Healthcare – Hospitals are Learning What Doctors, HMO’s and Insurance Companies Already Figured Out. You Lose!

I spent 7 years in the medical industry and according to the Malcolm Gladwell, 10,000 Hour Theory, that makes me someone who can weigh in on the complexity and politics of the healthcare industry.  As an entrepreneur, I entered the industry looking for edges, opportunities, and ways to make money in one of America’s largest industries, healthcare.

I did a turn around on a high complexity lab, I built a multispecialty practice from 4 to 14 providers, I started a medical weight loss business and a service company (Rainmaker Medical)  that had employees in Phoenix and Tucson and serviced a dozen medical practices. I lobbied and passed bills, I served on hospital merger committees, did a podcast on healthcare policy and started and lead research associations. I was IN the business of medicine.  After all my time and experimenting, I learned two important skills;

  1. How to function in a highly competitive and complex market.  American medicine isn’t about Doctors and Patients. It’s about codes and contracts.  As a C level business leader in that industry, my business skills were put to the test.  I learned a lot about a super complex industry.
  2. When to hand up the saddle and move on. I could see the end of my run in medicine coming when regulatory blocks kept coming as fast as I could come up with a new idea.

When I was in the industry from 2008 t0 2017 the big player that controlled everything was the hospitals. The power structure had shifted in America from the Doctors to the Executives and the HMO’s in the 1990’s (remember $5 co-pays?), then over to the evil insurance companies who got their lunch handed to them with the passage of Obamacare.  After 2010, the hospitals held all the cards and now it looks like they will be the next losers in politics of healthcare. Notice, in this long list of power brokers, the consumer is nowhere in site.

The solution? Stay healthy. As long as the power structure exists between the government and the industry the service will suck. Not until the power is between patient and doctor returns will anyone like what’s happening to them when they need help.

In a phone interview with Bloomberg, Malhotra warned about the next wave of hospital closings that could be triggered in the next 6 to 18 months.

They “are getting eaten alive from these market trends,” Perlman cautioned.

“Future M&A options could be too late – buyers may hesitate as debt-laden operators like Community Health Systems Inc. and Tenet Healthcare Corp. focus on selling underperforming sites to reduce leverage,” Morgan Stanley’s Zachary Sopcak said.

Some facilities are restructuring as outpatient emergency clinics with free-standing emergency departments. “Microhospitals,” or facilities with ten beds or less, seems to be gaining a foothold across the country. They have been springing up as of late in multiple states, including Texas, Colorado, Nevada, and Arizona. Dignity Health, a health system with facilities in Nevada, Arizona, and California, is also considering the possibility of testing the model in California, Kaiser Health News reports.

As for the incoming wave of hospital closures that Morgan Stanley expects to hit in the near term, well, it is more bad news for rural America that seems to have been left out of the “greatest economy ever.”

What Visionaries, Entrepreneurs, CEOs And All The Rest Of Us Need To Learn From Elon Musk (Forbes)

I saw this one coming when Elon Musk tried to grab the world’s attention during the cave rescue in Thailand.  I remember watching the twitter war with one of the rescue teams and thinking, ‘why doesn’t this guy just focus on delivering his cars?’.  Forbes nails the core of the Musk and Tesla issue. As I thought of the unravel of Musk I contrast him with Richard Branson or Bill Gates. Both men that have danced close to the sun. Branson using earned publicity and Gates because he’s held the title of Worlds Richest Man for 20 years. Both appear to me to have spent a lot of time focusing on their egos, gaining wisdom and not buying into their press clippings.

America loves a hero story and we love to tear them down. Musk looks like he’s in tear down mode right now but he’ll overcome.  I’m actually rooting for him and I’m hoping he’ll learn a valuable lesson about ego and vulnerability. As a CEO and Entrepreneur, I’ve learned that I’m no more than one ego step away from a similar mistake. I’ve fallen and I keep getting up and always keeping the lessons of the fall, front and center.

What Visionaries, Entrepreneurs, CEOs And All The Rest Of Us Need To Learn From Elon Musk

There are two big lessons from the vulnerabilities Elon Musk revealed in today’s remarkable New York Times interview:

  1. We all need to grow up (and I’m not talking about Musk here).
  2. Everyone, including visionaries, heroes, entrepreneurs and CEOs, needs to be aware of his vulnerabilities (which everyone has) and, with that knowledge, take specific, relevant, concrete actions that protect both himself and his business.

