A False Summit?

A False Summit?

While a divided Congress met at the Blair House to attempt to reconcile differences, America hunkers down , chilled by cold economic winds and unnerved by the gathering storm brought on by fiscal shortfalls and unsustainable deficits.  As our elected officials argued over a way forward, it was obvious that there would not be enough common ground found to chart a coherent course that improves access, reduces medical trend and moderates ballooning federal and state deficits driven by increasing obligations to existing entitlements through Medicare and Medicaid.

In between stumping and finger pointing, inconvenient truths tumbled like falling rocks on the heads of policymakers locked in the heated debate over whether to begin reforming healthcare by expanding access to 30M Americans or by addressing the underlying cost drivers of a system that all unanimously agree needs fixing.  While Kent Conrad ( D-ND), and Paul Ryan ( R-W ) came across as lucid scouts describing the decades deep crevasses of entitlement deficits and the imprecise orienteering of CBO accounting, other Congressional exemplars reinforced our belief that they were simply no longer fit to lead a next generation of climbers eager to move up the mountain.

The sad truth is we face a formidable obstacle in healthcare reform.  It is a Darwinian wilderness where the strong survive and individuals are unevenly protected.  It is a foreign land where neophyte consumers believe that “quality care” is getting unrestricted access to all the services that they believe they need for as low an out of pocket cost as possible. A diverse ecosystem of for profit and non profit stakeholders seek to accommodate this insatiable expectation and in doing so, assert that they create great value through the services they provide.  It seems no one believes they are part of the problem. Yet, people continue to die from exposure.  We fail to rope in the most vulnerable among us and have sadly become more indifferent to their personal tragedies.

We are in desperate need of reform but experiments such as Massachusetts that seek only to expand access to the uninsured  have taught us that the summit of universal coverage cannot be conquered without an underpinning of affordability.  They will end in financial disaster. The ropes that safely bind us to a fiscally sustainable path must be anchored by employer based insurance and woven with universal reforms in reimbursement, Medicare/Medicaid, access, consumerism and stakeholder engagement. The entire process must be reinforced with chronic disease management,  transparency and balanced regulation of the small and individual insurance markets.

Enormous time has been spent vilifying insurers, as if to convince us that aggressive oversight of payers can somehow fix our healthcare system.  Singling out a particular stakeholder as the primary barrier to our goals of quality, access and affordability is the reckless equivalent of telling an obese person that they can lose all the weight require simply if they just stop eating bread.  The mountain’s crest offers no easy access. The route is marked by tombstones of idealistic reformers who fell short of their objectives.  Stakeholders must recognize that we are all part of the problem but we do possess a map that can safely lead us to the top.   Ironically, many of the legislators attending the Blair House summit actually helped contributed to the treacherous conditions in which we now find ourselves – as we consider a future where public and private healthcare expenditures exceed an insurmountable 20% of our GDP.

In considering the rhetoric and reality of our circumstances, we must understand why the current House, Senate, GOP and Presidential proposals are false summits for conquering our current healthcare crisis.   Congressional leaders, desperate for re-election, will simply not commit to an honest discussion of the risks and realities of fixing healthcare. To conquer the mountain of public and private healthcare spending we must belay our way with:

1)   Reimbursement reform – 30M uninsured people will be entering a healthcare system that is graduating less than 2% of its medical school graduates as primary care doctors. This means no care coordinator to assist those who have historically accessed medicine through the most expensive setting in America -the emergency room.  Massachusetts as the first state to adopt universal coverage and individual mandates has discovered in their first years of universal coverage that ER visits are increasing by 8%-10% as individuals – now covered – default into old patterns of access.  The rural and urban family practice physician is disappearing as a disproportionate amount of federal, state and private sector reimbursement is going toward specialists and facility care and their treatment of chronic illness – – instead of its prevention. We must restore the role of the primary care provider as the control point and care coordinator for a first generation of consumers committed to health improvement. Reform should focus on higher reimbursement and educational incentives to study and practice primary care.

2)   Medicare and Medicaid reform – If the US government were an insurer, it would have been seized years ago by regulators for serial underfunding of present value obligations.  To propose $500B of physician fee cuts while promising seniors no benefit cuts and an expansion of the presently unfunded Medicare part D prescription drug program is irresponsible.  To even qualify to expand its role in covering more Americans, Medicare and Medicaid need to address an estimated $ 100B  in annual fraud, abuse and overtreatment.  The current programs achieve “ affordability” by rationing reimbursement to doctors.  Another 21% in fee cuts will only reduce the number of doctors willing to accept payment from the federal government. The ethical and moral no man’s land surrounding end of life care in America make funding the last six months of life in the US, more expensive than five decades of life preceding them.

3)   Access Reform – Consumers must accept and be willing to enter into medical home/gatekeeper delivery systems where primary care providers coordinate care and authorize access to specialty and tertiary care services.  Over 110M Americans access the healthcare system through the emergency room each year.  More than half of these individuals are insured but not under the care and control of a primary care provider.  Self-referrals and self diagnosis is leading to overtreatment of insured individuals – consuming, according to Overtreated,authored by Shannon Brownlee, as much as $700B each year that might otherwise be available to finance care for the uninsured and the underinsured.

4)   Consumer Reform – With 60M Americans overweight and slowly descending into lifestyle based chronic and catastrophic illnesses, we are not requiring those who might be eligible for expanded coverage to engage in healthier lifestyles.  Asymptomatically ill and chronically unstable individuals are more likely to incur catastrophic claims.  5% of Americans treated in Medicare and private insurance consume 50% of all services.  Subsidies and minimally credible coverage mandated for the uninsured should include plan designs that require biometric testing, lifestyle coaching, and compliance rewards for managing chronic conditions. Consumers must be limited in their ability to sue a treating physician if that doctor has followed evidence based medicine guidelines for treatment.

