Acronis and Independent Hardware Restoration

I would like to believe my horrendous experience chronicled here is just likely an exception and my sample size is just too small to draw far-reaching consequences. But being in contact with Acronis Customer Support 5 times and getting the same experience every time, it is becoming statistically significant and perhaps others learn from it.

Early last week I called Acronis to inquire about a hardware-independent restore need I have (my old PC is a Dell Precision 670 w/ a SATA RAID0 and I would like to load that system volume image onto my new PC, which is a Lenovo Thinkstation D20, w/ SAS RAID0 RAID as system volume and of course this PC has a different chipset and hardware components).

I use ShadowProtect from StorageCraft as well, but that failed to do the restore in this case as the target volume was a GB smaller than the imaged original partition. I called Acronis and asked whether the specific task I had could be solved with their newest and bestest software, Acronis True Image Home 2010 (http://www.acronis.com/homecomputing/products/trueimage/) with its trumpeted Plus Pack (http://www.acronis.com/homecomputing/products/trueimage/plus-pack.html).

I had a chat session with one of their people and I was reassured it was "absolutely" possible. I was skeptical so I specifically asked to consider my relatively involved hardware requirements. Based on that recommendation and went ahead and purchased the upgrade and the PP.

I created a boot CD and since my old machine ran ShadowProtect (and installations of the 2 imaging rivals cannot exist on the same PC at the same time), I did not have Acronis image of my old PC. I created one from the boot CD's restore environment and then I went ahead and attempted restoring that image onto the new PC.

That's when I ran into problems and contacted support I had the worst of experience. The agents were incompetent and unhelpful. Overall I had 5 chat sessions (including the initial). Some of it can be found here:

1. http://docs.google.com/Doc?docid=0ATbiHn2rgwJOZGZxMmZyY2tfMjg2YzRjYjluYzM&hl=en

and

2. http://docs.google.com/Doc?docid=0ATbiHn2rgwJOZGZxMmZyY2tfMjg1ZHpydzNmZ3Q&hl=en

These 2 samples accurately capture the way all sessions went down. I received a feedback invite, which I filled out at first with all of the questions answered with the worst available (1) answers and then when I hit "submit" it produced an error (imagine my frustration that on top of struggling much already, trying to find a channel to relieve my frustration, I lose many paragraph of writing.

In any case, I repeated the survey, this time making sure I don't pick all bad choices (in case the system filters those and that's why an error message was produced) and it went through. Here are the screen shots of the survey (http://docs.google.com/fileview?id=0BzbiHn2rgwJONWE4ZTkzOTQtMGQ1Ny00MTRiLTgwNzMtMzI5MmM0ZWY5NjBj&hl=en) and the text as not all of that is visible in the screen shots (http://docs.google.com/Doc?docid=0ATbiHn2rgwJOZGZxMmZyY2tfMjg3Y214emhmaGQ&hl=en). Please match the numbered text in the doc file with the free text fields of the survey.

Basically, I blasted them for (a) not being interested in solving my problems; (b) running a customer support system that is dysfunctional because of the quality of the agents.

I am not in this business, but I know providing software support is immensely costly and difficult. The price of the software does not cover an hour of wage, if you want to employ a competent and capable agent. You could instead hire somebody in an outsourced facility for 1/10 or 1/15 of that rate, which some of these companies opt for. However, you end up with a completely incompetent and useless bunch of imbeciles.

For example, in my case, I spent hours and hours chatting over several days and my problem was not solved. Maybe it is an aberration. But the problem I was having, even if not widespread, not unique either.

I believe (and saw samples of it elsewhere), there are 3 main ways of improving efficacy and overall customer care/technical support experience, without necessarily increasing the costs to the point of hurting the business model.

1. A tiered model of customer support is almost a must. The 1st line pawns should be encouraged to escalate a problem that they can obviously not solve. When it comes to escalating, I am afraid the current system disincentivizes 1st tier agents. They are pushed to do as many calls as possible and document that it was "resolved" in some manner. They wish that by luck they get all no-brainer easy calls. They dread complicated issues. When they get a problem that cannot be easily solved, they are faced with a dilemma. If they are ethical, they escalate it, maximizing the chance the problem actually does get resolved. But if they escalate too often, they increase costs, because higher tier agents need to be involved and higher tier=higher cost.

