange for whatever is important to that senator. In 2017, the 60th senator for repeal and replace will be a Democrat. A Republican is expected to win Louisiana’s run-off election, giving the GOP 52 seats in the upper chamber. Assuming Republicans vote as a block — something they’ve become quite adept at in the past eight years — eight Democratic votes will be needed to end a filibuster. The requests of each of the first seven will need to be considered and addressed, but it’s the demands of the eighth senator, that 60th vote, that ultimately matters. Unless … The Senate can temporarily eliminate the possibility of a filibuster against a bill under the rules of budget reconciliation. However, reconciliation bills must address the federal budget, a vague definition that Congress has interpreted with varying strictness throughout the years. Clearly, eliminating funding for exchanges, taxes and monetary penalties affect the budget. Much of the ACA, however, doesn’t. For example, requiring carriers to issue individual policies to all applicants regardless of their health conditions (what’s called “guarantee issue”) has no impact on the budget. The situation in the Senate creates dangerous possibilities. Just one example: Republicans use the reconciliation process to eliminate penalties paid by consumers who fail to purchase health insurance but not the guarantee issue requirement. Under this situation, few consumers — especially young, healthy consumers — will likely obtain coverage until they get sick or injured. This adverse selection would be cataclysmic, and few, if any carriers, would want to participate in such a market. After all, insurers are in the business of spreading risk across a broad population. Guarantee issue without an obligation to buy coverage guarantees a concentration of risk across a narrow population. See also: Why Can’t U.S. Health Care Costs Be Cut in Half?   President Trump can significantly affect the Affordable Care Act through executive orders, but the risk is the same as a partial repeal through legislation. The ACA is a multi-faceted construct with interlocking pieces. The wrong changes can cause devastating unintended consequences. Republicans in Congress and President Trump may not care. The ACA has taken on nearly mythic proportions as the symbol of all that is evil with the liberal, big-government side of politics. However, making careless changes would not only be irresponsible, it would risk the wrath of millions of voters tossed out of the individual market. Those votes matter. Keep in mind, Trump’s election was close. He lost the popular vote. His leads in Wisconsin and Michigan add up to a combined total of less than 40,000 (as of today). Yet failing to repeal Obamacare after making it so central to their 2016 campaigns could be a political disaster, as well. Republicans jumped on replace and repeal in 2010, and over the past six years this position helped deliver durable GOP majorities in both houses of Congress. Many in their ranks may not care about the consequences of dismantling the law. Assuming a desire to address healthcare reform in a responsible way will require the help of at least eight Senate Democrats. Fortunately for Republicans, 10 Democrats have an incentive to responsibly neutralize the ACA issue in 2017. All are up for election in 2018 and hail from red or nearly red states.

• Sen. Tammy Baldwin of Wisconsin
• Sen. Bob Casey Jr. of  Pennsylvania
• Sen. Joe Donnelly of Indiana
• Sen. Heidi Heitkamp of North Dakota
• Sen. Tim Kaine of Virginia
• Sen. Angus King of Maine (officially an independent, but he caucuses with Democrats)
• Sen. Joe Manchin of West Virginia (and arguably the most conservative Democrat in the Senate)
• Sen. Claire McCaskill of Missouri.
• Sen. Debbie Stabenow of Michigan
• Sen. Jon Tester of Montana

The important question, then, is not what Republicans want to replace the ACA with, but what will it take to get enough of these senators to come along? The task could be extremely difficult if new Senate Minority Leader Charles Schumer doesn’t make it politically impossible for many of these senators to break ranks. Republican then have two choices:1) Go nuclear and gut the ACA through the reconciliation process, but keep in place market reforms like guarantee issue; or 2) pass something palatable to eight Democrats, but which they sell as “repeal” to their base. Clearly the first option is irresponsible, but these are not necessarily responsible times. Nuking the ACA will appeal to many in the party, both in Congress and in their districts. The more responsible choice, repealing the ACA in name only, makes the law more palatable and workable. This last point is critical: once they repeal and replace the ACA, the GOP will own health care reform. It darn well better be clear by say, October 2018, that the new system is working. Which result — destruction or refinement — is most likely? We’re in a new and wacky world. We’ll find out soon enough.

Donald Trump's stunning win in the U.S. presidential election, together with the election of Republican majorities in both the House and the Senate, has generated a wave of coverage about the deep changes that will surely occur with Obamacare but not nearly as much about what the voting will likely mean for businesses in general and the insurance ecosystem in particular. While there are far more questions than answers, I'll venture a few observations.

The biggest concern is that Trump brings with him enormous uncertainty that could cause a pause in planning for investments, especially given that we are in the year-end budgeting season. Yes, a transition of power at the presidential level always brings uncertainty, especially when the new president is from the other party, but the uncertainty surrounding Trump will likely last longer than usual -- possibly far longer -- for three reasons and could cause significant problems for the economy.

