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Healthcare Costs: No Transparency and Ready for Massive Disruption

Healthcare costs are out of control and, in particular, negatively impact those of us whose healthcare is individually insured in the United States (the U.S. Census Bureau states that approximately 9% of we 323.1 million Americans are individually insured or uninsured).

There is no pricing transparency and healthcare is not a free market.

Whether it is the wildly differing prices of an MRI to our costs for pharmaceuticals being among the highest in the world, the fact that there is no transparency, near-zero alternatives, little power to drive costs lower as consumers, and that most of the health-insured in America don’t shop around since they are only responsible for a low co-pay amount, this is a market ready for massive disruption.

This massive disruption may start with Amazon inserting itself in to the drug supply chain and disrupting it as you’ll see below.

My post from yesterday about Why Trump and the GOP’s Healthcare Approach is a Barrier to Entrepreneurs compelled me to add something today about healthcare costs, specifically because our current president and Congressional leadership are doing nothing about controlling costs of pharmaceuticals, wildly different prices for procedures, and positioning consumers to shop around for lowest prices in order to create an actual free market.

This Wikipedia article points out why U.S. healthcare costs are so high and that it’s not a free market and outcomes are lacking:

Unlike most markets for consumer services in the United States, the health care market generally lacks transparent market-based pricing. Patients are typically not able to comparison shop for medical services based on price, as medical service providers do not typically disclose prices prior to service. Government mandated critical care and government insurance programs like Medicare also impact market pricing of U.S. health care. According to the New York Times in 2011, “the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care” and prices are the highest in the world.

As patients we generally do not have access to pricing information until after medical services have been rendered which is fundamentally flawed and goes against everything I believe in when it comes to the free market.

Would you buy ANYTHING if the manufacturer or retailer didn’t tell you until AFTER the purchase how much it would cost? Of course you wouldn’t. But that is EXACTLY what happens when you have a co-pay and figure that you’ll let the insurance company and provider fight it out over price since you only have to pay some nominal amount.

Here’s one example which, if you had to buy it yourself (like I would since our family is individually insured), is a reason I’m so up-in-arms about healthcare costs: A chest MRI in Minneapolis (where I’m from) is available from standalone MRI businesses for $460. One hospital here charges $2,026 for the same MRI! (from this article).

It gets worse with pharmaceuticals but maybe Amazon will come to the rescue.

[Read more…]

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Why Trump and the GOP's Healthcare Approach is a Barrier to Entrepreneurs

As small business owners, my wife and I are one of the 18 million individually insured families in the United States. In addition, since I’ve been in the tech community in Minnesota for my entire career (and also published Minnov8.com for over a decade), I know all too well the only way most startups can happen is if a spouse has healthcare insurance. You’ll see why in a moment.

This morning I received an email from our Minnesota healthcare insurance exchange called MNSure about a ‘sneak peak’ at 2018 health care plans. I immediately went there and discovered that the plan we’ve been on for 2017 has our family monthly premium rising by $200 a month to *over* $2,000.

The ‘range’ for our out-of-pocket medical expenditures go from a yearly “low at $25,115” (for which there is a 17% chance we’d actually be on the low side) to a “bad at $37,815” (and a 12% chance at that). The average is $31,155.

When you add up all the out-of-pocket prescriptions and little “nits” we pay, I’m gonna guess we’ll shell out $35,000 or so like we did the last couple of years.

WHO THE HELL CAN AFFORD THAT KIND OF AFTER-TAX MONEY!?! More to the point, even with a Health Savings Account (HSA) — which can’t be used for the $24,514.80 in premiums we’ll pay for 2018 — the total amount we will pay out for medical stuff is 73% of the U.S. mean household income (that mean is $72,641 and I’m assuming a conservative and low 35% paid in taxes).

Yes, Affordable Care Act subsidies still exist, but don’t Trump and his GOP minions truly understand that the #1 roadblock to startups in the U.S. is the enormity of individually insuring one’s family?

There is no f__ing way I’d start up a tech company today if my family was still young and take the risk of no insurance — or having a wildly expensive plan that would virtually guarantee we’d fail without significant VC backing — since there were many times in our past small business owning lives when we didn’t take a salary, sometimes for a couple of months at a time.

Hope they think about this as they stumble their way forward trying to hide the fact they don’t give a shit about the lower, middle or upper middle classes in America.

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The NSA is *Not* Securing Our Nation...On Purpose

By now you should have heard at least something about the WannaCry ransomware attack that’s been going on over the last few days. When I ask people about it and what they know, most have vague responses like, “those computers must be old or not updated” or “people were stupid and did something wrong.”