Therefore they feel a pressure to call problems "resolved" to avoid escalating. A good compromise is to give the customer dummy tasks that take time. That way they get rid of a complicated problem (so that they can work with easy ones to improve their stats and let some other loser get the complicated problem when the customer calls back finding at the end of the dummy task that their problem is unresolved). The dummy task option works perfectly for complicated problems they realize they can't resolve, by moving on from it quickly while not hurting their stats. The problem is that it can only go so far as there is only a limited number of "dummy tasks" that customers (who may not be complete dummies themselves) may not eat any sh*t the agent tries to sell (i.e. questions if an obviously unfeasible task is given to them).

So what can they do when all obvious dummy tasks are exhausted? Again, they are faced with a dilemma. They could either escalate at this point, if they are minimally ethical, or they could lie. They could suggest another dummy task that they know is completely useless AND EVEN THE CUSTOMER WOULD KNOW that it is completely useless HAD THEY BEEN HONESTLY INFORMED about the specifics of the recommended task.

But that's the point. The agent has to lie about the task, otherwise the customer would just hang on further. In our example, the agent first (after clearly realizing he could not solve the problem) suggested we discontinue the chat session and he would email the solution. Right. You know when he would have emailed. Of course he might not have realized that I saved the chat, but then again, the chances this would have come back to hurt him in any way or form are almost nil and he knows that.

Of course I refused the email offer (see the 2nd chat link above), knowing it was just a cheap trick. Then he came up with the ISO file, which was clever on his part, I should say. Given we discussed earlier (see chat file) that I burned a boot CD from an ISO I created from the Home Image 2010 software AFTER I installed PP (which is how it is supposed to be done), he sends me a link to an ISO file that contains a boot CD for version 2009! Of course that is not obvious from the name of the ISO and I only found out this when I burned the ISO and booted my PC from it.

Obviously, had he told me that the ISO he was sending was an EARLIER version of the software, which lacks the universal hardware support of the newer version, I would have told him that we should just forget that step as there was no conceivable chance it would have worked after the later version failed. In any case, I tried, and, as expected, it did not even go as far in the process as the 2010 version.

Sometimes older versions can work in certain situations better than the latest version, because some features in the new version are no longer available. If he tried to explain to me that the reason he wanted me to try the Home Image 2009 was related to some similar assumption, I would probably have gone with that, very skeptically, and asking further assurances and information. Clearly that is not how he did it. He pretty much got me on this one and achieved what he wanted, which is to end the painfully long and hopeless chat session and move on. On his end, he probably documented everything was perfectly resolved as I received an email from Acronis to that effect.

2. I digress, but let's get back to the "perfect" customer support system. The second element (additionally to a multi-tiered model, which is a must) is proper followup. Rather than sending an email next day and a survey, etc, a supervisor should check after EVERY call or chat session as to what happened, how the session ended, what was resolved what not, and why. Presumably the supervisor would be a higher paid, literate high tier agent, who could rather quickly figure out what happened. Tier 1 agents performance would be then rated based on the supervisor's documentation. If the problem was not resolved as it should have been, the supervisor could either reconnect to the first Tier 1 agent, connect to another one, or help solve the problem himself/herself, depending on the situation. If a task is given, the supervisor could check if that was appropriate. E.g. in this case, when (after seeing the 3 days of chats, especially the last one) a supervisor saw that the Tier 1 agent linked me to a clearly hopeless earlier software version, he could have then connected back to the Tier 1 agent and questioned him for why this was done and would have offered a more appropriate solution. If such a system existed, I am pretty sure my problem would not have required me to contact them 5 times and would not have still been left without a resolution.

3. Finally, in terms of incentives, at least for customers, it would be better to incentivize the Tier 1 support staff based on percentage of problems actually resolved as opposed to how many calls they could take in a given time. I sense some companies have this right. The agents are rather aggressive about the problem and pursue some form of followup as opposed to finding ways of moving on (and documenting the problem as "resolved"). I know there is more into it than what I can grasp based on the information I have. There may be some strategic decisions about how this should be handled and given the relative rarity of highly complex issues (and thus, because of their rarity, their low financial impact), it is more financially viable to have a large work force of Tier 1 agents, who are exceedingly low paid (and thus are unintelligent) and incentivize them by the number of calls taken as that system will satisfy 90% of customers (and exorbitantly piss of 10%, but if they are pissed, it probably doesn't matter how much they are pissed; the fact they are 10% limits their impact one way or another anyway).

Blog for 2010 DC Hungarian Pig Feast

Hi,

This is the first blog post on this event. Like last year, we are going to provide news, updates, all relevant info regarding the event here. You are welcome to post comments as well.

