After a rather bleak year, there are a few rays of hope for the U.S. individual health insurance market.

The Senate shot down Affordable Care Act repeal bills last week, and now Senate Republicans and Democrats are talking about cooperating on improvements to the existing law.

Lamar Alexander, a Tennessee Senator who can hardly be accused of being a wild-eyed liberal, announced a bipartisan meeting in September to stabilize insurance markets in 2018.

Like other parts of the country, a lot of people in Tennessee have come to rely on ACA insurance policies. And Alexander, while a staunch opponent of Obamacare, has no intention of setting them adrift in a sea of uncertainty.

Also, credit Senator John McCain with nixing the most recent bid to strip away the real meat of the ACA, ditching the individual mandate and opening up an opportunity for insurers to squeeze customers with pre-existing conditions. He was one of three Republican senators to oppose the final bill and his dramatic thumbs-down vote became a viral video clip.

Some accused McCain of being hypocritical because he actually voted for the first repeal-and-replace bill considered by the Senate, the one drafted by Majority Leader Mitch McConnell behind closed doors.

But McCain’s positions were consistent. He returned to Washington to vote in favor of opening debate on a replacement bill, a measure that passed with a 51-50 margin with Vice President Pence casting a tie-breaker. That’s because McCain is a right-of-center politician, but he believes in the American system of government.

So he approved starting the debate, and supported the McConnell bill because senators had an opportunity to debate it in open session. He voted against the final “skinny” bill for two reasons. One, the bill was a sham because nobody in Congress — either in the House or the Senate — wanted it passed into law. So why would you vote for something that you don’t want passed into law?

At the same time, the no vote allowed McCain, a prisoner of war in Vietnam, to stick it to President Trump for the rather nasty comment during the campaign: “I like people who weren’t captured.”

McCain knew Trump would be watching the video of his vote, and if he could have done it, he probably would have liked to have looked directly into the camera when he pointed thumbs down.

His vote was really a twofer. It was principled, yet at the same time it carried an element of revenge for McCain.

The potential winners — more or less coincidentally, I suppose — are Americans who rely on the individual health insurance market. Because if Alexander and other Republicans can rally enough support for a fix-it bill, customers will be looking at a lot more options next year along with more moderate price increases.

There’s still a long way to go, but if enough bipartisan support comes together there won’t be any “holes” in the insurance exchange — counties where there are no insurance choices. That was a very real possibility that market analysts have been warning about.

It still could happen if insurance companies go into the enrollment period rattled by fear of the unknown.

Long-term solutions to the U.S. health care fiasco remain elusive, and the best we can hope for is a clearer picture for 2018. We’ll take what we can get.



So the Russians get accused of hacking the U.S. election, and when the new U.S. president meets the Russian president he says: “Hey! I got an idea — let’s sign a cybersecurity agreement!”

And the Russian president says: “Da! You send cybersecurity protocols and information, and we send you ours later!”

And the U.S. president says: “OK! It’s a deal!”

And folks, that’s how a historic cyber-pact was born … or is it AN HISTORIC cyber-security pact, we’ll have to ask those beady-eyed intellectuals over at CNN.

“I’m sure that Vladimir Putin could be of enormous assistance in that effort since he is doing the hacking,” Sen. John McCain said on Face The Nation Sunday.

Sure, there might be some hand-wringing in the U.S. this week since it appears the country is getting the bum’s rush and may be more vulnerable than ever to hackers.

But there’s a bright side to all of this. Administration incompetence may have driven a silver spike into the Republican agenda on health care. We’re not out of the woods, but there are rumblings that Senate leaders may have to do something previously unthinkable on the health care issue: Work with Democrats!

There’s no question that the health care system has to be fixed. It may not exactly be in a death spiral, as critics suggest, but premiums for 2018 are poised to rocket upwards due in large part to all of the uncertainty.

Insurers currently have no idea what 2018 will look like — whether they will be required to provide coverage for the basic problems spelled out in the Affordable Care Act, or whether young, healthy people will drop health insurance without the ACA mandate.

Insurance companies don’t even know, from month-to-month, whether the federal government will continue to pay the subsidies offered in the 2017 plans.

So if it is imploding, guess whose hands are on the detonator?

Sen. Mitch McConnell has a 52-seat Senate majority along with a handy-dandy vice president ready to step in with a tie-breaker. But even within his own party, there are deep ideological differences and trying to pull them all together is like herding cats.

The Los Angeles Times said Monday: “Trump has further complicated McConnell’s task, giving mixed signals about how he wants to proceed.”

First the president wanted to repeal and replace. Then he switched gears and said maybe Obamacare should just be repealed. At one point he called the replacement bill passed by the House “mean” — a week or so after celebrating its passage in a Rose Garden high-five-fest.