First, while companies plan investments based partly on an incoming administration's policies, it's not at all clear what Trump's policies are in many instances. Often, he said something startling during one portion of the campaign, such as that he planned a 45% levy on goods from China that would start a trade war, but then backed off and let the furor die. Will he try to impose that levy; build a wall that would damage relations with Mexico, one of our biggest trading partners; cut taxes so much that he adds $500 billion a year to the federal deficit? Who knows? He likely doesn't even know at the moment on many issues.

He has expressed some plans consistently. For instance, he expects to lower nominal tax rates on businesses and simplify the tax structure, which businesses will welcome and which congressional Republicans will likely support. Trump plans to invest heavily in infrastructure, which draws mixed reviews among Republicans. He plans to reduce regulation, including defanging a major consumer watchdog group, which businesses generally welcome, though his thinking on regulation could cause consternation on health insurance. (He says he thinks health insurance costs can be driven way down by allowing any policy approved in one state to be sold in other states -- an approach that state regulators would surely resist and that would leave many companies in limbo while the fight played out.)

But even when Trump has been thematically consistent, he has been shy on details or even contradictory -- his campaign simultaneously cited two different versions of his tax plans that were $1.2 trillion apart in terms of how much revenue they would generate over 10 years.

Even under the best of circumstances, it will take many weeks for Trump's team to build out the details of the many policies that an incoming administration needs to have -- and that most have on Election Day. It could be months before the team even gets to the point of starting to turn the policies into legislation.

Which brings me to the second point about the unusual uncertainty surrounding a Trump administration: He doesn't have a team.

He needs to build a team numbering in the thousands to take leadership roles in the vast federal bureaucracy, but he just has the core of a team at this point, which is very late in the game as it's usually played. That core is mostly his family, four politicians and two political operatives. Two of those politicians -- former New York City Mayor Rudy Giuliani and former Speaker of the House Newt Gingrich -- have experience but have been out of office at least 15 years and don't bring sizable organizations with them. The two sitting governors on the team -- Indiana's Mike Pence, the vice president-elect, and New Jersey's Chris Christie -- have access to organizations, though Christie may be hampered by the Bridgegate scandal. The two political operatives -- campaign Chairwoman Kellyanne Conway and campaign Chief Executive Stephen Bannon -- have only modest resources to contribute to a team, and Bannon's organization, Breitbart News, is toxic to many.

Traditionally, the Republican Party would provide the core of the incoming president's team, but Trump has been at war with most of the leaders of his party -- notably not Chairman Reince Priebus -- almost as much as he has with the Democrats. In addition, many politicians will avoid Trump, at least initially, because of the racist, xenophobic and misogynistic things he said during his campaign.

He will surely build a team. The lure of high office will overcome the scruples for many. But the mechanics will likely take longer than normal, and there could be more than the usual sorts of problems getting the people Trump wants in the jobs where he wants them.

My third and final point: Even once Trump builds a team, it's not clear that he really wants one. He has said that he runs his business pretty much as a solo operator, reserving all key decisions to himself, and he certainly ran his campaign that way. He publicly contradicted his vice presidential nominee on a policy matter related to Russia. Trump and Gingrich reasonably often ventured contradictory opinions in public. Conway has said that she sometimes said things on TV to get Trump's attention, because she knew he was watching her on TV and couldn't always get his attention in private.

What will Trump delegate, and which decisions will he keep for himself? Will he be consistent in the division of responsibility? He has said that he trusts his instincts and doesn't read, so how will he manage a bureaucracy traditionally built on careful analysis, detailed briefings and internal debate? Does he have something entirely different in mind?

Those answers aren't yet clear, and they need to be as Trump figures out how to delineate policy and work with an enormously large team for the first time in his life.

This list of three reasons for additional uncertainty actually assumes otherwise benign conditions. It assumes that he controls his worst impulses, even though he surely wants to wreak revenge on or at least belittle so very many people at the moment. It assumes that he doesn't get bogged down in the lawsuits that are either already proceeding (the Trump University fraud trial begins later this month) or that may be filed against him, including by the women who allege he sexually assaulted them. It assumes that no crisis erupts in, say, Syria or in the economy, which could well pose some problems.

For me, the first big test will be whether he can make peace with the congressional leaders of the Republican Party. If he can, then he has the chance of building a team quickly enough to eliminate much of the uncertainty. But that will be tricky. His personal relationships with many of the leaders are awful, and allying with them would mean turning his back on the many supporters who urged him to "drain the swamp" in Washington, by which they meant getting rid of the entire elite, perhaps mainly Democrats but with many Republicans included.

The uncertainty will be with us for a while – and could well cause a pause in investment during a still fragile time for the economy.

