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Friday, August 19, 2011

Most impactful U.S. presidents of all time

In this article, I identify five of the most impactful presidents in the history of the United States. 

Lists like these are always controversial, and arguments can endlessly be made in favor of one president or another.

In this new answer to an old question, I analyze five of the most impactful presidents based upon the objective criteria of “character” and “preserving and extending liberty.”

The relatively objective nature of the list and much of the content is inspired by a book that is both insightful and innovative when it comes to picking presidential favorites: The Leaders We Deserved (and a Few We Didn’t): Rethinking the Presidential Rating Game by Alvin S. Felzenberg.

Saturday, August 13, 2011

The problem with Google search results

A recent article on the "On Faith" blog of The Washington Post got me thinking about the reliability of Google search results.

In this particular article, the author Michael Otterson refuted the idea that The Church of Jesus Christ of Latter-day Saints (aka, the "Mormons") is a cult. As part of his argument, he responded to a claim found in a British publication that a Google search for "Mormon" and "cult" resulted in 2.7 million hits by showing that the same search results in 4 million hits for Evangelicals, 4.3 million hits for Methodists, and more than 2 million hits for Manchester United.

We have become accustomed in our society to correlating the strength of an argument with the total number of Google search results. In many ways, this habit limits our ability to analyze issues.

Here are the results of a few random searches I conducted to validate the hypothesis that the total number of Google search results is not necessarily a testament to the validity of any particular argument:

Google keyword search
Total results
The White House is in Washington D.C.
The White House is in California

Pluto is not a planet
Pluto is a planet

John Wilkes Booth killed Lincoln
George Washington killed Lincoln

China is in Asia
China is in Europe

Kate Middleton married Prince William
Kate Middleton married Brad Pitt

Democrats voted for health care reform
Republicans voted for health care reform

Kurt Manwaring wrote this article
Kurt Manwaring did not write this article

Tuesday, August 9, 2011

Book review: The Innovator's Prescription - A Disruptive Solution for Health Care


In The Innovator’s Prescription, Clayton Christensen and his associates address the complex issue of health care reform. Their stated purpose is to “provide a road map for those seeking innovation and reform" (xviii).

The central thesis of this collaborative effort is that there is a market solution to the rising costs of health care.

The proposed solution illustrates health care reform is an extremely  complex undertaking that involves not only lowering the cost of insurance, but also addressing other critical issues such as expensive “one-size-fits-all” business models used by hospitals and physicians.

Nine major categories of problems are identified. Each must be addressed in order to permanently raise the quality of health care while simultaneously providing greater access at lower costs.

Christensen, a renowned consultant and Harvard scholar, applies his theory of “disruptive innovation” to America’s health care crisis. Disruptive innovation describes the phenomenon that occurs when a product typically only available to the rich is made available to the poor, albeit a product of initial lesser quality.

An example is the personal computer which initially gave rank and file individuals access to basic word processing and games. Over time, the quality of these products became better and better, eventually displacing the role of ridiculously expensive room-size computers and making high quality personal computers accessible at low costs.

The authors claim this same phenomenon can impact America’s health care system. For example, they argue that in some instances costs can be lowered by supplanting expensive physicians with less-expensive staff or technologies which have the same capabilities.

Christensen tells the story of a physician in Boston who was demonstrating a new technology for removing abdominal growths. The physician concluded the demonstration by declaring, “And the great thing about this… is that anybody can do it!” Quickly realizing that the comment negated the expensive skills of the doctors in the room, the physician immediately recoiled and said, “Oh! I’m sorry. I didn’t mean to say that" (323)!

In 2009, President Obama deplored the rising costs of health care in the United States, saying that “for all of this spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren’t any healthier.”

Yet time after time in The Innovator’s Prescription, Christensen, Grossman, and Hwang demonstrate how disruptive innovation can create a market solution to the health care crisis. They carefully dissect each known problem and demonstrate exactly how more citizens can obtain high-quality, low-cost health insurance designed to improve health.

Christensen and his associates do a masterful job at objectively presenting a complex issue in a reasonably succinct and impressively organized fashion. At the same time, they are likely to incite passion in many readers. Their belief in disruptive innovation is likely to anger physicians who are hesitant to accept less expensive technologies and business models. Their claim that a long-term solution is not possible without requiring everybody to purchase insurance—something akin to the “individual mandate” of national health care reform—is also likely to frustrate many conservatives. Nonetheless, the analysis is unmistakably nonpartisan and it is easy to see that the authors are more concerned with finding a solution than placating their audience.

While the book does not make for light reading, it will be a valuable addition to the library of anyone interested in truly understanding what is wrong with our health care system. The Innovator’s Prescription provides an impressively objective analysis of what is wrong with America’s health care system and what is necessary to create a long-term solution.

