Digital Roam

The Health Care Rollercoaster Unplugged

Time for a ride on the health care roller coaster again. Only this time forget about the Senate Finance Committee; we're talking the Big Dipper on the Santa Cruz Beach Boardwalk.

Next Thursday, Nov. 12, the Health Improvement Partnership of Santa Cruz County has invited me to share my health care napkins at their gala event.

Join me and Healthy Kids of Santa Cruz County for a rolling ride through the ups and downs of H.R.3200, The Baucus Bill, Nancy Pelosi's new price tag... and of course, solving problems with pictures.

Thursday, Nov. 12, 6:00 - 8:00pm. The Dream Inn at 175 West Cliff Drive on the Santa Cruz Beach, Santa Cruz, CA. Tickets are $25 per person, and all proceeds benefit the Healthy Kids program.

Health care napkins take top honors

I'm excited that the health care napkins I created with Tony Jones have just been announced as the "World's Best Presentation 2009" by Slideshare.net and Business Week.

It tells us a lot about the power of simple pictures that over 100,000 people have viewed the slides. After all, this is a PowerPoint presentation about health care; what in the world could possibly be more boring?

Yet by making it visual, simple and clear, people don't mind taking the time to look it over.

Healthcare Napkins All

View more documents from Dan Roam.

This is the real lesson for all of us who need to present information to others:

There is no such thing as boring knowledge.

There are only boring ways to present it.

The second and third place winners make the same point. Orphanages and kidneys? *...Yawn...*

NOT.

Sheltering Wings

View more presentations from Sarah Cullem.

Feels Bad On The Back

View more documents from mohamad faried.

Scaling the Grand Hyatt SF

On Sept. 23 I'll be talking and drawing at the SF Chapter of the American Marketing Association. I hope to touch on:

• Solving any problem with a picture.
• How anyone can draw.
• The best 2 business pictures ever made. (Einstein drew one of them.)

Reception starts at 6:00pm at the Grand Hyatt, drawing on napkins starts at 7:00. Thanks Mark Evans for setting this up. Hope to see you at the Hyatt, right off Union Square.

Register here.

My Speech to Congress (anticipating Obama)

Just when you thought health care was over... BUT WAIT, THERE'S MORE! (Now how much would you pay??)

After the success of our first round health care back-of-the-napkins, Dr. Jones and I realized we still had a bit more to say. When we heard that President Obama was going to be speaking to an extraordinary joint session of Congress next week (Wednesday, Sept. 9 at prime time) we took upon ourselves to say it for him.

So here are the index cards we recommend the President take with him when he mounts the stage next week. (Yes, we know he uses a Teleprompter, but we kind of liked the old-school approach. It lends an additional needed air of 'authenticity'.)

You can recite our proposed speech index card-by-index card below (click on each image to enlarge for better readability) or view as a PowerPoint on Slideshare.net.

We'll be watching next week to see if he takes up our talking points. Anyone have a direct line to Jon Favreau?

Health care napkins update: FOX news, Huffington Post, etc.

Two weeks ago, I published here and on slideshare.net a series of "back of the napkin" visual explanations of the health care debate. I created the napkins in order to myself understand the essentials of a public debate which had become more vicious than any in recent memory. I also hoped others might find them a useful baseline description of the issues.

The response has proven to me (again) the staggering power of simple pictures.

Healthcare Napkins All

View more documents from Dan Roam.

Since I posted the slide show, it has been viewed more than 76,000 times, embedded in 265 other blogs, cited on the HuffingtonPost.com and prompted FOX News to ask me to explain on air what the debate is really about.

(On a side note, I find it interesting that FOX was the first network to call. My politics rarely align with those of the pundits appearing on FOX, so it was gratifying that they found the clarity of my napkins more compelling than any political slant. That's something to be especially optimistic about.)

As the government reconvenes in the next weeks, I'm sure health care will remain as contentious an issue as it was before vacation. I plan to create a second set of napkins as the debate heats up again. Watch for them here.

Hey Jabba: can you draw me a map to Tatooine?

Nothing makes me happier than seeing a simple picture clarify a complex issue. This is especially true if the issue is one critical to the cohesion of society. Like understanding health care. Or like finding a good bar in the Dagobah System. 

