Entrepreneur Watch

Jeff Bezos vs. Steve Ballmer vs. Bill Gates

There's an interesting contrast in style in a Forbes article this week: Steve Ballmer looks to the past, insisting there is still life in the PC. Jeff Bezos continually looks to new opportunities, such as the Kindle Fire and cloud computing. Maybe we should start referring to Microsoft.toast.

The interesting thing is that Ballmer isn't that different from Gates in his latter days at Microsoft. In the late 1990s I asked him if the internet might start displacing the PC model, and he tried his usual tactic of sarcastic argument through belittlement. "Oh, sure, I mean, the internet can do everything!" He went on to say, "Do you think the demand for software is going to go away? I mean ,if that's true, then Microsoft is in trouble!"

There's still demand for software, just not Microsoft's software. The problem is that Microsoft always looked to the past. Gates always emphasized compatibility. It's how he took over the PC software market. Every IBM-style PC was compatible with the others and backwards compatible with previous generations (to an extent.) It kept everyone locked in to DOS, then Windows. Nobody else could gain a foothold, except Apple, which gained only a toehold when measured by volume sales.

Microsoft never evolved beyond that strategy. The need now is for software that can run mobile phones, tablet computers and other new devices. Gates -- and now Ballmer -- made the same mistake. They want to cram Windows into the small portable devices and maintain some level of compatibility. But they should have learned from IBM. You can take a small computer operating system and make it bigger, more powerful as the machines themselves get more powerful, but you can't trim a piece of bloated software down to make it fit in a smaller device with weaker processors.

That strategy hasn't worked for a decade. They should get over it. If you've got a good OS, software companies will develop for it. Relying on your locked-in installed base shows a lack of faith in your own ability to design new software.

Meanwhile, back in the Republic of Chad...

Another Forbes article shows Bill Gates is tackling his post-Microsoft role as the bringer of medicine to poor countries. He's forward-thinking here, creating new models to get pharma companies to develop vaccines, and making sure the drugs get to the right people. He always planned on being a philanthropist after Microsoft, and seems to be doing it well. 

Can Gaming Technology Help Medical Research?

The year is 2020. A massive contamination of a neurological disease is spreading rapidly and may affect up to 100 million U.S. citizens. Government leaders have convened a panel to try and stop the disease. You have 24 hours to find a cure. Go.

This is only a game, but one that three research organization hope will come up with new ideas for speeding up the rate of medical research.

They're hoping for 600 gamers, including university scientists, business leaders, healthcare innovators, biopharma executives and R&D professionals, government regulators, entrepreneurs, patients and the general public.

Actually, there will be two online games that will go live for 24 hours this Fall. One on Oct. 7-8, the other on Nov. 9-10. Anyone can play. 

The games are being offered as "idea sourcing" events. They're being sponsored by the Myelin Repair Foundation, with a grant from the Robert Wood Johnson Foundation. The Institute for the Future (IFTF) is designing the game.

Aren't medical breakthroughs coming quickly enough? The sponsors think not. Their concern is that, while there are substantial scientific discoveries these days, life-saving new treatments are not keeping pace. 

The game will try to embody a sense of urgency to solve a medical crisis, and see what innovations people come up with. Says IFTF game designer Jane McGonigal: 

“Those who play games have a sense of urgency and abandon when they are engaged in a game scenario. We have seen these behaviors in corporate strategic game play where there are real stakes. The game we are building for the MRF is designed to generate that sort of urgency and unleash creative ideas for finding ways to speed medical research.”

You can see the game scenario at http://info.breakthroughstocures.org/

There's a press release here.

Registration begins Sept. 3 if you want to play.

Good luck, and live long and prosper.

Do cell phones cause cancer?

Maureen Dowd and Gavin Newsom, both people I respect, think we need to be concerned about radiation from cell phones.

Personally, I'm more worried about radiation from flying saucers. Been thinking about lining my hat with foil.