5)    Stakeholder Reform – There are myriad opaque pricing and payment practices that plague the $ 2.2T healthcare system.  Transparency of services should not just extend to insurers but to brokers, agents, hospitals, pharmaceutical benefit management, specialty and other third parties who play a role in the healthcare delivery chain.  Affordability must focus on demanding value for payment.  You cannot improve what you cannot measure.  Consumers, employers and government are often ignorant to cost shifting, clinical variability, hidden remuneration and perverse incentives that threaten to compromise the objective treatment, advice and service support that must characterize a world class system.

The Blair House healthcare gathering reinforces our notion that Congress understands the logistical complexities of fixing healthcare but in its failure to find common ground, it was merely a false summit.  While our public policy guides argue on the best way forward, we lose confidence that neither group is actually carrying the essentials necessary for quality care to survive. The prevailing sentiment among Democrats is to follow the uncertain fiscal direction of Massachusetts choosing a less intimidating path of achieving universal access before tackling the more jagged and dangerous step of affordability reform.  The GOP has counseled a conservative route to the top – opting for an incremental and sluggish pace with no clear timeline to ultimately conquer the peak.

It remains to be seen whether Congress and the American people will fatigue before conquering healthcare.  For 180M Americans covered by employer-sponsored healthcare, the fear of leaving their base into the unknown thin air of change creates doubt and concern.  For 45M uninsured, the prospect of climbing higher seems a worthwhile alternative to their current circumstances.

The risk of getting to the top too rapidly is fiscal edema and a Darwinian rationing as we realize that we have finite resources.  If we move to slow, additional fellow climbers may perish from inaction.  One thing is for certain.  Storm clouds are gathering and conditions are deteriorating. We are in the “death zone”.  We have to go up or go down.

We simply cannot remain here.

Off Piste

Los Angeles skyline and San Gabriel mountains.
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Off Piste

“Skiing: the art of catching cold and going broke while rapidly heading nowhere at great personal risk.” Anon.

In 1970’s Los Angeles, winter sports were comprised of baseball, basketball and AYSO soccer. Our bleak midwinter days were filled with mild sunshine and temperatures that lingered in the low 70s. Ice was confined to a silver bucket on your Dad’s wet bar – reserved for those who might request a Dewar’s and soda. Snow was a Currier and Ives sentiment and a meteorological miracle.

Having fled eighteen endless Chicago winters, my father considered any voluntary recreational sport involving sleet, snow or ice as the equivalent of paying someone to perform a root canal on a healthy tooth.  It was a completely unnatural act.

He had cured us of our desire to play hockey and ice skate with one ill-fated trip to a local skating rink.  However, every four years, the Olympics would appear on television and captivate us with the notion that skiing could attract girls like bears to honey. It was clear that skiing was reserved for the rich, famous and those who spoke with European accents. It was a sport for patrician royalty, like falconry and fox hunting.

For my mother, raising four boys on an ad executive’s meager salary did not qualify our family for a vacation in a far off Alpine fantasyland. She was also uniquely sober to the risks of snow plow, parallel and telemark turns having broken her leg while racing downhill with college friends at Lake Tahoe. To our delight, she graphically recounted her compound fracture, hospitalization and surgery, showing us the 8 inch shin scar and a repair replete with plates and screws that permanently braced her shattered fibula.

She, like so many others, had succumbed to the allure of the slopes and its après ski romanticism. She was fascinated with the advertisements of magnificently tanned, turtle necked intellectuals drinking wine and laughing with affectation. She could almost smell the pungent bite from the bubbling cheese fondue. But, in this fantasy, she could only see them from the waist up.  No one was wearing a leg cast.

My father was secretly relieved of her aversion to downhill skiing and made it clear to anyone who inquired that it would require a small fortune to equip our adolescent army. Our money could stretch more economically if invested in a fortnight summer beach house in nearby Newport Beach. He had zero interest in driving with chains on his car, layering four boys in wool and down only to have them declare that they needed to use the bathroom.

In California, there were enticing rumors of snow – great drifts of moisture rich precipitation known as “Sierra Cement”. It fell in copious amounts measured in feet, not inches – somewhere to the north and east of Los Angeles. Occasionally after a fast moving local clipper of cold rain, we would be enthralled with the snow capped peaks of Mt Wilson and the surrounding Angeles National Forest as they peered through a conveyor belt of gray cotton clouds. Yet, snow was an abstraction to native Angelinos. It was something to be experienced vicariously – on the news, on ABC’s Wide World of Sports or on the distant peaks of the San Gabriel Mountains.

Yet, the lure of snow was intoxicating – to sled, build snowmen and barrage one’s enemies with an ordinance of hardened ice and snowballs was foreign and fun.  However, the thought of donning stiff plastic boots anchored by wire clips and leg breaking bindings did not really appeal to us. Playing in the snow seemed natural. Skiing was beyond our comprehension. To bind oneself into 205cm fiberglass spears and attempt to slide down an icy canyon, like a displaced piece of granite tumbling toward a certain compound leg fracture like our mother appealed to no one — except my contrarian older brother.

My brother discovered skiing in middle school after being invited by a well heeled friend to Mammoth Lakes, an exclusive ski resort. The alpine town rested at the base of jagged granite minarets that in some places, vaulted over 14,000 feet. On its tallest peaks, Sierra snow hid in sapphire blue couloirs year round. It was rumored that in good years, it was possible to ski in shorts and a tee shirt on July 4th.