Authors Dan Wallace and Jason Fry have taken three years to help us with that second, and it looks like it was worth the wait. Their brand new masterwork is called STAR WARS: THE ESSENTIAL ATLAS and it looks spectacular.

The best part for me isn't necessarily the beautifully rendered color maps (although they do look like something we could pour over for hours); what I'm most excited to see are the original "back of the napkin" sketches.

In the words of author Jason Fry:

In December 2006 I sat down at my desk, pulled a sheet of paper out of my printer, and started to draw. Using a blue ballpoint pen, I roughed out the approximate borders of Hutt Space, then added dots for the region's star systems that had appeared on maps: Here were Sriluur and Klatooine, there were Kessel and Honoghr, farther down were Toydaria, Nal Hutta, and Ylesia. There were eleven in all. Hutt Space looked awfully empty.

I put down the pen and picked up a pencil.

Here is a detail of Jason's original drawing of "Hutt space":

 

And here is the whole thing: (click to enlarge)

Why do I like the hand-drawn versions so much? Because I love to see someone's thinking made visible. Like grandma said, "It's the thought that counts."

American health care on (4) napkins. Now all together!

You can now download my entire series of four "back of the napkin" health care sketches as a single PDF file here.

For additional commentary, you may read them on my blog here:

Napkin #1: The health care equation.

Napkin #2: It's not about health care.

Napkin #3: The plans on the table.

Napkin #4: What's it mean to me?

These napkins have been getting a lot of circulation. They've been ranked among the most frequently cited presentations on SlideShare since I've been posting them this week. I've sent links to my Senators Pelosi and Feinstein, and have sent them through to contacts I met at the Senate while giving a workshop there last year.

If you know somebody in the administration who could use help clarifying what the heck is being talked about, please pass along these links.

Health care napkin #4: impacts and conclusions

Here is my 4th and final napkin in the health care series. (For now, anyway.) This napkin illustrates the impact upon us of each of the plan types, and offers three concluding questions.

This is the cover of the 4th and final napkin.

This napkin shows how the various insurance reform options will effect me.

In review: there are three main options in debate. All of them mandate universal coverage for all Americans; the difference is the degree of government-backed coverage they provide.

We should note that earlier in the debate there was a 4th option. Sometimes referred to as "single-payer", this option proposed a single national health insurance plan.

This option was not supported by the White House and is effectively off the table for any debate this year.

So what do these 3 options really mean for me?

If I am presently employed and covered, I will pay more for insurance under all proposed plans.

So why should we reform insurance? Because health care costs are already bankrupting the country and if we do nothing now, it's going to cost much more very soon.

At this point in the debate, the actual additional costs are unknown. What is known -- what we can try to influence -- is how the money will be taken from our pockets. Will we pay higher premiums to private insurers, lose our existing health care tax benefit, or pay more direct taxes?

An additional aspect of the various plans we need to be aware of is whether our employer continues to pay our insurance premiums on our behalf to a carrier they select (called "Defined Contribution" in the secret code of the insurance industry), or do they pay us in health care vouchers that we can spend on any insurance program (called "Defined Benefit"). The difference means an additional $250 Billion in revenues collected annually by the government to cover health care with no impact on our compensation and employer costs.

The good news is that under any option our health care at least shouldn't get any worse. All plans in debate allow us to keep existing coverage and providers as long we keep the same employer. And all plans will ensure that more Americans have health care insurance, which is the whole point.

Although today's debate is more about insurance than health care, there are several ideas to address on the "provider" side of the equation to help drive down costs: reforming malpractice will save the entire system money. The pharmaceutical industry has many opportunities to assist in minimizing costs. New technologies (most of which are expensive up-front to enable) could well create efficiencies that save huge amounts of money. These are all worth debating, but none of them are at the core of today's debate. For now, it's about insurance.

 
When all is said and done, there are really only three essential questions we need to ask ourselves in order to know how we should individually feel about insurance reform: first, should paying for our health be a profit-driven business? Second, since change is coming no matter what, how do we want to pay for it: as profits for insurance company shareholders or as taxes to the government? Third, will we be better off by continuing to shout at each other, or by listening and thinking?

Two things to remember: one, it is neurobiologically impossible to shout and think at the same time. Two, there are influential parties in this debate who do not want us to listen or think. Ask yourself who stands to gain the most by encouraging us not to think, and you'll know which option you are for.