Dowd harkens back to the time when we didn't know that sun tans and cigarettes were harmful.

Yeah, well, we did as soon as we ran some studies.

There have been many studies on cell phone radiation and cancer. The very few that suggest there may be a link look as authoritative as BP spokesman touting Big Oil's safety record.

Dowd cited "one Swedish study" that showed a 400% increase in brain tumors among people who started using cell phones as teens a decade ago. She doesn't say which Swedes did the study.

Right. How many people were in the study? How many in the control group? And just how many got cancer? Were any of them wearing aluminum foil in their hats?

If you want to see a good summary of studies about cell phone and cancer, check out Environment Health and Safety Online (ehso.org)

My summary of their summary:

Four studies concluded there may be a correlation between cell use and cancer. 

    -- One was done by the World Health Organization, but we have not seen the results of the study yet. Only says it may increase risk. Hostile aliens may land in my back yard, too. But we'll wait for further info.

    -- Another was conducted by an Australian neurosurgeon who reviewed studies others had done and concluded there was "an increasing body of evidence" for a link. But this paper was self-published and was not peer-reviewed, so I'd give it about as much authority as my college paper on Alexander Pope's "The Rape of the Lock." I hated that class.

    -- The third, from the Swedish National Institute for Working Life, concluded that heavy cell phone users had a 3.7 X higher risk of brain tumors. But it was criticized because it required the subjects to recall how heavily they used cell phones a decade ago, at a time when anyone with brain cancer figures the cell phone caused it. The subjects may have been biased. Maybe this was the study Ms. Dowd referred to.

    -- The fourth is another Swedish study. Very specific, this one. People in rural areas who use digital cell phones "may be at greater risk for brain cancer." But the authors admit their study was small and some bigger ones are needed.

Other studies have shown no cancer link. Ehso.com cited five.

    -- the first was done at the Florida Alzheimer's Disease Research Center, and found that cell phones may protect against Alzheimer's. Wierd. I guess if you use cell phones you'll get cancer, but at least remember that you have it.

    -- Another involving four Scandinavian countries found no increased risk at all. But the researchers say their population study of 16 million people may have been too small to determine a slight increase in risk. 16 million? The study also only covered five years, and it may take longer for cancers to develop.

    -- Tokyo Women's Medical University surveyed 322 brain cancer patients and 683 healthy people and found no correlation between cell use and the cancer.

    -- Scientists in Denmark followed 420,000 cell phone users over 21 years. Again, no correlation.

    -- A four-year British study of 966 people with brain tumors and 1,716 people withpout tumors showed no correlation. 

And finally, a big meta-study involving a bunch of researchers and medical organizations, (the study is here) went through 465 articles, 23 case-control studies, involving 38,000 people to find a link. The conclusion:

"The current study found that there is possible evidence linking mobile phone use to an increased

risk of tumors from a meta-analysis of low-biased case-control studies. Prospective cohort studies

providing a higher level of evidence are needed."

So this isn't exactly comparable to our ignorance of sunbathing and smoking. Lots of studies, inconclusive results, but generally hard to find a link. So choose your own paranoia.

And one other thing should be added: If cell phones are causing cancer, nobody knows why. The radiation they produce is NOT ionizing radiation, which can cause cancer. The radio frequency cells use has never been shown to cause cancer.

My feeling: 

Use a phone headset. Just to be safe. It's easier than the aluminum-foil route.

Google violates Kansas copyrights

Once again, Google has shown its blatant disregard for international copyright standards.

Earlier today, Google CEO Eric "Oh aren't I smart with my Ph.D©" Schmidt announced that the Mountain View, California company was changing its name to Topeka. 

Why? Because the city of Topeka, Kansas had supposedly given up the rights to that name when it announced it was changing its name to Google.