Zoltan (on behalf of the organizing committee)

Wilson and Lies

Link: http://www.washingtonpost.com/wp-dyn/content/article/2009/09/13/AR2009091301559.html

There has been much attention to the unorthodox manner US Congressman Joe Wilson decided to further the dialog on the health care reform proposed by President Obama. Obviously the health care battle is already heated to maximum. I posted a detailed blog on the greater issue of health care reform already (http://zneuro.net/blog2.php/2009/08/21/healthcarereform2009) and I will not repeat the specifics discussed there. But I felt I really needed to make a brief comment about the Wilson phenomenon, as it has far reaching implications.

BTW, on the issue of breach of house rules, it is interesting that in the referenced Fox Sunday interview posted on the internet by the Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/09/13/AR2009091301559.html) Wilson said the fact his colleagues are giving him a hard time about some "rules" was pure "politics". I.e. he believes the fact he is being held to keep the rules represents "politics". Why have rules then? Everyone could just do the "right thing" as dictated by their faith and feelings, and not let themselves get slowed down by some senseless rules dictated by "politics", as in yelling disrespectfully, verbally or even physically abusing others (whatever deemed necessary in the heat of the moment or otherwise driven by their unshakable sense of righteousness). No?

Wilson is now caught between the "positive" results of his shameful act, as seen in the great national (and international) attention and outpouring of support/campaign dollars (even calls for "Wilson for president") that are produced by his blatant disrespect to his floor colleagues and to a President some like-minded folks love to hate (for whatever reason, including his race; a race not usual for a president per these folks, but more usual for maids like the one Wilson's hero Thurmond got pregnant, revelation of which affair tarnishing Thurmond's legacy unfairly, per Wilson) and the "negative" aspects of it, like being seen as a reckless idiot by most law obeying and civilized folks. BTW, I do agree with the NYT (http://www.nytimes.com/2009/09/13/opinion/13dowd.html) that Wilson's dislike of blacks likely contributed to his "lapse", although he may have some mental health issues, too. I am not his doctor.

Nevertheless, the main conflict Wilson and his followers have about illegal immigration has not started with this latest brouhaha. Wilson's comments may, on the surface, suggest that he wants illegal immigrants GONE. Clearly, he certainly does not want them to receive tax-dollar-sponsored coverage of health care. That is a fair standing.

So what to do with those immigrants? Not let them in? Remove them? Find them all and deport them to their country of origin? Or jail them in federal prisons? I guess not letting them in in the first place would be logical if we don't want them to have medical care. Otherwise, i.e. if we wanted them here to help us with cheap labor, but wanted to provide no medical care to them, we would not only act unethically, but we would actually pose health risks to those of us who reside here legally. Well that may be something Wilson and Co. are either incapable or unwilling to comprehend/acknowledge. I believe it is the latter as they are not dumb.

Let's just examine the love-and-hate relationship the GOP has with illegal immigration. On the front end they want to please their xenophobic constituencies by harsh public bashing of illegal immigrants. On the back end they don't really want to stop illegal immigration to please their big ticket sponsors who enjoy the financial benefits of (ab)using undocumented workers.

Why would they not do everything to stop illegal immigration? Most people agree it could be stopped or at least drastically reduced, if that is what the US wanted to do. After all, illegal immigration is not only illegal, but it poses major risks to the rest if the US, including relinquishing control over potential terrorist influx.

So why is it that they are not more aggressive fighting illegal immigration? Well, that's because of the aforementioned "business aspects" of the issue. Completely congruent with the GOP's fundamental campaign philosophy (i.e. sell socially conservative tickets on the campaign trail, then focus legislative work on business interests once in office), the GOP likes to slam illegal immigrants publicly every chance they got, but then when it comes to legislation they drag their feet in the effort to curb illegal immigration.

Frankly, many businesses would not be pleased if they had to replace their work force of illegals (that needs no 401k, pension, healthcare, workers comp, is not unionized, has no right to complain, report, speak up, is not subject to minimum wage laws, does not even exist in the eye of authorities) with a work force that has all that and obviously costs a lot more in wages, too. Clearly, that replacement would eat into their profits big time (which would hurt campaign contributions, of course).

In an ideal GOP world, in order to maximize profits, the working class would produce labor at a substantially lower cost, would have no rights whatsoever and would be forced to provide underpaid labor, child labor, among other things. US businesses (supporting GOP political campaigns), by outsourcing work to countries where labor organization and regulation are absent, clearly improve their profitability. It could be even more efficient if they did not have to outsource, but found labor here within the US, with no workers' rights, similar to the Far East sweat shops. Therefore, undocumented laborers are "perfect" as they are here, they just keep "shut up" no matter what happens as they are greatly incentivized to stay invisible to authorities, and thus can be abused every which way without risk or review.