I watched with green envy as my mother took my brother to the local ski outfitter, Sport’s Chalet, where he rented skis, purchased an arctic parka worthy on a National Geographic explorer, ski pants and gloves. To add insult to injury, he was given a $ 200 stipend to cover lift tickets, food and miscellaneous expenses. Apparently my father was unwilling to accept anyone’s charity for his son’s first ski experience.  To this day, I am convinced he pocketed the money.

He was only gone for three days but when he stumbled through our front door, I could have sworn that he was speaking with a French accent. He regaled us with stories of snow storms, down hill ski racing, girls in hot tubs, gondolas and panoramic views of the jagged Ansel Adams wilderness. His raccooned eyes twinkled as he talked in a new foreign language that seemed to trivialize my plebeian suburban existence. “The key to skiing moguls is following the fall line and leaning over your tips” He said with expert familiarity. I had always thought a mogul was some kind of Indian prince or a businessman. He continued, “…and then Karl did this radical helicopter off a jump. I got some serious air when I jumped off the Cornice”.

I was insanely jealous. I wanted that cool neon parka, skin tight ski pants and raccoon tan. I wanted to be Olympic champion Jean Claude Killy seated on a bear skin rug, holding a Courvoisier brandy as I seduced my latest French model girlfriend by a roaring alpine chalet fire. I wanted to ski but all I could think about was my Mom’s twisted fibula.  Each Saturday my paranoia would be reinforced with the opening clip to the Wide World of Sports where Jim McKay would voiceover: “Spanning the globe to bring you the constant variety of sport… the thrill of victory… and the agony of defeat… the human drama of athletic competition…” At the point where McKay said “ and the agony of defeat” a ski jumper would descend down a massive ramp, catch his ski edge and hurtle sideways off the ramp,  presumably to break every bone in his body. As he crashed through barriers and exploded in a rag doll mass of spandex and equipment, you could not help thinking, “why would any sane person do that?”

There were apocryphal stories about this guy and his horrific crash. “I hear he died.” One kid said as we discussed the unfortunate ski jumper. Another more experienced liar chipped in, “I heard every bone in his body was broken and his head popped off in his helmet when they tried to remove it.”

My mother sensed my interest in skiing and encouraged me to accept a friend’s recent invitation to ski but I created all kinds of excuses to avoid the dangerous neck-breaking slopes to the north. I just could not help thinking of Hans-Peter Shatteredpelvis or whatever his name was. This was perhaps one sport I could do without. I was wracked with doubts. What if my ski bindings did not release – would I break a leg? What if my friends take me up to the top of the mountain assuring me I can traverse down doubled diamond runs called Spleen Alley and Tibia Twister. What if I take a wrong turn and get lost like the Donner party. Would I have to eat squirrels and perhaps another skier who had also strayed off piste?

As all parents do, I was forced to confront my demons and master them – lest they added to my bucket list of activities that I would regret never having tried. At gunpoint, I accepted an invitation to go to Mammoth for skiing. I was now the beneficiary of the investment in equipment and clothes. As I layered on itchy long underwear, pants, outer garments and a North Face ski parka, I wondered whether I should have worn a diaper as it would clearly take two hours to strip down to be able to use the toilet.

On that fateful day, I learned to snow plow and discovered the joy of a beginner’s ski run.  I developed a mild hemorrhoid going up and down an odd contraption known as a poma-lift.  I mastered the mounting and exiting the quad chair and by the end of the week had gone to the top of the mountain – only to wet my pants as I slid down a vertical black diamond face slope called, Dave’s Run.

My favorite part of the day was removing my cement ski boots and regaining circulation in my hands and feet.  We sat in a hot tub with fourteen other people including a cute girl who asked me where I was from.  For a moment, I entertained assuming a French accent and describing my parent’s modest ski chalet at the foot of Mont Blanc in Chamonix.  Instead, I blushed and dipped my head under a cloak of steam and bubbling water.  It was all too much.

Years later, I annually force my reluctant brood on to the slopes of a ski resort.  The mornings are always the same – a chorus of moans and complaints.  The death march to the first run is a time that is best forgotten with sharp words and hollow threats.

We ski together to gain an appreciation for the mountains in winter and for the sheer exhilaration of making first tracks after a midnight of soft powdered snow.  Unlike my family, I am able to consider the trip an investment rather than an expense.  We are making moments like snow angels. As we gather after a long day, broken and sore from moguls, tree skiing and chaotic racing, we lie next to one another – exhausted and content.  I am not Jean Claude Killy but I am Dad – – amie and provocateur of the annual winter ski adventure.

Survivor 2015 – PPACA Island

A recreation of the logo for the first America...
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Survivor 2015

“In the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed”  Charles Darwin

As the legislative reform volcano rumbles and angrily spews magma into the Washington night, nervous industry stakeholders competing for survival on this unstable island of American healthcare are still betting that the seismic activity is merely a false eruption.

Survivor contestants are using every possible means to ensure they are not voted off the island.  The stakeholders are a veritable who’s who of personalities – the powerful, the wealthy, the prima donnas, the tough love advocates, the national health zealots, the well-intended academics, the bellicose politicians, the under-employed, the overweight, and the disenfranchised. It remains to be seen whether Congress, market forces or the American people will be the ultimate judge of who stays and who goes.

If the contestants cannot change in the next five years, 2015 will find them staring at a terrifying wall of regulation and governmental intervention that will be more destructive than the changes from the 2010 proposed legislation.

