Obama Health Care

As I jetted the streets of Chicago in a perverse attempt to find a liquor store that still carried Mad Dog 20/20, I reflected on how odd timing could be.  Not thirty minutes ago I was a doctoral student sitting in lecture at a prestigious, private university and now I was actively seeking a substance whose sole purpose was the destruction of the brain I was just developing.  Truthfully, this was the first time I was ever looking to buy some Mad Dog; though I do remember it floating around throughout my college years.  So, when I jumped in my car I never thought that this search would be so difficult; I just assumed I could get it anywhere.  But, as I continued to swerve my little Saturn from liquor store to liquor store, I kept receiving the same twisted dirty look from the staff when I asked where they kept their Mad Dog. 

After about an hour of scouring the city streets I hit pay dirt.  The clerk had to go all the way to the back of the store, move some boxes out of the way and dig out my prize.  When I went to the register the second clerk asked to see my I.D.  As I reached for my wallet the first interjected quickly and said, “Now, we don’t need to see his I.D.  I trust him.”  With that he shot me a sly wink and bagged up my three bottles.  He must have thought he was doing some underage kid a favor.  I wanted to scream that I was really over 21 (by quite a many years) and decree the real reason I was purchasing this vile liquor.  But I hesitated and thought, maybe it just makes more sense to him that a youngin’ was buying such an inexpensive, atrocious alcohol.  After all, what respectable doctoral student would?

At this point you may think this article to be about the trappings of a young alcoholic.  Now, while working toward a Ph.D. may drive me into the bottle, I’m not quite there just yet.  In all actuality, I was preparing for a party I hosted on November 2, 2004.  The invitation read as follows:

All people and political parties are welcome to Election Night 2004!!! But, there is an agenda for the evening.  If:
1. John Kerry wins, I will have champagne for all.
2. If Dubya wins, everyone will be required to drink 1 glass of Mad Dog 20/20.
3. If Nader wins, I will personally buy an all-inclusive round-trip package to Hawaii for everyone who comes to the party.
4. If, somehow, the Democrats win the election but the Republicans steal it AGAIN then we all will pile into our cars and make a break for Canada!
Hope you can make it!!!

As I’m sure you can assume, the champagne was decidedly easier and much more expensive to obtain for the festivities.  Also, I didn’t exactly have American Airlines on hold with 20 round trip tickets to Hawaii in anticipation of the greatest political upset in the last 100 years. 

As a reluctant Democrat, I spent the weeks preceding the election debating with my academic colleagues about who was going to win.  With all the higher education Republicans being called into an undisclosed F.B.I. conservative protection program, these discussions were largely one-sided.  The tenor is best characterized as having a measured optimism.  Kerry was obviously intelligent; the fact that he “flip-flopped” on issues only proved he could in fact change his mind if given new evidence.  And, of course, how could the character of a decorated Vietnam veteran ever be tarnished? 

These discussions also provided ample opportunity for Bush-Bashing; I admit that I participated in these sessions with zeal!  Now, our President Bush has never been seen as a flip-flopper.  You either clearly knew his stance on an issue or you clearly knew he had no intention of taking any stance at all.  I think Chris Rock summed it up best:

Reporter:          Mr. President, What about the economy?  When’s it going to pick up?

Bush:                Well, you never know.  We’re talking to people. And economic indicators are indicating that indications are coming to the indicators. You know what I’m saying?  Alright.

Reporter:          Mr. President, what about gay marriage?

Bush:                F— them faggots!

November 2, 2004 finally rolled around.  I was incredibly thankful that my near round the clock vigil of all the major media outlets would soon end; I hadn’t watched this much news coverage since the days following 9/11.  At any rate, I ducked out of work, drove to my polling station and cast my ballot.  Even up until the second I punched out my chad I was conflicted, but ultimately chose to follow my mind rather than my heart.   I make this distinction because if I had voted for who my heart wanted, Nader would have been a single vote greater in Illinois.  But, I bought into the hype that this election was just too important.  As I said before, I am a reluctant Democrat.

The party that evening went well on its way and we watched the events unfold.  Of course nothing surprising initially happened; states were falling where we all new they would.  The northeast lit up blue, the south burned red.  Like clockwork, within 5 seconds of the polls closing in Illinois it was awarded to the Democrats.  I always take it as a matter of pride that my home state is the first blue beacon out to the west. 

My partygoers continued to munch through all the hors d’oeuvres and make small talk since it would be at least a couple hours wait until we started receiving a few of the “toss-up” state election results.  And then it came – Kerry was projected to win Pennsylvania.  Not wanting to fall prey to another Florida fiasco, we quickly checked out all the news outlets for confirmation.  All except Fox News (surprise, surprise) had the same wonderful blue color enveloping Pennsylvania; at that point a Kerry win felt much more tangible.  The South cards all fell for Bush, as expected.  Our numbers looked horrible, but we knew we could add on California’s 55 electoral votes to put us at ease.  Until this point in the evening I was guarded in my optimism, but now I started to allow myself to believe.  Maybe we wouldn’t have four more years of Bush. 

The night rolled on and Florida fell as I expected but along came Michigan, Wisconsin and Minnesota in the win column for us.  My eyes began to bore holes into Ohio on the TV map.  I don’t think I moved from my position for sometime as I sat hoping for an answer.

I have never claimed to be a mathematician at any point in my life.  Truth be told, in my first-year of college I was required to take a no-credit, remedial Algebra course.  Nonetheless, on election night I found myself doing incredible calculations effortlessly in my head as I watched the returns come in from Ohio.  It was still too close to call but Kerry was trailing.  None of that mattered, each time I calculated the number of votes we needed I rationalized ways we were going to get them.  After all, Democrats are lazy aren’t they?  I had bet they were lounging around their houses all day, continually putting off going to the polls.  I just knew they were watching T.V. like I was and suddenly realized “Oh damn!  Look at those poll numbers.  We had better go vote!” 

Plus, we were heavily relying on the college vote.  Having worked in colleges for many years now I’ve seen first hand just how adept students are at procrastinating.  They probably were piling out of their residence halls right now and slowly trampsing over to the polls.  Yeah, that must be it.  I pinned my hopes of the election on the fact that lazy Democrats and procrastinating college students from Ohio were going to save the day. 