Donald Trump's stunning win in the U.S. presidential election, together with the election of Republican majorities in both the House and the Senate, has generated a wave of coverage about the deep changes that will surely occur with Obamacare but not nearly as much about what the voting will likely mean for businesses in general and the insurance ecosystem in particular. While there are far more questions than answers, I'll venture a few observations. The biggest concern is that Trump brings with him enormous uncertainty that could cause a pause in planning for investments, especially given that we are in the year-end budgeting season. Yes, a transition of power at the presidential level always brings uncertainty, especially when the new president is from the other party, but the uncertainty surrounding Trump will likely last longer than usual -- possibly far longer -- for three reasons and could cause significant problems for the economy. First, while companies plan investments based partly on an incoming administration's policies, it's not at all clear what Trump's policies are in many instances. Often, he said something startling during one portion of the campaign, such as that he planned a 45% levy on goods from China that would start a trade war, but then backed off and let the furor die. Will he try to impose that levy; build a wall that would damage relations with Mexico, one of our biggest trading partners; cut taxes so much that he adds $500 billion a year to the federal deficit? Who knows? He likely doesn't even know at the moment on many issues. He has expressed some plans consistently. For instance, he expects to lower nominal tax rates on businesses and simplify the tax structure, which businesses will welcome and which congressional Republicans will likely support. Trump plans to invest heavily in infrastructure, which draws mixed reviews among Republicans. He plans to reduce regulation, including defanging a major consumer watchdog group, which businesses generally welcome, though his thinking on regulation could cause consternation on health insurance. (He says he thinks health insurance costs can be driven way down by allowing any policy approved in one state to be sold in other states -- an approach that state regulators would surely resist and that would leave many companies in limbo while the fight played out.) But even when Trump has been thematically consistent, he has been shy on details or even contradictory -- his campaign simultaneously cited two different versions of his tax plans that were $1.2 trillion apart in terms of how much revenue they would generate over 10 years. Even under the best of circumstances, it will take many weeks for Trump's team to build out the details of the many policies that an incoming administration needs to have -- and that most have on Election Day. It could be months before the team even gets to the point of starting to turn the policies into legislation. Which brings me to the second point about the unusual uncertainty surrounding a Trump administration: He doesn't have a team. He needs to build a team numbering in the thousands to take leadership roles in the vast federal bureaucracy, but he just has the core of a team at this point, which is very late in the game as it's usually played. That core is mostly his family, four politicians and two political operatives. Two of those politicians -- former New York City Mayor Rudy Giuliani and former Speaker of the House Newt Gingrich -- have experience but have been out of office at least 15 years and don't bring sizable organizations with them. The two sitting governors on the team -- Indiana's Mike Pence, the vice president-elect, and New Jersey's Chris Christie -- have access to organizations, though Christie may be hampered by the Bridgegate scandal. The two political operatives -- campaign Chairwoman Kellyanne Conway and campaign Chief Executive Stephen Bannon -- have only modest resources to contribute to a team, and Bannon's organization, Breitbart News, is toxic to many. Traditionally, the Republican Party would provide the core of the incoming president's team, but Trump has been at war with most of the leaders of his party -- notably not Chairman Reince Priebus -- almost as much as he has with the Democrats. In addition, many politicians will avoid Trump, at least initially, because of the racist, xenophobic and misogynistic things he said during his campaign. He will surely build a team. The lure of high office will overcome the scruples for many. But the mechanics will likely take longer than normal, and there could be more than the usual sorts of problems getting the people Trump wants in the jobs where he wants them. My third and final point: Even once Trump builds a team, it's not clear that he really wants one. He has said that he runs his business pretty much as a solo operator, reserving all key decisions to himself, and he certainly ran his campaign that way. He publicly contradicted his vice presidential nominee on a policy matter related to Russia. Trump and Gingrich reasonably often ventured contradictory opinions in public. Conway has said that she sometimes said things on TV to get Trump's attention, because she knew he was watching her on TV and couldn't always get his attention in private. What will Trump delegate, and which decisions will he keep for himself? Will he be consistent in the division of responsibility? He has said that he trusts his instincts and doesn't read, so how will he manage a bureaucracy traditionally built on careful analysis, detailed briefings and internal debate? Does he have something entirely different in mind? Those answers aren't yet clear, and they need to be as Trump figures out how to delineate policy and work with an enormously large team for the first time in his life. This list of three reasons for additional uncertainty actually assumes otherwise benign conditions. It assumes that he controls his worst impulses, even though he surely wants to wreak revenge on or at least belittle so very many people at the moment. It assumes that he doesn't get bogged down in the lawsuits that are either already proceeding (the Trump University fraud trial begins later this month) or that may be filed against him, including by the women who allege he sexually assaulted them. It assumes that no crisis erupts in, say, Syria or in the economy, which could well pose some problems. For me, the first big test will be whether he can make peace with the congressional leaders of the Republican Party. If he can, then he has the chance of building a team quickly enough to eliminate much of the uncertainty. But that will be tricky. His personal relationships with many of the leaders are awful, and allying with them would mean turning his back on the many supporters who urged him to "drain the swamp" in Washington, by which they meant getting rid of the entire elite, perhaps mainly Democrats but with many Republicans included. The uncertainty will be with us for a while – and could well cause a pause in investment during a still fragile time for the economy.