Musk was extraordinarily emotional and vulnerable in the Times’ interview. He described the past year as emotionally excruciating. He talked about an almost inconceivably grueling schedule of overworking and under-sleeping. His judgment and self-control have been questioned after he insulted analysts for their “boring and bone-headed questions” and especially after he posted an enormously consequential tweet on August 7 that rocked the market—referring to the possibility that he would take Tesla private. I agree with the Times’ assessment that he showed an “extraordinary level of self-reflection and vulnerability” in the interview.

We all need to grow up

There’s another reason too. Musk is larger than life. He believes in the miraculous and sometimes delivers it. In a recent insightful and compassionate opinion piece, Kara Swisher wrote that “Silicon Valley needs its complicated gods.” That role, she says, was filled by Steve Jobs for a long time and, with his death, Elon Musk was cast into that void. Swisher writes that all legendary makers of important things share a proclivity for “creative destruction.”

It’s not just Silicon Valley that needs gods and heroes. We all do. And we all engage in creative destruction, punishing them for being merely human, for being arrogant, or confused, or disappointing us, or failing or not being sufficiently god-like.

This response to heroic figures reflects a universal process that occurs in human psychological development. As children, we start out seeing our parents as omnipotent and omniscient. We need that illusion in order to feel safe in the world because, since we are still kids, we’re not yet able to feel secure in our ability to shape events. Gradually, we’re disillusioned, as we painfully become aware of their flaws and inadequacies. Any parent of an adolescent has been the brunt of the anger that this disillusionment evokes. Teenagers replace their now de-idealized parents with other heroes—rock stars, sports stars, remote figures whose human flaws can be overlooked.

Maturity requires building the capacity to recover from that angry disillusionment and regain the capacity to admire people but accept that even the most remarkable and competent are also human.

Another universal psychological phenomenon becomes relevant here. As humans, we all have the capacity to regress—that is, to slide back, temporarily, to earlier stages of psychological development and functioning. And regression is most likely to occur under times of stress or fatigue. I’d argue that there’s a group psychology phenomenon going on. We live in a time of intensified stress and terrible uncertainty. We often have a diminished sense of our ability to shape events. So, we are more in need of heroes and saviors, as we were as children, and we’re also more likely to attack them when they disappoint, as we did as adolescents.

Chicago Mayor Rahm Emanuel talks with Elon Musk  about constructing a high speed transit tunnel  (Photo by Joshua Lott/Getty Images)

Musk is the omnipotent-seeming hero. I live in Chicago. He came here two months ago and promised to build a super high-speed tunnel to get us all to the airport! It was thrilling. No more slogging through crushes of traffic on I-90! No more planning an extra hour in case things really just stop moving! Musk magic will zip us painlessly and reliably at 100 miles per hour under the city to catch our flights!

Let’s all grow up and try to accept that our heroes are human. Maybe that tunnel will never be built, but I sure love the idea that visionary provided.

Even heroes and CEOs need to attend to their human needs

Reading the Musk interview didn’t make me want to put on my psychiatrist hat. As Swisher wrote, “Mr. Musk’s mind and ideas are big ones.” And he’s not crazy, but he sure seems human. The interview, however, did make me want to put on my mom and doctor hats, and insist on these cautions for even the greatest leader and visionary:

  1. You can’t function without sleep.
  2. You can’t function without breaks.
  3. Trust a couple of people. You have to find someone you can trust to step in for you and do your job well enough, so you can sleep and take breaks and see your kids and take vacations. You also need to have a trusted advisor to talk to when you’re uncertain or overwhelmed. And you need someone you trust who can tell you to stop when you should stop. That’s at least three people to trust.
  4. There will be times you can’t function at your best—these come for everyone. Learn to recognize them and find the discipline to not make critical decisions or take consequential actions until you’re back to your usual excellent baseline of functioning.
  5. Have a primary care doctor and see her at least once a year. And listen to her advice.
  6. Protect yourself from an overload of information, especially meaningless negative and cruel comments about you from strangers.
  7. Don’t forget to eat and hydrate.

Prudy Gourguechon is a psychiatrist and psychoanalyst who advises leaders in business and finance on the underlying psychology of critical decisions. For more visit

The State of Foreign Policy In A Trump World

Give a listen to George Friedman founder and president of Geopolitical Futures a private intelligence service. He breaks down Turkey, Iran, Russia, and China. Things may not be as bleak as we are hearing.

Empty Churches Awaiting A Revival?