With fear starting to creep in, some of my companions began speculating about what four more years of Bush really meant.  The realization that we were going to lose continued to seep its way more and more into our psyche.  Needless to say, neither the champagne nor Mad Dog was drunk that evening.  And, my smart-aleck friend who brought with him a packed bag in hopes of a free Hawaiian vacation somberly went home.  The night ended on the familiar note of a build up minus a pay off reminiscent of 2000.  I struggled to stay awake into the night, but eventually fell asleep in my living room with the TV on.

Let me pause for one quick side bar.  If elections are going to keep ending like a Hollywood cliffhanger, can we all decide to move them to Friday?  On the Wednesdays following these sleepless nights I get absolutely nothing done between the frequent dosing off and even more frequent refreshing of every media outlet I have opened up on my desktop.  Days like this I am addicted to these websites even though I can get a better idea about what will be on next week’s “24” than I can about an election that already happened!

The early morning hours came without any news.  I turned on the coffee pot, no news.  I toasted my bagel, no news.  I showered while occasionally craning my neck out of the bathroom to see the TV, no news.  I was starting to get irritated.

Then came the Kerry concession speech; I knew it was coming, but just didn’t want to believe it.  I wish I could say that he left me with some solace or hope in the future.  I wish I felt united behind President Bush as the justified winner.  But honestly, I cannot remember one word the man said during this speech.  All I remember is thinking that maybe it was a good thing he didn’t get elected.  I mean, for God’s sake, no President of the United States should ever be seen wearing a tie resembling something donated by the makers of Pepto-Bismol!  Come on, you have to agree with me there! 

Of course, this was just my humor consoling the incredible loss I felt in this moment.  How could my calculations have been so off?  Did the unreliable college students of Ohio sell our collective souls down the river because of a good drink special on campus?  The parade of Bush parties all over the nation began to spring up and glow on my television screen.  Bush was then able to give the triumphant reelection speech his father never could.  As Bush supporters throughout the country were chanting enthusiastically “Four More Years” I sat down, put my head in my hands and muttered in a barely recognizable, guttural, pained effort of speech, “four…more…years.”

This article is not about what happened to the Democrats in losing this election.  I merely tell my story of the election to one, set the stage for what we see in liberal America today and two, as a method of cathartic release for the emotions I still have bottled up.  Looking back a year later, I can’t bring myself to hold Kerry solely responsible for this loss even though it seemed like a proverbial slam-dunk.  What concerns me more is the attitude and rhetoric my fellow liberals have employed in the months since November.  A year later I stand aghast at the senseless ramblings of individuals I thought to be patriots of this country.  I believe in many of their virtues and ideals and thought I was standing shoulder to shoulder with them in a fight for what we believed in. 

Unfortunately, many of my liberal co-patriots have gone off the bitter deep end.  It is sad to witness the disgust, bordering on hate, many have expressed for those who dared cast their ballots for Bush.  I even heard remarks after the Hurricane Katrina catastrophe that “those people down South” should blame themselves for President Bush’s slow response in their time of need.  After all, they are the ones who voted for him.  I find such a sentiment revolting.  These are the people we hope to serve and yet we have shown so little respect for them in the wake of this election.  If they do not “get” that we can serve them better than the Republican right, who’s fault is that?

In my junior year in high school, my entire class was unexpectedly called down to our large auditorium.   Not knowing why we were being beckoned, we hastened downstairs knowing the reason could not be good news.  A month or so prior we had all taken the Pre-ACT and evidentially our results had just been received. 

My high school was supposed to be a rigorous college prep program and our combined Math scores were far below the national average.  This is of course a foreshadowing to the future problems I would have in college requiring remedial coursework.  In any case, the school administration had called us down to one, inform us of this fact and two, berate us for so horribly embarrassing the school by our poor performance.  The principal spoke at us.  The dean of students spoke at us.  After about 10-15 more minutes of our own teachers criticizing our work ethic and performance to date I shot my hand into the air.  I just couldn’t take it anymore. 

When I was finally called on I could actually hear the hundreds of heads sweep back in my direction to see what I dared to say.  While what I said next was most definitely rooted in a rebellious, adolescent, smart-aleck rebuke to the administration, it was nonetheless a moment of truth and relatable to our current political situation.  I said, “Now, if I do poorly on a test, then that is my fault.  But, if ALL 400 of us do poorly on a nationally administered test, isn’t that YOUR fault?” as I pointed my finger in the direction of the faculty. 

As I am sure you can imagine, I got into an incredible amount of trouble for my outburst; but that does not mean that I was wrong!  If Red-Staters who have lost their jobs, are having their daughters and sons die in the Middle East and are suffering through a horrendous federal response to a natural disaster are still voting for the man and political party responsible for their plight, how can we place blame for the election at their doorstep?  We evidentially did an outright horrible job at teaching and explaining how we want to work on behalf of these honest, hard-working people occupying the land between Los Angeles and New York City.  We did not show them how we have their true interest at heart and not just interests of the richest 1%.  It isn’t their fault and there is nothing fundamentally wrong with them.  The problem lies within our nation of real-life, working liberals.

I absolutely refuse to align myself with rhetoric of dejection, mistrust, and constant bemoaning of how we have been cheated.  I have some news for all my fellow liberals out there…WE WEREN’T CHEATED!  But, even if we were cheated, we cheated ourselves.  I can’t believe that some of the most highly educated and respectable people in our nation are such incredibly sore losers.  We aren’t on the playground anymore folks and there will be another day for another election.  I have no confidence in President Bush either, but I do have confidence in us as a people.  Besides, if Kerry was elected, we have to be honest, we were only hoping for a slightly less screwed up world than we already have.  A messiah sent to heal the wounds in our country he was not.