Contrary to popular myth, the swamp has not been drained and there are more alligators than ever. But if they’re bickering among themselves maybe they won’t notice the folks who are trying to pick their way ever-so-carefully to the other side.

Image credit: Wikimedia Commons

A computer will soon be able to tell you how long you’ll live.

New technology is being developed to analyze images of your heart, lungs and other organs and then tell you what your chances are of dying in five years.

Researchers at the University of Adelaide’s School of Public Health in Australia have already used the system with a 69 percent success rate.

Red flags raised by the analysis can steer your physician toward the right kind of treatment to head off undesirable outcomes. Or, if you get the all-clear you can crack open a Fosters and throw another shrimp on the barbie.

“Our research has investigated the use of ‘deep learning’, a technique where computer systems can learn how to understand and analyze images,” said Dr. Luke Oakden-Rayner, a radiologist with the university and lead author of a study on the technique that appeared in the Nature journal Scientific Reports.

“Although for this study only a small sample of patients was used, our research suggests that the computer has learned to recognize the complex imaging appearances of diseases, something that requires extensive training for human experts.”

Patients who suffered from severe chronic diseases like emphysema and congestive heart failure were the easiest to call for the computer but it detects other, less obvious problems as well.

“Instead of focusing on diagnosing diseases, the automated systems can predict medical outcomes in a way that doctors are not trained to do, by incorporating large volumes of data and detecting subtle patterns,” Oakden-Rayner said.

“Our research opens new avenues for the application of artificial intelligence technology in medical image analysis, and could offer new hope for the early detection of serious illness, requiring specific medical interventions.”

-It_is_certain.-_-_The_Magic_Eight_Ball_(7246548230)Finally — something to replace the rather cryptic Magic 8-ball, which has been the go-to prognostication device since it was marketed for commercial use in 1950. (The concept was actually introduced by The Three Stooges in their 1940 film, You Nazty Spy!)

Using a computer is more scientific, but the analysis will undoubtedly cost a lot more than the $6.74 price tag for the 8-ball listed on Amazon.


DANGEROUS DEFINITIONS: A marquee over a bar on Dixie Highway in West Palm Beach reads: “Your hangover is not a pre-existing condition.”

Which brings up a very serious topic that will get lots of attention in the years to come if the Republican health care plan is signed into law. That is, what constitutes a pre-existing condition?

The point of the Affordable Care Act was to take this issue off the table. Once you put it back on the table in any way, shape or form, it becomes a slippery slope.

If someone has lung cancer, that’s obviously a pre-existing condition. But what if a patient is diagnosed — and successfully treated for — basal cell carcinoma? The risk of it spreading is low, especially if it’s caught early.

But will insurers be able to make a case that cancer of any type represents a pre-existing condition for all other types? So that if you are treated for basal cell, and later develop a different form of the disease, you won’t be covered?

These details will likely not be addressed by legislation. They may be worked out later in regulations that govern the new laws.

But in a political environment that is aggressively anti-regulation, will anyone have a watchdog role over these kinds of issues? Or will the health care market be left to run its own chaotic course?

Image credit: Zaneology via Wikimedia Commons

Predicting the future is a sticky but profitable business, as any stock trader can tell you. But people are eager for speculation, especially when things aren’t going well and there’s a lot of anxiety.

Hence the interest in the 1997 book by William Strauss and Neil Howe, The Fourth Turning. The book’s thesis — that America faces a major crisis every 80 years or so and one is now upon us — is on target for a lot of people, in particular at least some members of the Trump Administration and most notably White House Chief Strategist Stephen Bannon.

I picked it up from my library and had to be put on waiting list to get it. Normally a book becomes available in a week or two — The Fourth Turning took almost two months to cycle around to me, there were so many people waiting to read it.

It is intriguing that 20 years ago the authors wrote: “The next Fourth Turning is due to begin shortly after the new millennium, midway through the Oh-Oh decade. Around the year 2005, a sudden spark will catalyze a crisis mood. Remnants of the old social order will disintegrate.”

And: “Sometime before the year 2025, Americans will pass through a great gate in history, commensurate with the American Revolution, Civil War, and the twin emergencies of the Great Depression and World War II.

“The risk of catastrophe will be very high ….”

World_War_III_43240You could certainly argue that the economic melt-down of 2008 was the start of the crisis period. Despite assurances to the contrary, we haven’t found our way out of financial crisis, with vast under-employment (people holding down two service jobs at restaurants and bars don’t count as unemployed in government statistics), consumer credit scores in the tank and people still struggling to get past bankruptcies and foreclosures.

War seems more likely under the current administration, and it doesn’t appear that it would go down quick and dirty like some of our more recent conflicts.

The New York Times was interested enough to write “Bannon’s Worldview: Dissecting the Message of ‘The Fourth Turning'” on April 8.