The island has finite resources struggling to accommodate infinite demand.  Do these players have the emotional intelligence to change or are they too addicted to their way of life to yield to the need for transformation. Time is running out. As we handicap the winners and losers in the 2015, here’s what each group needs to do to remain on the island:

Insurers – In the brave new world, insurers will have to cede higher profit margins realized in the individual and small group business resulting from a formation of purchasing pools and guarantee issue coverage. Insurers must transform from B2B businesses to B2C business solving for the compromises that have frustrated consumers for years. Insurers need to aggregate clinical data on quality and efficiency of doctors in partnership with government to create a credible, non-partisan consumer reports to help patients make more informed choices of providers. High performance networks must become the norm to ensure optimal value over an entire episode of care.   Primary care reimbursement must increase over 30% for family practice providers as medical home and population health rewards based programs reimburse providers to keep patients well or stable when chronically ill. Insurers must become community stewards helping finance primary care into urban and rural ” hot zones “serving “at risk” populations in underserved communities.

Brokers/Consultants/Agents – Total transparency must mark the year 2015 as broker, agents and consultants remuneration is shared with all employers. Brokers and consultants must justify their role as an intermediary – less by marketing insurance and more by harnessing clinical, underwriting, administrative, compliance and population health management programs to advise small, medium and large employers on how to best manage and finance healthcare risk.

Hospitals – our most expensive delivery systems must yield to a new reality where chronic disease prevention spending exceeds spending on the inpatient treatment of chronic illness. Hospitals must accept value-based healthcare and accept risk through global case rates, helping actively manage the assembly line of care to patients being treated inpatient.  Intensity of services must decline over the next four years as well as inpatient days. Survivor hospitals sober to the reality that big is not necessarily better. There is focus on better managing the delivery of services to Medicare and Medicaid patients and total transparency of costs of services and clinical outcomes.

Specialists – specialists must yield to a brave new world of reduced reimbursement, consolidation and the first decline in practice growth as medical graduates begin to select family practice. Remuneration must be more closely managed as medical home plans reassert control of care, pre-empting self-referrals and overtreatment more characteristic of the early 2000s.

Government – Federal and state agencies must demonstrate they can manage cost through clinical and medical management services, not just through serial underpayment.  With improved oversight Medicare and Medicaid can claw back up to $100B a year in fraud.  The additional funds coupled with higher payroll taxes for higher wage earners, global case rates for hospitals, disease management and fee cuts aimed at overtreatment for of life evidence based medicine will help finance subsidies for the expansion of Medicaid and broader coverage for the most vulnerable of the estimated 45M uninsured. Government must enforce Certificates of need are reinstituted and moderate the hospital arms race of medical device purchases and redundant care delivery.

Congress must consider a controversial decision to promulgate a single reimbursement between Medicare and private insurance which can eliminate cost shifting and create a more unified public/private focus on clinical outcomes, reduced variability of care and population health management. The projected net present value of the Medicare deficit can been pared by responsible oversight impacting US debt standing and strengthening the dollar. State and Federal government should focus on interest free medical school loans to students electing to practice primary care as part of an American Family Practice Reinvestment Act.

Consumers – Medicare recipients must accept medical home models as an access point to the healthcare system. Focus will be on personal responsibility and the waiver of cost barriers (e.g. Co-pays and deductibles) for services required to keep the chronically ill stable. Consumers must comply with expectations for regular care and maintenance. Patients must become increasingly comfortable with compliance calls from physicians urging them to stay follow up with tests, maintenance drugs and check ups.  Patients must understand physicians will be rewarded for health maintenance and catastrophic cost risk mitigation. 80% of Americans in 2015 must access healthcare through a primary care provider and reduce ER visit for routine non-emergency treatment. Individuals must routinely check their biometric health indicators through work site based providers, kiosks, health clubs and provider offices to measure progress on key health management indicators.

Employers – Perhaps the most engaged stakeholders, employers must accept their reluctant role as the catalyst for market reforms. In striving for low single digit medical trends, employers must focus on population health improvement, compliance, value based plan designs, medical home, specialty services for key chronic illnesses such as diabetes, cardiovascular disease and orthopedic care. Partnering with CMS and private insurers, employers can take a front seat as the market force through the adoption of gate keeper, medical home models and high performance networks, to reduce, streamline and rebalance the secondary and tertiary care in America.

Pharmacy – Pharma and their intermediary partners, PBM’s must be required to disclose 100% of all rebates and to provide clarity around opaque pricing schemes. Decision support tools introduced through increased HIT and EMR  useage has elevated physician awareness around contradictions and the inconsistent outcomes surrounding certain specialty drugs.  Consolidation among pharmacy purchasers – state, federal, consortias and pharmacuetical benefit managers has eaten into industry margins.  Improved consumer adherance to chronic illness medication as a result of broader medical home oversight, digital consumer compliance tools and incentives has driven higher use of generics and reduced trends.  In this part of the island, only the large and strong survive.

Who Will Win? – As we watch Survivor 2015 unfold, we wonder whether the reality show of American Healthcare is a fair competition or rigged to the benefit of a few stakeholders.

In a free market economy, optimal balance is achieved differently in different segments of our economy.  The fewer the players and the closer one inches toward oligopoly or monopoly, the more important effective regulation is to allow for innovation while limiting abuses and excessive profit taking that disproportionately benefits too few while disenfranchising too many. However, Survivor 2015 must require personal responsibilities. There are no victims – only those who choose to be too self interested or too quick to default into angry populism that deflects from the real issues.

On this island, everyone needs to change. However, it is unlikely that we can have only one winner. In this fight for the future, we all win or lose. Stay tuned.

And The Winner Is…..

Ideasiivittäjä
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And The Winner Is….