One area of particular importance is health care in that process. Wilson (and his large following) obviously can become quite emotionally charged over the issue of health care to illegals. But wouldn't it be a morally sounder and more logical approach to try to enforce immigration laws and reduce illegal immigration in the first place? Perhaps that way we would not be talking about what to do with them and the dilemma about health care to them would not be so biting.

The issue of how to limit illegal immigration is complicated and is not the focus of this posting. However, I would like to point out that Wilson's anger and "brave" protest when he suspects (incorrectly) that the Administration was proposing health care coverage to illegals may elevate him to a level of a folk hero to some, but it actually raises an issue we would all need to think about in a more civilized manner.

I am not proposing we should insure illegals and I definitely do not support illegal immigration. An immigrant myself I can tell you that going through the loops associated with LEGAL immigration is just beyond imagination. For me, a medical doctor and scientist, who never committed any crime and considered by most standards a rather productive and desirable member of the society, there were immense hurdles to go through to become a legal resident. I find it rather ironic that as much effort and resources have been allocated to making sure people like me don't get in easily or without painstaking review, as little is done to stop the totally illegal entry of thousands of uneducated and unskilled workers (clearly posing much greater public health threats and other threats than the influx of foreign born doctors).

I do think that shoving our heads into the sand about illegals is neither moral nor responsible. It is true that for Wilson it is just convenient to have undocumented folks that ca be abused every which way, while not costing anything at either business or societal level, and still available to public bashing for immediate gratification of xenophobic constituents with little insight of the related deeper issues. However, coming back to the importance of preventative health care (http://zneuro.net/blog2.php/2009/08/21/healthcarereform2009), illegals' lack of care and registering process poses significant health risk for the rest of us and Wilson can't yell himself out of that reality. These people are not isolated from the rest of us and without review they can serve as natural reservoir of infectious agents, including HIV and TB. And I did not even mention the costs to hospitals when these people get really sick.

I believe the right thing to do (as opposed to yelling disrespectfully at the president like in a rowdy bar full of rednecks) is to:

(1) Maximize efforts to limit illegal immigration. This is a complex and huge task with multiple facets and clearly bipartisan approach is necessary. Politicians will have a hard time engaging in this, as their campaign contributions can come under fire, given the likelihood some of their major campaign contributors won't like this plan. But they could perhaps translate the outpouring anger we are witnessing in demonstrations, town hall meetings, and protests in DC into cash for their campaigns, to make up the revenue lost from illegal labor loving big business folks, effectively turning their legislative work from special interest driven into grass root driven. Wouldn't it be nice that politicians actually were answerable to voters and not big special interest donors?

(2) There should be a path for illegal aliens, who are already in the US and working here, to become legal, tax-paying citizens. And sorry, their employers should also pay taxes and all necessary fees and contributions, according to US labor laws. That way a "public option" wouldn't mean we would be spending good legal taxpayer money on illegals, but it would mean we would have a choice of a not-for-profit health care option for all of us, legal and tax paying residents, sponsored from the taxes we all pay.

The epitome of right-left conflict, as reflected in the healthcare reform debate

Link: http://www.cbsnews.com/stories/2009/08/21/opinion/main5257556.shtml

I think most healthy minded and reasonably moral humans would agree that arguing against the use of preventative medicine is egregiously unethical (if not all of them; depending on your definition of "healthy minded and reasonably moral"; one could argue that the very fact someone does not agree that prevention is good medicine actually is a proof they are either not healthy or not moral).

Now, that said, I absolutely agree with the need to have a dialogue. Dialogs are useful and usually constructive. Certainly a much preferred way of dealing with disagreements than violent methods or yelling. I also do not advocate name calling. I don't think that is useful or helps any cause really.

Then how come my first paragraph apparently insulted the writer of the cited CBS piece, calling him names (i.e. either mentally sick or immoral) and/or refusing to have a dialogue he apparently has helped develop by penning his opinion? Well, that's just to show that most things are not absolute and sometimes you have to make an exception. Would you agree that, however healthy and positive the idea of a dialog is, there is probably no need to consider it when it comes to Nazi ideology? Or would you agree that it's OK to call Hitler immoral (or crazy)? Well, those extremes just demonstrate that you "never say never", even if it comes to rules on dialogs being generally healthy and name-calling generally being bad.