Assume, reasonably, that voters chose Donald Trump to be the next president because they feel big business and government are in bed together. If indeed they are, workplace wellness is their sex toy. There is nothing, certainly in healthcare and possibly anywhere, that more embodies the complete disdain for the average worker than the joined-at-the-hip partnership between big business and government known as workplace wellness. That claim might seem extreme, but put yourself in the shoes of the average worker. You used to have a good health benefit. But then, following the passage of the Affordable Care Act, your benefits were reduced, and you were put in a high-deductible plan. True, your benefits might have been reduced anyway due to the increasing cost of healthcare, but coincidence to the average person smells like causality. See also: The Value of Workplace Wellness   A benefits reduction sounds like a wage cut. However, you are told you can earn some or all of it back. All you have to do is allow your employer (and, yes, it isn’t really your employer, but it smells like your employer) to pry into your personal life with a questionnaire; poke you with needles to do blood tests that over a 15-year period have proved useless at reducing the country’s heart attack and diabetes event rates; and prod you, in violation of all guidelines, to go to the doctor when you aren’t sick. You (remember, “you” are still the worker) are then left with this Hobson’s choice: You must throw yourself at the mercy of an unregulated wellness vendor that – if last month’s C. Everett Koop award to Wellsteps for being the “best wellness program in the country” is any indication – is more likely to harm you than benefit you, while invading your privacy and sucking up your time. As an employee, what recourse do you have? Basically none. The Equal Employment Opportunity Commission has no provisions against “voluntary” workplace wellness programs, and the word “voluntary” has now been defined to include even programs with non-compliance penalties that might exceed $2,000. The net result: You can be forced to pay a large fine for refusing to participate in a voluntary program, and there’s nothing you can do about it. You can’t sue for malpractice because wellness vendors aren’t clinical professionals, and you can’t complain to the licensing authority because wellness vendors aren’t licensed. You can’t claim they violate the industry code of conduct because – unlike everything else, including war -- wellness has no code of conduct: The wellness trade association has stonewalled on the code of conduct, which embraces only the simple notion that wellness should respect the dignity of workers and not harm them. Should you opt to maintain your dignity and not violate clinical guidelines, by declining to be part of a wellness program, you may lose four figures in compensation just by wanting to be left alone to do your job. Don’t take my word that this is how employees feel. Simply read the comments by employees to any article on wellness. Meanwhile, what is the government doing? Simple. The government is carrying the Business Roundtable’s (BRT) water. The Senate is in the BRT's pocket, holding “hearings” that are basically just ads for the BRT. And the president put the EEOC on a short leash after the BRT threatened him. As members of the BRT, and their like-minded compadres at the U.S. Chamber of Commerce, corporations are gleeful. They can cut benefits and “offer” employees the opportunity to earn them back, or just fine employees directly. One vendor, Bravo Wellness, even dogwhistled to employers that they could get immediate “savings” by fining employees. What happens now, and what should you do? Wellness is likely to become a touchstone for all that is wrong with the Affordable Care Act, because, almost uniquely in the ACA, the wellness provision has basically no upside. (Disagree? Show I’m wrong, and claim the $1 million reward I’ve offered to anyone who can show wellness has broken even this century.) The American Association of Retired People (AARP) is already shining a light on wellness via a lawsuit, and the effort may make it much more difficult for the wellness industry, the BRT and the Chamber to hide behind the EEOC. As representatives of the employers who may very well be abusing employees (and not knowing it, any more than the Boise School District realized it was being snookered by Wellsteps until the problem was exposed by a leading healthcare journalist -- even though the invalidity and ineffectiveness of the district's wellness program was perfectly obvious to Wellsteps’ colleagues on the award committee), you should get ahead of this curve. Drop punitive wellness programs, or programs with low participation (which reflects low satisfaction). Or swap out programs that “do wellness to employees” for programs that “do wellness for employees.” The difference is fairly self-evident. Are employees lining up, or do they need to be coaxed? Are there big bribes or fines involved? Is the program something you yourself would do without an incentive? See also: ‘Surviving Workplace Wellness’: an Excerpt   You shouldn’t need to wait for the law to change to make changes yourself now. “Pry, poke and prod” programs were a bad idea to begin with, and the passage of time and rise of populism hasn’t made them any better. Disclosure The editorial viewpoint in this article, though reflecting my opinion, is colored by my leadership of Quizzify. Quizzify does not “pry, poke and prod” employees, but rather just enhances their knowledge base in an entertaining way. Not just theirs – even yours. Play the sample game on the site and see for yourself. We hope to benefit from the likely retreat from government support for intrusive and ineffective wellness programs in the new administration. On the other hand, you are free to publish opposing comments or viewpoints. Join the conversation, even if it means hollering at me by quoting people who know they are wrong claiming savings they know are fabricated.