We liberals here on the ground floor, living real lives, will not have success just happen to us.  We have to create our own fortune.  The Democrats may be the best we have and, unfortunately for us, the only thing they have successfully created is an ocean of failure.  Just take a quick look at the results for the past 10 elections:

                        1968 – Richard M. Nixon (R)

                        1972 – Richard M. Nixon/Gerald R. Ford (R)

                        1976 – James E. Carter (D)

                        1980 – Ronald W. Reagan (R)

                        1984 – Ronald W. Reagan (R)

                        1988 – George H. W. Bush (R)

                        1992 – William J. Clinton (D)

                        1996 – William J. Clinton (D)

                        2000 – George W. Bush (R)

                        2004 – George W. Bush (R)

Are you able to see the problem?  We have elected 2 Democrats to our nations highest office in the past 36 years and one of those was JIMMY CARTER!  There are problems that pre-date the “Dubya” era of our history.  We have to take a critical look into how this history and the Democratic Party has affected the nation of liberals of which I am proud to be a part.  Proud yes, but not satisfied.  We can be better than we have shown ourselves to be this past year.

One, we are not going to win allies by calling people stupid.  It is just that simple.  Liberals are quick to chastise President Bush for pushing around the world like he is Clint Eastwood in some Western.  He is not well liked around the world because he is a bully and thinks he knows what is right; let’s not make the same mistake.  Let’s not assume we naturally know what a family living in Stillwater, Oklahoma wants or needs.  We may share in a collective American culture, but our individual experiences are far removed from one another.

Two, we are not going to win allies by looking down our noses at people.  Do you remember the stuck up professors you had in college who thought they were God’s gift to the world?  Did you like them?  Of course not!  Pretentious academics end their life in the solitude believing that they were always better than everyone else.  Notice closely that I said their story ends in solitude.  An important point here is that solitude doesn’t carry much voting power.

Three, we are not going to win allies by telling people how easy it would be to improve their situation.  First off, I have rarely met a person whose situation was easy to begin with.  Everyone has a story about the hardest thing they have ever had to deal with in their lives.  To them it was difficult and, even if another’s experience was different, no one has the right to pass a value judgment.  Everyone’s story deserves respect.

Many Red-Staters like their “situation” and don’t need people filling their head with the idea that there is something wrong with them.  We have fought and are still fighting hard battles for equal opportunity.  This means all people have the equal opportunity to lead any kind of life they want.  I too get annoyed when NASCAR clogs up my nightly ESPN time, but being a fan of NASCAR does not infer that you also possess a lower I.Q.  Again, I say we have constantly fought for the choice.  Why would we begrudge anyone that? 

We should learn from and show respect to the Republican Party and Red-Staters.  They are ardent Americans and a large section of the population we hope to serve.  Furthermore, when the Republicans took a presidential back seat in the 1990s, never once did I hear that they wanted to flee to Canada as I heard loudly exclaimed from many liberals this past year.  I point the finger right back myself in this instance in reference to my Election Night invitation.  How more un-American and juvenile can a person sound by saying that since I didn’t get my way I’m taking my ball and going home.  If the Left is going to flee the country because the current King of the Right is still in office, I have to respect Republicans even more for deciding to continue the fight and not just BLOW town when Clinton held the same JOB.  Remember, the Right was exactly too ecstatic when we had our president in the 90s. 

Special Note: For those of you who want to move to Canada over election results my first instinctual response is to help you pack.  We don’t need you here; you’re nothing but a pessimistic weight holding us down.  But, if you really are willing to move over this, then could you at least take one for the team and move to Ohio?  We need some more blue voters there.

The point is that I have not seen my peers leading with respect this past year and I call upon them to do so.  I don’t care about the politicians; they are going to do what they are going to do.  I say again that I am talking to the real world, working liberals where the true charge for change falls.  We are better than this and only by being better are we going to reclaim positions of power in politics.  It is 3 more years until the next election and I am guessing it is at least 8-12 more years before Barrack Obama can run.  We need answers and leaders today.  Get your game face on liberals!

Art Munin
http://www.articlesbase.com/law-articles/election-night-2004-the-liberal-report-a-year-later-3858.html

The new world of consumer-driven healthcare is opening up many opportunities for people to save money on their medical expenses. As more people carry high deductible plans in conjunction with health savings accounts, medical providers are beginning to compete for that business in a variety of innovative ways. One way many people are saving money on doctor visits is through telephone consultations.

Many times an expensive doctor visit could be avoided if you could just talk to the doctor to discuss the situation over the phone. If you could do a quick email exchange and have a prescription waiting for you at the pharmacy, you could save time and money, and let the funds in your Health Savings Account continue to grow for your retirement. There are now online physician consultation services that allow you to do just that.

While an ER visit may indeed treat medical needs, the reality is that most visits end up being more about peace of mind. If your child’s skin is turning red in the middle of the night, you might not know if it’s harmless flushing, or a serious allergic reaction. So you rush off to the emergency room, fill out some forms, and sit in a room full of contagious people. You wait and wait, finally get to speak to a nurse, then wait some more, and explain your problem again to the resident. Then you may have a battery of tests done, wait some more, and finally leave with a prescription and a bill for $650.

All this for a problem that could have been far less expensive, and handled more simply and expediently by discussing the situation with your doctor. According to the American Medical Association, about 70% of doctor and emergency room visits are actually just informational.

However, asking your doctor a health question is rarely as easy as picking up the phone. Because insurance companies do not normally reimburse doctors for phone care, most traditional practices avoid offering such service. Instead, their objective is to get you into the office so that you can be billed for the service you receive.

Paying for that office and the surrounding bureaucracy is not cheap. A doctor’s costs may include the office itself, a receptionists, a triage nurse, someone handling insurance billing, office managers, and expensive medical equipment. All this is very expensive to maintain, so generating as many office visits as possible is critical for most doctors to even stay in business.

So you get stuck in a system that is inconvenient, expensive, and does not value your time.

Telephone Consultation Services

As health savings accounts become more popular and more people are paying for their own doctor visits, several companies have begun offering inexpensive telephone and email consultations with board-certified physicians. These companies can offer dramatically lower prices because they have cut out most of the costs that burden traditional medical facilities.

Though telephone consultations are obviously not appropriate for all medical conditions, it is an accepted standard of care for many health-care problems. In fact, telephone medicine has been around as long as the telephone, and is practiced throughout the country by most doctors at nights and on weekends.