In a society where there is as much wealth as in the US, I believe it is justified to think we can afford to consider improving the quality of life of all, including the less fortunate. The argument against it, i.e., the less fortunate will just have to suck it up because they don't deserve a share of the wealth they did not help produce (and probably largely if not entirely are responsible for their "bad luck", perhaps even other ailments of the society, so "the least" they deserve is no "goodies" they did absolutely nothing for), not even to the point of basic needs such as health care, still boggles my mind. That somebody can come out with a straight face and announce that those folks deserve to die young leaves me speechless... Well, actually not really, for why I decided to write this.

I would like to get something out of the way up front. I don't think health care reform should be bipartisan. In fact I do not think it can be bipartisan. The fact of the matter is that the voters in the US spoke last November and they trusted the President and his ideas, including those on healthcare. Do you think if the Republicans had won, they would now be reaching out to win Democratic support for a plan (if they ever had one) where they sought to advance the cause of industrial interests and capital? I believe this question was voted on. The voters spoke. If you will, there already was a referendum on the issue.

Of course it does not sound very team-spirited to say that. But I believe the healthcare reform debate drives right to the heart of the fundamental disagreement about how we collect our common wealth (i.e. taxation) and how we then redistribute it (i.e. public spending). I believe most of us reasonable folks would agree that you cannot distribute taxes exactly in proportion of their collections and the way their distribution is disproportionate is that lower payers receive benefits out of proportion/in excess of their contributions. The question is really just the degree of disproportion; a continuum with communism on one end and extreme capitalism on the other.

Republicans and democrats are decidedly on opposing ends of the debate with republicans believing paying less taxes is the ultimate heaven, at the expense of public spending; while democrats are leaning to benefit the public at the expense of taxing the wealthier. The health care reform cuts to the heart of this disagreement, because the public option is funded on taxes and benefits the public, in a relatively major even radical manner, aiming to overhaul a health system that is huge, dysfunctional, but overall inclined to benefit the wealthy and the industry.

Why then, as it may seem to you, would the public be having a problem with a proposal that aims to benefit them, at the expense of the wealthy minority and insurance industrial interests? Sure, there is much trumpeted opposition. One that is marked by outrage, foul language, disrespect, disorderly conduct, visceral and emotional outburst. Then this opposition is pointed to by Republican media (and occasionally Republican political leadership) as "evidence" of public opposition to the health care reform plans. A grand campaign of misinformation, purely motivated and directed by minority interest, absolutely not grass-root, leading to much upheaval and emotionally charged riot type reactions. The media, of course, will cover these, as anything that sells (and people with overcharged emotions acting out of the ordinary, especially in the context of a big ticket political debate, is definitely as coverage-worthy as it will ever get) they cover. The right-wing media is particularly incentivized to cover these phenomenal manifestations of public outbursts opposing the reform. The right-wing media apparently makes a concerted attempt to display the situation as if the reform plan would need any selling to the public. Frankly, that is NOT the case. The angry yelling people at town hall meetings are NOT the public. The public is what voted this president in office with the notion there would be a public health plan, which was quite prominent in his campaign and win. Besides, all relevant polls indicate the public still favors public health care option, which is remarkable considering that is despite the insurer industry's mega-campaign to mislead them.

Yet, these people yelling at senators from the bottom of their lungs is quite a spectacle. Have we seen something like this before? Actually, misinformation is a well tested tool, a routine, in which special interest groups are cynically misinforming and fueling emotional outbursts to benefit their cause. The fact of the matter is that when people are really angry in a democratic society, that's usually because they don't understand something.

I am very sorry they are misinformed and that they are angry. They should be better informed. And I fully agree with the administration's willingness to reach out and educate, in their effort to make all the damage done already undone. But this is just a distraction without any true grass-root foundation. In terms of spending energy on their education, in the same time, effort should be focused on actually pulling the reform off and pushing it through, bipartisan or monopartisan, as it won't be an easy task and efforts are needed...

***

Let me come back to the immorality of the argument this CBS piece has made regarding preventative medicine. It is stated that screening (as one example of preventative care) is bad, because it does not pay off. Let's just assume a respective medical society issues a guideline or practice parameter, based on scientific evidence, that a certain screening is recommended to people of certain age (let's just keep it simple and say that is regardless of race, education, or income). To stay with the example in the CBS article, this costs $500. The uninsured (likely poor, etc) will obviously not get it, while the insured will get it. What difference will that make? The small minority whose cancer is caught in time as a result of screening will live and their unscreened counterparts will die (unnecessarily early or in a way that could have been prevented). The writer says that is quite all right, because we cannot afford to screen all the masses to save a few. Their lives are less worthy, he determines.

