JUST IMAGINE: IF WE HAD TREATED SOCIAL SECURITY LIKE WE ARE NOW TREATING HEALTH CARE

Of the defects in the just-passed tax legislation by the Senate, the most destructive by far in my option is the removal of the individual mandate for health insurance. Not that the mandate could not have been reshaped or improved but its removal is forecast, per the non-partisan Congressional Budget Office to result in:

 " Without the mandate, health insurance premiums would rise 10 percent in most years over the next decade on the individual market and 13 million people would lose coverage by 2027, the nonpartisan Congressional Budget Office said in a report last month". 

So what in heavens name is the justification to vote for this?  "High-minded" legislators will say they want to give the public the right to choose. Others, being honest, note the "savings" because the need for government subsidies are reduced.
But costs won't be reduced globally because those without health insurance will not only risk their own health (and perhaps life) but will depend on the very high cost of emergency rooms for treatment. 

Can you imagine if social security as a means to provide a financial basis for retirement were proposed today? You would probably hear the argument that people should have the freedom to opt in or out of social security. Young healthy people might well say, "I don't need it." They would choose to wait until they got much older. The accumulated life time savings that accrue with our current all-in system wouldn't occur and the system would fail.  Many would be left close to destitute as they aged. They would live in deep poverty or become wards of the State. Would we argue that would be a better state for our Nation than where we are today?

Universal coverage for health care is standard fare for all developed Nations other than our own. The removal of the individual mandate will be looked back on as a grievous error. One that in time will need to be reversed. The negative consequences of this action will become apparent sooner than those voting for this legislation may expect. 

THE WIT AND WISDOM OF JOHN PEPPER

THE WIT & WISDOM OF JOHN E. PEPPER Jr.

(Compiled by my former P&G colleague and good friend, Eugen Mihai)

“Life isn’t always pretty, but you have to put up with ugliness sometimes to get a big job done; and it only happens when very competent people believe in something deeply and act with all their might to make it happen.”

“Tell me what you think and act on what you believe to be true”

“Life is funny. It’s made up of dots that somehow connect”

“My wife and children have been my constant and underlying source of joy, energy and emotional stability and comfort in my life”

“You are making differences in people’s lives today you don’t even know you are making”

 “Everyone counts!”

“When I go to church the one thing I pray for is the wisdom to know the right thing to do and the courage and perseverance to do it”

“None of us are saints. All I can do and what I must do is do my best to fulfill our responsibilities and help other people whose lives we touch do the same”

“Everybody combines self-centered instincts and noble instincts”

“The greatest thing we will leave behind is the influence that we have on others; most importantly, on our family”

“It is MY choice: do I approach this new day positively or not?”

“Don’t stop pushing for an idea if you really believe in it”

“My two most important mandates: to be of service to others and stand out for what I believe is right”

“My three North Stars are: service, leadership and growth”

“Make sure you take vacation and long week-ends because the best ideas will come when you have some free space”

“The qualities of the best leaders I have met are:

-       Empowering vision and their commitment to it. They simply won’t give up

-       Laser-like strategy

-       A maniacal commitment to executional excellence

-       They build great teams.  They help people grow.

-       Character; integrity and courage.  Perseverance; they don’t give up.  They do what they think is right. 

-       They always look for a better way

-       They love what they do

-       They have respect for themselves and for others

-       They are genuine: what you see is what you get

-       They have an incredible zest to continue to learn”

“I want to be anywhere my wife and children are. That’s where I want to be. Nowhere else!”