This argument doesn't wash any better than my uncle Ernie after a night drinking with the hoboes in U.N Plaza in San Francisco.©  

Google, sorry, Topeka, knew that the people of Topeka, sorry, Google, were only planning on making the change temporary.

The Topekans, sorry, Googlans, simply wanted to call attention to the fact that children in that city of 122,000 have never had the luxury of Web-surfing faster than 122K baud, 1,000 times slower than that enjoyed by children in more developed parts of the world like Singapore. The good people of Topeka, sorry, Google, Kansas want to convince Google, sorry, Topeka, to install a Singapore-speed© broadband network in its fair city. 

Google, sorry, Topeka, has promised to do that for any U.S. city willing to change its name to Google, sorry, Topeka, wait, I'm confused now. So that city-that-must-not-be-renamed in Kansas obliged, but only for a month.

I know that Google knew this change was temporary because, in another blatant copyright violation in its attempt to destroy mainstream media, Google CEO Eric "Oh, aren't I smart with my Ph.D" Schmidt's announcement actually linked to a CNN article that described Topeka's, sorry, Google's sad attempt to gain Schmidt's attention so that the children of Kansas might catch up to the technology of the "Singapore Age"©. In that article, mayor Bill "No, I don't have a PH.D."© Bunten said it was only for a month.

CNN, of course, is owned by Rupert Murdoch©, who has complained about Google, sorry, oh to hell with it, Google stealing his intellectual property by linking to his news articles. Dr. so-smart Schmidt is just trying to goad Murdoch© into doing something stupid, like blocking his news articles from Google searches. 

When is Google going to learn that EVERY WORD any American ever writes down or steals from a native American tribe is automatically copyrighted and nobody else has ANY rights to it? Just because Topeka is temporarily relinquishing the name, Schmidt cannot violate the city's copyright©. The city has exclusive rights to that name for 123 years past the death of the city's last living resident.

Please, write to your Congressman and ask the Justice Department to crack down on Google before it becomes any more powerful. Before long, it will have a monopoly on every city name in America©.

Let's face it, if this doesn't prove that Google is evil, nothing will. ©

Shopping for cheaper health care

Ah, yes, disconnects in the health care market.

I've already talked about the fact that the rich get the best health care. Sometimes that means get rich or die.

But the rich get better everything. No news there.

Will the health care proposals now being considered help? Who knows? But maybe it will be a start.

Here's another disconnect in health care. Health care is provided by the health care industry, received by patients, and paid for by insurance companies. The seller and the receiver are one step apart.

So the receiver wants the best care available, no matter what the cost. Heath care providers want to provide every service it can, including unnecessary tests, "just in case," with the sick person assuming it is necessary and will be paid for by the insurers. And because an enormous amount of money is spent on creating new diagnostics and treatments and drugs, the health insurance companies keep raising rates. 

When it comes to health care, there is no capitalist feedback loop to keep things under control.

Gee, rising health care costs are as surprising as discovering that a starving pack of wolves will eat you if they get a chance.

We need better information. Take a look at this article by a cancer patient, a journalist, who is going broke despite having a good health insurance plan.

Her doctor ordered a medication on a "borderline call," but didn't happen to let her know how expensive it is. Two injections cost her $750. If she had no insurance, it would have cost her $17,522. Of course, her insurance agency gets a discount, so it paid only $6,850.

So why is it that the uninsured have to pay more than insurance companies? Something wrong there.

The act of getting each injection, which took all of five minutes, I'm sure, cost $93. That's about $1,116 per hour. Nothing to be done. That's the "industry standard" rate. No way to get it cheaper.

There's no control over any of this. No feedback loop to try to keep costs in line.

And we don't like it when the insurance company is the one to decide what treatments are necessary or should be cheaper. We don't trust the insurance company, and for good reason. The person trying to keep costs down has no stake in the outcome. That person is not the one who dies if necessary treatment is bypassed.

Can you say, "death panels"?