The writer of the CBS piece wants people (I assume poor people/uneducated people and/or minority people, whose longevity is generally shorter) dead young and not bother spending on prevention and spending on keeping them alive when they are old. As, in his world, preventative medicine will only make them gratuitously live longer, only to increase healthcare costs paid for by good and wealthy citizens. That by adding up [1] the costs of increased preventative health care; plus [2] all the even costlier ailments these folks will end up suffering when growing old. I.e. if the young Hispanic or African American factory worker, the writer most likely had in mind, dies from a heart attack at age 45 with never having seen a PCP, he would cost virtually nothing or maybe (if he makes it to the ER alive) a (relatively limited) sum of unpaid bills in the hospital. He, on the other hand, of course would eat up thousands and thousands of dollars more in health care costs going for regular checkups from age 30 and living all healthy up to 75, when gradually one medical problem would pop up after another, making him a disaster, (sort of) living with bad multi-disciplinary problems for another 10 years or so, perhaps with constant medical care in the last couple of years, costing an arm and a leg to the society.

Not from my hard earned dollars! Only through my dead body! Says the writer, protecting his paltry tax dollar. Why not then, just pass a law in Congress that people are allowed to live until age 45 or until healthy, whichever is sooner, and then be executed by lethal injection so that no health care costs are inflated to care for them... Maybe not for all the same way, maybe with some amendments to the law allowing exceptions from the lethal injections. Perhaps the "exception" would be something that would be available to the privileged, right?

Seriously: what if those dozens of healthy years added by preventative care actually mean something MORE than just the fact we, as a society, have to pay for extra preventative health care dollars for them and they lead to senile incontinent nursing home vegetables (a disappointing vision that enhances his remorse over the futile death of those beautiful dollars even further)? What if living to see their grandchild graduate from college, growing old enough to see the world become a better place, to be able to tell the new generations how the world was many years ago, could actually mean something MORE than dollar thousands rendered to the care that helped them achieve this. No? Extending the life of a human by another 3 decades may be worth something? Perhaps even as much as the money that pays for the preventative checkups or even their nursing home care in the end while they ready themselves for a solemn and respectful exit, with dignity all humans deserve? Clearly, not for the writer of the CBS article.

Also, I am not living in dreamland. I know somebody would need to pay for it. Sad reality is that we just can't finance what it takes to provide top health care solutions and cutting edge medicine to everyone, as we would go broke. But making an argument that preventative health care is a lost cause is clearly a blatantly immoral notion.

Nevertheless, in his conviction and righteousness about letting people die young, I think the writer ignores a significant financial aspect of the issue. What if allowing the individual live longer actually lets him/her extend their years of production? What if with prevention we can keep the population healthy and longer in the workforce and these are the folks who already have had the most training and experience. Can that pay for the extra prevention cost and even the end game? Well, we can argue about it. The writer would probably think (or even say) that "well, these folks are the low level unskilled workers, who, even if employed, are not very productive, so then what added productivity are you talking about by making them live longer?". I would counter that although they may vary on a wide range in skills and experience, many who would be saved by improved preventative care probably could produce enough to help pay for the costs their extended life causes and if not, the rest of us should.

***

It is interesting how in (mostly industry sponsored) scientific articles on anti-cancer drugs it is argued that a 6 months extra survival can mean the world to the patient, as that 6 months could help them survive to see something major (e.g. one of my great-grandfathers died a month before I was born). And that is priceless (even though there definitely is a price tag on the new cancer drug in question and it costs dearly). How then is it OK to argue (by the writer of the cited CBS piece) that forgoing saving decades of life is the wrong thing to do? Isn't this a conflict? Also, drug companies and medical device makers would probably be pleased to see an older and sicker society; there would be more business for them, no? Just as would be for insurance companies, too! How can we resolve this apparent contradiction?

Well, by being a bit more specific. That it is only helpful not extending the lives of the poor and the "unworthy" (in the writer's and his party's view). I am sure the writer would not agree his own life for example should go short in the altar of cost-saving, would he? The poor and uneducated add little, the writer would say, the only thing they can do is they eat up costs and do no good. That seems to resolve the apparent conflict. To put it in simple terms: saving lives for the productive, educated, and wealthy = GOOD; saving the lives of the unproductive, uneducated, and poor = BAD. That kind of sums up the message of the CBS article. So now there is no conflict, right?

Well, actually there still may be some. The writer may even seem confused as to whose interest it is he really wants to defend most. He is only clear on whose interest he is NOT interested in protecting, i.e. the public and I sort of discussed and analyzed already why that is. But then there are several ways you can support anti-public interests as there are more than one interests out there! Namely three.