One of the chapters on my 12 Arguments For The Decline of America, is the decline of religion.  In the work, I put forth a dozen arguments that point to a disappointing trend in America. I started working on the thesis in 2012 after five years of the daily analysis from my perch as a morning talk show host. Over and over, I’d read a bit of news or economic data and tell the listeners, ‘this doesn’t look good’.  I compiled these trends into 12 categories and started researching my theory.

With the decline of religion argument, I’m not advocating for a particular type of religion.  I’m a Catholic and committed. Modern-day scandals and historic failures and all, I appreciate the rituals, the formality, and the foundations. I’ve been able to separate the politics, which I’ve seen my share of in leadership positions within my faith.  I am smart enough to know that people are fallible and no matter what position they are in mistakes will happen.

In my argument faith arguments, I point out that spiritual connection and its role in Western society has been an important part of advancing our societies.  No matter if you worship in a Mosque or a Synagog, the very act of gathering together to realize that there is something bigger than our selves is an important part of a functioning society. Religion is most often followed by morality and personal accountability. Organized religion helps provide society with a roadmap and a sense that we are in this together.  The Golden Rule is the foundation of most organized religions and a pretty good way to live your life.

The decline of religion argument, coupled with the flight from an agriculture/rural-based society to service-based cities and the decline of the family unit all combined add up to a bad trend for America.  We’ve had a series of Great Awakenings in the past and I believe we are open for one right now. As we get lost in our social media, shut off from the world and disconnect from other people, an economic jolt could bring about another Great Awakening;

The First Great Awakening (sometimes Great Awakening) or the Evangelical Revival was a series of Christian revivals that swept Britain and its Thirteen Colonies between the 1730s and 1740s.

The Second Great Awakening was a Protestant religious revival during the early 19th century in the United States. The movement began around 1790, gained momentum by 1800 and, after 1820, membership rose rapidly among Baptist and Methodist congregations whose preachers led the movement.

The Third Great Awakening refers to a hypothetical historical period proposed by William G. McLoughlin that was marked by religious activism in American history and spans the late 1850s to the early 20th century. It affected pietistic Protestant denominations and had a strong element of social activism.

The Fourth Great Awakening was a Christian awakening that some scholars — most notably economic historian Robert Fogel — say took place in the United States in the late 1960s and early 1970s, while others look at the era following World War II.

We are social beings and wired to connect. As we drift apart we are going against thousands of years of evolution.  Check out my favorite lectures from Jonathan Haidt and Dr. Joseph Henrich on my SOCIETY Page for more background on evolutionary sociology.  Check out my RELIGION Page for a deeper dive into faith.

Losing My Religion

Trends suggest that organized religion is “on the wrong side of history.”

Posted Aug 17, 2018 – From

The latest research on worldwide trends shows that religious beliefs are deteriorating,” reports, adding that at the same time “those adhering to a secular belief system devoid of God are on the rise.”  Various recent studies have also shown that secularism—literally the separation of religion from government—is proliferating, a function of the decline of both church and state.  Churches all over the world are shutting down as more people lose their religion and, in its place, acquire a moral compass grounded in humanist values.  (Humanism is a philosophy that does not incorporate a divine entity or supernatural beliefs, and assigns people the responsibility of living ethical lives.)  Atheism and agnosticism are thus growing, so much so that in some countries (notably Great Britain and Norway), there are more non-believers than believers.

Even in the United States, a profoundly religious nation, more citizens are adopting secular humanism as their creed of choice.  About 80% of Americans have consistently claimed to be members of a particular religion, but that figure is gradually dropping due to a generational effect.  Baby boomers have turned out to be significantly less religious (but more spiritual) than their “greatest generation” parents, and millennials are showing signs of continuing this pattern.  As older churchgoers die off, houses of worship are having trouble filling their seats, with no great awakening on the horizon to reverse the drift.  In fact, it’s now atheists and agnostics who are increasingly banding together either online or at Meetups to share their beliefs (or lack thereof) with like-minded people.  Growing up in a predominantly Christian community may have been tough for the non-religious, but that is fast changing in America and elsewhere.

While in some areas of the world such as sub-Saharan Africa, religion (Christianity, to be specific) is gaining ground, that is more the exception than the rule.  With its 1.4 billion population, China is highly secular, a function of the Communist government’s successful efforts to steer people away from religion.  Secularization is also rising in nations with official state religions because of anti-government sentiment.  In the West, Islamophobia appears to be fueling what has been termed the New Atheism, as many come to see religion as a whole as more of a problem than anything else.  Both financial security and education are tied to secularization, making it not surprising that religion is on the wane in developing nations with a growing middle class.  The increase of women in the workplace and of households with fewer children also correlate with a decline in religious values, and the aging of the global population is likely another contributing factor.  The Internet too is promoting secularization by exposing people to alternative forms of spirituality and by allowing non-believers to connect.