Here are a few companies that are now offering telephone consultations with licensed physicians:

Doctor on Call (www.unadoctoroncall.com). This company currently has over 240 board-certified physicians on call, with 24-hour access. The physicians with this service will not diagnose or prescribe, but they will provide information based on your questions. The price is a bargain – only $5.95/month for the family for an unlimited number of calls.

TelaDoc Medical Services (www.teladoc.com). This company also provides 24-hour access to members and dependents age 12+. Telephone medical consultations are with primary care doctors who can also diagnose medical problems and prescribe appropriate medications. There is an initial $18 registration fee, and a monthly fee of $4.25 for an individual or $7 for a family. Consultations are a flat $35.

Doctokr (www.doctokr.com) is a practice run by Virginia physician Alan Dappen. Though this service is only available to people who can come in to his office for an initial visit, it is a model likely to be copied by other providers as consumers become more price conscious when shopping for medical care. 24-hour access is available by telephone and email. Consultations are billed in 5-minute increments ranging in price from $15 to $22.50. A simple consultation to request medication refills costs from $10 to $15 for up to 5 medications. There is a monthly fee of $5.95.

Saving You Time and Money

Not only will these services save you money when compared to a typical doctor visit, but they will also save you time. You may be able to quickly resolve routine medical issues in a fraction of the time you would spend accessing care from urgent care facilities, emergency rooms or physician offices. If you use a service that will prescribe medications, you could have your consultation finished and the medicine in hand in less than the time it would otherwise take just to visit the doctor.

As telephone technology evolves, these services will add picture taking and even recording vital signs, and the scope of these physician consultations will become broader. With doctor visits approaching $100 each and ER visits in excess of $800, it doesn’t take much to justify the small monthly fee for most of these services.

Though there are certainly times when visiting your doctor’s office or the emergency room is the most appropriate thing to do, as a smart HSA consumer, you owe it to yourself to be aware of all your options. Using a physician telephone consultation service can help you avoid the expense, time, and hassles of urgent care facilities, emergency rooms, and visits to the doctor.

Wiley Long
http://www.articlesbase.com/medicine-articles/health-savings-accounts-are-creating-innovative-medical-services-106043.html

Information Technology managers lucky enough to have developers at their disposal sometimes face the decision of whether to buy a software product off-the-shelf, or to have their engineers create the needed functionality.  This classic, “buy versus build” decision can cause more consternation than one might imagine because making the wrong decision can be costly or even disastrous. 

For some products, the decision is obvious: few IT managers proposing to write their own core accounting or payroll system would be taken seriously.  On the other hand, if the needed functionality is so unique to company requirements that it can’t possibly exist as a commercial product, then building from the ground up is the only option, but there may be quite a few gray areas.  As the CEO of a software company whose flagship product is an emerging technology, I can offer a unique perspective here: IT managers often misunderstand the depth and breadth of a new technology (like new employee onboarding) and embark upon a build-our-own project that is doomed from the start. 

One of our customers had pursued a project to build their own paperless onboarding system for new employees, and when we met them, they characterized their project as 80% complete.  After just a few meetings they realized they were—at best—only 20% complete and wound up buying our onboarding product.  Valuable time and resources were lost as they pursued a development project.

How did we convince that client to switch from build to buy?  We simply took them through a more thorough analysis of the buy versus build (or is it build versus buy?) decision.  The process is simply to evaluate the following seven considerations regarding buy vs. build.

1. What is the availability of resources and how fast is the functionality needed?

Even if the only choice is to develop your own solution because a suitable product doesn’t exist, or can’t possibly exist, building a product might not be an option if resources are in short supply.  Programmers are a scarce resource, even during a slow economy (and expensive, though I’ll cover that below).  Considering the build option requires an examination of your programmers’ outstanding projects, prioritizing the new build project among the existing project backlog, and comparing the estimated delivery date with the date the functionality is required.  If there are plenty of resources available, it’s obvious that even low priority build projects might be tackled sooner.  If resources are short and the project backlog is long, only the highest priority projects will (and should) get quick attention.  If the functionality is needed (or desired because of the potential return on investment—ROI) more rapidly, then buying is the best option.

2. Is subject matter expertise needed?

A principle reason to buy an off-the-shelf application is that it encapsulates some sort of subject matter expertise, or what I like to characterize as “depth”.  For example, a payroll system is a pretty “deep” system in that it encapsulates a great deal of subject matter expertise; a timekeeping system, on the other hand, is considerably more “shallow.”  The depth of expertise explains why there are far fewer payroll systems than there are timekeeping systems; products with deep subject matter expertise are more difficult to develop so there will be fewer of them.  For your project, you must thoroughly evaluate the depth of subject matter expertise.  Projects in regulated functions and long-term strategic functions, such as human resources and corporate governance, almost always require deep subject matter expertise and are better suited with the buy option.  Projects in unregulated functions or projects that are short-term in nature—such as sales and marketing and certain aspects of operations—may prove to be shallower in their need for subject matter expertise and are likely better suited for building.

3. Is company-specific functionality important?

Some desired functionality may be so specific to your company that buying an off-the-shelf product isn’t possible.  This situation is most likely to exist in those areas of the business that aren’t regulated or that are particularly unique to your business.  For example, finance, human resources, and corporate governance are all regulated functions (GAAP, SOX, tax and HR law, etc.), but processes that are truly unique—like operations derived from company patents and intellectual property—are only going to be implemented through building a solution.  Similar to topic number 2 regarding depth of subject matter expertise, this is more like “sequestered” subject matter expertise: regardless of how deep or shallow the expertise is, if it doesn’t exist in the wild, you’ll have to build it.

4. Are there product lifecycle issues to consider?

Some products might be constructed, deployed, and never touched again.  This is most likely to be true if the product’s life span is expected to be short.  Other products might need constant tweaking and maintenance for indefinite periods of time; these products are likely associated with outside influences like regulation.  For example, employment law (being the government domain)is highly susceptible to change, and new regulations will appear (unfortunately, old regulations never seem to go away).  If a long or permanent product lifecycle is anticipated or if the product is associated with regulatory compliance, buying is preferable to building.  Don’t get caught in the temporary project trap, though; temporary projects have a propensity for turning into permanent deployments.