First, his own tax dollar. He just does not want that to go to the "wrong" cause, i.e. to help others who are in more need. That's fair, I guess. I am not sure about the writer's financial situation, but I assume he is not homeless or hungry or without medical insurance. He probably has all the ingredients of a modern day comfortable life with safe retirement, etc. Could he afford to not go for one extra vacation or not buy that extra home in Florida? I guess he could. Make no mistake, I am no communist. I do think individuals and business should deservedly be rewarded according to their talent and market success. But how much we contribute to help the needy is a constant area of disagreement among us and a highly ethical one, something far beyond the scope of this blog (maybe for another time). But nevertheless the question of taxation and distribution of public wealth apparently drives the writer primarily. The writer's clear incentive against insuring the 47 million uninsured is probably his main motive, not allowing his tax dollar to go to "waste".

Second, there is the interest of health insurance companies. They are also against a public option and in some ways their interests are aligned with the writer's, perhaps in the second most important manner after his self-interest described in the previous paragraph. Health insurance companies are administrators with great power in how care is actually provided. I have seen many many examples how powerful they really are. In the same time they are arrogant and leave little need for guessing as to what their motives are. A recent example of this patient I saw in our Ataxia Clinic. Because of the course of her disease I suspected paraneoplastic etiology (http://en.wikipedia.org/wiki/Paraneoplastic_cerebellar_degeneration). The most sensitive test is a combination of CT and PET, not a cheap way of imaging. I don't order it on everyone, only when strong clinical suspicion arises. (There are alternative methods, which are less expensive, but which also miss the majority of cancers.) As usual, it was denied by the insurance company. I wrote an appeal and I also spoke to the decision maker at the insurance company ("medical director", and MD). He was unfamiliar with the concept of paraneoplastic disease! He told me (on the phone and also in a letter of denial) that PET is NOT a proven way of detecting malignancies in the brain!! When I explained that we were actually looking for cancers in the body OUTSIDE the brain, he was confused and did not understand how a cancer in the ovarium or the gut can cause problems in the brain/cerebellum.

So the appeal was denied and a 3rd, too. The patient had the study done nevertheless (costing several thousands of dollars), paying out of pocket (not a wealthy patient) and it revealed a lesion retropharyngeally with high glucose uptake, very likely cancerous. This is unfortunate to the patient and it would be an even more heartbreaking story if it is now in a more advanced stage with respect to prognosis than it was 7 months ago, when the 3-round appeal saga began with the insurance company. But from the perspective of this blog and the point I am making the punchline is that the insurance company, as opposed to what you and I would probably do, i.e. feel very bad for the earlier denials, denied to pay for the study, EVEN knowing it revealed a likely cancer. BTW another lesion, which is being further investigated as I write this, along with the retropharyngeal lesion, in the colon was discovered as well.

The writer of the CBS article argues that the existence of 52 insurance companies is in itself a glowing proof of healthy competition, a diametric opposite of monopoly. All good then, job well done, huh? So why do we even need to talk about health care reform if all is good? Oh, those liberal bastards just want to "spread the wealth around" and now this health care reform is their newest excuse. Those bastards.

One problem, to circle back to the conflict between the 3 interests the writer likes to align with at one point or another, is that insurance companies, too, would want sick people and insured people. So why allowing insurance for more is not their interest. Well, because the public option would be a competition to them.

However rosy the mentioning of 52 insurance companies seemed, a government/taxpayer funded public option would be a huge crushing competition for them, as a whole, and who wants to compete now, all of a sudden, when they managed to bribe themselves into a perfectly settled and relaxed position?

"But it's also true that government programs, even ones that start out fairly simple, tend only to grow and expand over time and grow less efficient as their competition is eliminated and the political power of those who draw salaries and contracts from them grows." This is of course, true. Government workers are people, too, with all the human defects. As the private sector is at risk for ignoring the health of the public for profit motives (see the example above about my patient), government agencies are prone to allow corruption. However, vigilance, transparency, and continuous public debate can help reduce these risks. Which is better? Allow the private industry "compete" (for greater profit, that is the only measure of their survival and in a true Darwinian capitalist marketplace) and run the risk of letting them kill people on the way or run the risk of government agencies becoming large and corrupt and an impediment to their own cause? The writer leaves no doubt he prefers the first. Do I prefer the second? No. I prefer maximum transparency and accountability and fair and strict business regulation in the area of healthcare business, the area where we have the most direct and continuous impact on human life.