“Men are like pumpkins. It seems like all the good ones are either taken or they’ve had everything scraped out of their heads with a spoon.” Anonymous

According to the Chinese calendar, 2009 was the Year of the Ox.  Yet, 2009 was also a year dominated by H1N1 and men behaving badly. For all intents and purposes, it was the Year of The Swine.  It is appropriate on Valentine’s Day that we should always pay homage to those committed souls who understand that a lasting relationship is a lifetime achievement.  To remain faithful in an age that condones common law relations in lieu of marriage, transient “hook ups” and “don’t ask, don’t tell” liaisons is no easy feat.  It is like trying to whistle one’s way through a candy store while on a diet.

Men and women navigate these straits of fidelity differently. Men struggle at times with the concept of monogamy.  For all their bravado, men possess fragile egos that can enlarge or be damaged by seemingly prosaic events leading them to become more vulnerable to the siren’s call of life’s lost souls and home wreckers. Iconoclast Oscar Wilde saw men clearly as raw physical forces of nature.  In their pursuit of ego and power, men roam the world root out validation the way a swine might forage for truffles in the forest. “A man can be happy with any woman” mused the indulgent Victorian, “as long as he does not love her”

And so it has been since our meager beginnings as creatures creeping out of mud and dark waters, men continue to screw up a good thing.  Hubris, self-pity and the invention of hair coloring products have ruined more marriages and relationships than eating crackers in bed. Each year, a new class of “pigs” is admitted to the pantheon of philanderers, cheats and “is he out of his freaking mind” losers.  These offenders are indeed in dubious company.  The Hall of Shame is a who’s who of  “my will be done” piglets whose serial indiscretions visit shame and pain on anyone within a 200 miles radius.  They are politicians, CEOs, talk show hosts, average Joes and yes, even religious leaders.The more pious the offender, the porkier the pretender appears to us when they are finally outed for their reckless indiscretions.

2009 was quite a year for the sultans of swine.  This year we have chosen a Whitman’s Sampler of Valentine offenders who are all in contention for Swine of the Year.  It was a close race and our judges – John Gray (Men Are from Mars), Maureen Dowd (Men Should be Killed), Hillary Clinton (I Am Secretly A Man) and Regis Philbin (I am Secretly a Woman) were challenged to produce a single winner who validated the old saying that, “men marry women assuming they will never change.  Women marry men assuming they will change.”

After much deliberation, we offer for your approval a troika of tomcats who have managed to monopolize the media, ruin their careers and cause every man to feel guilty even when he has done nothing wrong. No words can truly describe just how far back these heels have set back male/female relations.  However, we have tried to memorialize their Win, Place and Show actions as a reminder to others that slime does not pay – -but the celebrity gossip group TMZ does. In winning the coveted Divine Swine award, these pigs have in their own way, helped families across America and have begun to establish fact patterns for women who are worried that partner is cavorting with a home wrecking strumpet.  Yes,  these 2009 “boys will be boys” curly-tailed infidels stooped lower than a well digger’s shoes. Let’s meet them, shall we?

(Applause)

Third Place Swiney – Governor Mark Sanford. This pig hails from the state that has a history of being the first to behave badly.  South Carolina was first to fire on the US in the civil war, and first to secede from the union – – as was its governor who seceded from his marriage after using tax payer money to carry on with an Argentine mistress.

Sanford caused a media sensation when he dropped off the radar for several days while the state legislature was in session. The father of four claimed that he was doing “foreign policy” research during his frequent trips to South America. We now know he was not camping in the Andes to clear his mind. He left his pup-tent at home along with his dignity.

What really distinguished this particular wild boar from the other straying swine was his public admission that he was indeed in love with his younger mistress who he considered his “soul mate.” He went on to say that he was going to return to his wife, Jenny, of 20 years to “try to fall back in love”.  The only thing he did not say was that he and his wife had one thing in common – they both love the same person. Yet, the Love Guv has met his match. Ms Sanford is no slouch.  She is a former VP of M&A at Lazard, tough campaign manager and the heiress to the Skil Power Tool fortune. She has now realized that she married the biggest tool of them all.

Second Place Swiney – Tiger Woods.  What can one say about this wax winged God of the dimpled ball who fell faster than the’ 08 Dow? Turns out Tiger was leading a double life and Scandinavian wife, Elin, did not clue in that the text messages signed “LOL” meant “lot’s of lap-dancing”.  The inch wide and a mile deep, uber athlete had an awkward, underdeveloped adolescence where he had not been allowed to play spin the bottle until he was 24.  According to Tiger’s high school sweetheart, Dina Parr, Father Earl, was also a serial slicer, known to occasionally drive out of bounds with female “friends”.

Tiger was not just leading a double life – he was playing an extra eighteen after the course had been closed.  Apparently his night vision goggles were not quite as keen as his light of day Tiger’s eye. As the legions of augmented, collagen lipped trollops crawled out from underneath bar stools and slid down stripper poles to greet us, we were expected to believe that these wholesome girls next door were really victims and that Tiger was just having, well – a putting problem.

You have to hand it to Woods and his spin doctor caddies.  They tore a page out of the Book of Really Lame Excuses and announced that the PGA pro was suffering from “sex addiction”.  He joins a long bread line of wayward souls who have finally found a clinical term to justify acting on the belief that the grass is greener on the other course. Have some empathy! This is a sickness. Just watch Dr Drew and Celebrity Rehab – Sex Addiction. Imagine if the stomach flu involved that much fun.  The clincher that cemented Eldrick Woods as our runner –up 2009 number two piglet was his rumored assertion to Elin that “none of the women meant anything. “

We have saved the best for last.  This human manatee has taken slime ball to a new level leaving his super libido pals behind to play handball against the curb. What is it about the Carolinas that spawns these swamp things with antlers the size of continents and brains the size of electrons?

