Donald Trump’s German Counterpart

Germany would have to build too many walls to stem the immigrant tide that has enveloped that nation of 81 million people. But there is a growing yearning for walls there. At first, Chancellor Angela Merkel wanted to prove to the world that country that gave rise to Nazi genocide was no longer like that anymore. She opened her arms to welcome Syrians, mostly Muslims, fleeing the unbridled and seemingly random brutality of their own government, with the overt assistance of their Russian and Iranian allies. Merkel rallied Europe to a noble cause.

But as time passed, eastern Europeans and Greeks were the first where an angry right wing reared its head to challenge this massive influx of darker-skinned refugees, fearing the clandestine terrorists who might be mixing with the crowd. Fences, barriers and rules soon followed. Even the Danes got into the game, confiscating even minor wealth from refugees as their cost of admission. The initial welcome turned stone cold.

The wave of concern washed over Europe. David Cameron angled for more restrictions over cross-border emigres from Europe to the UK as part of the price of recommending that the UK remain in the European Union in the upcoming UK referendum on EU membership. The free movement, open borders elements of the EU’s Schengen Amendment seemed to be facing an end of days.

Meanwhile, back in Germany, Merkel’s own tide appeared to be turning. Unlike the United States, where populists are trying to take over both parties, Bernie Sanders the Dems and Donald Trump the GOP, in most nations, when a new movement arises, so does a new party. And historically, some of those new little parties become big powerful ruling parties.

A new movement in Germany is drawing a bead on Merkel’s conservative centrists: “A far-right party fiercely opposed to Chancellor Angela Merkel’s welcome for refugees made startling gains in three state elections in Germany on Sunday [March 13^th], dealing the chancellor a blow as she tries to seal a deal with Turkey to reduce the influx of migrants.

“In elections that showed how strongly the refugee crisis has scrambled politics and daily life in Germany, Ms. Merkel’s center-right Christian Democrats failed to wrest control of two states in western Germany where they had once been expected to do so.

“In the one eastern state that voted, her party finished first. But the Alternative for Germany, a populist, nationalist party formed in 2013, was only five percentage points behind.

“Ms. Merkel, now facing the toughest challenges of her political career, had no immediate comment on Sunday. She left that to party lieutenants on television talk shows that spent hours dissecting the muddled outcome of the first big electoral test of Ms. Merkel’s refugee policy.” New York Times, March 14^th. No Merkel isn’t about to lose her top spot in the near term, but the changes to the German political spectrum represent a warning shot across her bow.

“Sunday’s [March 13^th] results showed considerable opposition to her policy within Germany. And in Europe, several countries have refused to take in refugees and have closed their borders to migrants, rejecting Ms. Merkel’s appeal for a unified approach to the challenges posed by the more than one million who have arrived since early 2015.

“[In mid-March], Ms. Merkel [hoped] to conclude a deal with Turkey to stem the flow. In exchange for European concessions such as visa-free travel for Turks and up to 6 billion euros, or about $6.7 billion, in aid, Turkey would take back any illegal migrants crossing from its shores to Greece.

“But a crackdown on the news media in Turkey, growing clashes between Turks and Kurds, and general violence there — a bombing was reported in Ankara on [March 13^th] — make the deal tough for some European countries to accept…

“Karl-Rudolf Korte, a professor of politics at the University of Duisburg-Essen, predicted that Germany’s big parties, which govern in a ‘grand coalition’ nationally, would draw closer together as a result of Sunday’s elections. In other European countries, a closing of the establishment ranks has kept extremists from power, but has not necessarily brought their voters back to the mainstream parties.

“At the Alternative for Germany’s celebrations in Berlin, jubilant supporters insisted that they were not far-right extremists… ‘The current policy of the national government has done everything as wrong as it could in presenting us as Nazis and not as people who just want change,’ said Klemens Riebe, 59, who works at a utility in Berlin. ‘And let’s remember that many of our members come from the middle class.’” NY Times.

There are deep, right wing populist voices rising throughout the West. Likewise, in China, we can hear the sounds of doors shutting to foreign investors and vendors, as that nation contracts into her own priorities. Look at our own populist candidates, threatening to build walls or reject open trade agreements. Global economic and political turmoil is not creating warm and fuzzy openness, but when economics improve, perhaps the cycle will revert. The big question is when, and the bigger question is if, that overall reversal of fortunes reignites these Western economies before the political axe falls.