5. Which is cheaper: buying or building?

Answering this question is always challenging.  The costs of buying are pretty clear cut and relatively predictable: licenses or SaaS startup costs, implementation service costs, ongoing maintenance or usage fees.  Building projects require accurate estimation of the project length and its costs, labor and benefits (programmers are relatively expensive), general and administrative costs, as well as the costs—sometimes allocated—of the infrastructure needed to support the system.  While the trick to evaluating the cost of buy versus build comes down to figuring out the long term maintenance costs of a home-grown solution, there’s no clear cut rule of thumb.  One obvious benefit is that the costs of buying a solution should be more predictable than building: use this to your advantage if pursuing the buy option by pressing for fixed prices or not-to-exceed prices for implementation service costs, or consider taking on much of the implementation yourselves (but be aware that the provider of the product will almost certainly have have a better understanding of their own product and therefore should be more efficient at its implementation).

6. How “standards-sensitive” is the product?

If the product is sensitive to an industry or business standard, even if the standard has nothing to do with regulatory requirements or depth of subject matter expertise, then buying will be advisable over building.  For example, there are generally accepted practices and processes for project management; even if you don’t need to hire a professional project manager today, you might in the future.  An off-the-shelf product will usually better and more fully represent the standard and therefore would be preferable to building.

7. Are there unique business dynamics to consider?

There might be unusual business dynamics at play that influence the decision, such as transfer of license issues.  Some commercial software end user license agreements, or “EULAs,” may prohibit the transfer of the license, preventing the company from moving the license to an assignee, say in the event that a division is sold or the company goes through any kind of M&A activity.  Similarly, an evaluation of assets may be able to regard commercial software licenses as quantifiable assets, which may prove difficult for software products that were built.  There may also be privacy or security issues, such as dealing with healthcare data or employee benefits information, which, for liability reasons, may be better served by an off-the-shelf product; on the other hand, the company may have highly proprietary and guarded data (think Coca-Cola formula) that they would prefer not to embed in a commercial application that is maintained by an outside vendor.

The buy versus build decision is a classic technology management decision.  Armed with the ”7 Considerations of Buy Vs. Build”, start in a room with plenty of white boards and draw seven “T’s” with buy on one side and build on the other.  List the pros and cons of each and thoroughly weigh each benefit.  Make the most informed decision possible because making the wrong decision can prove to be incredibly costly.

Chuck Ros
http://www.articlesbase.com/management-articles/7-buy-vs-build-considerations-for-it-managers-518002.html

Decision to enter the labour market for single mothers is linked with the issue of taking care of their young children. Child care costs will continue to be an important factor determining welfare participation in the welfare reform environment because of the low expected earnings of low-skilled workers and the high percentage of earned income that must be devoted to purchase reliable quality care. In addition to facilitating mothers’ employment and thus reducing poverty and the need for income supplements, quality child care is also an important social concern in and of itself, given the strong link between quality child care and positive child outcomes, particularly for at-risk children.

In this paper, we analyze the effectiveness of child care assistance policies indirectly by considering explicitly the effect of the cost of child care on welfare recipiency. We find that, over a set of alternative specifications, welfare recipiency and employment of single mothers are sensitive to the predicted hourly price of child care.

1. Brief Review of Existing Evidence

There are three main sources of information related to our research question on the effect of the price of child care on employment and welfare recipiency. The first source is econometric works on the effect of child care costs on employment. Second is a set of papers focused on the welfare side of the coin. Finally, there is some evidence from evaluations of welfare -to-work demonstration projects of the importance of child care costs to employment and welfare recipiency.

In terms of the econometric work on the effect of child care costs on employment, that body of work has been well summarized elsewhere (Berger&Black 1992; Blau&Alison 1998). Almost all the studies on employment find a significant negative effect of child care costs on women’s employment, although the estimated child care price elasticity with respect to employment varies widely across studies. Most relevant to our current topic are three papers—Berger and Black (1992), Blau and Alison (1998), and Bowen and Neehan (1993)–each of which uses data to look at differences across marital status. Each of these papers finds evidence that the elasticity of single mother’s employment with respect to child care costs is greater in absolute value than married mother’s employment elasticity.

Blanck (1985, 1989) review the relationships between welfare recipiency and childcare costs and suggested that a 50% child care subsidy would increase the labor force participation of single parents by 2.9 percentage points and that a 20% reduction in the AFDC guaranteed payment would increase the labor force participation of single parents by 1.6% and reduce their welfare transfer program participation by 1.2 percentage points.

Evidence of a positive relationship between child care costs and welfare recipiency can also be found in a number of evaluation studies of welfare -to-work demonstration projects, though the results are not uniform. Graham and Beller (1989) reviewed evidence from several major welfare -to-work demonstration projects that included child care components. They wrote, “Although the confluence of services, mandates, and incentives in these demonstrations suggests caution is required in interpreting their results, based on this evidence it seems reasonable to conclude that subsidized child care may have a modest effect, at best, in increasing employment levels of very low-skilled, single mothers with small children” (Graham and Beller, 1989, p.665). However, as the authors point out, none of these demonstrations explicitly examined the importance of child care costs within an experimental framework, so any conclusions relating to the importance of child care costs are tentative at best.

The Minnesota Family Investment Program (MFIP), which was included in Joesch review (1991), deserves extra scrutiny. This program was an innovative program based on the dual (and often competing) goals of encouraging work and making work pay. It contained two key work incentive provisions, the second of which related to child care. The MFIP paid child care costs directly to providers for all parents working or participating in employment-related activities. The AFDC reimbursement scheme differed because the parents paid the providers directly and were reimbursed later. The practice of reimbursing the mother after the expenditure occurred may have hindered the mother’s efforts to get and stay employed. Also, the AFDC reimbursement rules tend to discourage providers from accepting such subsidized clients because of the uncertainty of receiving payment. The report finds significant impacts in numerous areas, including employment rates and earnings of the MFIP approach.

Finally, Waldfogel (2001) analyzed Massachusetts state data on current and former TANF recipients who also receive child care vouchers. He found that increased funding for child care subsidies and availability of full-day kindergarten are associated with increased probabilities that current and former welfare recipients will work.