Let’s give a southern “Deliverance”, Ned Beatty, pig squeal for our winning divine swine of the year – – VP, Presidential and STD candidate, ex-North Carolina Senator John Edwards.  This lying, pathetic sack of self deception fell into a deep coma of denial as he philandered with a bizarre earth mother who followed him 24/7 as his personal campaign videographer.  A recent kiss and tell book by ex-aide, Andrew Young called “The Politician” has unmasked this hypocritical scumbag (who made millions as an ambulance chasing, medical malpractice attorney) as a pathological liar and ego maniac.  Old “Love Lips” denied and then, when confronted with DNA evidence, admitted to being the father of Reille Hunter’s child – – carrying on while wife Elizabeth was being treated for terminal cancer.  Spouse Elizabeth is not entirely a poster child for “victim” according to Young, who claims she possesses a rather flinty and ambitious personality.  However, no amount of character defects can justify the senator’s frequent indiscretions and his duplicitous contempt for everyone that he was charged with serving or supporting.  Young portrays Edwards “as preening and arrogant, an Atkins dieter who hated making campaign stops at state fairs where ‘fat rednecks try to shove food down my face.’ Edwards was overheard to hiss,” I may have to represent them but I do not have to eat with them.”

Sen. Edwards is perhaps our most compelling choice in quite some time. He has carved a grand canyon of disappointment as a human being and a politician ( you notice that I distinguish between the two )  Edwards was portrayed to America as a pious, church going family man who was desperate to champion the cause of the little man.  Instead he chose to sire a little lady out of wed-lock with a Haight-Ashbury throwback who believes that their love child is “a golden messiah… the reincarnated spirit of a Buddhist monk who is going to help save the world.” One thing this miracle baby cannot save is Mr. Pig’s career, reputation and future as a reality TV star.  Possible contestants with Citizen Edwards on Celebrity Rehab – Lower Than Lowe (That’s Rob Lowe) will include 2001 Swiney winner, OJ Simpson, Son of Sam and Richard Simmons.

And there you have it – our 2010 Swine.  For 2011, we plan on expanding our ” Swiney” awards to include subcategories of cheating wives, star-crossed lovers and those caught en flagrante dilecto.  There is so much material and so little time.

However, do not let this dark Valentine drive you into the provinces of the cynical.  Love remains eternal, sacred and the essence of our human journey.  It is only through giving it away, that we can possibly hope to find it. The goal, as one poet shared, is to fall in love and keep falling in love with the same person – again and again.

Just make sure it’s the same person.

Fight Night At The Octagon

I’m a charming coward; I fight with words.  Carl Reiner

In the 1952 John Ford classic, “The Quiet Man”, John Wayne and Victor McLaglen square off in what some film critics have touted as the greatest fistfight in the history of American cinema.  The confrontation follows the two combatants across a half mile of County Mayo countryside as they exchange blows for a full twenty minutes.  After seeing John Wayne in action, it seemed to me that a boy wasn’t really a man until he had administered or been given a fat lip in a fistfight.

When you grow up among boys, you get beaten more times than your grandma’s throw rug. It is a rite of passage to be punched in the arm every morning and pinned to the ground by your older sib’s friends who proceed to administer medieval tortures like ” pink belly’, ” cauliflower ear”, “super melvins” and the dreaded “monkey bump”. You learn quickly that to cry outside the family is to invite further ridicule. You choke back tears; rise up out of the dirt, florid and humiliated – – intent on plotting the slow, painful death of each tormentor. In later years, you just hope that one of them comes to you looking for a job.

Being regularly beaten up for a decade left me two choices – man up or move to Canada. In the 1970’s all conscientious objectors moved to the great white north.  However, when it was pointed out to me that Canada had no McDonalds, I realized I must adapt to my hostile environment. Like an anthropologist I studied other families.  I noticed that the best adjusted and least bruised kids were those who were quickest to cry wolf at the slightest fraternal infraction.  I discovered that if I pretended to be more hurt than I really was, I could inflict greater pain than if I fought back.

It was a clever ruse to fake serious injury. At some level, my father knew that I was faking but he just could not stand the crying. He was angrier at my ear splitting screams and the disruption than the actual infraction.  He would ruthlessly administer swift corporal punishment to the offending brother and then yell at me to calm down.  Like a method actor, my ability to feign injury was the equivalent to the Star Wars Missile Defense System. It became a valuable prophylactic against the tyranny of older brothers.

While the internecine wars of boys were measured in scratches and welts, most of the scrapes I witnessed later in life, were one-punch affairs. Seasoned street fighters understood that landing the first punch improved their chances of survival. Cowards and thugs sometimes overcame opponents out of their weight class simply by deploying an underhanded technique called the “sucker punch”. The sucker punch was a risky and devious instrument of foreign policy where one considers the mere threat of violence as sufficient cause for a preemptive strike. This unanticipated offensive usually took the form of a head butt, nose punch or knee to the groin. It bought you time – precious time to press your advantage or in my case, run away if the attack failed.

Being the descendant of French Huguenots who fled from virtually everything, I was a pacifist and believed avoiding a fight was a good as winning one.  Having spent a childhood getting pounded, I could sense when social tensions were creating a low-pressure system that only a fight could fill. When the potential for confrontation began to escalate, I would ease towards an exit. If a fight did break out, I would be out of harm’s way. Once the outcome was determined, I could stumble upon the scene and pretend that I was furious at having missed the combat. Yet fights were like flash fires and sometimes one could not be avoided. When the bullets started to fly, it was important to pick your fox hole mates very carefully.