While both have some truth in it, this analysis by Richard Clarke* about an ABC News story on WannaCry had one of the best paragraphs that describe the #1 problem I’ve been mad about for years which was the root cause of this cyberattack, namely that the NSA is not disclosing so-called zero-day vulnerabilities (zero-days are ones that aren’t yet known so companies can fix them):

First, America’s own National Security Agency (NSA) found the vulnerability in Microsoft Windows that would permit a hacker to gain control of a device. When the agency found that vulnerability, it should have told Microsoft right away, so that the error could have been fixed as part of the regular monthly “patching” program without calling attention to it.

Yep. The NSA should have told Microsoft right away so they could patch the vulnerability but then the NSA couldn’t use it themselves. The NSA has a long history of not disclosing vulnerabilities though the NSA chief claims they do disclose 91% of them (which means they likely keep the good stuff, the other 9% that are devastating like WannaCry has been when leaked, to themselves).

Clearly there needs to be a balance, as this Georgetown Security Studies article suggests, between national security and actions that cause national weakness, which I would argue the NSA is doing by keeping vulnerabilities to themselves. The NSA could go a long way toward protecting the American people by disclosing vulnerabilities that are obvious to them and potentially crippling to our nation, as well as not being breached and having their tools stolen.

That Georgetown article had these words to say about the United States’ Vulnerabilities Equities Process (VEP) that should compel the NSA to be more forthcoming, but it contains a loophole that anything before 2014 doesn’t have to be disclosed (which is millions upon millions of computers and servers running older versions of operating systems and software):

Established under President Barack Obama in 2014, the Vulnerabilities Equities Process (VEP) is an interagency framework used to determine whether the US government and its contractors should disclose software and hardware vulnerabilities to the public and private sector or foreign allies.

The public and private sector have increasingly called for full transparency of the VEP and disclosure of all known exploits. According to the National Security Agency (NSA) Director Admiral Michael Rogers, the NSA shares more than 90% of the vulnerabilities it discovers. However, the VEP currently provides a loophole that exempts any vulnerabilities discovered before 2014 from the vetting process. This is problematic for transparency given the long shelf life of a zero-day.

Sadly, I don’t think the current White House administration will do anything to thwart the NSA’s runaway, do-anything-they-want agenda. Transparency is certainly not their forté so my expectations are low.

Let’s hope Congress steps-in and helps drive national cyber security a little harder when it comes to the NSA actually caring about national internet security vs. just performing signals intelligence while the nation’s I.T. infrastructure is hacked.

This WannaCry ransomware attack is a wakeup call to this nation (and the world) that all of the intelligence agencies (we’re looking at you too, CIA) had better start helping the world instead of acting like a bunch of high school hackers exploiting whatever weakness they can before they are found out and get caught.

FURTHER READING

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Secure Your Communications *Before* Trump Takes Office

eff-ssdSeveral people I know have asked me for guidance on how to secure their communications prior to Trump taking office. The reason they are concerned is the same reason I am: The Trump administration could very well accelerate (or use extensively) the vacuum mass surveillance apparatus in place by the National Security Agency.

Electronic Frontier Foundation Guide
Here is the guide you should use for staying safe with email, chat, voice calls, if you’re at a protest, and so on.

eff-logoModern technology has given those in power new abilities to eavesdrop and collect data on innocent people. Surveillance Self-Defense is EFF’s guide to defending yourself and your friends from surveillance by using secure technology and developing careful practices.

The guide has an Overview if you’ve not yet secured your computer, tablet or smartphone, to Tutorials that include step-by-step guides on how to install software and tools, and finally with Briefings which are detailed guides for specific situations.

Bonus link from The Intercept: Surveillance Self-Defense Against the Trump Administration

Could Trump Accelerate the Use of NSA’s “Google for Private Communications?”

Illustration: Blue Delliquanti and David Axe for The Intercept

Illustration: Blue Delliquanti
and David Axe for The Intercept

Yes, possibly and perhaps even likely. I would say it is likely since the Trump administration people—especially those like the highly controversial pick of advisor to the president, Steve Bannon—won’t be able to help themselves with the power of the office and the tools at their disposal…so I am going to assume the answer is yes, they will.

One of those tools is XKEYSCORE, the name of the NSA’s Google-like search engine and one of the agency’s “…most powerful tools of mass surveillance (which) makes tracking someone’s Internet usage as easy as entering an email address, and provides no built-in technology to prevent abuse.