Writer Jeremy Peters said the book is “central to the worldview” of Bannon, who has apparently been interested in its theories for almost a decade.

Harvard historian David Kaiser, who writes a blog every Friday called History Unfolding, wrote a piece that appeared on the Time Magazine website on Nov. 18 of last year headlined: “Donald Trump, Stephen Bannon and the Coming Crisis in American National Life.”

Kaiser was interviewed by Bannon in 2009 for his documentary film, Generation Zero, at least in part, Kaiser says, because he has embraced portions of The Fourth Turning theories.

Kaiser wrote: “Strauss and Howe’s major prediction has now obviously come true: Few would deny that the U.S. has been in a serious political crisis for some time, marked by intense partisan division, a very severe recession, war abroad and, above all, a breakdown in the ties between the country and its political establishment.”

But he was concerned, he said in the article, that Bannon “expected a new and even bigger war as part of the current crisis, and he did not seem at all fazed by the prospect.

“I did not agree, and said so. But, knowing that the history of international conflict was my own specialty, he repeatedly pressed me to say we could expect a conflict at least as big as the Second World War in the near or medium term. I refused.”

While Bannon’s influence in the White House may have slipped recently, The New York Times reports that Trump himself was “channeling their thesis” — referring to Strauss and Howe — when he said during the campaign that “The American Dream is dead.”

The idea that history is cyclical isn’t new, of course. Mark Twain said: “History doesn’t repeat itself, but it rhymes.”

However, events are more likely to unfold in new and unexpected ways with lots of twists and turns that nobody can predict.

Absent some sort of cyber-catastrophe, it seems far more likely that the future will fall into the grip of Extreme Automation — call it Hyper-Automation or Super-Automation, whatever you’d like — with enormous social and culture-changing consequences.

This is discussed in an equally intriguing 2015 book by Silicon Valley software developer Martin Ford, Rise of the Robots: Technology and the Threat of a Jobless Future.

Think of a society with everything from self-driving cars to robotic garbage pickup, lawn service, and all types of maintenance. Think of sports, business and political stories written for media outlets by artificial intelligence products.

Think of mechanized and computerized fruit and vegetable pickers, self-checkout lines at the supermarket, and web-based programs that assist you in writing wills and executing real estate deals.

What will anxious, thumb-twittling Americans do then? Maybe that’s the real Fourth Turning.

Image: Cover of World War III comic books via Wikimedia Commons

A major part of our lives slipped away Thursday when we lost our dog, Miles, who was around 14. Nobody knew for sure how old he was and Miles himself refused to say, and in fact kept the story of his previous life a deep secret.

He came to us the most well-mannered, cool and calm dog who sought everyone’s attention and was always going up to strangers in search of a handout or a good petting. That won him instant admirers.

He was born sometime around 2002 or 2003 and apparently lived in Collier County, Florida, near Naples. His exact role remained a mystery to the end. Was he a family dog or someone’s individual trusted companion? Was he a mascot for some mom and pop shop who greeted customers and put a smile on their face?

miles-nelanderThe only thing known is this: He became separated from his owners and roamed the countryside for an undetermined amount of time, scrounging up his own food or relying on the kindness of strangers to keep him going.

This is the surprising thing about Miles. As friendly and good-natured as he was, he always seemed to claw back from the brink of disaster, a survivor who could never be counted out.

When he was picked up in Collier County and taken to a shelter, he was in sorry shape, underweight and dirty and had matted fur and fleas. He’d been outside for so long that he suffered from a number of major health problems, including heartworm, which is very often a death sentence for a dog.

In fact, the public West Coast shelter had deemed him a lost cause. But someone from Animal Aid, on Florida’s East Coast, thought he had a shot and took him to the other side of the state. He cleaned up nicely, but what to do about the heartworm?

Animal Aid brought him to their Boca Raton facility. They put him in with other — much yappier — dogs his size and that’s where my wife and I found him in January of 2010. “He was the best dog I ever fostered,” said one of the volunteers who had named him Serge.

We took him to an outdoor courtyard for a short get-to-know-you session and I was skeptical, since he had so many health problems. But as I sat on a bench with him he put his head on my knee, a sales pitch that closed the deal.

We opted to give him the full heartworm treatment, which was risky, but it worked, thanks to the Animal Aid vet. He was free from the disease after a few months, although he was left with an enlarged heart and a heart murmur, which would affect him for the rest of his life.

He was a little slow-paced and never did much running. When he did run, it was a cantor or lope. Nor did he bark much. If the UPS guy came to the door, he’d look up and bark exactly once.

He became the family’s social ambassador. When we took him to the park or an outdoor festival — of which there are many in West Palm Beach — he would wander over to people’s tables and wait for attention. He almost always got it.

They would ask what kind of a dog he was. We didn’t know, and gave them an abbreviated version of his backstory.