I’m Peter Dekom, and world appears to be turning inwards, more and more, every day.

A Healthcare System We Can No Longer Afford

Obamacare, catering to pharmaceutical companies to win their support for the legislation in 2010, made sure that Americans were (1) unable to buy prescription drugs from overseas (under the rubric that we could not assure sufficient quality standards from foreign sources in such untrustworthy places like Canada, the U.K., France or Switzerland… countries which, by the way, actually manufacture drugs sold in the U.S.) and (2) the healthcare exchanges here were not allowed to do what every other nation with state-controlled healthcare systems can do: use the bargaining power of their masses of consumers to negotiate lower prescription drug prices.

We spend 60% more for healthcare in this country than the next highest country, Switzerland, because of so many reasons, yet millions of Americans are still without coverage. We seem to have a proclivity to protect the big institutions in this country at the expense of consumers, and the medical/healthcare profession is far from innocent in this battle.

You can see above why we have to pay so much for pharmaceuticals, but a normal trip to a doctor’s office or a hospital emergency room is often nothing more than an emergency trauma center and/or a triage-designed referral system. All-too-frequently, it takes way too long, with way too many levels of filtration, to reach some of the most basic diagnoses.

Increasingly, countries with a chronic shortage of doctors and really stringent budget shortages – a fact of life staring the United States in the face as we open up the medical system to more Americans – have had to redesign their screening and diagnostic systems to increase accuracy and decrease the time to diagnosis and treatment. Automation with a built-in testing procedure, which includes a reasonably thorough diagnosis of blood and urine leaving only the critical summary analysis by a physician, can reduce the time for such an entire diagnostic “office visit” to 15 minutes, from soup to nuts. All medical records are recorded electronically, available instantly to any authorized physician through a centralized cloud-based repository.

We’ve always pictured India as massively dysfunctional society with problems heaped on problems multiplied by just too many people to handle. But India is also a nation with a tradition of technological excellence, home of the academically stellar Indian Institutes of Technology, a country where so many American medical facilities and doctors outsource their medical record-keeping, billings and even complex diagnostics (overnight when India is awake and America is sleeping). Whether local medical facilities use technology developed locally or systems designed in the United States, the obvious need for the highest levels of efficiency to cope with the volume of patients have force Indian medical practitioners to adopt processes that could teach their American counterparts a thing or two.

Perpetually running for office, Congress men and women spend a significant amount of their time raising campaign money. For those in the House, estimates suggest that well over half their professional efforts are focused on fundraising. So it’s no small wonder that there are many groups stroking the palms of legislators in exchange for assurances that anything that would make them more competitive (hence driving the price of services down) will die in flames even before such an “offensive effort” makes it to a floor vote.

And so it was when India-born Kanav Kahol, a biomedical engineer and researcher at Arizona State University’s department of biomedical informatics, developed a sophisticated automated diagnostic system known as the Swasthya Slate… “[A $600 medical] device, the size of a cake tin, performs 33 common medical tests including blood pressure, blood sugar, heart rate, blood haemoglobin, urine protein and glucose. And it tests for diseases such as malaria, dengue, hepatitis, HIV, and typhoid. [See the above test grid summary from their Website.] Each test only takes a minute or two and the device uploads its data to a cloud-based medical-record management system that can be accessed by the patient…

“[Kahol] became frustrated at the lack of interest by the [U.S.] medical establishment in reducing the cost of diagnostic testing. He worried that billions of people were getting no medical care or substandard care because of the medical industry’s motivation in keeping prices high. In 2011, he returned home to New Delhi to develop a solution…

“Kahol had noted that despite the similarities between medical devices in their computer displays and circuits, their packaging made them unduly complex and difficult for anyone but highly skilled practitioners to use. They were also incredibly expensive — usually costing tens of thousands of dollars each. He believed he could take the same sensors and microfluidics technologies that the expensive medical devices used and integrate them into an open medical platform. And with off-the-shelf computer tablets, cloud computing, and artificial intelligence software, he could simplify the data analysis in a way that minimally-trained front-line workers could understand.