The NSA’s XKEYSCORE program, first revealed by The Guardian, sweeps up countless people’s Internet searches, emails, documents, usernames and passwords, and other private communications. XKEYSCORE is fed a constant flow of Internet traffic from fiber optic cables that make up the backbone of the world’s communication network, among other sources, for processing. As of 2008, the surveillance system boasted approximately 150 field sites in the United States, Mexico, Brazil, United Kingdom, Spain, Russia, Nigeria, Somalia, Pakistan, Japan, Australia, as well as many other countries, consisting of over 700 servers.

NOTE: All we actually know of XKEYSCORE is from 2013 and no one knows what advances have been made in the last three years. The deep concern is that the tool has become more powerful, and access could be as simple as logging in with a White House web browser. Imagine that someone’s full communications portfolio is instantly laid out for review by anyone wanting to know what you’re texting, browsing, who you’re calling and more, all at the click of a mouse.

Unless, of course, your communications are secure.

fairy2I hope I’m wrong and President-elect Trump becomes a centrist and moves away from his childish, vindictive behaviors. That hope extends to Trump stopping his being tone-deaf on what more than half this country needs from a president. But I don’t believe in fairy tales, magic, or that “God will make it OK” like many people I know believe.

Instead, my communications are already secure so I highly recommend you make your communications secure and do so right now…while you still can.

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Stunned, Scared & Disappointed Trump Won? Time For a Chuckle

1984-trump Apple’s 1984 ad introducing the Macintosh in January of 1984 with Donald Trump in
the role of overlord, about to be overturned by a disruptor with a sledgehammer

Yeah…he’s scary and I’m disappointed he won too. But it was a close election with Clinton winning the popular vote with 59,943,009 votes (47.7%) and Trump with 59,705,048 votes (47.5%). We all now know that Trump won the should-now-be-abolished electoral college with 279 votes vs. Clinton’s 228 and he’s our (shudder) president-elect.

Turns out that the 47.7% who did NOT support Trump are quite unhappy about getting a clown as president and there are protests in the streets, uncertainty everywhere, and the circus will soon arrive in our nation’s capital.

Fortunately the 47.5% who DID vote for Trump are incredibly excited because “it was God’s will” (which they influenced ’cause they prayed a lot), they now have a shot to delete the Affordable Care Act, overturn Roe v. Wade, revert to marriage as “one man, one woman“, get rid of Muslims, Mexicans, Somalis, and anyone who doesn’t look like them, invest in the military so we can crush all global militaries 10 times over instead of just 7 times over, and make sure that “political correctness” dies like Trump would speaking to a group of millennials.

But hey…we’ve got nearly two months left before we have to go nuts against a Trump administration and fight what will certainly be the attempted execution of an old man’s vision for the United States of America.

Until then it’s time for a chuckle. Here are a few videos that will hopefully help you overcome your stunned disbelief:

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Why the Young Feel Hopeless *and* Optimistic

hopelessIf I was 25 years old right now I’d probably be feeling pretty hopeless. Is it any wonder everyone, including young people, are furious and feeling hopeless? But this post will focus on our children and the world they have already inherited and how they still have optimism about the future.

Right after September 11, 2001 I remember peeking in to each of my kid’s bedrooms before going to bed myself. Our daughter was 13 years old and son was about to turn 7 years old. After that devastating day I stood there saddened when considering the world they were going to inherit and I felt a twinge of hopelessness.

That feeling turned in to irritation and then anger as the months unfolded. I saw the 9/11 tragedy turned in to a justification for war, one where the slimmest amount of intelligence possible was used as justification for invading Iraq and Afghanistan.

From 2002 through 2008 I grew increasingly concerned as the Bush administration seemed to be bending the rules of intelligence with CIA ‘enhanced interrogation‘ and rendition, along with initiatives like Total Information Awareness (TIA). TIA was killed off but as we now know thanks to Edward Snowden’s revelations, any paranoia and concern I had at the time paled in comparison to what was really going on as the goals and objectives of TIA lived on.

Next came the global economic meltdown, inadvertently created by the financial services industry whose greed overshadowed their fiduciary responsibilities and destroyed the economy. A greed, I might add, that was fueled by the laissez faire attitude toward oversight and regulation by the GOP and Bush administration. The same administration that squandered a surplus while cutting taxes and going to war. According to The Center on Budget and Policy Priorities:

“If not for the Bush tax cuts, the deficit-financed wars in Iraq and Afghanistan, and the effects of the worst recession since the Great Depression (including the cost of policymakers’ actions to combat it), we would not be facing these huge deficits in the near term. By themselves, in fact, the Bush tax cuts and the wars in Iraq and Afghanistan will account for almost half of the $20 trillion in debt that, under current policies, the nation will owe by 2019. The stimulus law and financial rescues will account for less than 10 percent of the debt at that time.”