Despite the growing numbers of Muslims in the world (Pew Research estimates that their numbers will increase from roughly 23% of the global population in 2010 to around 30% in 2050), it’s difficult to make the case that fundamental religion will play a greater role in most of our lives in the future.  Ever since the Renaissance, in fact, the philosophy of secular humanism has spread throughout much of the world, along with a growing faith in the promise of science versus religion.  (“Science and religion are incompatible because they have different methods for getting knowledge about reality,” Jerry A. Coyne wrote is his 2015 book Faith Versus Fact.)  A long view suggests that official forms of religion are, as the saying goes, “on the wrong side of history,” and that humanism will seed further secularization in the 21st century.

Worth a read;

If the Internet Makes You Sad or Angry, Read Tocqueville — and James Poulos

….That’s the ground level of the crisis we’re facing. This is what we have to deal with to learn again that we are not merely individuals but are also relational beings, in need of the love and friendship of others. We’re not social in an abstract sense. We’re not about “relationships” but about relationships you can put a name to, as with family, friends, love, marriage, etc. Real people are the only real opposition to our twin temptations, to chase after change and success almost worshipfully — or to withdraw from society, in fear of humiliation or just exhausted by the uncertainty and the hustle and the hypocrisy.

Poulos deals with these subjects in his book — not just change, but also the role of money in our lives, sex, play, love and faith, and even death, the perpetually unconfessed object of our fear. He works hard to bridge the gap between the esoteric level of political philosophy, where Tocqueville is at home, and the level of pop culture, where we have stories about what troubles us, but never reflections that are honest and thoughtful. He shares our agonies and has also thought through them — and his book is a rare example of the benefits of a liberal-arts education. Humanistic study actually in service of our humanity!

Econ 101 – Technology Is The Great Disrupter – and Equalizer

Just when you think everything is figured out, a technological breakthrough has the ability to disrupt everything. From KMart to Amazon, to energy generation and storage (which I cover a lot in this blog), the impact of technological breakthroughs on our daily lives is constant. Being able to read trends and adapt to the changes is what separates most companies from oblivion and success.

Think of how; penicillin, steel, combustion engines, radio/TV/Internet, gunpowder, printing, the personal computer and so many other technilogical advancements have changed the world.

Five Things We Need to Know About Technological Change

posted by Jason Kottke   Aug 06, 2018

In 1998, author and media critic Neil Postman gave a talk he called Five Things We Need to Know About Technological Change. Here are the five ideas Postman shared that day, which are all still highly relevant today:

1. All technological change is a trade-off. For every advantage a new technology offers, there is always a corresponding disadvantage.

2. The advantages and disadvantages of new technologies are never distributed evenly among the population. This means that every new technology benefits some and harms others.

3. Embedded in every technology there is a powerful idea, sometimes two or three powerful ideas. Every technology has a philosophy which is given expression in how the technology makes people use their minds, in what it makes us do with our bodies, in how it codifies the world, in which of our senses it amplifies, in which of our emotional and intellectual tendencies it disregards.

4. Technological change is not additive; it is ecological. The consequences of technological change are always vast, often unpredictable and largely irreversible.

5. Media tend to become mythic. Cars, planes, TV, movies, newspapers — they have achieved mythic status because they are perceived as gifts of nature, not as artifacts produced in a specific political and historical context.

What can we expect over the next 110 years?

Liquid Batteries Made from Nano-Molecules …. Think Of How This Will Change The World

Liquid battery could lead to flexible energy storage –

August 14, 2018, University of Glasgow

In a new paper published today in the journal Nature Chemistry, chemists from the University of Glasgow discuss how they developed a  system using a nano-molecule that can store electric power or  giving a new type of hybrid  storage system that can be used as a flow battery or for hydrogen storage.

Their ‘hybrid-electric-hydrogen’ flow battery, based upon the design of a nanoscale battery molecule can store energy, releasing the power on demand as electric power or hydrogen gas that can be used a fuel. When a concentrated liquid containing the nano-molecules is made, the amount of energy it can store increases by almost 10 times. The energy can be released as either electricity or hydrogen gas meaning that the system could be used flexibly in situations that might need either a fuel or .