The only way I can see to really bring sanity to the system is not a happy solution for the patient. Forget health insurance altogether, and make patients pay for everything themselves. THAT will bring prices down. It will also make doctors less wealthy.

But, as I said, the broken system is too expensive for 99 percent of the population to pay for it on their own. Any the wealthy will order any test or treatment, no matter how expensive, if the alternative is dying.

Wouldn't you?

Health care: Get rich or die.

Look, something has to be done about health care costs in the U.S. We've probably got the best medical care in the world -- when we can pay for it.

I don't know if the health care reform bills will prove to offer decent solutions. But it seems to me it's obvious what some of the problems are.

There are huge disconnects in our health care system. 

Free markets work when consumers have a choice of providers and can shop for price and quality. If I can't afford a BMW, I might go for a Honda. It's up to the sellers to give us the best product or service they can for the lowest price they can.

Those are foreign concepts to the health care industry.

Here's the first disconnect: We're not talking about a new car or a new home or a better job. We're talking life or death. Our own life or death.

Everybody wants the best health care possible. When it's your own life at stake, you don't want to say, "Well, what's the best doctor I can get for my budget? Maybe I can stop getting those lattes at Starbucks every day and pay a little more." 

You want the best. Period. Whatever it takes. And you're really pissed when you can't get it.

Of course, most of us can't get the best. 

Eleven years ago, my sister got breast cancer. When she first found she had breast cancer, I brought her up from Santa Barbara to San Francisco to talk to a specialist at UCSF. I had absurd notions of paying for her care myself, or paying the difference between what was covered by her insurance (which was very good) and what the best treatment centers would charge. 

Yeah, right. There's no way anyone with a salary of less than $50 million a year can afford the best.

Several years ago, I also read Lance Armstrong's autobiography. He had cancer that almost nobody recovers from. Then he found that he had lost his health coverage. But, let's face it, he had already made millions of dollars and was famous. Doctors were willing to treat him just because he was famous.

They got mentioned in his autobiography. 

Lance went broke getting treatment-for a while-and had to fight to get his coverage back. But he got the best treatment in the world.

He lived. 

My sister died. 

Five years ago, the cancer we thought was gone metasticized and spread to her brain. The fourth anniversary of her death is June 29, the day after her 57th birthday.

Life just isn't fair. We just have to deal with it. Even in health care.

What's surprising to me is that most wealthy people don't get it. 

More than a decade ago, I did an interview with Oracle CEO Larry Ellison. He was talking to me about why he was trying to get some initiatives together to improve public education in the U.S. He said that President Clinton talked about the health care crisis, but if that was a crisis, education was a disaster of epic proportions.

Personally, I don't know which is worse in this country, the problem with health care or the problem with public education.

But Ellison's justification was this: If health care in this country was so bad, and Canada's socialized medical system was so good, then why did so many Canadians with life-threatening illnesses come to the U.S. for their treatment?

Yeah, well, maybe the folks who go to the same parties he does. But not the average Canadian. The ones coming to the U.S. for treatment are the ones who can afford the extraordinary treatment we're famous for. 

But the problem in the U.S. isn't just that the average person can't afford the best health care. It's that the average person can't afford average health care.

We may or may not have the best medical treatment in the world. But we certainly have the most expensive.

Here's some data from a Senate Finance Committee report from April 2009:

In 2008, the U.S. spent more than 17 percent of its gross domestic product on health care. That's more than any other industrialized country in the world, both in total cost and in cost per capita.

By 2017, the report estimates it will reach 20 percent of GDP. That's $4.3 trillion annually.

According to my calculations, at this rate, health care costs should reach 100 percent of GDP by about 2105.

I knew I should have gone to medical school.

Almost half of Americans can't pay their medical bills?

41 is the White House number for today.

Its Health Reform by the Numbers site says that 41% of Americans under age 65 accumulated medical debt or had trouble paying medical bills in one recent 12-month period.