As the election results rolled in, it became increasingly clear that America — and the world — would never be the same. The American people overlooked all of Republican nominee Donald Trump’s faults and elected him to office in the belief that he will fix the nation’s deep-seated problems of inequity and injustice. And they rebelled against the business interests and corruption that they believed Hillary Clinton represented. Trump’s victory was enabled by technology — everything from his use of social media to Clinton’s email scandals to Russian hacking. But advancements in technology and how they reshape our economy may also keep him from delivering on some of the major promises that made him so popular during the campaign season. The truth is that, over recent decades, the rich have been getting richer. Power has shifted to Wall Street and business. Globalization has caused the loss of millions of jobs in the U.S. Some white Americans have also been terrified at the changing complexion — and values — of the country. Trump very smartly played to these fears and promised his supporters what he knew they wanted: greater economic opportunity by bringing back jobs shipped overseas. See also: How Technology Breaks Down Silos   But those jobs, many in the manufacturing sector, are increasingly done by technology. Machines are learning to do the jobs of manufacturing workers; artificial intelligence-based tools are mastering the jobs of call-center and knowledge workers; and cars are beginning to drive themselves. Over the next decade, technology will decimate more jobs in many professions, inequality will increase and more people will be disadvantaged. Some robots already cost less to operate than the salaries of the humans they replace, and they are getting cheaper and better. Boston Consulting Group predicts that, by 2025, the operating cost of a robot that does welding will be less than $2 per hour, for example. That’s more affordable than the $25 per hour that a human welder earns today in the U.S., and even cheaper than the pay of skilled workers in the lowest-income countries. Trump may be able to keep immigrants out, but how will he stop the advance of robots? Uber and many other companies are working on developing cars and trucks that don’t need a driver in the driver’s seat. According to the American Trucking Associations, approximately 3 million truck drivers were employed in the U.S. in 2010, and 6.8 million others were employed in other jobs relating to trucking activity, including manufacturing trucks, servicing trucks and other types of jobs. So roughly one of every 15 workers in the country is employed in the trucking business. According to the U.S. Bureau of Labor Statistics, roughly another 300,000 people work as taxi drivers and chauffeurs. We could be talking about millions of jobs disappearing in the early 2020s. And then there is the “gig economy” that has some businesses shifting toward part-time, on-demand employment. Uber has already done this to taxi drivers, and other technology companies are doing it to a wide range of jobs. A study by software company Intuit predicted that, by 2020, 40% of American workers will be independent contractors, temps or self-employed, and that full-time jobs will be harder to find. We are talking about 60 million people in this category. The problem is that not only do such part-time workers lack reliable full-time jobs and sick pay, but they are not entitled to health insurance and longer-term benefits. Even if Obamacare continued, they would not be able to afford it. The remedies that are being proposed are to impose trade barriers. But closing the doors to foreign trade won’t bring jobs back. It will only slow the global economy and hurt American exports, thereby shrinking the U.S. economy and accelerating job loss. See also: Technology and the Economic Divide The silver lining to this dark cloud is that these technology advances also provide solutions to the problems of humanity, such as a lack of energy, food, education and healthcare. The production costs of clean energies, such as solar and wind, will keep falling until they are almost free. With artificial intelligence-based applications, we will have digital doctors advising us, and advances in medicine will allow us to live longer and healthier lives. Robots will do our chores; digital tutors will teach us skills. It becomes possible to provide for everyone’s needs. But all of this requires understanding the cause and effects of inequity and applying more carefully the technologies that are going to change the equation. We now need a nationwide conversation on how we can distribute the prosperity we are creating. We must create equity and fairness in our legal, justice and economic systems. And, recognizing that technology will disrupt entire industries and wipe out millions of jobs, we must ease the transition and pain for the people most affected and least prepared.

The massive distributed denial of service (DDoS) attack that cut consumers off from their favorite web haunts recently was the loudest warning yet that cyber criminals can be expected to take full advantage of gaping security flaws attendant to the Internet of Things (IoT). For much of the day, on Friday, Oct. 21, it was not possible for most internet users to consistently access Twitter, Spotify, Netflix, Amazon, Tumblr, Reddit and PayPal. Using malware, dubbed Mirai, an attacker had assembled a sprawling network of thousands of hacked CCTV video cameras and digital video recorders, then directed this IoT botnet to swamp the marquee web properties with waves of nuisance pings, thus blocking out legitimate visitors. See also: Insurance and the Internet of Things   Mirai is designed to take over lightweight BusyBox software widely used to control IoT devices. The source code for Mirai can be found online and is free for anyone to use. ThirdCertainty asked Justin Harvey, security consultant at Gigamon, and John Wu, CEO of security startup Gryphon, to flesh out the wider context and discuss the implications. The text has been edited for clarity and length: ThirdCertainty: Why do you think these attackers went after BusyBox systems? Wu: Because Busybox is lightweight; it’s used on most IoT devices that have limited memory and processing. Busybox is a utility with lots of useful commands. Harvey: BusyBox is very standardized. It is highly used in the field, and it also runs Linux, so the internals are very straightforward and easy to duplicate in testing systems. 3C: How did the attacker locate so many vulnerable devices? Wu: Standard IP scanning would identify the devices, and then the attacker could use the admin interface to install the malware. These devices had weak default passwords that allowed hackers to install Mirai. Harvey: Cross mapping manufacturers with types of devices. Then using the website Shodan to get a list of open devices. Once they had the list of devices, they could create a massively parallel script to step through each and determine whether they used the version of the OS they wanted. 3C: How many devices did they need to control to carry out three waves of attacks over the course of 12 hours? Harvey: 300,000 to 500,000.  Wu: Probably a few hundred thousand devices. Because it’s distributed, there is no way to simply block all the IP addresses. 3C: Are there a lot of vulnerable devices still out there, ripe for attack? Harvey: Yes! Shodan specializes in noting which devices are out there and which are open to the world. The devices used in this attack were but a small fraction of open or insecure IoT devices. Wu: We don’t know exactly how many devices are still out there as sleeper bots. Mirai also is actively recruiting new bots. From what I understand, these IoT devices had open channels, and the users had practiced poor password protection for root access to install additional components. 3C: What do you expect attackers to focus on next? Wu: I would expect the attacks to get larger and more sophisticated. Mirai also is working in the background to recruit more devices. The next attack may not be as public because they’ve already shown what the botnet network is capable of. 3C: What should individual consumers be most concerned about at this point? Harvey: Consumers need better education on changing the default access and security controls of their IoT devices. Manufacturers need to take security seriously. Period. Congress needs to step in, conduct some hearings on IoT issues and perhaps regulate these devices.  Wu: Consumers need to be concerned if their device is one of the devices already compromised or at risk of being compromised. They should contact the manufacturer to ask if a security patch is available. A simple solution would be to take the device offline, if it’s something you can live without. 3C: What is the most important thing company decision-makers need to understand? Wu: If you are dependent on the internet for your revenue and business, you should be planning alternative communication channels. If DNS is critical to your business, you should look at backups to just one service provider. Let people know that, if email is down, you can still get business done over the phone. Harvey: Businesses need to understand the implications to running IoT devices within their companies and question the business need for using IoT devices versus the convenience. See also: How the ‘Internet of Things’ Affects Strategic Planning   This article originally appeared on ThirdCertainty.