One potential benefit of this system is that  could be charged in seconds, as the material is a pumpable liquid. This could mean that the battery of an electric car could be “recharged” in roughly the same length of time as petrol cars can be filled up. The old  liquid would be removed at the same time and recharged ready to be used again.

Read more at:

Enjoy The Moments

Former Massachusetts prosecutor, 63, dies after a crowbar crashes through his windshield and strikes him in the head

  • John F. Madaio, a 63-year-old attorney from Paxton, died at Harrington Hospital after the piercing object ‘was kicked up or fell from another vehicle’ on Route 9 


As I run across these types of stories it’s a reminder to enjoy the moments. Madaio seems like a great guy who lived a long life.  At 63, he had a lot of life left to live. He obviously educated himself, worked hard and distinguished himself in the courtroom. Who knows about family or if in fact, he lived a happy life.  I’m sure as John was driving down Route 9 at 10am he had no idea that his last moments on earth were upon him.

Am I living life like every moment counts? Can I look back and say I’ve laughed, loved, learned and experienced more joy than sorrow? Remember, the next time you’re down or feeling blue, at any moment a crowbar can bounce off a truck and kill you instantly. 







The Old American Western – As Values Changed So Did Movies

Take a trip down memory lane of America and Museum of Modern Art (MoMA) cinema. Clearly, times have changed and along the way, our storytelling has evolved, sometimes for the better, sometimes not.  Dave Kehr taps into something about our culture.



Toy Story tapped into this shift in culture with the move from the favorite cowboy toys in Woodie, to the new space toys in Buzz.


Instilling Purpose In Your Company – HBR Ideacast

Instilling purpose in my organization has been the game changer in our success. This interview with Gerry Anderson puts the power of purpose into focus.  Follow this up with a repeat of an interview with Pepsi CEO Indra Nooyi on vision and culture being the drivers for big companies too and you will start getting the picture of the WHY that I strive to be.

Turning Purpose Into Performance

Gerry Anderson, the CEO of DTE Energy, and Robert Quinn and Anjan Thakor, professors at the University of Michigan’s Ross School of Business and the Olin Business School at Washington University, respectively, discuss how an aspirational mission can motivate employees and improve performance. Anderson talks about his own experience. Quinn and Thakor explain their research showing how leaders can foster a sense of purpose that sharpens competitiveness. They wrote the article “Creating a Purpose-Driven Organization” in the July-August 2018 issue of Harvard Business Review



Listen to Indra Nooyi – HERE

The Fall From The Top Is A Long One. What Was LEARNED Makes The Journey Worth It. Lance Armstrong

I found this interview with Lance Armstrong fascinating. Freakonomics did a great job of telling his story, his aftermath and what he learned.  In the end, the Lance Armstrong story is about redemption. I found his story of tenacity and grit appealing but his ‘everyone is doing it’ excuse was a bit disheartening.  Clearly, he lied, but he justified it as everyone lied. When asked if he didn’t dope, what his chances of winning a Tour De France would be…answer….0%.

When Dubner pressed in on how he’s different or similar to Alex Rodriguez and his doping scandal, Armstrong responded that he fell further because;

  1. He was a single star, not on a team
  2. He did a lot outside of the athletic arena that was high profile
  3. A Rod was allowed to return to his sport

The big question was;

DUBNER: Well, let me offer a fourth possible explanation. As everyone has said throughout history, the cover-up is way worse than the crime — usually, right? The situation as I see it is that: a) you were the tallest tree in the land, you win seven, that’s going to be number one; and number two, even though your argument and the argument of a lot of people is everyone was doing it, when you were confronted with it and charged with it all along, you didn’t kind of duck it, but you denied it with a vigor and a venom and sometime really viciously against individual people, that when it came out that it was true — to me, that’s what people don’t want to forgive. And if that’s what it is, the difference between you and a Mike Vick and you and A-Rod — I’m curious whether you think that maybe is a worse infraction.

ARMSTRONG: If you believe what you read — and, believe me, I’m the last one to believe everything I read — but if you believe what you read, and let’s just use for the purposes of this discussion, there was not just one offense, there was two, which is worse. There was an extremely litigious nature to his action and reaction. And so not to debate it with you, but there is no difference.

So to carry on my 7 Deadly Sins rational, Pride, of course, Wrath of course (in Armstrong’s response), Gluttony (why not stop at 3, or 4 or 5 wins and hang out as the face of Live Strong?).  Armstrong has demons he’s working on, as do we all.


The commentators were not kind to this interview: