Perpetual Innovation

Author: Del Phi

  • Out of Control Healthcare Costs, Delinkage may help?

    We have a new blog post in IPZine about trying to control healthcare costs by taking a new twist on the linkage in BIG phara to patent protection. Check that out this article on delinkage of intellectual property protection.

    In 2017 we talked about scenarios that jump out at you.

    Scenarios that Jump Out At You
    Scenarios that really stand out, including compounding effects.

    One that always is front-and-center is the out-of-control escalation of healthcare costs in the US, now up to 18% of GDP. In an Nov 20 2019 blog over at IPZine there’s discussion of “delinkage” related to pharma patents that has some potential for taming the out-of-control healthcare costs.  Included in that blog post is a discussion of how long it will take before healthcare costs escalate from 18% of GDP (approx. $3.6T of the $20T GDP) to 50% of GDP, and even 100% of GDP?

    Here is some of the math. You can do your own figures. Assume that Healthcare costs increase by 10% per year as they have for decades (even though that rate is lower currently). Say that GDP growth is 2.5% and inflation is 2% (real GDP growth is =+0.5%). How many years before all healthcare costs in the US reach 25%, 50%, 75% and even 100% of the US GDP!???

    Year Description (+10%) Targe%GDP # of Years
    2025 Years til % of GDP 25% 4.5
    2034 Years til % of GDP 50% 14.1
    2040 Years til % of GDP 75% 19.7
    2044 Years til % of GDP 100% 23.7

    That’s right, with 4 or 5 years, the total healthcare costs of the US could be 25% of GDP. In 14 years it could be 50%, and in 20 years it could represent 75% of GDP. If this doesn’t scare you into taking some actions, then you obviously don’t understand the magnitude of the problem! This was the problem that we faced for decades when Healthcare costs were increasing at 10% or more each year.

    Okay, so healthcare costs are lower now since the Great Recession; let’s say they may have dropped to 5% to 7.5 increase per year (2 to 3 times CPI inflation).

    At 5% healthcare inflation:

    Year Description (+5%) Targe%GDP # of Years
    2033 Years til % of GDP 25% 13.3
    2061 Years til % of GDP 50% 41.4
    2078 Years til % of GDP 75% 57.8
    2089 Years til % of GDP 100% 69.4

    Note that it is no longer 4 or 5 years to reach 25% of US GDP, it takes more like 13 years. It takes 40 years to reach about 50% of GDP.

    When you consider that the US spends 4 times what the rest of the world spends on healthcare (about $10k) and more than twice what the typical developed country spends… For outcomes that are no better… Some place in here we need to rethink.

    Hall and Knab (2012) outlined 10 other items besides healthcare costs that were non-sustainable trends/practices that appeared to have compounding and accelerating forces at play. The (US) Federal deficit is one. Each of those scenarios loom as large or larger today than back in 2012.

    #scenario #healthcare #gdp #compounding #ipzine #patents #intellectualproperty

    References

    Hall, E., & Knab, E.F. (2012, July). Social irresponsibility provides opportunity for the win-win-win of Sustainable Leadership. In C. A. Lentz (Ed.), The Refractive Thinker: Vol. 7. Social responsibility (pp. 197-220). Las Vegas, NV: The Lentz Leadership Institute. (Available from www.RefractiveThinker.com, ISBN: 978-0-9840054-2-0)

  • Democratization of Power

    SustainZine (SustainZine.com) blogged about a rather cool idea on the decentralization of power (here). The idea in Nature Communications is to have buildings everywhere use their renewable power sources to generate a biofuel of some type. And the authors had the Heating Ventilation and Air Conditioning (HVAC) unit extract CO2 from the atmosphere to generate the fuel. Some of the technologies they pointed to were new-er technologies that are now (hopefully) making their way into main-stream. (Read the nice summary article in Scientific American by Richard Conniff.)

    Basically, everyone everywhere can now produce their own power at rates that are a fraction of lifelong utility power. Storage is now the big bottle neck to completely avoiding the grid. The distributed power should only be a big plus to the overall power grid; however, the existing power monopolies are still resisting and blocking. So complete self-containment is not only a necessity for remote (isolated) power needs, but a requirement in order to break away from the power monopolies.

    In the US, there is the 30% Renewable Investment Tax Credit which makes an already good investment even better for homeowners and businesses. Plus, businesses can get accelerated depreciation making the investment crazy profitable after accounting for the tax shield (tax rate times the basis of the investment). Many of the states also sweeten the deal even more. But the 30% tax credit starts to reduce after 2019, so the move to renewable starts to drop off precipitously at the end of 2019.