In sum, a thorough review of the broad literature relevant for this paper reveals a uniformity in the direction and significance of the child care price effect but a rather broad range of empirical estimates concerning the importance of child care costs on employment probabilities of single mothers.

2. Single mothers’ choices in welfare recipiency

One of the most important aspects of the market for child care is that individuals face widely different costs for similar services depending on the availability of low- or no-cost child care options. We begin with analysis of individual decision making that represents the discrete choices about welfare recipiency and employment of mothers with young children. In our case, we assume that mothers of young children seek to maximize their utility over goods and child services, subject to four constraints: a money budget constraint combining the mother’s labor income and nonlabor income, a production function for child services, a mother’s time constraint, and a child’s time constraint. Child services are the commodity parents are consuming from their children; it could be companionship or love or pride in one’s progeny. They are produced with a combination of the mother’s time at home, the child’s time with other caregivers, and money inputs. Total nonlabor income is the sum of family income from sources other than the mother’s labor market participation and means-tied transfer income, such as welfare payments. Mothers have three uses of their time: work in the labor market, time spent with children, and leisure. The child has two types of time: time with the mother and time with a nonmaternal caregiver.

From these assumptions, we derive that single mothers decide whether to be employed or not taking into account two or four different values corresponding to the different possible work and welfare outcomes. Increased expenditures on child care lower a woman’s effective wage in the labor market when she is not receiving AFDC. Also included among these factors will be her predicted wage, nonlabor family income, dichotomous factors indicating that the mother is nonwhite or unhealthy or lives in an urban area or in the South, factors affecting the value of a woman’s time at home (specifically, two factors indicating whether the youngest child is age zero to two years and whether there are two or more preschoolers in the family), the state’s average Medicaid expenditures per enrollee, the state’s average monthly AFDC payment, and the state’s unemployment rate.

Because of kinks in the budget line caused by AFDC regulations, as well as possible discontinuities in hours of employment and child care availability, it is reasonable to suspect that decisions about AFDC recipiency are made jointly with decisions to work for pay.

3. Demographics, Employment, and Child Care

According to Berger and Black (1992), employed single mothers are 28.5 years of age, on average, and have 12.5 years of education. Only 26% live in poverty, but two-thirds have income less than twice the poverty threshold. Approximately one-fourth work part time, and 53% report paying for child care. The oldest single mothers are those who are employed and paying for child care, and this subgroup also reports the highest education levels, with 12.6 years of education. Focusing further on the issue of paying for child care, those single mothers employed and paying for care are a bit less likely to be nonwhite and less likely to live in poverty or receive welfare than all employed single mothers. Additionally, they are less likely to work part time, and they earn higher average hourly wages ($8.96 vs. $8.25 an hour).

4. Employment and Welfare Status

According to Berger and Black (1992), the working single mothers not reporting welfare recipiency are the oldest and have the most education and the lowest poverty rates. Their higher nonlabor income may indicate that they are more likely to be receiving child support payments. The other group with relatively higher nonlabor income is the group not employed and not on welfare. Some of these women are also receiving child support, but there is substantial variation among themselves, as the high poverty rate indicates. Others may be queued for welfare, waiting for their savings to be depleted.

The nonwelfare group is far less likely to be employed part time and receives a considerably higher average hourly wage. In addition, while the welfare recipient group is less likely to pay for care (36% vs. 56%), the recipient group pays a higher hourly price for child care. This may reflect the higher cost of part-time child care or the receipt of child care subsidies.

5. Child Care Mode Choice and Weekly Expenditures by Mode of Care for Employed Single Mothers

According to Bowen and Neehan (1993), single mothers receiving welfare are more likely to rely on relative care and less likely to rely on center-based care. But recall that they are also more likely to work part time, an employment state more often associated with this pattern of modal choice. In addition, the welfare recipients are less likely to pay for relative care and less likely to pay for center-based care. Neither subgroups are very likely to pay for relative care. The welfare recipient subgroup’s average weekly payment for center-based care is considerably higher than for those not receiving welfare. For all single mothers, center-based care is the most expensive, followed by home-based care and relative care.

Child care costs present a problem for the researchers in that they are often unknown unless the mother is engaged in market work. This situation is similar to the problem of wages that are unobserved if the person is not employed. In addition to the problem of limited observation of the relevant variable, child care is complicated by the fact that many families do not pay the “market price” for child care. Nonprofit centers are often subsidized in the form of free rent and require no return on investment capital. Relatives and friends may be willing to provide child care at a reduced price or at no charge either because they receive in-kind payments or because they enjoy caring for the child.

How one approaches this problem depends in part on the information available and in part on the question one is trying to answer. Because the focus here is on the mother’s decision, only the portion of the cost she pays is relevant. Since we are interested in the effect of child care costs on welfare recipiency and employment, we analyze the cost of child care per hour of employment, not the cost per hour of child care used. This is the relevant decision choice for mothers of young children who are evaluating the costs and benefits of entering the labor market, with one alternative being receiving welfare.

As it was previously mentioned, differences among families in their access to low- or no-cost care is a very pertinent issue for our problem. Using the average local market price of child care alone ignores substantial differences among families in access to below-market child care. The problem is that there is not really an exogenously given price of child care that is relevant to all consumers in the marketplace. Instead, because of differences in family circumstances and location of residence, each individual faces her own price per hour of child care. Nonwhite mothers, mothers who reside in urban areas, and mothers reporting poor health are more likely to receive AFDC. The state’s average AFDC payment per enrollee is related positively to AFDC recipiency, but the average Medicaid expenditure per enrollee is related negatively (Graham and Beller, 1989, p.668).

6. The effect of predicted child care expenditures on the probability of AFDC recipiency

According to findings of Berger and Black (1992), that effect of predicted child care recipiency is positive and significant. Those with higher nonlabor incomes are also less likely to receive welfare, while families in which the youngest child has one or more siblings under the age of six are more likely to receive welfare.

