• I want to be in a rock band so that I can have a highly-public falling-out with its leader over creative differences — music shorthand for who took the wrong drugs when.

• NFL coach-speak is an odd but highly-evolved dialect whose purpose is to kill time in mandatory post-game interviews while avoiding saying anything of substance.  Mike Tomlin, head coach of the Pittsburgh Steelers, is a master of the form.  Tomlin’s recent commentary on his team’s up-and-down performances: “We know it’s something we’re very cognizant of.”

• Carnegie-Mellon University in Pittsburgh has announced its tuition and fee schedule for undergraduates entering in the fall of 2016.  Yearly tuition rises to $51,196 — standard room and board will cost $13,270.  This is in addition to the activity fee, technology fee,  transportation fee, media fee and orientation fee, which together total $1,114.  Without textbooks, this comes to $65,580.  When I entered college 45 years ago, the tuition was $2,500, including the $10 activity fee; room and board was $1,150.  So, the cost of going to CMU has gone up 18-fold in the last 45 years (an annualized rate of 6.6%) while per capita income in the U.S. has increased only 10-fold in the same period.  Small wonder that Bernie Sanders is popular among the young, educated and indebted.

Course description of my college creative writing class• The reading list for my freshman “Literary Imagination” course was very formative and very 1960s: Slaughterhouse Five; Catch 22; Trout Fishing in America; One Flew Over the Cuckoo’s Nest; and The Electric Kool-Aid Acid Test.  None of those titles was written by a woman, nor did any of them involve strong female characters — Nurse Ratched excepted.  In retrospect, what passed for literary imagination in 1970 was still pretty limited.

• One recent clue on Jeopardy referred to the 56-bedroom, 61-bathroom Hearst Castle at San Simeon, California.  This led my wife to exclaim, “Who would want to clean all those bathrooms?”  Though phrased in the form of a question, this was not the right answer.

• Three Georges, three aphorisms:

There is nothing more dangerous than the conscience of a bigot.
— George Bernard Shaw

One cannot judge the value of an opinion simply by the amount of courage that is required in holding it.
— George Orwell

In comic strips, the person on the left always speaks first.
— George Carlin

• When I was growing up, I had the impression that poet was on equal footing with barber, policeman or scientist as something a person might do for a living.  That it was folly in me, thou mayst say! [Shakespeare, Cymbeline, 1610]

• As I write this, the U.S. stock market, as represented by its largest corporations, has fallen more than 10 percent below its long-term trend (see sidebar).  Declines of this magnitude are referred to — by the financial community — as volatility.  (Ordinary people call them losses.)  Sudden drops in the market always bring out the financial pundits, telling the public to stay calm.  As David Lebovitz of JPMorgan intones in Barrons, “To us, this recent sell-off looks more like a repricing, rather than the beginning of something more serious, and long-term investors should stay the course.”  [My emphasis added.]  Does no one else see the irony in Wall Street imploring the public not to sell, when the selling by Wall Street traders is the very reason prices are falling?  I know precisely why  the market is volatile: because these people are playing with other people’s money.

Feels Like 3.69999999999Finally, a bit of nerd humor to zap your neurons. Last winter, a local personal weather station (PWS) reported an unusual reading (see image at right).  As you see, the “feels like” temperature differs from the 3.7 ° thermometer reading by seven units in the sixteenth decimal place, an astounding degree of precision.  How did they find someone with such sensitive skin?

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This is the year.  Until now, I have put off addressing various physical issues that paid me a short visit and then decided to stay.  So I am in the midst of scheduling an array of visits, tests and procedures for restless legs, varicose veins, a colonoscopy and a minor surgery.  In the spring, I check in with my physician about blood pressure; in the fall, I have my one-year followup with the dermatologist.

That is in addition to my quarterly retinal scans and yearly injections of 2 mg of Eylea™, a drug that costs me $3000 a dose.  This works out to be $42,524,250 an ounce, just a trifle more than the $41,965,424 annual compensation of Leonard S. Schleifer, M.D., founder and CEO of Regeneron, the outfit that makes Eylea.  Schleifer is the highest-paid biopharma executive in the U.S.  He is now a billionaire and I (eye) helped put him there.

Money Shot - Image by CHCollins (2016)I have a hunch that Leonard S. Schleifer, M.D., doesn’t think much about his health insurance deductible when he needs medical care.  But I do.  The way our system is designed (and I use that term loosely), it pays to defer care until there is enough to do in one calendar year to satisfy one’s annual deductible and out-of-pocket maximum.  Many people don’t have the luxury of timing their medical needs — and those people wind up paying more.