“A good strategy is:

-        Based on capability (deliverable)

-        Truly choiceful (differentiating)

-        The basis for sustained advantage vs. competition

-        Robust”

“Be on somebody’s ‘If it weren’t for them’ list. It means you did make a difference in that person’s life”

“Be choiceful, strategic and principled in deciding what to do and how to do it”

“Accept yourself as you are even as you work to improve”

“Remember – God will help you if you trust in Him”

“Don’t worry about things you can’t affect”

“Respect, not popularity is what matters”

“We have a life to live – do it fully and authentically”

“Be true to your purpose and values”

“Let us never forget that we are in business to improve the lives of consumers by offering them better performing and better value brands and by giving them information that enables them to make the best use of these brands”

“Our success depends on our personal leadership in all those things that produce accelerated growth in our business and strengthen organizational capability”

“View navigating change as a growth opportunity, not a burdensome challenge (though at times it will seem and be that). Avoid negativism and grousing. Don’t get discouraged”

“Never give up on something you believe in strongly”

“Insist on quality with maniacal commitment”

“Ask what you can do to serve those to whom you owe service”

“Listen carefully and pay attention to your spouse. Keep having ‘first dates’ as years go on”

“Remember: family comes first!”

“Personal leadership makes things happen”

“Effective leadership grows out of LOVE. Love for what you are doing, so you become passionate.  Love takes you out of yourself and makes you focus on the purpose and the people of your organization”

“Our trust and respect are the greatest gifts we give one another.  They can’t be forced.”

“Life is all about relationships”

“Give people the benefit of the doubt”

“Intimacy with the consumer is critical if we are to perceive the true consumer need which we can fill”

“Creating holistic and highly integrated innovation and marketing strategies that make a brand more appealing and harder to imitate is increasingly important today”

“We need to be alert and responsive to changing situations, anchored to only one commitment – doing the right thing to provide superior consumer value”

“We must never give consumers a reason to switch from our brand”

“We are in business to serve all the world’s consumers, not just the rich ones”

“We need to be first and we need to be better in delivering what appeals to consumers and produces greater total satisfaction for them”

WitWisdom_EugenMihai110217

AN ACCURATE DESCRIPTON OF MY CONCERN ABOUT PRESIDENT TRUMP –

ANATOLY CHERNYAEV

Anatoly Chernyaev was perhaps Mikhail Gorbachev’s closest confident from 1986 onward.  He was his principal foreign policy advisor.  

In what follows, I want to make it clear.  I am not equating President Trump to Stalin, in the way he thinks let alone what he did.

*****

In reading William Taubman’s excellent new biography of Gorbachev:  His Life and Times, one reads this on Page 260:

Chernyaev’s family was particularly cultivated; he received music lessons, learned French and German from private teachers and fell in love with Gogol and Shakespeare in school.  He studied history at Moscow University in the late ‘30s, fought heroically in World War II (part of the time on skis in an Alpine battalion), then got a Candidate’s Degree (roughly equivalent to an American PhD), writing his dissertation on the topic, “Britain’s Role During the First Years After World War I.”  Unlike so many of his generation, he never worshipped Stalin.  It wasn’t the repressions, he said, “about which we didn’t know much and which we thought might have been mistakes or even justified” or “the terrible losses early in World War II” or “in a revulsion against policies like the 1939 Hitler-Stalin pact.”  For Chernyaev, it was the sense that “a crude, ignorant, completely alien force” was ruling over a culture that cherished Tolstoy and Chekhov and admired foreign writers like Shakespeare and Anatole France.”

So it is for me:  My revulsion against Trump rests on his lack of values and his disrespect for other people, his lack of kindness, empathy and his disregard for the truth. He stands in opposition to the very values which, using his own term, have made America great. 

These are the qualities of this man which have repelled me from the start.  We should not stop calling them out, but nor can we afford to wallow in them with a sense of superiority.  Worse yet, we cannot fall into the trap of believing that our denunciation of Trump’s behaviors is sufficient to carry out our responsibility. We must also act proactively and positively in our own world, in our own way to live those values we hold dear and improve the lives of those whom we can touch. 

THE LAS VEGAS MASSACRE--LIVING PROOF THAT THE PLETHORA OF GUNS IS A MATTER OF "PUBLIC HEALTH"

 I AM RE-POSTING THIS ESSAY  WITH SOME EDITS FROM 15 MONTHS AGO.

HOW MANY MASSACRES WILL IT TAKE FOR US TO ACT ON THIS REALITY AS OTHER COUNTRIES HAVE?