    You would think that the power companies would join in the solutions, and not spend so much time (and massive amounts of money) on obstructing progress. All those tall buildings that are prime candidates for wind. Think of all the rooftops, roads and parking lots worldwide that are prime candidates for solar. Distributed power. As needed, where needed. No need for new nuclear, coal or nat-gas power plants. Little need for taking up green fields with solar farms.

    Of course, the oil, coal and gas companies need the perpetual dependence on the existing infrastructure. When we all stop the traditional fossil fuel train — and all indications from the IPCC show that we must stop that train sooner, not later — then all the oil and gas in the world will need to stay in the ground. Call me an optimist, or a pessimist, but I would not buy oil or gas for almost any price. I definitely wouldn’t buy into the Saudi-owned oil company spinoff.

    It is probably a mistake to think that technology to take CO2 out of the atmosphere after the fact can repair past sins. Avoiding putting pollution into the air, water and land — the negawatt and the negagallon, in this case — are by far the best approach.

    In Sustainzine, BizMan concluded with this thought about the here-and-now scenario, not in the future at all:

    “Hidden in this whole discussion is that scenario that is here and now, not futuristic. Renewable energy is cheaper and massively cleaner than conventional energy, and it can be located anywhere. Storage, in some form, is really the bottleneck; and storage in the form of synthetic fuels is a really, really cool (partial) solution.

    References

    Dittmeyer, R., Klumpp, M., Kant, P., & Ozin, G. (2019, April 30). Crowd oil not crude oil. Nature Communications. DOI: 10.1038/s41467-019-09685-x

  • More prisoners in US than any other country: Criminal (In)Justice Scenarios

    Here are Scenarios and sources of the injustice in the Criminal Justice system in the USA.

    The US has the most people incarcerated of any country in the world… Even though we only have 4.3% of the world’s population, we have more inmates — 2.2 million — than China (1.5m) and India (0.3m), combined (36.4% of world population)! We have 23% of China’s population but 40% more incarcerated. We have almost 1% of our population (0.737%) incarcerated! We have 6 times higher incarceration rate than China, 12 times higher that Japan, and 24 times the rates in India and Nigeria. That’s right, an American has a 1,200% greater chance of being incarcerated than a Japanese citizen. We have even a 20% higher incarceration rate than Russia with 0.615% of their population in (Siberian) prisons and jails.

    I know what you’re thinking, Americans must be more criminally inclined than any other country in the universe. And, no, it is not those *bleeping* Mexicans. The evidence shows that the Mexicans (legal or otherwise) cause less crimes than the typical “American”, plus crimes involving illegal Mexicans are far more likely to go unreported.

    So now, I’m at a loss. Where did the criminal genes come from? You can’t really blame the American Indians.

    Some of the ugly mechanisms and profits in the prison system are summarized nicely here in ATTN by Ashley Nicole Black, Who Profits from Prisons (Feb, 2015).

    “There are currently [2.2 million] American in prisons. This number has grown by 500 percent in the past 30 years. While the United States has only [4.3] percent of the world’s population, it holds 25 percent of the world’s total prisoners. In 2012, one in every 108 adults was in prison or in jail, and one in 28 children in the U.S. had a parent behind bars.”

    For years I heard stats that half of the people in prison in the USA were for non-violent (no weapon) drug offenses. That’s insane. It seems like the wrong people are institutionalized here. With the legalization of marijuana in many states these incarceration rates should be reducing (improving). July 2018 shows 46% of US inmates are for drug offenses: https://www.bop.gov/about/statistics/statistics_inmate_offenses.jsp

    Okay, so what does that have to do with scenarios and scenario planning? What would be some of the scenarios that might lead to something more sane in terms of our incarceration rates. One approach would be to focus on those deflection points that might result in a lower level of criminals (criminal activity). Just one would be a new approach related to the prohibition of marijuana. As we learned from alcohol, prohibition doesn’t work. But there are several other ways to provide a mechanism for less criminal activity and/or less people incarcerated and/or less people incarcerated for so long. We’ll talk about two of our favorites at a later time: education and community engagement/involvement. (The Broken Window concept of fixing up the community and more local engagement is very intriguing. See article by Eric Klinenberg here.)

    The big thing that escalated US incarceration rates was a get-tough-on-crime movement that began during the Nixon “I’m-not-a-crook” era. Part of this was obviously to have some tools to go after the hippies and the protesters. Tough on crime with mandatory sentences, lots of drug laws, and 3-strike laws came into being. Not to be outdone, as the toughest on crime, the 3-strikes moved to 2-strikes to, essentially 1-stike. As we filled up the prisons, we had to build more.

    One current trend that should increase incarceration is the current epidemic of opioid-ish drug overdoses. Most forces, however, seem to be pushing toward reductions in incarceration.