Today, GPS makes getting directions easy. A successful trip, however, is much different and a greater challenge than just good directions. Today, as a passenger on Planet Earth, you are heading to 2020 with more than 7 billion other folks. Our destination is known – what we’ll find when we get there, is not. Your starting point is January 2017. You destination is January 2020. The journey is your road to tomorrow. There will be numerous hazards along the way. These are the difference between your current reality and the change that is tomorrow. The bad news of change is best defined by Machiavelli, “There is no more delicate a matter to take in hand, nor more dangerous to conduct, nor more doubtful to success, than to step up as a leader in the introduction of changes. For he who innovates will have for his enemies all those well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new.” See also: 8 Exemplars of Insurtech Innovation   The good news is that in the hyper-competitive world that will be tomorrow, well-prepared Davids can compete with the Goliaths of yesterday. This requires innovation – anticipating customer (prospect) needs and providing FAST, HOT AND CHEAP delivery. “Different isn’t always better, but better is always different.” (Dale Dauten) Consider these sign posts you will need to spot on the super highway to tomorrow:

1. Who will be your customers?
2. What will be your offerings?
3. What will customers be buying?
4. How will you communicate?
5. How will you compete?

Who will be your customers? Your renewal customers will be older. Your new prospects will be younger, smarter, diverse, tech-savvy and less verbal than they are today. Fewer in your data base will be members of the Greatest Generation and the Boomers. Buyers may be less enamored with your 40 years of experience because they are only 30 (Millennials). The “old boys club” will have closed; decision makers will be more diverse (gender, age, culture/ethnicity, expertise, etc), may speak a language other than English and will make decisions as a team – not as one boss. Having your marketing team more closely “mirror” them in tomorrow may be a good first step. What will be your offerings? Today, we can use a 3D printer to “manufacture” an ear. With the possibilities in technology, your products sitting on shelves and the slow manufacturing process of today may not be enough for tomorrow. Also, with more data capture and artificial intelligence, many customers will understand the price/cost structure of your offering and those of competitors. You may not sell on price, but some will buy that way. Your value proposition must include a “differentiator” that brings value to the buyer. In 2020, health insurance may be part of a single payer system, or you may wish it was. The ACA is not sustainable. At current rate trends, this one product will be sucking out a majority share of every family’s income to cover premiums. Healthcare expenses may include unintended consequences in the pricing of workers' comp and liability policies. What will customers be buying? With a global market and unlimited competition and less regulated competition, it is possible that consumers will find new solutions to traditional problems that don’t include the products you’ve offered in the past. You may find yourself tomorrow selling against what you sold yesterday with something tailored to a single client. How will you communicate? My generation used speedy memos, the phone, Rotary Club and PTA meetings and lunch at the City Club as relationship-building and communication opportunities. Today, text messaging, Facebook and other social media platforms are used to bond and communicate. If you don’t believe me, call a Millennial and see if he calls you back. How will you compete? This is one area of tomorrow that is out of your control. Competition will be defined by the marketplace. Your question is how to respond to the demands and expectations of this new world. See also: Spending on Agents Beats Spending on Ads   My guess is that, for agents, many products and service offerings today will be the commodities of tomorrow. Your success will be in what you do differently from the unwashed masses. Offering to facilitate the strategic planning for your best clients may keep you ahead of your competitors. You’ll have arrived when your clients invite you in on most, if not all, serious issues in their lives. Trust will matter. Success will be in your ability to gain and retain client intimacy by exceeding their expectations and the offerings of competitors. Look who is gone and who is prospering in today’s world. Will you be good or gone in tomorrow’s bazaar? Carpe Mañana!