A PERSPECTIVE ON REDUCING GUN CARNAGE IN OUR NATION

JULY 20, 2016

 

GUNS, CANCER, TOBACCO AND AUTOMOBILES – WHAT DO THEY HAVE IN COMMON?; 

WHAT CAN WE LEARN ON HOW TO REDUCE THE CARNAGE CAUSED BY GUNS IN OUR NATION?

My reading of an outstanding “biography of cancer” titled The Emperor of all Maladies by Siddhartha Mukherjee has led me to conclude that we should re-frame and attack the issue of the enormous number of gun -caused deaths in our nation as an issue of PUBLIC HEALTH. 

 

One thing guns, cancer, tobacco and automobiles have in common is their association with high rates of mortality, actual and potential.  And with their association with morbidity, automobiles, guns and tobacco have, to different degrees and at different points in time, raised the question of how “causal” the relationship is.

 

The struggle, or more precisely the “fight” (for industry did fight every step of the way) against the ever more evident and deadly linkage between cigarette smoking and cancer was brutal. 

Cigarette smoking skyrocketed during the first half of the 20^th century.  In 1870, the per capita consumption of cigarettes in America was less than one cigarette per year.  By 1953, the average adult American was smoking ten cigarettes every day.  (Sadly, as we went into the 1960s, I was smoking at four times that level!)  Not surprisingly, in this same period—the 1950s—a meteoric increase in lung cancer was being observed in the U.K. and the United States.  But was it being caused by the increase in cigarette smoking?  At first, that notion was greeted with more than skepticism. It was disbelief.  One evidence of this: medical journals were routinely carrying cigarette advertisements.  At the annual conferences of the American Medical Association in the early 1950s, cigarettes were distributed free of charge to doctors who lined up outside the tobacco booths.  When I joined Procter & Gamble in 1963, there was an ashtray placed in front of every member of the Executive Committee, with no thought it was carrying a danger (though by then research was amply available to demonstrate that).  Almost everyone smoked, many nonstop. 

 

Ironically but profoundly, and this has great significance to the issue we face on the causal relationship of the availability of guns to increased morbidity,  it was the “rapid, viral ascendency of tobacco that made its medical hazards virtually invisible.”  

Mukherjee points out that our intuitive appreciation of statistical correlations “performs best at the margins.”  When rare events are superposed against rare events, the association between them can be striking.  That had been seen in drawing a link between scrotal cancer and chimney sweeping in the U.K. Both the profession and the disease were uncommon enough that the juxtaposition of the two stood out starkly like a lunar eclipse; two unusual occurrences in precise overlap.

 

However, as cigarette consumption escalated into a national addiction, and the documented incidence of cancer also sky rocketed,  it became harder to discern an association  of smoking with cancer. 

 

Similarly, with the penetration of guns today growing at a rate which like cigarettes in the past can only be described as an “addiction”—over 300 million in homes in the United States, twice the level of 1968—and, sadly, with deaths involving guns also becoming more prevalent day to day, it becomes harder to make direct associations.

 

In time (measured in decades)  and with great difficulty, the causal relationship of cancer and smoking, was irrefutably established.  It happened thanks to the perseverance and courage of scientists and academics.  Prospective trials were carried out, ironically  first among doctors, matching those who smoked and those who didn’t and then documenting the prevalence of lung cancer over many years. The results were unarguable. 

Even then, getting clear warnings on packages and banning televison advertising was resisted by the industry-- and by legislators committed to the industry, just as is the case today with guns.   It took decades to bring regulations which recognized and grew from the knowledge that cigarette smoking is a “public health issue” of the highest magnitude. And it came through the Public Health Administration, not Congress which was beholden to special interests just as  is the influence of the NRA on legislators today.  

I do not believe it would be possible to create the kind of irrefutable " prospective" research to establish the causal relationship of guns and various forms of death that would match the research which eventually documented the causal relationship of cigarette smoking and cancer.  