There are services, I know, that will trace your dog’s DNA if you send them a sample and will give you a detailed rundown of his or her breeding. But we decided to leave that a mystery, a topic of speculation and debate.

Several years ago, we started bringing him to our respective offices where he would make the rounds of the desks, cubicles and private offices. He’d always manage to extract treats, especially chicken and cold cuts. Toys were not his thing. He never whined.

On days when he didn’t come in people would ask: “Where’s Miles today?”

As everyone who has ever lost a pet understands, it’s a question we’ll be asking ourselves for a very long time.


Health insurance premiums are on the rise and taking up a bigger and bigger share of Americans’ incomes. (Credit: The Henry J. Kaiser Family Foundation)

It’s astonishing that the dominant issue in this year’s presidential election is sexual misconduct when there are so many other things crying for attention, including the student loan crisis, reasonable gun laws and fair trade.

Not to mention healthcare.

The U.S. healthcare system is such a horror show, it would need a dramatic overhaul just to be considered broken.

Financial writer John Mauldin looked at the problem the U.S. finds itself in with an interesting analysis this week on his blog, Thoughts From The Frontline. It included lots of sobering facts and figures, like the fact that many Americans are spending hefty percentages of their income on insurance premiums that offer deductibles of $5,000 or more.

Deductibles have risen 10 times faster than inflation over the last six years, Mauldin notes.

The Affordable Healthcare Act has resulted in 25 million more Americans getting coverage — which is a good thing — but for those consumers who pay full freight because their incomes don’t qualify for subsidies it has become a crushing financial burden.

Many people are quick to put the blame on “Obamacare” but as Mauldin points out: “The problems I am describing would have happened with or without Obamacare.”

One of the reasons is the world’s aging population makes it a lock that healthcare costs are going to increase dramatically over the next 10 years.

We can only hope that there will be productive debate after the election dust settles and the White House and Congress can come to some agreements on healthcare fixes — assuming the government is functional after such a raucous and contentious campaign.

One idea under consideration — at least by some Democrats — is a public option, which would force private insurers to come up with more innovative products in order to compete in the market.

Ideas are needed and solicited. If you really want to go outside the box, why not consider fundamental changes to licensing healthcare providers? A class of provider could be developed similar to physician assistants, but one that would allow them to set up a private practice.

Further, let’s say providers who get this training have their college tuition covered by Uncle Sam if they agree to provide services in the public sector for five years.

It’s a matter of supply and demand: more healthcare providers lead to lower-cost options through increased competition.

What you end up with is a mix of market-based solutions along with government supported change. And anyone can keep the healthcare they have if they choose.

Whatever happens, creative solutions are required and perhaps our newly elected officials will get serious once the election — with its assorted sex scandals — is in our rear view mirror.

Theories have sprouted up over the last few years contending that humans may be capable of living to ripe old age of 200.

People might live so long that instead of having 55-plus communities, they’ll have to have 150-plus communities as well, a sort of two-tiered retirement living option.

Under this scenario, you wouldn’t technically reach middle-age until around 100 or so.

Except that this isn’t going to happen, according to a new study released by the Albert Einstein College of Medicine. Researchers said humans are likely already closing in on their natural lifespan limit, which is around 115.

Sure, there could be a few outliers, known as supercentenarians. In France, a woman named Jeanne Calment lived to 122, the maximum documented lifespan in history.

Calment always looked much younger than she was even though she smoked cigarettes until age 117 and enjoyed wine. Her example offered hope that, as the BBC put it in a story last year, “Ageing is not an inevitable fact of life.”


A bowhead whale can live to 210 … so why can’t humans? (Credit: Wikimedia Commons)

Scientists in the article were inspired by the bowhead whale, which has a lifespan of 150 years “and perhaps as long as 210.” They are studying the animal to unlock its secrets.

But the Einstein College researchers looked at the pace of statistical gains in lifespan over the last century. In 1900, the average American lived to 47. A baby born today can expect to live until age 79.

However, they found that gains in longevity started to decline rapidly after the age of 100 — regardless of the year a person was born.

“This finding indicates diminishing gains in reducing late-life mortality and a possible limit to human lifespan,” said Jan Vijg, professor and chair of genetics at the college.

Vijg and colleagues found that age at death increased for supercentarians between the 1970s and early 1990s, reaching a plateau in 1995.

“Further progress against infectious and chronic diseases may continue boosting average life expectancy, but not maximum lifespan,” said Vijg. “While it’s conceivable that therapeutic breakthroughs might extend human longevity beyond the limits we’ve calculated, such advances would need to overwhelm the many genetic variants that appear to collectively determine the human lifespan.

“Perhaps resources now being spent to increase lifespan should instead go to lengthening health span—the duration of old age spent in good health.”

Their research was published in the journal, Nature.

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