Global trade and investment have been great engines of progress for much of the world. Over the past two decades, poorer countries reduced the gap between themselves and their richer counterparts for the first time since the Industrial Revolution, in no small part because of the opportunities opened by global trade. Technology has the same transformative potential in industries as varied as energy, health care, transportation and education. Inventions that are imminent or already here could transform the lives of billions of people for the better. Yet, as we see in the 2016 U.S. election campaign, and as we have seen in Europe and elsewhere, rapid change has a dark side. If too many people are unable to adapt quickly and successfully to these changes, they will push back – blaming trade or immigrants or the elites – and demand a reversion to a simpler time. The task of governments is to help people manage these transformations so that they benefit many and do as little harm as possible. In the U.S., governments mostly failed at that task during the era of globalization; if the full benefits of the coming technologies are to be enjoyed, governments will have to do much better this time around. See also: ‘Interactive Finance’: Meshing with Google   The competitive pressures created by globalization should have been no surprise. About 45 years ago, President Richard Nixon’s top international economic adviser, Pete Peterson, warned him that rising competition from Japan and Germany, with much more on the way, “poses adjustment policy which simply cannot be ignored.” Americans have unquestionably gained by the lower prices and higher quality that import competition enabled. Apple iPhones and the latest Boeing jets are the result of the collective input of tens of thousands of collaborators in dozens of countries around the world. But many lost well-paid manufacturing jobs to import competition or outsourcing, and the U.S. government has made little effort to mitigate those costs, even in worker retraining. President John F. Kennedy promised in 1962 that the government would help American workers who lost out to trade competition as the U.S. lowered its barriers to imports. “When considerations of national policy make it desirable to avoid higher tariffs, those injured by the competition should not be required to bear the full brunt of the impact,” he said. But today, the U.S. spends a smaller proportion of its wealth on worker retraining than any of the other 34 member countries of the Organization for Economic Co-operation and Development except for Mexico and Chile. Too often, the attitude of the U.S. government has been deeply irresponsible, assuming that markets would simply sort everything out for the best. In the long run, everybody may end up with work and income, but, in the short run, as Peterson told Nixon, the failure to help Americans adapt to the new reality will “leave long periods when the transition is painful beyond endurance.” With technology change, too, we know well in advance exactly what is coming. Driverless technology, for example, will soon become the standard in the trucking industry. Driverless trucks can run 24 hours a day and won’t demand overtime pay. There are 3.5 million truck drivers in the U.S., and an additional 5.5 million jobs in related industries – roughly one in every 15 American workers. They could perhaps go to work for UPS or deliver pizzas, but many of those delivery jobs will be lost to drones. Personal-care robots will increasingly replace home healthcare aides, and self-checkout machines are already replacing retail-store clerks; these are jobs that filled some of the gap left by the disappearance of manufacturing jobs to global competition, but they, too, will soon be under siege. Automation is even hitting law and education, two sectors long thought immune to technological substitution. See also: How Technology Breaks Down Silos   These vulnerabilities necessitate something that too often was absent in the era of globalization: good public policies. Artificial intelligence will transform teaching, for example, but, without access to the highest-speed broadband, students in poor and rural areas will fall further behind their urban counterparts. And unless we strengthen social safety nets and retraining schemes, there will be far too many losers in the labor market. There is no way to avoid the huge impact that technology will have on employment; we have to prepare for it and help those whose skills it antiquates. Much more even than globalization, technology is going to create upheaval and destroy industries and jobs. This can be for the better, helping us create more interesting jobs or freeing up time for leisure and artistic pursuits. But unless we find ways to share the prosperity and help Americans adapt to the coming changes, many could be left worse off than they are. And, as we have seen this year, that is a recipe for an angry backlash—and political upheaval. This article was written with Edward Alden.