But there is powerful "retrospective" and "associative" evidence to show the correlation between gun penetration and deaths caused by fire arms. The facts are staggering. Based on 2010 research reported in the Journal of American Medicine, deaths caused by fire arms are (per 100,000):

U.S. 10.2

Canada 2.3

France 2.8

Germany 1.1

UK 0.2

Gun penetration per 100 people:

U.S. 112.6

Germany 30

UK 6.6

Russia  8.9

The death which a gun can cause in a domestic dispute or mass public shooting of the kind we have just witnessed in Las Vegas makes it altogether more lethal than other weapons  because it can cause instant death and as we have tragically witnessed scores of times, multiple deaths before anyone can intervene. 

While the term seems too pristine, this represents a  "public health" issue of enormous magnitude. 

Today, no one who can read can mistake the danger that they are embarked on in smoking.  This is not being done with the usage of guns.

So what about automobiles?  How do they come into the picture?

 

On a per capita basis, automobiles used to place far higher in the ranking of the causes of death (and injuries) in this country than they do today.  In this case, it was easy to establish the causal relationship.  There was no mistaking that, when a car crashed and there were no seatbelts, and the passengers flew through the windshield and died, that the cause of death was irrevocably related to the car accident.  And in time, for this and other reasons, sharp regulations have been brought to driving a car.   You need to have a license and you have to have that license renewed regularly.   You have to pass a driver’s test to show that you know what you’re doing when you drive the car.  Surely we should insist on nothing less than that when one buys a gun.  We don’t insist on that today.  There is no logical explanation for that.

 

Many will raise the familiar argument that guns don’t cause death, killers do. It is their choice.  

Of course, that could have been said about tobacco—and  indeed it was, literally, vehemently, repeatedly.  

It wasn’t the tobacco that caused cancer, it was the smoker.  And it could be said about automobiles, too.  It wasn’t the car; it was the driver or the weather or the road.  

Yes, but…we have identified a causal relationship of such importance that we ought to be certain that proper steps are being taken to regulate its use so that not only harm to the “owner” but harm to others who are not the owner can be constrained.  That is certainly the case with guns.  Sometimes, it is the harm to the “owner” in the case of accidentally shooting oneself and suicides

  But much more when it comes to "public health" I am addressing the danger to people who don’t “own” the gun.  

To not require a license and training on how to use a gun, especially one capable of firing multiple rounds quickly,  is absolutely irresponsible. 

 

Which brings me to my last point where the relationship of tobacco and cancer, and of automobiles and guns, has something to teach.  It come under the heading of prevention.  It was decades before the medical community was prepared to really address the issue of “prevention” when it comes to cancer.  There were those who favored surgery; others, oncology; many, both. It was only later that  “prevention” to reduce the risk of cancer --in terms of diet and living habits--was addressed,  especially in the focus on not smoking.  This has had a major effect in reducing lung cancer. 

 

“Prevention” has played a big role in the reduction of deaths through automobile accidents too.  The requirement for seatbelts, speed limits and other safety devices, have all come into play, under the mantra of “public health”.

 

We have failed to think deeply enough, or taken action, on what can be done to prevent needless deaths from widespread gun ownership--just as we have done on smoking and driving a car. There are common sense actions that can be taken such as registration for all guns, positive owner identification like we have on cell phones, etc. 

 

There will be many, including the NRA, that retreat to the familiar citation of the “rights” conferred by the 2^nd Amendment.  This argument should carry no weight when it comes to making intelligent modifications on the requirement for gun ownership dictated by learnings from history.  The authors of the 2^nd Amendment did not contemplate that it would confer the right to have semi-automatic and automatic military-style weapons in the hands of millions of people; weapons capable of killing dozens and dozens of people in a matter of seconds as just happened in Las Vegas.

 Just as with automobiles, or now with tobacco, I cannot believe the authors of this Amendment would object to there being strict rules dictated by the well documented knowledge of the risks these guns pose to public health and life.

I believe the great majority of the American people would agree that guns should require registration before they are purchased and training before they are used to be as sure as possible that they were going into responsible hands that are capable of responsible use.   

 

I hope this provides actionable perspective on what it took to understand, document and control the causal impact of cigarette smoking on cancer and the impact of automobiles on highway deaths in a way that provides insight on what we should do to diminish  the horrible loss of life from the broad and inadequately regulated penetration of guns in this country today.