I always stuck close to my buddies who wrestled. There was a great mythology around the physical prowess of football players.  In my experience, a 260lb lineman moved like a Brontosaurus and possessed a similarly proportioned brain that gathered and processed data very slowly. Linemen were like the French forts of the Maginot line – big, imposing, and useless. Large guys just invited a sneak attack.

My fellow baseball players were generally useless in a scrape. They did not know what to do if they could find a mound to rush. Swimmers? Forget it.  They were usually preening their green chlorinated hair in the bathroom and waiting for any opportunity to remove their shirt so they could show us their 42 abdominal muscles. A swimmer might attempt one swift, girly kick before rushing off like a seal to find water where they would dare you to come and get them.

It was always the scrappy 158lb middleweight wrestler that was the force to be reckoned. This was a guy that you ignored at your own risk. He was the high school equivalent of a Navy Seal. He was frozen in a permanent state of self-imposed suffering. He would spit, starve and sweat while wrapped in a plastic suit for three days trying to make weight for his next match. He had less body fat than a POW and a surly disposition from all of his personal sacrifices that went unnoticed by a student body that was mesmerized by more mainstream power sports. He labored anonymously on a dusty mat for hours, risking staph infections and dislocated limbs – often contorted against his will into positions worthy of a cirque d’ soleil acrobat.

On many occasions, a fight would threaten to break out, only to have the 175lb team captain slip underneath an errant blow and wrap the drunken offender up faster than you can say ” Little Annie’s Pretzels” At this point, the wrestler would look up like an annoyed animal trainer and say, “could you guys get me a beer?” Below him, the larger, more sloth like offender was straining to get out of a hold that Houdini could not have escaped.  His captor would merely tighten his neck lock and whisper, “Had enough?” This was the inglorious bastard that you wanted as a wingman when things got hot.

Fighting was a part of growing up.  Before society became wildly litigious, it was a foregone conclusion that where there were boys gathering, fists would fly. Some parents came up with creative ways of resolving disputes including forcing the adversaries to put on the boxing gloves and resolve differences in the ring.

My dad grew up boxing. In those days, kids would go to the YMCA or hang around gyms and learn the proper art of pugilism. ” Keep up your left” he would coach.

“Jab-jab-jab!   Now, hit with the right cross!”

This was an era when professional boxing still held America captive with flamboyant light, middle and heavy weight fighters like, Alexis Arguello, Roberto Duran, and the greatest, Muhammad Ali.  Hollywood glorified the grit, violence, discipline and rags to riches nature of boxing through movies like “Somebody Up There Likes Me”, “Rocky” and “Raging Bull”.

Where there is sanctioned violence, corruption is not far behind.  Professional boxing ultimately turned on itself – fighting and splintering into divided federations and associations all claiming to be the lineal descendant of the National Boxing Association championship.  A grittier and less heroic generation of thug fighters emerged and with them, America’s thirst for a heroic fist-fighter descended to a new low –- Ultimate Fighting.

In this graphic spectacle of modern day gladiators, combatants wrestle, kick, punch, choke and assault one another until a bloodied fighter taps out (yields), passes out, is knocked out or is TKO’d by the referee.  They fight in a cage. When introduced many ultimate fighters reference years spent fighting in “The Octagon”. I have no idea where the Octagon is or if it is a real place.  It sounds like it should be next to a cock-fighting ring in Bangkok. I know where the Pentagon is but this citadel of pain actually has three more sides than the epicenter of all American military operations.

Ultimate fighting is brutality and the new breeds of fighters that engage in this sport are not muscle bound pugilists but ex-college wrestlers and kick boxers.  They are often former special-forces personnel who understand the art of hand-to-hand combat.  They have names like Kevin “Kimbo” Slice and Quinton “ Rampage “ Jackson. I am drawn to it like a spectator watching a barroom brawl.

It seems as if fighting has “devolved” It has become more primitive.  There is irony in this shift.  Perhaps it is a reflection on our society. We discourage our children from fighting.  We have become more gentrified and more accountable for our actions.  We seek to tame the “Id” within us. In our efforts to evolve into a more gentile, lotus eating society, our reservoir of anxiety and hostility cannot find an outlet.  Ergo, our need for brutal full contact fighting found inside an Ultimate Fighting cage.  Are we more or less violent than 40 years ago?  Are we unfulfilled and at our nature violent creatures?  Is boxing dying because it’s not aggressive enough?  Perhaps, we may find the answers to these and other questions inside the Octagon.

But just where the hell is it?

Learning To Play The Game

John Wooden at a ceremony on Oct. 14, the coac...
Image via Wikipedia

A long time ago in a galaxy far, far away vertically challenged, slow moving kids from the suburbs were actually able to compete in basketball at the collegiate level. And so it happened that my father was able to play Division I freshman basketball for the Golden Bears at the University of California.

He is quick to admonish anyone who presumes his alma mater has any relationship to his political orientation. He went to school on an ROTC scholarship – which was the equivalent at Cal of being a carnivore at a vegan retreat. He firmly asserts that he is but one of five conservatives to ever actually graduate from that collectivist pocket of neo-liberalism that agitates restlessly within the nuclear free city limits of Berkeley, California.

My dad does not attempt to gild the lily of his on-court experiences. Unlike a graying collegiate whose hyperbole ages to a point of becoming fallacious fact, he would talk openly about rising to the level of his incompetence his freshman year at Cal.  I can recall walking into his study and seeing a black and white photograph of a young man with tight dolphin shorts and a body shirt jersey numbered 14 crouched in a defensive position.  Later in life, I would run into his high school and college fraternity brothers who would refer to him as “Hoops”.  They would fondly share stories about his competitiveness.  “ Your old man played with such intensity that it felt like there was more than one of him on the court. “

One of his old teammates reflected nostalgically on my Dad’s feverish energy level on the Cal freshman team. “The coach kept him on the team because he was so damn aggressive. He might foul out playing a guy tight but he could provoke the other team into making mistakes and inspire guys to push harder.  He was one of those players who made as many contributions away from the ball as he did when he was handling it.  He made other people better.