Third, the interest of those drug companies and device makers. Does the writer of the CBS piece support their cause? Well, maybe to some extent. At least if it comes alongside opposing public interest, but definitely not beyond that (i.e. not against the special interests #1 or even #2, discussed above). Nevertheless, he seems to be somewhat supportive of their cause... I believe it is rather revealing as the writer opines "And if labor responds to financial incentives, capital is even more sensitive: slash the profit margins of drug companies and medical device manufacturers, and inevitably there will be less investor capital for those companies and less coming out of the pipeline in terms of drugs and devices that save or improve lives."

Wow! Improve lives, huh? Are these companies in any way incentivized to "improve lives". Come on. Will their shareholders praise them for improving lives? Right. No, they are incentivized to increase their profit, and only that. Period. It is true, they are in a business where their products compete with other products that are used in healthcare and as such, will improve lives. But that's not because this is their core mission. That is just a side effect of the type of business they are in. Do you think drug companies who repeatedly and consistently conceal knowingly adverse clinical trial data unfavorable to their marketing incentives are acting in pursuit of "improving lives" (when they actually destroy and end lives)? Do you think that paying off leading doctors to help bring about studies with falsified data so that their sales improve and cause deaths of children are driven by greatness, humanity, and altruism? No.

Having said that, of course we do want private industry in medical care and research. With tight oversight. Making it a transparent and fair marketplace. No crazy landfall profits, CEO extravaganza, nothing like that. This is not the area for it. Not in pharma and medical device industry where human lives are at the line. My solution to the conflict affecting this industry (the conflict between making profits and serving patients' interests) is total and maximal transparency of policy and corporate behavior (of course not counteracting competition, i.e., there still would be classified and sealed data for later review, but still accessible by Congress if need be).

The writer is right, the absolute health care cost cannot be less if add more. However, it is unquestionable we need health care reform, as the current system is absolutely unsustainable, corrupt, and inefficient. It is also clear we must include a public healthcare option to give healthy competition to private insurers. We perhaps should consider supporting health care co-ops, where partners are the same as beneficiaries and are very disincentivized to inflate overhead and bleed into big administration, but also profit-taking against their own care. We need to be very thoughtful how we regulate the private sector connected to health care, as they inherently have a major conflict of interest between being accountable to their shareholders and being moral toward their sick clients/customers. All government activity must be exemplary transparent to the public with tight and constant oversight.

Finally, human life must be respected above all and cynical right-wing anti-humanists should never convince us that preventative health care is bad policy unless they begin forgoing it themselves first.

On tired dictators and tired analysts in the context of Clinton's North Korea visit

Link: http://clivecrook.theatlantic.com/archives/2009/08/north_korea_tests_the_limits.php

I read the linked writing on "The Atlantic" with interest. Especially, for it being exceptionally short (its greatest asset; I clearly have work to do in that department to come close). But besides it is short, I'm afraid not much praise is due.

This and many other "analysts" commented in all sorts of negative ways about Clinton's trip. Some including the cynical view that he was trying to help his wife's diplomatic clout and success (which is clearly a less than analytical comment, given it was the North Koreans who apparently picked Clinton, over other candidates.)

Even the analyses that sort of positively approached the issue almost invariably failed to even mention a rather significant aspect: this whole trip was about 2 unfortunate individuals, whose lives (or at least a likely horrible 12 years of it) were at stakes. That bothers me to the point to making me write this.

It is quite disturbing how a "know-it-all" wisecrack "analyst" comments in the above referenced article that "But what more is there to say? Precisely nothing. Watching cable news and especially CNN give this topic blanket coverage and color commentary from all hands, for lack of anything else to report in a slow week, was sometimes almost harrowing." (which kind of includes about half of the entire writing BTW). Nothing, huh? I am sure the families of the 2 freed journalists would rather sharply disagree. I am not sure if Clive Crook considers himself a journalist, but if he did, some professional sympathizing wold have been nice, too.

Crook sums up the story as "Tired megalomaniac dictator trades ego-stroking photo op with former US president for two US hostages." In turn, Crook himself seems to be tired of the media coverage of this "nothing", while talking about the 2 lives as subjects of the trade, nothing more.

Well, in my opinion what is truly "harrowing is exactly the process of this all-crusted and tired, bordering apathetic, approach, which completely ignores the fact there actually was saving of 2 human lives here. I know we all see much greater human suffering and toll on a day-to-day basis. We are tired of that, of course. But that should not make it less significant when we witness good will and humanity, which leads to saving human life, even if it was just a couple of them, even if there is a major sensationalism component associated.