With child care expenditures reduced to one-half for all single mothers, AFDC recipiency would fall further to 12.5%, while employment is predicted to rise to 74.7% (Blau and Allison, 1998, p.105). Tying the child care subsidy to a reduction in average state benefits reduces the receipency rate still further to 15.1% and increases the employment rate to 69.5% with further cost saving in AFDC expenditures (Blau and Allison, 1998, p. 104). Subsidizing child care costs for all single mothers may be an important policy tool leading to lower AFDC recipiency rates. These subsidies could be packaged with existing federal TANF program restrictions on length of total, lifetime welfare recipiency, and work requirements to improve living standards for ex-recipients by helping to “make work pay.”

Conclusion

This paper looks specifically at the effect of child care costs on the decisions of single mothers concerning employment and AFDC recipiency. In doing so, it seeks to answer the questions made so relevant first by the Family Support Act of 1988 and more recently by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996: Can subsidizing child care reduce the welfare dependency of single mothers? The answer seems to be an unequivocal yes, though the size of the estimated effect is found to be sensitive to the estimation strategy used.

In the short run, AFDC benefits should be made more uniform across states, and raised, at a minimum, up to the federal poverty level. If the policy goal is to expand the labor market options available to welfare recipients, the most important consideration should not be welfare reform, but rather raising the effective wages of the work that is available. Such a change, which would affect all single mothers, not merely those collecting public assistance, would begin with the important first step of raising the minimum wage.

Publicly provided health care and child care programs are needed if women are to support themselves and their families through participation in the labor market. Child care must also be available for low-income working women. First steps toward the establishment of a national child care system include the extension of Head Start, a federally funded program for economically disadvantaged preschool children.

For too long social policy has assumed that single mothers should derive income from either the labor market or the state. Today’s welfare-to-work programs presume that paid employment will end women’s need for government support. However, the reality for most single mothers is that neither labor market income nor public assistance at current levels can adequately support their families. A meaningful family policy would expand the opportunities and the income available to women with children–both from the labor market and from the state.

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Andrew Sandon
http://www.articlesbase.com/women’s-issues-articles/entering-the-labour-market-by-single-mothers-90181.html

WASHINGTON, D.C. Rep. Chris Carney (D-Pa., 10) said he is beginning to see significant support in his district for the health care legislation which was recently signed into law by President Barack Obama.
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A Florida doctor who opposes the new health care law posted a sign on his office door telling patients who voted for President Obama to get care elsewhere, the Orlando Sentinel reported.
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Now that the government has balied out the auto industry, if that’s what you want to call throwing good money at bad, guess who’s next in line for some of that fake money that seems to make things ru moe smoothly? California and the steel industry. And when I say California, I’m talking all of the fifty states but California is the most critical situation.  <

Governors of five U.S. states urged the federal government to provide $1 trillion in aid to the country’s 50 states to help pay for education, welfare and infrastructure as states struggle with steep budget deficits amid a deepening recession.

The governors of New York, New Jersey, Massachusetts, Ohio and Wisconsin — all Democrats — said the initiative for the two-year aid package was backed by other governors and follows a meeting in December where governors called on President-elect Barack Obama to help them maintain services in the face of slumping revenues. Gov. David Paterson of New York said 43 states now have budget deficits totaling some $100 billion as tax revenues plunge.

Who doesn’t want more money? Then there’s the steel industry.

The steel industry, having entered the recession in the best of health, is emerging as a leading indicator of what lies ahead. As steel production goes, and it is now in collapse, so will go the national economy. That maxim once applied to the Big Three car companies. Now they are losing ground in good times and bad, and steel has replaced autos as the industry to watch for an early sign that a severe recession is beginning to lift.

Is there no end to who we don’t hand money out to until the world figures out that the money isn’t worth anything and we have spiraling and deadly inflation?

Ernie Fitzpatrick
http://www.articlesbase.com/economics-articles/steel-states-707490.html

“Metrosexual” is an oft-used term these days, particularly in reference to fashion. Young male celebrities are often described as metrosexual. And you can find metrosexual clothing, swimwear, makeup, and many other items.

So what does “metrosexual” mean? It is basically a generic term to describe a young man who takes pride in his appearance, wears fashionable clothing and is well groomed. And while he has all the style and panache of a gay man, he’s more likely to be straight. Also, he tends to be an urban professional with high disposable income, much of which he spends on his appearance.

For men in the middle and upper classes being well dressed was always a requirement, particularly professionally. But the metrosexual is different. He dresses uniquely. He doesn’t have a standard style; he has his own personal style. He’s not just another clean shaven man in a suit. He wears one that is distinctive and unique. And he’s fit, strong and looks after his skin and hair.

Needless to say, the metrosexual is not like most men. Blokes generally don’t prize their appearance highly, and are apt to “let themselves go” physically, particularly as they approach middle age. Also, in many countries there is a widely held belief amongst men and women that a man who takes care of his appearance is vain and effeminate, and quite probably gay. So, in nations where there is pervasive homophobia, it is much more more likely for men to affect a more rugged, blokey attitude and sneer at the whole idea of being metrosexual.

So there is definitely widespread resistance to the whole phenomena. Because of this many have argued that the metrosexual revolution isn’t anything more than a passing fad. Many have compared him to the dreaded “Sensitive New Age Guy” or “SNAG” of the eighties and nineties. The term was used derisively as often as not back then. And it’s hardly ever used now, if at all.

But it must be remembered that the metrosexual has been around for quite a while already. The label was originally coined by the journalist Mark Simpson in an article he wrote for The Independent back in 1994. He expanded on this in an article for the online magazine Salon, in 2002, after which it became widely popular.

While hardly any prominent males have ever wanted to be called a SNAG, many of today’s most famous celebrities are happy to be known as metrosexuals. These include David Beckham, Ewan McGregor, Orlando Bloom, Leonardo DiCaprio, Johnny Depp, and Robbie Williams.

There are even a few politicians who have been similarly categorized – Bill Clinton for instance. Although older than most other metrosexuals he does fit this definition well. And many are also calling the new American President, Barack Obama, a metrosexual.

These two examples illustrate one facet that a majority of men find appealing in the stereotype: power. You don’t become the leader of the most powerful nation in the world if you’re a wuss! Unlike the SNAG, the metrosexual hasn’t sacrificed his masculinity. And this is the key to why he isn’t an endangered species doomed to extinction, but is here to stay.