It’s supremely intuitive that customer focus is the key to business success. It is also something that industries that have typically focused on products or distribution are now aware they need to change. Bravo! However, how many leaders are really harnessing the full power of customer focus? If after reading that question you immediately thought “big data,” please stop, put your smartphone down and back away from the table. This is not the kind of power I am talking about. The type of customer focus that I am talking about is better referred to as customer care — not just caring for customers, but caring about them. Maybe a good way to describe this would be customer indebtedness. These are companies that truly live, breathe and feel grateful for their customers, and put them above all else. Very few companies actually do this. They may say it, but being it is completely different. See also: How to Bottle Great Customer Experience   I was inspired while attending a recent LIMRA conference in Barcelona. One of the speakers, Artemis Pantelidou, general manager from EuroLife, owned by the Bank of Cyprus, humbly told the story of how her company was on the brink of collapse during the economic crisis in 2013 when Cyprus faced an EU and IMF bailout. EuroLife was damaged by these market conditions. People were panicked. They wanted (and oftentimes needed) their money, and the company faced the risk of losing a significant amount of its customers, thereby jeopardizing its financial position for those who stayed. However, it weathered the storm by staying focused on the customer and doing everything it could to make sure its customers were taken care of. It was in constant, open, honest dialogue with its customers, employees, agents and regulators. The company asked for all constituents to stay focused on customers and find new and different ways to satisfy as many as it possibly could. While some suggested it shut down to prevent a “run,” the way banks and stock markets do, Pantelidou insisted that EuroLife stay open for business and deal with each situation one customer at a time. After all, an insurance company is there to help with risk, not run away from it. Once customers understood the situation and how it could hurt so many people, they were even more grateful the company did so much to help them. And the storm passed. When it was time for the Q&A segment of the presentation and attendees were looking for the magic bullet that helped EuroLife persevere, Pantelidou repeated that there was no more to success than doing what’s right for the customer — each customer. She gave credit to her leadership team and to everyone who worked together, but that was it. Without saying these words specifically, the sentiment was that the company owed a debt of gratitude to its customers, whether they stayed or didn’t stay. They emerged stronger than ever, with advantages in the following areas:

1. Leadership team's trust and respect for each other
2. Employee respect for leadership
3. Customer loyalty
4. Confidence in team's abilities to handle volatility and uncertainty
5. Regulators' trust
6. Public image
7. Ability to innovate solutions

While nobody wishes to have an experience like EuroLife's to achieve a competitive advantage, what lesson can be learned in the chaos of the everyday? See also: How to Get Broader View of Customers   If your company seems to be wrestling with any of the seven issues above, running around frustrated with leadership alignment, uncertainty or business barriers to innovation, perhaps adopting an attitude of customer indebtedness now could help your culture overcome those issues sooner rather than later. If you are longing for the everyday chaos to calm down before you can adopt this attitude, you’ll need a real crisis to break the cycle. Why wait?

With Halloween just past, it seems appropriate to blog about something thematic. Usually, the word “scary” isn’t used to describe insurance writings, but there is a twist to one important question that can be as frightening as things that go bump in the night. Often, a technology adoption discussion starts out with a question about why an insurer should adopt a specific technology. That’s a good question. But the more telling question may be: What happens if you don’t adopt it? It’s a scary way to look at technology adoption, perhaps, but it is important to assess the implications of not adopting specific technologies. When it comes to business intelligence (BI) tools and data warehouse modernization, there are some very frightening downsides to not putting these critical components of an enterprise data strategy first. See also: 4 Benefits From Data Centralization  

• SMA research shows that 53% of responding insurers believe establishing a data strategy should precede a core technology initiative. That still leaves a good percentage of insurers who see things differently. And simply believing a data-first strategy is the right way to go doesn’t mean that executing it is easy. However, insurers who put off data strategies until after core system choices have been made actually run the risk of choosing the wrong provider (architecturally), relative to a data and warehouse strategy that would work best for their organization.
• Migrating legacy data to modern technology has kept many an IT and business leader awake at night or has given them a data migration nightmare. In fact, the sheer magnitude of doing a legacy data migration has led many insurers to decide to leave legacy data alone, resulting in a myriad of work-arounds. This will most certainly lead to poor service for both customers and distributors. It can also lead to a great deal of added expense and employees who are frustrated by having to deal with work-arounds. A solid data strategy with BI tools and a modern data warehouse can make the migration of legacy data into the new systems significantly easier.
• Business leaders are clamoring for analytics. Most of the technology demos we see at SMA address (or at least mention) analytics value in one way or another. However, without a data strategy, there may be a disconnect between the data architecture of the technology and the data structures decided on in a later data initiative. The result: delayed analytics value. Waiting for analytics can make business partners feel they are only getting incremental value from the new technology.
• Many insurers have accelerated core modernization initiatives because of the pressing need for modern portals and expanded mobile capabilities. However, if customer and distributor data is still fragmented — not centralized in a modern data warehouse and not unified with a common data strategy — the full value of portals and mobile will not be attained. And no insurer can afford to fail at fully delivering in these areas.
• Across a whole host of technology categories, software with out-of-the-box reporting tools is fairly common. On the surface, this seems to be an answer to a lot of problems. However, while technology-specific reporting tools have value, without an enterprise BI reporting tool an insurer can be creating reporting silos... and no insurer needs more silos. Additionally, while software-specific reporting tools may be useful for a specific category of data, such as operational data (which can be very good), they may not be what insurers need to gain deep insights into all categories of data.

There are a lot of scary things in the world today — besides Halloween — that we can’t control: terrorism, cybercrime and global warming, to mention a few. But all insurers can, and should, take steps to minimize the things that provoke fear. Electing to decide on an enterprise data strategy, business intelligence tools and modern data warehouses — and doing so first — is a way to mitigate other worrisome outcomes. Remember when deciding on an enterprise data strategy, BI tools and warehouses was the scary thing? Fortunately, technology has matured. And modern data management tools can be the key to dealing with the next wave of scary things.