TitleThe Innovator's Prescription: A Disruptive Solution for Health Care
Author(s)Clayton M. Christensen, Jerome H. Grossman, & Jason Hwang.
Number of pages441
Publish Date2009

Saturday, August 6, 2011

Pelosi's remarks in context

In the third article of my health care series on KSL, I include a quote by Nancy Pelosi referring to the health care reform bill. The context of the quotation from the article is as follows:
Before the Affordable Care Act was signed into law, questions abounded as to what was actually in the legislation. And at least for the general public, there weren’t a lot of answers.
In 2010, House Speaker Nancy Pelosi addressed the National Association of Counties. While extolling the virtues of what would become the Affordable Care Act, she also stated, “We have to pass the bill so that you can find out what is in it.
The bill was passed a few weeks later, but questions still remain about what is in the legislation.
Shortly after the article was published, I received an email from a reader who said that I had "mis-quoted her by truncat[ing] her sentence improperly."

In the first draft of my article, I included the entirety of her sentence. However, her quote was one of the most infamous political statements of 2010. As one of the goals of the series is to remain bipartisan, I removed part of the sentence and the associated commentary because I felt it had a tone that reflected poorly on Pelosi. Such was certainly not my intent, and I included a hyperlink to the full text of her speech in my original article for anyone who wanted to investigate further.

For any who feel as this reader, please be aware that remainder of Pelosi's sentence reads as follows:
"We have to pass the bill so that you can find out what is in it, away from the fog of controversy."

Friday, August 5, 2011

How many pages are in the Affordable Care Act?

Most recent posting on ACA legislation and regulations can be found at this address:

*******  *******

One of the topics I am addressing in my health care series for KSL is how the Affordable Care Act works. In the third article of the series, I touch on the fact that it’s difficult to know exactly how the health care reform legislation works because there is still so much of it that has yet to be written.

The Affordable Care Act on its own was passed and signed into law in March 2010. However, the Secretary of Health and Human Services (HHS) has responsibility for producing associated regulations—and there will be a lot of them. So many, in fact, that former HHS Secretary Michael Leavitt warns that too much power has been invested in one office and that it represents a threat to the “United States’ viability as a global economic leader.”

The implications of his comments are worthy of an article — or a book — of their own, but space limitations being what they are, it was something that I couldn’t address while giving it the attention that it deserves.

What I did look at, however, were some of the issues surrounding the HHS regulations.

Government entities — and relevant private and non-profit organizations — know that they need to make certain adaptations as a result of the Affordable Care Act. In most cases, they even know when. But rarely does any major change broadcast in the legislation come with a full array of details. So governments and businesses are in the sticky situation of having to plan without knowing exactly what they are planning for.

This concept — that it is difficult to know precisely how the legislation works because there is so much of it which has yet to be written — led me to look into just how much is still left unfinished.

My initial findings were startling.
So… how many “pages” are in the Affordable Care Act? In the actual legislation itself, there are just over 2,400. But the legislation is incomplete with the accompanying regulations, most of which have yet to be published.

Paul Bedard, a journalist with U.S. News, reported in April 2011 that the first set of HHS regulations covered six pages of the actual legislation—but resulted in 429 pages of regulations.

I was curious to see what that would mean for the totality of the health care legislation if I applied a ratio of 71.5:1 to the Affordable Care Act.

The result?

More than 170,000 pages.

No, that’s not a typo. It really is a six figure total. By comparison, the U.S. tax code by my calculations is approximately 13,000 pages.

Now, there are admittedly a couple of problems with this projection. First, you really want to be comparing total words and not total pages. Second, I think that it’s highly unlikely that HHS will maintain its current pace in terms of a regulations-to-legislation page ratio.

But the sheer vastness of the number caused me to think that it would make for a helpful illustration of my point.

Future research
If I have time down the road, I might look into this further. A truly valid projection would entail at least two key components:
1.       Compare total words, not total pages.
2.       Look more closely into which sections of the legislation the regulations relate to. In other words, some sections of the legislation may take a few pages to put forth and result in hundreds of pages of regulations, while other sections may take many pages in the legislation and result in only paragraphs of regulations. A more reliable projection would have to take this into account.

 UPDATE: Click here for an update on the length of the Affordable Care Act published Dec. 12, 2013. 

Tuesday, August 2, 2011

Top 5 issues of 2012 presidential election

In a recent article on, I highlighted five issues voters want to see addressed by candidates in the 2012 presidential election. In selecting the five issues, I tried to combine timeless questions which apply to any election along with some of the hot-button issues of the day. The end result of necessity is less than comprehensive, but is nonetheless something which I hope will spark conversation.

My Top 5 will certainly be different from lists of others. For instance, one of the readers who commented on the article asked why unemployment was not on my list. While I addressed a related macro-level issue, unemployment is an issue that could have easily made its way into my Top 5.

But that is one thing I hope to accomplish with this article. What issues do others feel are most important for 2012 presidential candidates to address - and why?

Forthcoming series on health care reform

I have begun work on a series of nine health care reform articles. My goal is to present several of the major issues surrounding healthcare in a manner that is both succinct and easy to understand.

The series has been picked up by KSL and will cover nine general topics (in order):

  1. The basics
  2. Is it necessary?
  3. How does it work?
  4. The "individual mandate"
  5. State insurance exchanges
  6. Will it work?
  7. Debunking popular myths
  8. Political controversy
  9. What comes next?