Matt Hayden
http://www.articlesbase.com/fashion-articles/the-metrosexual-is-here-to-stay-738820.html

Digital medical imaging is a field continuing to develop and grow in the world of healthcare. This is all in large part to advances in computer technology. Technology is expanding and constantly improving, especially true in the speed and quality of medical images. A great example of this in the field of cardiac care and how much treatment of the heart has improved thanks to cardiology PACS and the PACS archive systems in general. It’s a widely known fact that PACS and digital medical imaging has completely changed healthcare. If you look up any major disease from a mild fever to cancer, medical imaging will inherently be involved in the diagnosis or treatment of that sickness. Not only are diseases identified and diagnosed earlier, but the PACS archive gives more options for treatment. The PACS appliance is also being implemented to see if current treatment is working towards success and in some cases, medical imaging and scaleable PACS is being used to administer treatment. Digital PACS archive provides doctors and specialists with a remarkable view of the body’s inside structure and functioning without needing to cut the body. Imaging technologies such as ultrasound, CT, MRI, Cardiology PACS, PET, and X-ray allows doctors and health professionals to perform a wide variety of minimally-invasive medical tests, treatments and procedures. More and more health offices often, and mistakenly, cite cost issues as the main reason they haven’t invested in this new ground-breaking technology. However, the techniques utilized from a digital imaging system such as a PACS Archive system can replace expensive or painful surgical procedures. One example of this is when a patient suffers from a brain tumor. Previously, this patient would need to endure a painful procedure in which air was injected into their skull as they were rotated upside down. This is no longer the case thanks to MRIs and computed tomography scans stored on a PACS appliance. Since, digital imaging through a PACS system is generally non-invasive; a patient would not need to stay in hospital for an extended period of time as they normally would after surgery. This alone saves a hospital a great deal of money. The cost savings of Scaleable PACS are easy to identify thanks to the fact that hospitals and medical offices are beginning to split into specific sections with their own budgets. Another way of getting around the high cost of digital medical imaging equipment is to implement mobile PACS appliance units which can be moved around. These PACS allow the equipment to be shared between hospitals and other offices within their network. This feature is indispensible as the size of the equipment shrinks but the size of the hospitals are continuing to increase.

Wayne Hemrick
http://www.articlesbase.com/health-articles/digital-medical-imaging-is-forever-changing-the-medical-landscape-693189.html

Tummy tucks and a visit to the Taj Mahal is not unusual, what with the escalating medical costs the world over, patients are flocking Eastwards to countries like India, Singapore, Malaysia and Thailand. The quality of medical services is often found better than some of the care centre in the United States and the UK. Many countries have now developed official partnerships for speedy treatments in India for their residents most of whom have to wait for extended periods of time to undergo operations. In India, medical treatment is not only fast but would also costs a fraction of what it would costs in USA or Europe.

So, scale or whiten your tooth at $ 300 in the US, or do so at $75 in India. A smile designed at US$ 8000 can be yours at one eighth the cost in India. Forget, cosmetic surgery, a dialysis in the US will shortchange you for $ 300 as against $50 for the same procedure in Chennai. Bone marrow transplant, surgical oncology, cord blood transplants, transplants of the heart, lung, liver are all possible at lower costs in countries like Singapore, Malaysia, Thailand and India than most developed countries where health insurance continues to shoot up in a heavily taxed public health-care system.

A chance to visit India and the Far East while healing and treating ailments at affordable costs has led patients from the developed nations to utilize health services in India at a fraction of the costs in the West. Five to seven per cent of Escorts’ patients are understood to be from abroad. Most patient traffic is from West Asia, South East Asia and Africa. International health insurance companies abroad are looking to forge partnerships with renowned specialty hospitals for Non Resident Indians (NRIs) to combine their treatment in India with their annual family visits.

Most Indian states have either established themselves as destinations for health care and tourism or are building medical brand images. Add to this, Yogic healing, Transcendental Meditation (TM) along with alternate therapies of ayurveda in India has been repackaged and redefined and goes hand in hand with India’s rise in ‘Health Tourism “also called Medical Tourism. Further, impetus has come from corporate such as the Tatas, Fortis, Max, Wockhardt, Piramal, and the Escorts group who are investing in setting up of modern hospitals in major cities. Many have in fact built health packages designed for patients, including airport pickups, visa assistance, boarding and lodging. With advanced medical and biotechnological progress, India along with Singapore, Malaysia and Thailand are leaders in selling healthcare the world over.

With India’s infrastructure and technology quite at par with those in the USA, UK and Europe, also boasts of some of the best hospitals and treatment centers in the world. A favourite world getaway, India as a health and tourism destination is here to stay.

A joint report by the Confederation of Indian Industry (CII) -McKinsey study on Health tourism says that at its current pace of growth, healthcare tourism alone can rake over US$ 1.7 billion additional revenues by 2012. Medical tourism is now a US$ 299 million industry, as about 100,000 patients come each year.

The biggest driver for healthcare tourism is the disparity in costs, nearly one fifth of the cost in the developed world. India is definitely capitalizing on its low medical costs and the expertise of its highly skilled medical fraternity.

· A heart surgery in the US costs US$ 30,000 as compared to US$ 6,000 in India.

· A bone marrow transplant in the US costs US$ 250,000 and US$ 26,000 in India

Lately, the Indian Government launched the six month medical Visa in 2005. The Visa allows a foreigner to stay for a year for medical treatment in India. In addition, the Government has also introduced policy measures such as the National Health Policy which recognizes the treatment of international patients as an export, allowing private hospitals treating international patients to enjoy the benefits of lower import duties, an increase in the rate of depreciation (from 25 per cent to 40 per cent) for life-saving medical equipment and several tax sops.

The ease in international travel, the improvement of technology and standards of care in many of the Far Eastern countries and in India score a point with patients in Britain or Canada who have to rely on the heavily taxed public health-care system for routine heart surgery, a hip resurfacing or a hip replacement which sometimes take years to be treated.

Manoj Gursahani
http://www.articlesbase.com/health-articles/medical-tourism-in-india-98431.html