Photo for Glenn Fleishman



What I Do



Turning technology from mumbo-jumbo into rich tasty gumbo

« September 2005 | Main | November 2005 »

October 30, 2005

Concierge Care

By Glenn Fleishman

I’ve been seeing a concierge practice doctor for several years now since he and his partner decided after the departure of two of their colleagues to form their own high-priced retainer service to opt for a middle-class one. I pay several hundred dollars a year for unlimited care from my doctor. This has been invaluable to me, although more useful when I was coordinating my cancer care in 1998 than in recent years. Until Ben’s first cold several months ago, I had avoided any cold or flu that was more than a passing runny nose for two years. Now I’ve had several colds via Ben, and I don’t blame him a bit.

Concierge medicine involves a doctor assuming only the risk to provide their service to a patient and the services of their office. This has caused Washington State’s insurance commissioner to investigate the practice as he believes it might fall under the provision of an insurance company. I don’t believe risk is really involved because the doctor is pledging his or her own services. My doctor’s practice puts fees in escrow until after each month in which service is provided, thus limiting a patient’s actual dollar exposure to $0.00 for any given month.

The New York Times is picking up on this trend quite late. The Wall Street Journal wrote about my and other doctors back in 1998, and I was quoted in the article. I have the same reaction as many of the folks on both sides of the concierge debate in this Times article: I love the access I have and I know my doctor enjoys his practice more. And I know that he is able to better keep up on developments in treatment and have his own life. Nobody said that being a good doctor should involve 80-hour or 100-hour weeks for your entire career.

The “lavish care” in the headline doesn’t apply to most retainer-based doctors. Lavish means getting the doctor on the phone when you call, getting in the same or next day for an appointment, and spending 15 to 30 minutes with a doctor when you’re there. Lavish. Right.

On the other side is the fact that the more doctors that retreat into retainer-based services, the fewer doctors available for general medicine. Retainer-based doctors have fewer patients in their practices. Because I can afford his fees, it means I get better health care than others who have to see whomever.

Of course, my reaction is that Medicare and other social support systems for healthcare should organize to build networks of retainer-based clinics that would allow patients to avoid expensive emergency room visits and save everyone in the system money. For fairly small fees, people with little or no money could be subsidized into better health care. Right now, hospitals eat huge bills (or pursue people with no money like they’re the Erinyes) or people face financial ruin.

There is a lot of evidence that the lower you are on the income totem pole in the US, the worse you sleep and the worse your health. Because you make less money, the less you are able to improve your health through routine care and medication that might cost a fraction of emergency-room visits or late-in-the-process care. There’s that telling scene in As Good As It Gets when Helen Hunt’s son who has some kind of asthma-like disease is finally seen by a regular private-practice doctor paid for by Jack Nicholson: the doctor says, this is pretty easily treated as long as we’re on top of it. This is not Hollywood magic.

Posted by Glennf at 1:53 PM | TrackBack

October 26, 2005

US Out of WalMart

By Glenn Fleishman

Does any small fraction of our population understand that WalMart is a scourge not because it offers low prices, but because it’s destroying our healthcare system?

The company has 1.33 million employees. According to a leaked memo in today’s NY Times on reducing health-care costs, 46 percent of those employees children are uninsured or on Medicaid. Because WalMart pays essentially poverty wages (legally), when they replace jobs in communities through their predatory practices that first drive out businesses through underpricing, they do the following:

This is sort of free-market capitalism at its worst: Because we as a country don’t require health-care insurance for all employees of large companies, this allows a firm to offload its health-care burden. It’s easy to argue that predatory underpricing shouldn’t be regulated because the market will take care of it—and it often does—it’s very hard to say that a company should force local communities to lose tax revenue and pay for health care.

This is not to say, by the way, that WalMart isn’t paying anything for health care: 45 percent of their employees are covered. They spent $4.2 billion last year. Even so, a $17,500 per year job has a limit of $2,500 in out-of-pocket expenses or more, according to the Times article.

But it’s another key to the broken health-care system that the increases in costs outpace inflation by a factor of three to five per year, and that this leaves more people behind instead of prompting massive reform by the affected businesses.

Posted by Glennf at 7:41 AM | TrackBack

October 25, 2005

Scott Adams Starts a Blog

By Glenn Fleishman

Pearls of wisdom!

The blogger’s philosophy goes something like this: Everything that I think about is more fascinating than the crap in your head.

See Dilbert Blog.