I selected a high-deductible, high out-of-pocket ($10,000 maximum) policy, which is still available thanks to President Obama’s famous line: “If you like your health care plan, you can keep it.”  It’s not so much that I like my plan, but it makes the most financial sense.  I did the math: for any given amount of medical care I might need in 2016, I would pay the least in premiums and total out-of-pocket costs with the highest-deductible plan.  It is just the way policies are priced.  The sooner you want an insurance company to start sharing your costs, the more you will pay in monthly premiums — but you are unlikely to make up the difference in terms of overall benefits.

The problem with health insurance in the U.S. is that all plans create perverse incentives, depending on the deductible and out-of-pocket figures.  For example, an insured person has no incentive, once the out-of-pocket maximum is reached, to limit his demand for health care for the rest of the calendar year.  In fact, one who is close to his out-of-pocket limit has an incentive to accelerate care so that its marginal cost is shared by the insurer.  On the other hand, high deductibles force people to decide between seeking care and doing without, which puts the burden on the individual as to how much his or her quality of life is worth.  This is unfair.  One’s health and life expectancy should not be subject to how deeply the notion of frugality has been ingrained into you.

It may be impossible to devise a health care system that cannot be gamed by consumers, physicians, hospitals or drug companies.  But our goal as a nation should be to implement a system that delivers the greatest health benefit in the most efficient way.  To be efficient, we must tackle fraud, abuse and predatory pricing in all corners of the health care system, and end this nation’s simple-minded fixation on throttling consumer demand by way of the insurance industry.

Who, after all, wants to be sick?  Who wants to go to the doctor?  You don’t, and I don’t.  In the long run, insurer-based disincentives to seeking health care (such as deductibles) have a perverse outcome of their own: by making health care seem precious and desirable, they counter our natural reluctance to even enter the health care system — and they all but invite cynicism and gaming behaviors.

I would not be surprised if Medicare Part E (for Everyone) would reduce the demand for health care, once our citizens were assured that good, affordable care would be available to anyone when it is needed.  In the meantime, we play these games.

• • • •

Insurance companies are run by smart people.  They know that some of their subscribers will lump medical procedures into the same calendar year so that the insurer pays a larger share of the cost.  What they don’t know is whether I plan to do it.  They’ll soon find out:  this is my year of living deductibly.

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chc-silI have, on average, gained two pounds a year since I quit smoking and about three pounds a year since I retired.  This means I am now 36 pounds over what I consider to be a good weight, and 5 inches over my desired waist size.  I am not going to tell you my current weight and waistband, but I will share this: the expansion of my personal universe will be ending as of Sunday, January 3, 2016.

Here is how I plan to do it.  I know better than to adopt some self-sacrificial strategy that is miserable to follow.  What works for me (based on experience) is a combination of limits, allowances and positive steps.  These will include:

• No chips, pretzels, crackers or other snacks
• No potatoes, rice, bread, toast, etc.
• Nothing fried or breaded
• One drink (wine or beer) a day.  Limit of one martini a week.
• Unlimited vegetables
• Unlimited lean meat (steaks, chicken breast, turkey)
• Unlimited broth-base soups (vs cream soups)
• One item per week of fatty meat (pork, hot dog, hamburger, sausage)
• One six-ounce pasta dish OR two slices of pizza for dinner, per week
• One bread item per week, only if needed for a hot dog, hamburger, etc.
• One bowl of Cheerios with 1% milk OR one hard-boiled egg, per day
• One-half (3/4 ounce) of a chocolate bar or equivalent treat, per week
• No messing with my morning coffee.
• Thirty minutes of real exercise (elliptical) at least four times a week

The main idea is to get rid of gratuitous calories but keep the satisfying ones, so that I am more likely to stick with the plan.  I know losing 36 pounds will not happen overnight, so I will need to be patient.  I hope I can lose 3 pounds a month and achieve my goal in a year.  We will see.  If my initial plan is not aggressive enough after six months, I will be prepared to take further steps.

Since I have a blog, I can (and will) post a cool graph documenting my progress every few months, which is more often than any of you want.  In a sense, however, I am doing this for you, future readers of The 100 Billionth Person.  I will have a lot to say about the decade of the 2040s, and it would be in our mutual interest if I were around to say it.

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