 Put simply, this is a "public health" issue of enormous importance. It covers the rights--including the right to life--of the public, of all people, not only the gun owner. 

It demands action now. 

 

MEMORY, MEMORIALS AND THE IMPORTANCE OF LEARNIG FROM HISTORY

The frantic, rather impulsive even if understandable rapid removal of statues in public places memorializing symbols of slavery and  leaders of the Confederacy raises important questions in my mind.

I suspect much will be written on this in the coming months by people, including historians, better equipped to provide perspective on this than I am. But I would offer these very preliminary thoughts.

1. Anything that "celebrates" or appears to celebrate or condone racial, ethnic or religious prejudice or violence or the division of our Union such as the swastika or Confederate flag or KKK outfits should never be commemorated as something to be emulated in a public space.

2. We should use history--the good and the bad with all its complexity--to learn for the future and not obliterate it or pretend it did not happen.

We should recognize that some leaders like Robert E. Lee had some noble characteristics that led them to support what they felt they owed service to (in Lee's case, Virginia) even though in hindsight that decision--as well as his view on racial equality-- was wrong.

Rather than tearing down statues, we should surround them with contextual historical information which elucidates what is to be learned from them, with all its complexity. Alternatively, these statues should be placed in a museum, again surrounded by information as described above.

One way or the other, the historical learning from our history, both in conveying the best and worst of it, and the values that drove leaders to do what they did, should not be lost. We need more of this history, not less.

Deciding what to do with these statues and the interpretation which should surround them should be decided locally and time should be given to do this properly by giving a wide group of people the chance to speak so the decision will not be seen as arbitrary and will be as informed as possible.

3. I believe we may need a national museum which we may not have today which would tell our nation's history in an honest, comprehensive way, exposing what we are most and least proud of and revealing the complexity and mixture of motivations which have guided leaders, for good and for ill.
Undoubtedly,  the content of that museum would be controversial. So be it.

The Civil War Museum in Richmond (which I have never seen) could be a good place to tell much of this history from the founding of the Nation through Reconstruction and beyond.

The National Underground Railroad Freedom Center in Cincinnati also has the Mission and much of the content necessary (film, exhibits) to contribute to telling this story honestly and in  a way pointing to the future.

4. Whatever, we do,  we must  continue to share and learn from the "reality(its)" of history even as we acknowledge that the definition and interpretation of those realities will be complex and likely evolve over time. There are  themes which I hope would emerge founded on the prefatory principles of our Declaration of Independence ("all men are created equal") and the call of all religions to treat others as we would want to be treated ourselves.

IN THE END IT IS ALL ABOUT CHARACTER--DONALD TRUMP

 I posted this originally on October 10th, 2016. About a month before the election.

I hoped my deep concerns then about Donal Trump's character would be modified by his actions.

They have not.

This cannot continue.

A message to Donald Trump and myself and all of us:

"Watch your thoughts; they become your words.
Watch your words; they become your actions.
Watch your actions; they become habits.
Watch your habits; they become character.
Watch your character; it becomes your destiny."

Frank Outlaw

ONE OF MY SONS JUST ASKED ME: "WHERE DO YOU STAND ON THE SENATE'S HEALTH CARE BILL?"

MY ANSWER: 

This remains an ill-conceived, cruel piece of legislation. 

It should be rejected. 

The reduction in coverage (20MM plus) makes it inconceivable that we would put this in place.

It fails to deal with the cost issues that have to be addressed at the root cause level (e.g. cost of drugs; multiple profit centers picking up $$; lack of consumer visibility into true costs, etc. ). It fails to study other health care systems which are affording close to universal health care at a cost  40%  BELOW ours. 

The process followed to do this, after 7 years of seeing the flaws of Obamacare, is tragic.

There are two premises which will ultimately have to be and will be accepted:

1. Everyone should have health insurance. Everyone. We don't allow people to opt in or out of Social Security. Or having automobile insurance. It is an issue of the national interest, not just the individual. 

2. Providing quality health care is a Right, just like education is and safety is. For everyone and it is the government's responsibility to provide it. Like Social Security. For the National Interest.