Posted by Glennf at 11:49 AM | TrackBack

October 19, 2005

The Senate Dismisses Inflation's Power

By Glenn Fleishman

By denying a Democratic move to raise the federal minimum wage from $5.15 an hour ($10,300 per year for a full-time job) to $6.25 over 18 months, the Senate Republicans have decided that on one hand, wages don’t need to increase along with inflation’s affect on decreasing buying power and, yet, on the other that business isn’t increasing its revenues at least as fast as inflation. The most recent previous proposal by the marvelous and bilious Sen. Ted Kennedy was for a $2.15 increase (to $7.30) over 26 months, and this reduction picked up a vote.

A Republican counterproposal would have kept the $1.10 increase but required a remarkable array of horrible add-ons, such as allowing “flex-time,” in which overtime one week could be made up through undertime another. These senators are pretending that people working these kinds of jobs have the easy flexibility that would allow the kind of schedules that employers would impose if no longer subject to week-based overtime rules. Jeesus.

Inflation increased 25 percent from 1997, the last increase in the federal minimum wage, to last month. Thus $6.25 would still be slightly short of inflation across that period. I live in Washington State, which requires a minimum wage of $7.35. This is still a ridiculously low wage: $15,700 per year. There are few communities in Washington in which a single person earning that wage and paying no tax on it would spend much less than one-third of their take-home on rent; in Seattle, you’d pay 75 to 100 percent of your take-home pay on rent.

Posted by Glennf at 9:04 PM | TrackBack

October 11, 2005

Here's How Ethical I Believe I Am

By Glenn Fleishman

RealNetworks and Microsoft just settled for $761 million—that’s Microsoft to RealNetworks—which covers resolving lawsuits and partnering for services. This is fantastic news for Real, which gets the payoff for years of fighting, and Microsoft, which has now settled all of the major domestic lawsuits and government actions against it. This has distracted them, to be sure, and given Google an opening. Microsoft is now the underdog…with tens of billions of dollars in the bank.

Why does this make me ethical? A reporter called to ask me my opinion on this, and I had to decline to comment. About eight years ago, Real bought the assets of, a company I had helped incubate, and I received a small but very nice chunk of stock for my participation in that. During the Internet heydey, I sold about 2/3rds of that stock paying, among other things, for a new roof for my house.

The remaining stock is Section 144 insider stock which means I have to file about 1 inch of paperwork for it. I’ve sat on the small number of shares that remain because there was only a little upside versus what I thought might happen if Real resolved its Microsoft difficulties. When Real retained money in the bank turning profits, I had to think Microsoft now knows it can’t simply outlast the company which is making money in spite of what it’s spending on lawyers. (A commenter pointed out that Real has had little GAAP profit; nonetheless, they have increased shareholder equity while only very slowly tapping cash reserves over the last three years.)

It would be wrong of me holding insider stocks with a material benefit of literally hundreds of dollars—no typo—to comment on it even though I never worked for Real.

Posted by Glennf at 11:23 AM | TrackBack

October 9, 2005

Amazon's Review Rules

By Glenn Fleishman

A rule I set many moons again is apparently still in place at When I was catalog manager briefly (a six-month stint at the company in late 96 to early 97), I had to deal with the burgeoning number of user-submitted reviews which were posted live instantly on the site when I got there. I fought a battle over several months, culminating before I left, in which reviews were reviewed by a staffer before going live. I won this battle partly because more and more reviews were both unpleasant, offtopic, and not noticed until we got complaints. There were turds in the punchbowl, in other words.

One of the rules I set for my staff in reading over reviews was that reviews that attacked the author and that otherwise didn’t address the substance of the book were off-limits. This is the “attack ideas, not authors” notion which is a specific case of a general forum policy on most forums prohibiting ad hominem attacks.

An Amazon spokesperson said in a New York Times piece (in Monday’s paper), “the posts violated guidelines, which require reviews to focus on the content of the book, not the character of its author.” The article covers a tax-denier’s book that had reviews that said things like follow this book’s tips and go to jail.

Posted by Glennf at 7:41 PM | TrackBack

October 4, 2005

Baching It

By Glenn Fleishman

44582772 0Fc8A8E99E MLynn and Ben are off to visit her parents for 10 days starting tomorrow. Let the waterworks begin on both ends. I may slip out on a frequent flyer ticket to see them, but my list of house repairs while they’re gone is quite long. We’ll see if I (and they) can hold out. Ten days in the life of a nearly 14 month old is a long, long time. He went from standing to walking well within 10 days. I’ll miss them.