“By Jan. 2013, Kahol had built the Swasthya Slate and persuaded the [Indian] state of Jammu and Kashmir, in Northern India, to allow its use in six underserved districts with a population of 2.1 million people. The device is now in use at 498 clinics there. Focusing on reproductive maternal and child health, the system has been used to provide antenatal care to more than 22,000 mothers. Of these, 277 mothers were diagnosed as high risk and provided timely care. Mothers are getting care in their villages now instead of having to travel to clinics in cities.

“A newer version of the Slate, called HealthCube, was tested last month by nine teams of physicians and technology, operations, and marketing experts at Peru’s leading hospital, Clinica Internacional. They tested its accuracy against the western equipment that they use, its durability in emergency room and clinical settings, the ability of minimally trained clinicians to use it in rural settings, and its acceptability to patients. Clinica’s general manager, Alvaro Chavez Tori, told me in an email that the tests were highly successful and ‘acceptance of the technology was amazingly high.’ He sees this technology as a way of helping the millions of people in Peru and Latin America who lack access to quality diagnostics.” Washington Post, March 11^th.

We may believe in shortened terms towards getting an M.D. or relegating an increasing amount of screening, diagnosing and even prescriptions to nurse practitioners, but we need to deploy any and all viable methods and technologies to increase medical efficiencies. We need to purge unjustified protectionism accorded our medical elites from every nook and cranny of our healthcare system. We need this clear and obvious focus a whole heck of a lot more than we need to throw out Obamacare and think that somehow, we can replace it with a new system that will solve all our medical ills. Let’s address the obvious fixes… now.

I’m Peter Dekom, and it is fascinating that so many of the bastions of capitalism are the first ones in line to make sure that they face no competition.

Universal Basic Income (“UBI”)

With all the talk about the impact of accelerating computing power – generating the kind of artificial intelligence (“AI”) automation that can replace even some of the most sophisticated and highly-educated professions (see my February 21^st blog, Well-Educated Professionals and Automation) – there are a lot of people trying to figure out how political and social systems will cope with a growing dearth of good jobs for highly-trained people. Inevitably, the conversation gravitates to income redistribution… socialism pure and simple. Just as there are climate change-deniers, so are there job change-deniers, people who believe that somehow we will find well-paid new jobs in a technologically advanced future.

But you just have to look at the current landscape – and the concomitant anti-incumbent, anti-establishment populism that is running scared at the changes they see around the – to understand that we are already facing job/earnings polarization where a few make lots more and most make a lot less. Some skilled workers have been permanently displaced, leaving the job market with no place to go, and massive declines in demand for certain professions (lawyers being a prime example) hint at a future for most professions. AI is generating not just the physical ability to replicate the processing power of the human brain, but we are providing new sophisticated self-learning software to apply that processing power to very sophisticated work.

The March 15^th FastCompany.com tells it like it is: “If the goal of the economy is to provide decent-paying work for everyone, that economy clearly isn't doing a good job at the moment. Real wages for most Americans haven't increased in 40 years. Real unemployment—which includes the ‘under-employed’—is above 10%. Many jobs are now part-time, flexi-time, or ‘gigs’ with no benefits and few protections. And, we spend a lot of money to subsidize so-called ‘bullshit jobs’: more than 50% of fast food workers receive some form of public assistance, for instance [like food stamps].” The powerful theme of income inequality is the biggest issue of our time. But there is nothing on the horizon, notwithstanding the abstract promises of presidential candidates from both sides of the aisle, that is likely to stem the tide of AI replacing skilled workers with increasing frequency.

The biggest questions relate to whether we can continue to pay those who own the machines, who paid good money to develop those machines, that are displacing the workers… in effect the money once paid to workers – increasingly pushed into marginal pay rates, where they even have work, as our middle class continues to contract – is now going to those who own the automated machines. Is there a point where the whole or significant part of the revenues from such machines has to be redistributed to those whose jobs have been displaced? Does society owe its population a minimum-but-well-above-subsistence income – a “universal basic income” (also known as “unconditional basic income”) if you will – where the jobs simply do not exist… or do we simply let the raw capital marketplace determine their fate?