That figure came from a 2008 study by the Commonwealth Fund and the year in question was 2007. the percentage was up from 34% in 2005. That's 72 million people. Add in another 7 million people over age 65 who also had problems and the number comes to 79 million.

The study also says that because of these medical bills, 28 million adults used up all their savings, 21 million racked up huge credit card debt, and another 21 million were unable to pay for basic necessities.

I can't wait to find what the numbers are for 2008 and 2009. 

The Commonwealth Fund is a private foundation that supports health care reform. So I'm open to info from groups with a different bias as well.

The Gallup-Healthways Well-Being Index says 21% of Americans struggled to pay their medical bills in December 2008, up from 18% in January 2008. But half the people who were uninsured couldn't pay their medical bills. All this is described in a USA Today article.

So presumably the other 20 percent in the Commonwealth study fell into the category of "accumulating medical debt" but were not having trouble paying it?

Regardless of which numbers are right, the Gallup folks do say that this is an enormous problem. According to the USA Today article:

"The biggest problem that the country has is actually the cost of health care," says Jim Clifton, Gallup's CEO.

The American Heart Association says that 56% of people with a heart condition, stroke or high blood pressure can't pay their bills.

Let me know if you have any better numbers.

White House on health care reform: 8 denials/minute, 8 lobbyists/lawmaker

More stats from the White House. This one titled "8".

Excerpt:

8 -- that's the number of people every minute who are denied coverage, charged a higher rate or otherwise discriminated against because of a pre-existing condition. (HealthReform.gov, Coverage Denied: How the Current Health Insurance System Leaves Millions Behind)

8 is also the number of lobbyists hired by special interests to influence health reform for every member of Congress in 2009. (The Center for Public Integrity, Lobbyists Swarm Capitol To Influence Health Reform)

Link to White House site

Health Care in Socialist San Francisco

I live in San Francisco. A "socialistic" city. Very often too P.C. Too socialist at time. Good intentions, bad results. 

It offers a free program called Healthy San Francisco. As part of that, Healthy Kids is free. If you want to pay a little for the entire family (the amount depends on income), it offers a Healthy Families program.

As a freelance journalist, I cannot afford any health insurance program I investigated. So I signed up for Healthy San Francisco. My family of three pays $300 quarterly and $14 per month. Yes, a total of $114 per month, $1,368 per year. Co-pays are $10 per doctor visit and $5 per prescription.

It is not health insurance. It offers coverage at SF's facilities: SF General hospital and some clinics. Some private practitioners also offer services through the program. The state puts in some funding and employers who do not offer health insurance kick in some (much cheaper than buying actual coverage for employees.)

It really sucks. In many ways, it's an option that most people wouldn't like. 

It takes three months to get a doctor appointment if you're not really seriously ill. 

You end up at SF General along with the street people, the drug addicts and city prisoners. I was waiting for a physical therapy appointment once after I broke a finger and sat next to a guy in an orange jumpsuit and handcuffs in the waiting room. 

It has been hard for us to find a pediatrician that our daughter is comfortable with. We never could find a decent psychiatrist to help deal with possible ADHD issues she has. The one we found was the worst psychiatrist I have ever come into contact with.

However, it is SO astoundingly better than no insurance, which is what my family had for seven years, that it's hard to describe. 

My daughter has a severe fish allergy. She ended up exposed and started an anaphylactic reaction. We gave her two Benadryl and drove her to SF General emergency room. They took her immediately. No waiting. They checked her out, and it happened that the Benadryl was sufficient to stop the reaction and keep her from going into shock.

But they spent a considerable amount of time with her, asking her about her reactions to the fish. It was dangerous, enough that it's the kind of thing she could die from. They explained that it could get worse as she gets older, and could be a more serious reaction each time she is exposed. They gave us detailed info about the kinds of fish people with allergies tend to react to. They gave us prescriptions for two EpiPens, fast auto-injection devices to deliver epinephrine to prevent anaphylactic shock -- one to keep at school and one for home.