Posted by Glennf at 10:15 PM | TrackBack

October 3, 2005

Kenwood's Latest HD Offering

By Glenn Fleishman

Kenwood-1Kenwood just announced last week its EZ900HDS, which is a tour de force of integration: it has AM/FM, HD, and Sirius built in. No external modules as far as I can tell. It’s $799 list or about $600 street, which is a tidy price for something with that much integration. The CD player handles MP3 and WMA, of course. The street price drops by $250 for a similar unit without HD Radio.

Posted by Glennf at 11:25 AM | TrackBack

October 2, 2005

August Wilson Dies

By Glenn Fleishman

I have a tiny bit of personal history to add to the knowledge that August Wilson has died in Seattle today at 60 of liver cancer. When I was an undergraduate at Yale, I quickly joined the new weekly newspaper, The Yale Herald, and just as quickly became the regular theater reviewer, handling the Yale Repertory Theatre, then run by Lloyd Richards. Richards was the definitive and premiering director of Wilson’s history of black experience in America by decades.

I had the opportunity to interview Wilson through the good offices of the Rep’s press department, which treated at least our paper like a real news source, and gave us access to folks. I spent more than an hour with Wilson in 1987 after reading his earlier plays and before seeing The Piano Lesson. He was gruff but willing to talk, and I asked not entirely stupid questions.

But he stressed an interesting point several times that was new to me, white boy that I was having grown up in a white suburb in California and then in Eugene, Oregon, before going to school in New Haven. He said that blacks would have been better off if they hadn’t made the great migration out of the Deep South into inner city neighborhoods for blue-collar jobs. He said that if blacks had stayed, they would have changed the destiny of the South by eventually owning a lot of it. He used the phrase, and I have this on tape still, separate but equal, but meant it that the blacks would have created their own nation.

Now having followed his career since, I’m not sure he continued to subscribe to that notion. It wasn’t revolutionary, I found out, but it was very interesting. It’s hard to say what would have kept blacks in the south—and not like there isn’t a large African-American population there now—but as far as my history lessons teach me, the movement north was for jobs and a change from overt, deadly racism to implicit, hostile racism.

Hard to evaluate what would have happened if the folks who had the resources and skills to leave had stayed, but it’s hard to imagine a South that isn’t deeply divided by economics and in which race and poverty often go hand in hand. Poverty still seems to be the overriding problem, but race continues to compound.

Posted by Glennf at 7:16 PM | TrackBack


October 2011
Sun Mon Tue Wed Thu Fri Sat
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31          

Recent Entries


October 2011 | August 2011 | June 2011 | May 2011 | February 2011 | December 2010 | November 2010 | October 2010 | September 2010 | August 2010 | July 2010 | June 2010 | May 2010 | April 2010 | January 2010 | December 2009 | November 2009 | October 2009 | September 2009 | August 2009 | July 2009 | May 2009 | April 2009 | March 2009 | February 2009 | January 2009 | December 2008 | November 2008 | October 2008 | September 2008 | August 2008 | July 2008 | June 2008 | May 2008 | April 2008 | March 2008 | February 2008 | January 2008 | December 2007 | November 2007 | October 2007 | September 2007 | August 2007 | July 2007 | June 2007 | May 2007 | April 2007 | March 2007 | February 2007 | January 2007 | December 2006 | November 2006 | October 2006 | September 2006 | August 2006 | July 2006 | June 2006 | May 2006 | April 2006 | March 2006 | February 2006 | January 2006 | December 2005 | November 2005 | October 2005 | September 2005 | August 2005 | July 2005 | June 2005 | May 2005 | April 2005 | March 2005 | February 2005 | January 2005 | December 2004 | November 2004 | October 2004 | September 2004 | August 2004 | July 2004 | June 2004 | May 2004 | April 2004 | March 2004 | February 2004 | January 2004 | December 2003 | November 2003 | October 2003 | September 2003 | August 2003 | July 2003 | June 2003 | May 2003 | April 2003 | March 2003 | February 2003 | January 2003 | December 2002 | November 2002 | October 2002 | September 2002 | August 2002 | July 2002 | June 2002 | May 2002 | April 2002 | March 2002 | February 2002 | January 2002 | December 2001 | November 2001 | October 2001 |

Powered by Movable Type 3.33