Do people continue to receive higher-levels of education if the underlying jobs just aren’t there, and if so, who pays for that? Is such schooling merely a luxury we will no longer be able to afford? Do we just lie back and let the machines take over? And if we agree that a UBI is necessary, where do we get the money to write those checks? From those who own the machines? For civilizations which have defined self-worth in terms of occupations and wealth, what does society look like in the future where such opportunities just do not exist?

“The fundamental problem could be that work is losing its value. The thing that provided—that allowed families to prosper and individuals to build a sense-of-self—is under attack… In response, many are now calling for a ‘universal basic income’… —where the state gives everyone enough to live on. This would put a floor under the class of people we're calling the ‘precariat,’ people for whom work doesn't lead to increased financial security. It would free us from the bullshit, allowing everyone to benefit from automation, not just the lucky few. And it would leave us more time for creative, fulfilling things, enjoying the ‘abundance’ that new technology affords (think how useful and cheap computers are today and imagine what they might let everyone do in the future). There are several UBI trials planned in Finland, Switzerland, and Canada (and, indeed, several reasons why the idea is attractive).

“Critics of UBI says it's unaffordable, impractical, and liable to lead to millions of layabouts living off the government dime—and perhaps they're right. These criticisms are reasonable. But before dismissing UBI too quickly, it's important to consider the idea not in the context of our current economy, but of what the economy could become in the future. UBI is not so much an idea for now; it's an idea for an economy where capitalism isn't as socially productive as it's traditionally been.

“To understand the type of economy we have and how it's not providing for a lot of people, you need to read Postcapitalism, a profound and important book by Paul Mason, a British economist and journalist. Mason makes the case for UBI, among a larger set of changes necessitated by the failure of the current system. Presenting a long economic history showing how innovation and prosperity rises and falls in waves, he shows how our current arrangements aren't as innovative and prosperous as we tend to think (the invention of Facebook isn't as momentous as the coming of the steam engine).

“Mason says we need to move towards a ‘postcapitalist’ economy, where working for money loses its centrality, where goods, information, and intellectual property are shared, and where economic actors collaborate in new ways, whether it's credit union-type financial institutions or co-operative-type retailers. Importantly, Mason also shows how current economic orthodoxy—based around ‘free markets,’ globalization and an oversized role for the financial services industry—isn't some historical end-state, perfecting everything that went before. Rather, it's the result of a particular set of choices, starting in the 1980s, that advantage some people over others.” FastCompany.com. But can you picture such a system working here in the United States? And if so, exactly what sacrosanct political and economic structures will have to be sacrificed? What are your thoughts of the coming years and the redefined labor market?

I’m Peter Dekom, and we can add the above discussion to the admonitions from American capitalist icons like Elon Musk and Bill Gates who have been sounding the alarm for years.

B.A. or B.S. – Undereducated

As post-high school tuition continues to fly upwards way above any semblance of the cost of living increase, and as financial aid opportunities and sources are drying up faster than a California farm deeply embedded in drought, the polarization that seems to have redefined every aspect of American life clearly extends to education. The commercial world has all but relegated those without even a high school degree – a status that applies to huge segments of our inner city drop-out mills – to a lifetime of hopeless poverty and dependence on government support or resort to illegal activities. Those who’ve earned their high school degree (or G.E.D.), but not much more, face dead-end jobs with limited prospects in a society that is automating them to the bottom tier of earning power and economic stability.

Trade schools and community colleges, to the extent they teach immediately relevant skills that are in demand, are clearly producing better, practical results, often eclipsing even those with superior bachelor degrees. And notwithstanding a steady trend towards automating even high-end professional skills (see my February 21^st blog, Well-Educated Professionals and Automation), today’s job market has effectively moved those with most bachelor degrees to the ubiquitous educational status accorded to those with high school degrees a generation ago. Master degrees have become what bachelor degrees used to be. And most of the new jobs created since the end of the great recession for those without those higher degrees are either part of the uncertain “gig” economy or just plain lower-paying jobs with relatively little chance for advancement.

“Nearly a third (32%) of employers are bumping up education requirements for new hires. According to a new survey from CareerBuilder, 27% are recruiting those who hold master’s degrees for positions that used to only require four-year degrees, and 37% are hiring college grads for positions that had been primarily held by those with high school diplomas.