Add to all of this the student debt crisis. The Economist reported in June 2014 that U.S. student loan debt exceeded $1.2 trillion, with over 7 million debtors in default. Today, there is approximately $1.3 trillion of outstanding student loan debt in the U.S. that affects 43 million borrowers who have an average outstanding loan balance of $30,000.

Lastly we have the Wells Fargo controversies which have shown that even one of the most profitable, respected banks in the world is no better than a plaid-sports-coat wearing salesman hawking non-running used cars on some inner city lot.

How can we not all be FURIOUS and filled with RAGE? If I was 25 years old I’d be marching in the street, campaigning for Bernie Sanders, and doing whatever I could to change the system and make a wholesale change in Congress.

But there are bright spots that are fueling optimism, no matter what the obstacles and barriers fueling hopelessness. [Read more…]

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Why You Should Use The Signal App

hackerUnless you’ve been traveling in space for the last few years, you obviously know all about the mass surveillance by the National Security Agency and Edward Snowden‘s revelations, as well as the continued acceleration in security hacks globally.

Besides using a virtual private network (VPN) when you are on public Wifi (here is why a VPN is extremely important), I’ve found the simplest method for my family, friends and even clients is to use a super-secure, open source app on our phones called Signal by Open Whispher Systems.

Even non-geeks know that email is laughingly insecure, which is why this app is so important and how I use it:

a) My bookkeeper sends me important, private information over the Signal app.

b) I have clients send me passwords and credentials for their services.

c) Several of my friends and family members I’m connected to use Signal to send me messages that need to be secure. We often share items like passwords, especially when I’m helping one of them with some website or online application requiring me to login.

c) But what really sold me on Signal was when my wife was on a recent business trip to Hong Kong. Her hotel’s Wifi was set up to disallow the use of VPNs so she was not able to set up a secure, encrypted channel. This is because of what is euphemistically called the great firewall of China which the country uses to restrict what their citizenry has access to outside of China.

So my wife and I connected on Signal and, because the system has both private messaging and voice calling, we knew we would be secure and assured that some Chinese government flunky wasn’t eavesdropping on our messages or listening-in on our calls.

As I’d mentioned, Signal boasts highly secure private messaging using end-to-end encryption. In fact, the Signal protocol (the underlying technology) is being used by WhatsApp (though there are other insecurity issues with the app so I do NOT recommend using it). As of this writing, all other messaging apps (yes, even Apple’s Messages) have good security layers, but some are still accessible by the NSA’s warrantless surveillance activities, law enforcement, or possibly a system administrator at the app company.

End-to-end encryption (especially the way Signal implements it) means NO ONE can eavesdrop on your messages. Same thing with phone calls made via Signal due to its quality. When my wife and I were talking over Signal between Minnesota and Hong Kong I was pleasantly surprised with the quality of those calls while using the app on our iPhones (Signal is available for both iPhones and Android phones). It was better than if we had been talking over mobile connections (she was on good Wifi in her hotel, but often other voice-over-internet-protocol (VoIP) phones like the insecure Skype don’t sound very good).

SIGNAL FOR THE DESKTOP
signal-iconOnce you start using Signal you will probably come to the realization (like most Signal users do, I suspect) that it would sure be great to be able to use Signal on the desktop. Well now you can!

Signal is now an app for Google Chrome, the browser I use every day (Note: it does require that you have already set up Signal on your smartphone). Besides the computer version of Chrome, I also have two colleagues that use Chromebooks and now can use Signal on them.

You can connect the Chrome app with your smartphone’s Signal app by opening the app and instantly scanning a QR code. Once done you are connected and can even have your smartphone’s Signal app contacts imported in to your desktop version.

This is so easy to use and so secure that there really is no reason why you shouldn’t be using Signal right now.

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Tinfoil Hat & Edward Snowden

tinfoil-hatsJust after the horrific tragedy of 9/11, I began to see quite disturbing things unfolding in the U.S. in the name of “security” that was (in my, and many other’s, minds) clearly trampling on the Constitution. Most of my friends teased me for several years about wearing a “tinfoil hat” to shield my brain, but then Edward Snowden came on the scene, ensuring that the unconstitutional domestic surveillance underway by the National Security Agency (NSA) was exposed.