Tony and I thank you for staying with us this long, and sincerely hope these four napkins have made things at least a little clearer.

Health care napkin #3: the plans

Here is napkin #3 of 4 in my ongoing visual explanation of the health care debate. This napkin draws from the fundamental pieces illustrated in napkins #1 and #2 and maps out that actual legislation being proposed.

(You can download the whole sequence here on SlideShare.)

This is the cover of Napkin #3.

Let's map out what proposed legislation is really on the table. (Does not include 'death panels' or 'assisted suicide'. Sorry.)

Today (with the exception of Medicare), America has a purely business-driven insurance model. Insurance companies collect premiums from us (usually through our employer), invest that money until needed, then pay the providers and keep any profit. To keep costs manageable, these insurers restrict who and what they will pay for.

There are 3 new models on the table. The first option changes nothing substantial except demands that private insurers cover all citizens.

The second option adds insurance "co-ops" (or exchanges) on top of the current system and legislates that all citizens must have insurance from one or the other. (No fundamental changes are demanded of the existing private insurers. These co-ops offer non-profit pools of insurance that citizens may choose to pay into instead of paying private insurers. (More on co-ops on Napkin #4.)

 

The third option adds a government-managed insurance option to the existing system and makes health insurance mandatory for all citizens. The government option can't make a profit by law. It does not replace today's insurers but adds another option for people who chose not to pay a private insurer but legally are still required to have insurance.

 

When this debate began in March 2009, most political conservatives were happy to keep the existing system in place. It was the White House that demanded reform and wanted to create the government insurer in Option 3. As the debate has gotten nasty, the White House seems to have given up on Option 3 as too politically difficult to achieve. The conservatives likewise realize that the status-quo isn't going to last, so are hoping for Option 1.

 

The many bills being developed and debated stretch across this spectrum. H.R. 3200 is the Democratic House bill sponsored by Rep. Dingell. It promotes Option 3. The big Democratic Senate bill sponsored by Sen. Kennedy appears to support both an Option 2 and 3. Senator Wyden's bill (also a Democrat) supports Option 1. The Republican House and Senate have been slower to propose options. It looks like both Rep. Blunt and Sen. Coburn's bills will support Option 1. 

 

The private insurance industry does not like any of these options. All options open the insurance market up to increased competition (either private, non-profit, or public) which upsets the few remaining big private insurers who presently hold most of the market.

 

Of all options, the private insurers see the first as being the least threatening, so have gone to extraordinary lengths to demonize Options 2 and 3. Town hall meeting participants have picked up on several misconceptions and are out-shouting participants who want to open the debate to all options.

 

In the next and final napkin, we'll look at how the underlying differences in each option would impact me.

Health care: napkin #2.

In my continuing series of "back of the napkin" sketches, created to help more of us understand the health care debate, here is napkin #2. (I'll post #3 tomorrow and #4 on Thursday).

(You can download the whole series here.)

This is the cover of Napkin #2.

It's not "health care" reform at all; it's insurance reform.

Remember how all the reforms are focused on the insurance side of the equation?

The White House would do all of us (and itself) a favor if it just called this what it is: a for-profit insurance smack-down.

Is it fair to demand so much reform of the insurance business? Let's think about that. Aside from making a profit for its shareholders, the only value a private insurer provides is to keep costs down for its members.

Private insurance has miserably failed in its one value-added task: it has not managed to keep premiums down for members. If insurance can't manage costs, then why does it exist?

 
On the contrary, as the rest of the American economy has tanked, the private insurance industry has done exceptionally well. While the government bails out GM (that's failing in large part due to health care costs), the top three insurers averaged profits of $2,400,000,000.00 each for 2008.

Aside from insurance, is anyone else being asked to reform? A little, but nothing that government can legislate.

In the end, whatever reform package is adopted, it will all be paid for by me. If I'm employed and/or have coverage, I'm the only player putting money into the system.

Where will my money go? Depending on the decisions made by government in the next month, there are three possibilities: 1) Into the profits of private insurer shareholders; 2) Into funding new non-profit insurance co-ops and exchanges; 3) Into funding a new government insurance plan that by law cannot make a profit. (It really is that simple.)

In the next napkin, we'll sketch out the plans on the table.

See you tomorrow.