“CareerBuilder conducted a nationwide online survey that culled responses from over 2,300 hiring and human resource managers across different industries in the private sector… Their responses revealed that employers pushing their education requirements toward higher degrees are doing so across all levels of their companies. The majority of employers (61%) say they are looking for more educated candidates at the mid-level skill level, but 46% are looking to hire better educated candidates at entry level and 43% think the same for 
higher levels.” FastCompany.com, March 17^th.

You can see the obvious amplification of polarization on access to this higher level of education: those whose families can afford the burden of this extra-level of education produce another generation of elites with higher earning power. This inherent unfairness is helping to institutionalize class distinction, but it is just a fact of life.

“This comes at a time when the cost of a four-year college degree is out of reach for the average American family. But employers argue that a tight job market and evolving need for different skills are making it necessary. For example, 60% of employers who were satisfied with hiring high school graduates in the past claimed their work requires the skills held by those who have completed higher education.

“And even though the U.S. unemployment rate is at a historic low, more than half (56%) of employers said they are able to get college graduates for positions. Indeed a 2015 report revealed that about 2.8 million university graduates (holding bachelor’s, master’s and Ph.D degrees) entered the workforce, but millennials account for about 40% of unemployed American workers. The worst off were those between the ages of 21-25.

“Although the cost is exorbitant, a four-year degree still translates to a better earning potential than just a high school diploma. A recent Pew Research study found that high school graduates earn about 62% of what those with four-year degrees earn. That’s evolved since 1979, when people with only high school educations earned 77% of what college graduates made.

“Employers told CareerBuilder that higher education not only increases an applicant’s chance of getting hired, but it helps boost the chance they’ll be promoted down the road. Thirty-six percent of employers reported that they would be unlikely to promote someone who doesn’t have a college degree.” FastCompany.com. So unless we can figure out a different way to pay for college, not only are we killing upward social mobility (reflected in a contracting middle class), we are simply editing hope out of the equation. And we wonder where all this populist anger fueling this presidential race is coming from?

I’m Peter Dekom, and if we care about our society, we need to start leveling the playing for everyone or risk losing it.

Vigilance and Compassion, Not Panic and Overreaction

As I was getting ready to head to the airport this morning for week in China, I heard the sad and horrific news of the terrorist attacks in Brussels. My hopes and prayers go to the victims, their families and friends. It has happened and will again happen here. There are no excuses. There never are.

Likewise, we must remember that the vast majority of victims of Islamic terrorism and cruelty are Muslims as well. We can give in to our greatest weaknesses and fears… or we can stand united against a Godless enemy with a reprehensible moral code. Stand tall with those who are inflicted and afflicted the most. Let these horrible events bring out the best in us… not the worst.

I’m Peter Dekom, and I cried today… really.

Chronic Traumatic Encephalopathy – Huh?

It’s a super-hot topic at the National Football League these days, and the above photograph really brings it home. Wikipedia: “Chronic traumatic encephalopathy (CTE)… is a progressive degenerative disease found in people who have had a severe blow to the head. The disease was previously calleddementia pugilistica (DP), i.e. ‘punch-drunk’, as it was initially found in those with a history of boxing. CTE has been most commonly found in professional athletes participating in American football, association football, ice hockey, professional wrestling, stunt performing, bull riding, bicycle motocross, rodeo, and other contact sports who have experienced repeated concussions or other brain trauma. Its presence in domestic violence is also being investigated. It can affect high school players who have played for just a few years…

“Symptoms of CTE generally begin 8–10 years after experiencing repetitive mild traumatic brain injury. First stage symptoms include deterioration in attention as well as disorientation, dizziness and headaches. Further disabilities appear with progressive deterioration, including memory loss, social instability, erratic behavior, and poor judgment. Third and fourth stages include progressive dementia, slowing of muscular movements, hypomimia [reduced facial expressions), impeded speech, tremors, vertigo, deafness, and suicidality. Additional symptoms include dysarthria [motor speech disorder], dysphagia[difficulty swallowing], and ocular abnormalities - such as ptosis[droopy eyelids].