    Various scenarios should lead to a significant reduction in incarceration rates. The resulting scenario of low incarceration should have several ramifications. If you are in the business of incarceration, then business should – ideally – get worse and worse. Geo and Corrections Corp of America (now CoreCivic) should expect their business to drop off precipitously. Plus, there seem to be several movements away from private (or publicly traded) companies back toward government run prisons because private has been shown to be less effective — even if cheaper on the inmate-year bases.

    Here’s a discussion of the business of incarceration. Note that the “costs” of incarceration are far, far more than the $50,000+/- it costs per year per inmate. Plus, having more people as productive members of society has them working (income and GDP) and paying taxes, not a dead weight on society.

    Do you think that the relaxation of marijuana laws might be a “Sign Post” (in scenario terms) that indicates a rapid drop in prison population? Also, super full employment, might be a solution all by itself. People, especially kids, who can get jobs and do something more productive, may be less inclined to get into drugs and mischief? There’s no reason why the Sign Post need to be only one, or even two signs. In fact, the crime system is just a sub-system of an economy. Multiple reinforcing systems can be really powerful.

    If we do take other approaches to the incarceration system, what would those approaches be? And who (what businesses/industries) would benefit most?

    What do you think? Is it time to get out of the criminal (in)justice system?

    Resources

    Half of the world’s incarcerated are in the US, China and Russia: http://news.bbc.co.uk/2/shared/spl/hi/uk/06/prisons/html/nn2page1.stm

    Incarceration Rates: https://www.prisonpolicy.org/global/2018.html

    US Against the world: https://www.statista.com/statistics/300986/incarceration-rates-in-oecd-countries/

    New Yorker Article in Sept 2016 by Eric Markowitz, Making Profits on the Captive Prison Market.

    How for-profit prisons have become the biggest lobby no one is talking about, by Michael Cohen in 2015.

    Follow the money, in 2017, with a great infographic as to where all the prison moneys go.

  • Salt and Battery, When does Storage make Fossil Fuel Obsolete

    Last week the world’s biggest Electric Vehicle (EV) battery company made a big opening splash on its IPO. CATL is a Chinese company that IPOed with a massive 44% pop on open. The company offered up only 10% of the shares in the IPO, valuing the company at more than $12B. China has limits on how much a company can IPO at (price based on PE ratio) and a 44% limit on the amount an IPO can rise in first day of trading. Expect this company to jump continually for some time. CATL is now the largest EV battery company in the world, primarily with lithium-ion for autos.

    Of course, you can just use power as needed, when needed. With the rapid increase in efficiencies of wind (where the wind blows) and solar (where the sun shines) this is becoming ever-more critical. Once the infrastructure of transmission lines are in place, the renewable power plants are far more cost effective than any other options. Both wind and solar are now less than $.02 per KW, and the combined wind-solar is coming in at less than $.03. Such new power can come onboard in months, not years or decades required for other types of power.

    Still, the problem is smoothing out the power for night time when the wind is not blowing. Thus the reliance on storage if we are to move to total renewables. If – well, when – the combined renewable energy and storage costs are lower than coal, oil and natgas, there will be no need for fossil fuels, except maybe for those places where the sun doesn’t shine (much) and the wind doesn’t blow (much).

    There are many different options for storage of energy.

    Fixed storage can be in the form of solar that moves water (back upstream to a dam that is above the existing hydro power system). It can use mirrors to focus heat for molten salt, for example.

    The old lead battery technology has been tried and proved for a century and still is alive and well in the golf-carts.

    Many players are after the battery storage market. GE is fighting hard against Tesla (powerwall battery built in their GigaFactories for fixed and battery packs for their cars) and Siemens. Storage options that are as good, or better, then lithium are coming fast to market for different applications. See a great view of new battery technologies in Pocket Lint. Batteries technologies that contain more carbon, nickel or cobalt seem very intriguing. Hydrogen options using fuel cell has been right at the edge of mass breakthrough into the market for decades.

    When will certain storage options become a game-changer for existing “built economy” such as fossil fuels?

    At some point, the combined renewable and storage will be sufficiently powerful and affordable to render the old fossil fuel options obsolete. McKinsey report discusses this massive drop in price and trend in their battery report. In 2010 battery storage cost about $1,000 per kilowatt hour of storage; their June 2017 report shows it at $230 per kwh in 2016 and dropping fast. It should be well below $200 per kwh now. (Batteries for the Telsa Model 3 are supposed to be at about $190 per kWh based on mass manufacturing; estimates based on SEC filings are for $157 kWh by 2020.)

