Monthly Archives: August 2018

Upstream vs. Downstream – Healthcare

Upstream vs. DownstreamHealthcare

One other glaring example of attempting to solve a problem by focusing downstream is healthcare. Within this issue are two significant factors: 1. The occurrence of ailments requiring treatment and 2. The cost of treatment.

Occurrence: Looking at the reasons that people seek treatment for ailments one significant factor is the condition of a person’s immune system. There is considerable evidence that folks with strong immune systems require far less treatment than those persons that have impaired systems. In general, obese & overweight and individuals who smoke have much weaker immune systems than the rest of the population. Currently, in the U.S., 34% of the population are obese and 2/3rds are overweight. These rates are 3 to 4 times that of most European countries. The solution to this issue is relatively simple; regular rigorous exercise, a sensible diet and smoking cessation. There is no magic here and billions are spent every year to educate folks on this. Despite this spending the obesity and overweight rates continue to rise. (fortunately, progress has been made on the % that smoke). One suggestion that would reverse this trend is to initiate a process whereby the users of the healthcare system bear costs in relation to usage. Currently tax payers with healthy immune systems pay a heavy tax subsidy to support the remainder of the population.

Cost of treatment: In the past I have posted numerous reviews on this issue and I would encourage readers to look back at these if you missed them. In summary: The per capita costs to our tax payers for healthcare runs 3 – 10 times that of most European countries. The areas that contribute to this massive burden on the tax payer are: a) The frequency of occurrence as explained above b) the excessive per day cost of a hospital stay c) Cost in US of RX drugs d) Physician charges e) Insurance overhead & profits f) legal costs associated with ineffective RX & malpractice.

The solution to the cost issue is again very simple, but change will require efforts that are contrary to the interests of very powerful industries that control legislative decisions. When you think about this situation we are being “taxed” at a very high rate by our elected representatives. The industries that control our healthcare system are achieving excessively high revenues and profits at the expense of the tax paying consumer. In my view this represents massive corruption at the very highest levels.

Upstream vs. Downstream – Example Illegals

Upstream vs. Downstream

When we attempt to mitigate “problems” it seems that proposed solutions too often focus on the outcome of the issue in question and not on the cause. In other terms, we focus our efforts downstream rather than upstream.

An example:

Consider the problem of illegal immigration. Regardless of political affiliation the vast majority of our citizens do not support illegals. Most of the proposed solutions focus from the midpoint and downstream. To focus on the causes of the problem it requires us to examine the why people from other country want to enter our country and further why they avoid the process of legal entry? The main draw for illegals is work and pay levels for work vs. their local options. One reason is that gets thrown around is that illegals come to take advantage of benefits through our Medicaid system. While there are very specific conditions where illegals are able to access Medicaid, they are infrequent and amount to less than 1% of the Medicaid budget.

Working a bit upstream, why are there so many jobs available for illegals? Good question. One significant (and legal) method of entry is through the seasonal visa process. Once an alien secures a visa (whether a work or travel visa) it is fairly easy to “get lost” in America. While Big Agriculture is a significant employer of work visa aliens, the construction industry is a significant employer of “lost” workers. Regrettably the primary reasons for this support of illegals is their willingness to perform hard manual labor for relatively low wages, but with a superior work ethic. If there was not income available in the form of jobs most temporary visa holders would not stay on as illegals.

How much will it cost to build a wall and how effective will it be in stopping the demand for low paid workers? How much are we spending to enforce the laws in place to prevent employers from hiring & paying illegals? You do the math.

stay tuned for another example next week



Roundabouts & traffic circles are huge pet peeves with me. In my view a roundabout is typically a one lane intersection transition and a traffic circle will accommodate two lanes or more. I spent nine years living in New Zealand and was amazed at the lack of traffic signals at intersections. I spent 4 years in a city of 60,000 population that only had two traffic signals within the city limits.

What is a roundabout, really? It is the same as an intersection with a yield sign at each corner. How big does the “round” part need to be? In some cases is can be as small as a 6 – 8’ circle. Does the circle need to be raised? Ideally yes, for safety, but in small intersections a painted circle can suffice.

What seems to be the main disadvantage of roundabouts and traffic circles? The primary disadvantage is fear of change.

What are the advantages of roundabouts?

  1. They are significantly more cost effective – Current traffic signals for intersections will cost over $100,000 plus.
  2. They keep traffic flowing, almost no stop and go.
  3. They are statistically safer
  4. They are more fuel efficient

How to get past the fear factor: Initially post yield signs at each corner. The rule is simply to look to the left. If someone is already in the intersection, then they have the right of way.