When asked about his hoop playing days, my father was always appropriately self-deprecating. He would joke and pointed to his opportunity to start as the end of an epoch when slow guys who could shoot with either hand had a chance to make a college team. Dunking was still something only policemen did with donuts.

My father was drilled relentlessly in the fundamentals of passing and dribbling. He was a thinking man’s point guard.  He was ambidextrous, feisty and possessed that innate invisible eye in the back of his head that allowed him to sense a pick, double team or someone cutting through the lane open for a pass. He was a team player always telling us that a “good assist is better than a good basket”. His coach was an irascible Southerner whose thick Mississippian drawl rendered him virtually unintelligible to his players with the exception of an intense chant that he would make as he watched his players, ” hum-baby, hum-baby, hum-Turpin”!

His hero was number 14, Bob Cousy of the Boston Celtics who at 6’ 1” and 175 lbs was a 13-time all-star, and remains the all-time leader in assists for the Celtics with 6,945.  The Houdini of the Hardwood drove the Green and White to six of their NBA ten championships. To my father, Cousy was the epitome of the unselfish player and reinforced the notion that a team wins or loses championships – not individual players. Cousy exemplified the notion that sports did not build character, but revealed it.

My father also idolized John Wooden, the wizard of Westwood, who coached UCLA to 10 national championships and 4 undefeated 30-0 seasons.  Wooden’s “ Pyramid of Success” was preparing his players not just for games but also for life. Dad would repeat Wooden, as we would discuss sports. “Do not let what you cannot do interfere with what you can do.”  “Never mistake activity for achievement.” “Talent is God given. Be humble. Fame is man-given. Be grateful. Conceit is self-given. Be careful.

Growing up, we would gather under a rotting wooden backboard unevenly mounted on a trellised ivy fence and shoot baskets for hours. Ever the advocate of Wooden, my father colorfully referred to practice as “relentless repetition leading to rehearsed exhibitions of excellence” He installed a light so we could spend our warm Southern California nights working on free throws, lay ups and jump shots.

While family genetics denied us height and speed, he was determined that we would have heart. We were reassured that it was literally possible to out work any one if you wanted it bad enough. Basketball was my first glimpse into my father as a person.  I saw his passion and his child-like love of the game.  The hardworking taskmaster would transform before our eyes when he touched that 29” ball.  This orange orb would spin on his finger and then loop between his legs  revealing to us the child that grew up hustling on the West side of Chicago.

My father explained that basketball was a physical game about using your God –given assets. As my quicker, more nimble brothers would head fake me and dribble past me like a road sign, I would simmer with competitive anger.  As he studied my abilities and weaknesses, he taught me to camp in the lanes and block shots.  He told me to use my body and to make guys “pay for coming into my neighborhood”

I was a big, solid kid with cement pipe legs and a turtle shell stomach.  My asset, in this case, was my rear end which I would deploy to box people out of rebounds, and hip check a driving guard into thinking twice about coming my way again.

“Don’t let him come into your area like that! If he dribbles past you and no one picks him up, foul him. Make him shoot a free throw. Always remember, you have five fouls to give.”

As with all youth sports, high school changes everything.  I was determined to try out for the basketball team but knew that my passion for the game would not show up on any depth chart.  I was slow, had the vertical leap of a houseplant and was confused by the fast break offense that was a staple of our coach’s playbook.

I worked my tail off that fall – running, diving, practicing and participating in tournaments as the coach slowly whittled the thirty some odd candidates down to a dozen players.  On the last day, there were fifteen of us and we knew three would not make it.  We held a scrimmage that day and I held my own, sinking a jump shot to help cushion our squad’s win.  I made sure that I did not finish last in the sprints and suicide line drills even though this left me to the point of puking.

I will always remember that call the next day as the coach called me to his office to tell me I had been cut.  In an era before cell phones and real time updates, I stayed after school at the local pizza parlor – waiting to go home to coincide with the end of practice.  I ate a large pizza. I did not want to tell my father I had been cut from the basketball team.

I recall walking into the house and seeing him reading his paper – wearing the same apron that my mother made him wear to prevent him from staining his shirt and tie.  He lowered his paper and smiled. “ So buddy, how was practice? Did they announce the team? “ I vaguely flirted with lying to him but the thought of spending the next several weeks hiding out at Tony’s Pizza waiting for practice to end would turn me into an overweight, pimple ridden loser.  I had let him down.  I could not outwork the guys who made the team.  I had failed him and myself.

I burst into angry tears and swore – sharing the news that I had been cut.  He put the paper down and sighed.  I saw again in his face that same youthful enthusiasm I would see on that driveway basketball court each weekend.  He smiled.  “Pal, John Wooden used to say, ‘if you’re not making mistakes, then you’re not doing anything.’

I am proud of you. And I know you gave it everything you had.  Failure isn’t fatal, it’s the thing that ultimate makes you better.”  He returned to his paper.

He looked up at me. “ And besides – – that coach is an asshole!  He obviously doesn’t know talent when he sees it!”

In the kitchen I heard my mom drop a dish and I could tell she had been listening – preparing to rush in upon my exit to tell her husband what a wonderful father he was.   I laughed and hugged my dad.  He winked at me and I went off to bed.  As I climbed the stairs I could hear him fighting off my mother’s stern reproaches.  “ Oh Ruth, I was just trying to….”