“Currently, CTE can only be definitively diagnosed by direct tissue examination, including full autopsies and immunohistochemical brain analyses [looking for a buildup of tau, an abnormal protein that strangles brain cells].” In short, it’s really serious, problems often do not surface for years, and there is a strong feeling in the NFL that CTE is likely to impact a majority of players, particularly the longer they play. And even as the NFL has paid out millions of dollars to settle player claims, no one at the NFL has simply come out and declared a clear and direct link between concussions sustained during professional training and play… and CTE. Until now.

“After years of the N.F.L.‘s disputing evidence that connected football to chronic traumatic encephalopathy, the degenerative brain disease found in nearly 100 former players, a top official for the league for the first time acknowledged the link. To many, it was an echo of big tobacco’s confession in 1997 that smoking causes cancer and heart disease.

Representative Jan Schakowsky, Democrat of Illinois, asked during a round-table discussion about concussions whether ‘there is a link between football and degenerative brain disorders like C.T.E.’

“Jeff Miller, the N.F.L.’s senior vice president for health and safety policy, said, ‘The answer to that is certainly, yes.’ His response signaled a stunning about-face for the league, which has been accused by former players and independent experts of hiding the dangers of head injuries for decades.” New York Times, March 15^th. Some high schools have abandoned tackle football as an on-campus sport, and there are many who question whether there will come a day, for America’s most popular professional sport, when we will look back at tackle football the way we look back at Roman gladiators today.

Certainly, the legal position of the NFL has changed. “Lawyers for some players involved in a lawsuit with the N.F.L. over its handling of brain injuries quickly seized on the league’s admission.

“A settlement was approved by a Third Circuit district court judge last April but is on appeal. The players argued that the league should pay damages to all players found with C.T.E., not just those found to have the disease before the settlement was approved a year ago.

“In a letter sent early [March 15^th] morning to the United States Court of Appeals for the Third Circuit, Steven Molo, their lawyer, said Mr. Miller’s comments on Capitol Hill were ‘a stark turn from its position before the district court.’

“‘The N.F.L.’s statements make clear that the N.F.L. now accepts what science already knows: a ‘direct link’ exists between traumatic brain injury and C.T.E.,’ Mr. Molo’s letter said. ‘Given that, the settlement’s failure to compensate present and future C.T.E. is inexcusable.’

The N.F.L. rebutted those claims. In its own filing to the Third Circuit late [on the 15^th], the league said that the settlement compensates players if they have symptoms “allegedly associated with C.T.E.” The league added that it ‘previously acknowledged studies identifying a potential association between C.T.E. and certain football players.’

“More broadly, the league’s public position could influence other levels of football because many college, high school and youth leagues take their cues from the N.F.L.

“Others in the sports world, including parents of young athletes, ‘have trusted the N.F.L., and the N.F.L. was on the fence for a long time,’ said Chris Nowinski, a co-founder of the Concussion Legacy Foundation. ‘We now have a significant confirmation from the N.F.L., and that could have ripple effects around football and sports.’

“The N.F.L. has spent millions of dollars in efforts to tamp down fear among parents over football’s physical toll. It has directed millions of dollars to research C.T.E. and head trauma. It gave $45 million to USA Football, a formerly obscure nonprofit, to promote safe tackling and reassure jittery parents that football’s inherent risks can be mitigated through on-field techniques and awareness. The league has hired experts to monitor games.” NY Times.

With television’s most lucrative per game contracts, ratings soaring through the roof, the NFL recently moved from being a non-profit league to one with full for-profit status with the IRS. That also suggests that there is a very deep pocket with an ability to pay the millions of dollars that might result from new claims. While helmet technology is creeping along – the big issue is the sudden deceleration of the brain as it slams into the skull itself – and treatment requiring very early detection of concussion damage, the league has a long way to go. Spotting a concussion instantly and pulling a player off the field immediately is just a beginning. Careers may end a lot earlier than those in the profession might like… but the risks of long term damage are seemingly exceptionally high. At least folks are admitting where causation truly lies.

I’m Peter Dekom, and while I recognize how deeply tackle football is ingrained into so many American communities, we really do owe it to our kids to be particularly watchful and wary of this rather horrible long term risk.