Photo by Laura Poitras / Praxis Films

Edward Snowden
Photo by Laura Poitras, Praxis Films, under a CC BY 3.0 license.

While I was (and am) less disturbed by some of the global spying activities the NSA is performing—other than egregious hacking of world leaders’ mobile phones and such—there is no question that making U.S. citizens aware of the extent of the domestic spying was the first wake-up call for those ignoring the signs of the obvious, disturbing and unconstitutional activities going on.

After essentially reading every single news article and snippet about what Snowden (and others, I might add) have released to date, yes I believe Snowden did the world a great service and is a patriot. No, I don’t think he will get a pardon (yet) since it’s still too early on and Congress has not yet bothered to rein in the NSA in any meaningful way with regard to domestic spying.

The U.K. news organization The Guardian has an entire section called the NSA files which is likely the most comprehensive compendium of items sparked by Snowden’s whistleblowing document release. It’s a bit daunting to wade through, so I was intrigued this morning to see that Business Insider just compiled this bullet-point list of items Snowden had provided to select journalists that were released between 2013 and 2014. It’s pretty amazing to see them listed and realizing just how profound were these leaks and, in my view, extremely important. 

Here are just a handful of those links just to get you started:

  • The NSA accessed and collected data through backdoors into U.S. internet companies, such as Google and Facebook, with a program called Prism. — June 6, 2013
  • The NSA has a program codenamed EvilOlive that collects and stores large quantities of Americans’ internet metadata, which contains only certain information about online content. Email metadata, for example, reveals sender and recipient address and time but not content or subject. — June 27, 2013
  • Internal NSA document reveals an agency “loophole” that allows a secret backdoor for the agency to search its databases for U.S. citizens’ email and phone calls without a warrant. —Aug. 9, 2013
  • The NSA broke privacy rules thousands of times per year, according to an internal audit. —Aug. 15, 2013
  • Expanding upon data gleaned from the “black budget,” the NSA is found to be paying hundreds of millions of dollars each year to U.S. companies for access to their networks. — Aug. 29, 2013

Read more here at Business Insider

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Is Congress Really Gearing Up for an Encryption Battle?

bitsAfter the attacks in New York on September 11, 2001, Congress passed the poorly thought-out Patriot Act. Friday’s Paris attacks seem to be (once again) providing Congress with another excuse to try and legislate making United States encryption weak and putting another obstacle in the way of U.S. technology companies selling overseas.

That’s right….weak. Virtually every single cryptography expert on the planet knows that a force-mandated “backdoor” in software or devices will not work and will make the systems vulnerable to attack by black-hat hackers or state-run military cyberattacks.

Today’s Wall Street Journal had this front-page article, “Paris Attacks Fuel Debate Over Spying – Growing belief that terrorists behind assaults used encrypted communications prompts re-examination of U.S. policy on surveillance.” A few things from the article leapt out at me:

“A growing belief among intelligence officials that the terrorists behind Friday’s Paris attacks used encrypted communications is prompting a far-ranging re-examination of U.S. policy on data collection and surveillance.”  

No kidding. Anyone on this planet with intermediate technical skills can encrypt their communications.

Senator Richard Burr

Senator Richard Burr

Sen. Richard Burr (R., N.C.), chairman of the Senate Intelligence Committee, said Tuesday his panel will launch a review of encryption use. “It is likely that end-to-end encryption was used to communicate in Belgium and France and Syria,” Mr. Burr said. He said encryption was likely because no direct communication among the terrorists was detected.”

Really Senator? Maybe they met in person?

But this is the part of the article that made me choke on my breakfast muffin:  [Read more…]

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Google Cultural Institute

google-cultural-instituteIt was happenstance today that led me to the Google Cultural Institute, an online place to “Discover exhibits and collections from museums and archives all around the world. Explore cultural treasures in extraordinary detail, from hidden gems to masterpieces. Create your own galleries and share favorite finds with friends.

While I ate lunch I viewed ‘exhibits’ and took virtual tours of:

Though I’m quite astute with the web and user interface design, I struggled a bit with how the site’s collections were displayed. Most troubling was my inability to find that opening page again for the Anne Frank exhibit. I had to go back to my browser’s history to find the first page! It’s not as intuitive as it should be.

But that lacking ease-of-use is outweighed by the value inherent in these collections. All I could think of as I went through many of them was “Wow!”. Give it a try yourself.