Cost: Zero dollars.

I woke up one morning with no feeling in my left hand and no ability to make a fist. We went to SF General emergency room. They took me immediately, fearing stroke or heart attack. Immediate EKG. Turned out to be minor, but they did significant tests to make sure.

Cost: Zero dollars.

My wife and I have some very expensive prescriptions to take every month. Before Healthy SF, we were spending over $300 per month, and sometimes simply could not afford to get them. Healthy SF now covers them.

Cost: $40 per month.

I went in for a routine checkup and blood test. The blood test came back with outrageously high triglyceride levels in my blood. Essentially, fat that the body uses to store energy. Despite what I thought was a pretty damn healthy diet (no fast food, very little junk food) I have 1,115 mg/decaliter levels. 150 mg/dl is considered normal. It seems to be genetic. Heart attack city.

My doctor immediately prescribed a triglyceride-reducing medication, and I re-started my running routine to burn up the excess fat I've accumulated around my waist.

Cost: $5 per month.

Let's face it, one of us could die without this coverage.

And here's the interesting part. The SF Chronicle wrote an article pointing to studies that conclude the program SAVES San Francisco money. Emergency room visits are down because poverty-level, mostly minority families, now get regular care instead of waiting until things are dire. And yes, that includes illegal immigrants.

Of course, due to the recession, funding for the program is being cut. How's that for saving money by ending socialistic programs?

Everybody, including taxpayers, could save money with a public option for health care.

$1,115: Obama uses Internet to fight back on health reform

I get occasional emails from the White House. I got on the list by sending him an email once.

Today's is interesting. An email titled $1,115. That's the average MONTHLY price of employer-sponsored health care coverage. the Obama administration is trying to take this to the population at large in an attempt to spread its messages virally. Great idea.

I hope they can get the point across, which people don't seem to understand, that the "public option" does not mean we have universal socialized medicine. It just needs to be an option for people who can't afford private options.

As a freelance writer, I fall into that category. There is no health insurance program I can afford. More on that later. In the meantime, here is the letter from Nancy-Ann DeParle, a White House spokesperson.

Good afternoon,

$1,115 -- that's the average monthly premium for employer-sponsored family coverage in 2009.  Annually, that amounts to $13,375, or roughly the yearly income of someone working a minimum wage job.¹

It gets worse: a recent survey found that if we do nothing, over the next ten years, out-of-pocket expenses for Americans with health insurance could increase 35 percent in every state in the country.²

In an effort to put the past year's debate over health insurance reform into perspective, we're launching "Health Reform by the Numbers," an online campaign using key figures, like $1,115, to raise awareness about why we can't wait any longer for reform.  We'll be sending out a new number every day.  Learn what you can do to help spread the word:

$1,115 is more money than what many Americans pay for rent or mortgage. But there's more to the problem than just numbers.

Take Leslie Banks, an American mom with a daughter in college.  In January of this year, she received a notice from her health insurance provider that her plan was being dropped. To keep the same benefits, the premiums for her and her daughter would more than double.  Leslie was told by the insurance company that there was nothing she could do -- it was an across-the-board premium hike.  If she paid the same monthly premium amount as before, the deductible would increase from $500 to $5,000, and she and her daughter would no longer have preventive care or prescription coverage.

Yesterday, Leslie introduced President Obama at a health reform event in Pennsylvania.  Check out what they had to say.

It's important to raise awareness about numbers like $1,115 and stories like Leslie’s because skyrocketing health care costs impact all of us.  So take a moment to forward this email to your family, friends and online networks.

With all of us working together, we'll send the message loud and clear -- the time is now for health insurance reform.  It's time we made our health care system work for American families and small businesses, not just insurance companies.

Let's get it done.

Nancy-Ann DeParle
Director, White House Office of Health Reform