Tag Archives: Hillary Clinton

What Trump Means for Best Practices

On Tuesday, Nov. 8, 2016, the majority of a major minority of the people in this country opened the window, stuck their heads out and yelled just as Howard Beale instructed in Network: “I’m mad as hell, and I’m not going to take it anymore.”

The rest will be history. Power to the people!

As you and your organization move from yesterday, through today (2016) to tomorrow (2020), will you complete this “first term” into the future, be thrown out before your term is complete or be reelected by a landslide? The choice will be made by the marketplace.

Your performance is determined by your clients and prospects — your voters — not your measurements of “best practices” and “peer studies.” Best practices are the judgment of our peers comparing us with our “superior” peers. Best practices are inside baseball. They’re all about us – our industry.

In Tuesday’s election, despite all the best practices and peer studies that meant all the media “knew” that Hillary Clinton was the winner – SHE LOST!

The media knew she would win not from some impulsive whim but rather through history, polls, the wisdom of the elders of their tribes (Democrats, Republicans, independents) and those who had grown up in the industry of government – lobbyists, consultants, pollsters, elected officials, etc. As a practical matter, 16 of the most successful players in the Republican party scoffed during the primaries at the idea that a reality-TV star should be taken seriously.

On the other side, the Democratic party in its arrogance ignored millions of outsiders (the children of their insiders plus many of the alienated members of their tribe) who marched in protest behind and beside democratic socialist Bernie Sanders.

See also: What Trump Means for Workplace Wellness  

Now do you understand? THE MARKETPLACE HAS CHANGED!

Enough about politics. Let’s get back to real life – marketing in a dynamic and divided world. Tomorrow is not about the mass market of yesterday. It is about the narrow niches of tomorrow (left-handed diesel mechanics who smoke, or some other affinity group you’ve never considered), their affinity and your knowledge of and intimacy with them, their wants, needs expertise, culture, etc.

I recently worked with a non-profit organization that had it all: good people serving a marketplace that their peers would “die for,” plus a membership group with sophistication, economics and education that any niche would envy. The organization included a successful history of 50-plus years and, unfortunately, the baggage and culture problems that nearly always accompany such success. The organization had become “dumb, fat and happy,” focused internally in their comfort zone, and they had let their finger slip off the pulse of their individual members.

These very good folks in this organization had done what far too many folks do after an era of success. They existed in their comfort zone versus working to ensure that their clients were comfortable! Conversations about the “good old days” outnumbered asking “what if,” “what now,” and “what next?” They were looking internally at each other versus at the future!

Don’t believe me: Test this on your team! Gather your team or a cross section of your team for a futuring group meeting. Draw a circle large enough to hold the assembled group. Ask them to stand on the circumference of the circle to discuss the future. What will happen? Will most (or all) face each other, or will they turn their back on the “history” inside the circle and look at the possibilities on the horizon?

Whether you think the above is silly or provocative, the reality is this: Your current processes are perfectly designed to get the results they are already getting.

Twenty-three years ago, I naively suggested we “change the culture.” After I tried this a few times and had my rear end handed to me, I learned that to change the culture you must change the people. But this is a foolish fantasy in a world filled with humans with free will and the ability to sabotage change. (Remember Maxine’s wisdom, “Change is good as long as I don’t have to do anything different.”)

I then evolved to a more real model suggesting you work to maximize the results that can be obtained in the culture you have. Now with decades of scar tissue, I know better. In fact, Harvard Business Review in its April 2016 cover story, agreed with me – YOU CAN’T FIX CULTURE; just focus on your business, and the rest will follow.

See also: What Trump Means for Business  

I’ll wrap up this monologue with three slides from a recent planning retreat that acknowledge that you can’t fix culture — but that you can do other things:

  1. You can’t fix culture, but EACH OF US CAN GROW!
  2. You can’t fix culture, but ALL OF US CAN COLLABORATE BETTER!
  3. The final slide included seven words and one picture. The picture said it all, with a young woman with a “sad face” looking down and back over her shoulder to a yesterday of hurt and a “happy face” young lady looking up and out at the positive possibilities on the horizon! The words – “IT’S ALL ABOUT WHICH WAY YOU LOOK!”

What Trump Means for Job Creation

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.