    So, what is the break-even point where storage becomes the game changer, and renewables with battery deflect the entire energy industry onto another course? Apparently, $125 per kWh is the disruptive price point. A scientist name Cadenza has developed battery technology at this price point using super cell and is now working on an extended version that includes the peripherals with the battery at, or below, the magical $125 kWh. She must demonstrate both cheaper and safer, so the housing is critical to avoid fires and short-circuits. “In March of this year, Cadenza published its report (pdf) saying that its super-cell technology can indeed hit that point.”

    The technology is already here, yet new improvements are leap-frogging each competing option. How long before fossil fuels are an obsolete option? For just plain generation, fossils are dead and dying. Combined is where the war is won, however.

    We argue that you really want to be careful with your oil and gas investments because you can find yourselves, like the oil patch (countries and companies and refiners) with stranded assets.

    Moore’s law is at work in the battery complex. How long before combined renewables with storage supplants fossil fuels? Five years? Ten? Twenty?

  • Consensus too, outcomes and consensus

    Consensus continues to be a big issue is designing a Delphi Study. It is more than a little helpful to figure out how the results will be presented and how consensus will be determined. Even if consensus is not really necessary, any and all Delphi studies will be looking for the level of agreement as a critical aspect of the research. Look at our prior blog article  Consensus: Let’s agree to look for agreement, not consensus. Hall (2009) talks about suggested approaches to consensus in the Delphi Primer including the RAND/UCLA approach used in medical protocol research. Hall said: “A joint effort by RAND and the University of California is illustrated in The RAND/UCLA appropriateness method user’s manual. (Fitch, Bernstein, Aguilar, Burnand, LaCalle, Lazaro, Loo, McDonnell, Vader & Kahan, 2001, RAND publication MR-1269) which provides guidelines for conducting research to identify the consensus from medical practitioners on treatment protocol that would be most appropriate for a specific diagnoses.”

    In the medical world, agreement can be rather important. Burnam (2005) has a simple one page discussion about the RAND/UCLA method used in medical research. The key points by Burnam and the RAND/UCLA are:

    • Experts are readily obvious and selected by their outstanding works in the field. They may publish research on the disease in question and/or be a medical practitioner in the field (like a medical doctor).
    • The available research is organized and presented to the panel.
    • The RAND/UCLA method suggests the approach/method to reach consensus.
    • The goal is to recommend an “appropriate” protocol.

    Appropriate is clear. Burnam says, “appropriate, means that the expected benefits of the health intervention outweigh the harms and inappropriate means that expected harms outweigh benefits. Only when a high degree of consensus among experts is found for appropriate ratings are these practices used to define measures of quality of care or health care performance.”

    Burman compares and contrasts the medical protocol with an approach used by Addington et al. (2005)that includes many other factors (stakeholders). Seven different stakeholder groups were represented, therefore the performance measures selected by the panel to be important represented a broader spectrium. The Addington et al. study included other performance measures including various dimensions of patient functioning and quality of life, satisfaction with care, and costs.

    Burman generally liked the addition of other factors, not just medical outcomes, saying that she applauds Addington et al. “for their efforts and progress in this regard. Too often clinical services and programs are evaluated only on the basis of what matters most to physicians (symptom reduction) or payers (costs) rather than what matters most to patients and families (functioning and quality of life).”

    The two key take-aways from this comparison for researchers considering a Delphi Method research. Decide in advance how the results will be presented, and how consensus will be determined. If full consensus is really necessary – as in the case of a medical protocol – then fully understand that at the beginning of the research. Frequently, it is more important to know the level of importance for various factors in conjunction with the level of agreement. In business, management, etc., the practitioner can review the totality of the research in order to apply the findings as needed, where appropriate.

    References

    Addington, D., McKenzie, E., Addington, J., Patten, S., Smith, H., & Adair, C. (2005). Performance Measures for Early Psychosis Treatment Services. Psychiatric Services, 56(12), 1570–1582. doi:10.1176/appi.ps.56.12.1570

    Burnam, A. (2005). Commentary: Selecting Performance Measures by Consensus: An Appropriate Extension of the Delphi Method? Psychiatric Services, 56(12), 1583–1583. doi:10.1176/appi.ps.56.12.1583

    Fitch K., Bernstein S.J., Aguilar M.D., Burnand, B., LaCalle, J.R., Lazaro, P., Loo, M., McDonnell, J. & Vader, J.P., Kahan, J.P. (2001). The RAND/UCLA appropriateness method user’s manual. Santa Monica, CA: RAND Corporation. Document MR-1269. Retrieved July 3, 2009, from: http://www.rand.org/publications/

    Hall, E. (2009). The Delphi primer: Doing real-world or academic research using a mixed-method approach. In C. A. Lentz (Ed.), The refractive thinker: Vol. 2. Research methodology (2nd ed., pp. 3-28). Las Vegas, NV: The Lentz Leadership Institute. (www.RefractiveThinker.com)