What Is a Year of Life Worth? (Part 2)

In making decisions about medical care, everyone should factor in cost — patients, doctors health insurance companies and government. Consider two alternative procedures, A and B. If for each $1,000 spent on procedure A, patients gain one extra month of life whereas using procedure B costs $2,000 for the same gain, A should be preferred to B. By making the efficient choice, we free up money to meet other health and non-health needs.

There remains this problem, however: What if the person who makes the decision about cost is different from the person who realizes the gain? That is what gives rise to charges of “rationing” and “death panels.”

Aaron Carroll writes: “Other countries routinely use cost-effectiveness data to make decisions about health coverage. In Britain, the National Institute for Health and Care Excellence, a government agency that gives guidance about which services the National Health Service should cover, has a threshold of 20,000 to 30,000 pounds per QALY [quality-adjusted life year] — that’s about $31,000 to $47,000. The health service doesn’t make decisions on whether to cover therapies based on this number alone, but it is certainly  a factor.”

And because government healthcare budgets are strained everywhere in the world, you can be sure that the cost-effectiveness criterion is “considered” a lot.

According to a 2002 World Health Organization report, 25,000 cancer patients die prematurely in Britain each year — often because of lack of access to drugs generally available in the U.S. and Europe. (See also this 2013 NHS estimate on all causes of premature deaths.)

To use an example closer to home, in 1994 Hillary Clinton decided that as part of her own health reform, health plans would provide free mammograms only to women 50 and older — and only at two-year intervals. In contrast, the National Cancer Institute and the American Cancer Society at the time were recommending mammograms for women after 40, either annually or every other year, and yearly mammograms after 50.  Similarly, Clinton hinted that she would relax the usual recommendation of a Pap smear every year for sexually active young women. (Canada, at the time, offered the test every three years.)

While these decisions were being made, a review of the literature by Tammy Tengs and her colleagues showed that:

  • Annual mammograms for women age 55 to 64 were expected to cost $110,000 for every year of life saved.
  • Annual mammograms for women in their 40s were expected to cost $190,000 per year of life saved.

In essence, Clinton decided that the lower number was an acceptable use of money while the higher figure was not. The review of the literature on Pap smears showed that:

  • Screening young women for cervical cancer every four years costs less than $12,000 for every year of life saved — a very good deal in the risk-avoidance business.
  • The cost soars to about $220,000 per year of life saved at three-year intervals and $310,000 at two-year intervals.
  • Giving Pap smears every year (as opposed to every other year) is really expensive: $1.5 million per year of life saved.

Clearly, Clinton and her advisers thought $1.5 million was way too high.

These decisions are said to have turned the general public against Hillary Care and doomed the Clinton health reform effort. But we shouldn’t take the wrong lesson away from that experience.

Hillary Clinton was not wrong about the cut-off choices she made. She was wrong in thinking that the White House should make this decision for all the women of America. The tests involved are relatively inexpensive. They can easily be paid for from a health savings account. If not getting a test is keeping someone awake at night, then by all means she should be encouraged to spend the money and get the test.

Here are some public policy principles to guide us going forward:

  1. Wherever possible, people should make their own decisions about risk — using money from savings accounts they own and control.
  2. Doctors should be encouraged to help patients make sensible decisions based on their own knowledge of the literature on cost effectiveness. That is, doctors should be financial advisers as well as health advisers when their patients have to make choices about medical procedures.
  3. Insurance companies should be encouraged (and maybe even required) to reveal what standards they use in making decisions about coverage, and we should encourage an insurance market where people can pay higher premiums for more generous coverage – especially if they are unusually risk-averse.
  4. Government health programs should make coverage decisions that are in line with private-sector insurance. And, like private insurance, the government should announce what monetary cut-off standard it is using. But we should encourage a secondary market for “top up” insurance — for example, providing coverage for expensive cancer drugs the government refuses to cover.

In case you missed it, Chris Conover has applied cost-effective analysis to the entire Obamacare program, based on results from Massachusetts. He writes:

“…. even under the most wildly optimistic assumptions possible, Obamacare costs a jaw-dropping $224,000 per QALY. In the worst case, the costs would be as high as $1.3 million per QALY.”

He presents this chart (green = low estimate; red = high estimate):

Photo credit: Christopher Conover, Duke University

Photo credit: Christopher Conover, Duke University