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Posts from the ‘wellness’ Category

The Human PRIMARY Operating System is Not Rational

The Human Primary Operating System is Not Rational

We are not rational beings who emote; we are emotional beings with the capacity to think rationally. Big difference. Emotion trumps reason. Absent primordial prevention, sickness trumps wellness and survival trumps thrival.

It’s time for a new social health contract.

Let’s be very clear, society (government, healthcare providers, employers) must take the lead role when it comes to responsibility and accountability. This is a partnership, a social contract whereby—we, the people—voluntarily relinquish the freedom of action we have under the natural state (a state of existence that is not contingent upon man-made laws or beliefs) in order to obtain the benefits provided by the formation of social structures. Building on the philosophy of John Locke, who said, “…no one ought to harm another in his life, health, liberty, or possessions.” Thomas Jefferson et al, framed government responsibility under the umbrella of securing inalienable—natural—rights including “life, liberty and the pursuit of happiness.” By obeying man-made laws and complying with accepted standards and mores, we implicitly agree to our part of the social contract. In turn, we have the legal, moral and ethical ground to demand that the custodians and protectors of our natural rights—our elected officials, medical providers and employers—be held accountable.  This speaks directly to the issue of healthcare access and affordability.

In its simplest form, our implied social health contract requires that society provide:

  • Awareness of the consequence and benefits of lifestyle choices
  • Education needed to initiate and sustain healthy living
  • Access to affordable primary, secondary, and tertiary healthcare
  • Evidence-based medicine and prevention measures
  • Supportive infrastructure (parks, healthy worksites, recreation, green, etc.)

And, when provided with all of the above, individuals representing themselves and their minor dependents are responsible for:

  • Making healthy choices
  • Self-exams (paying attention to changes in personal health)
  • Keeping up with recommended age and gender clinical screenings
  • Seeking timely and appropriate medical attention
  • Complying with evidence-based recommendations and directives involving lifestyle habits, medications, lab work and rehabilitation protocols

Evaluate your contribution to this social health contract.  Are we, as a society,  providing awareness, education, full access to treatment, evidence-based medicine and prevention and a supportive culture for ALL of our citizens?  If not, why not?  And, as an individual, are you keeping up your end of the bargain?  If not, why not?

Caution: Grandma & Grandpa are Killing Our Children!

Caution: Grandma & Grandpa are Killing Our Children!

Fat Kids Grow Up to Be Fat Adults

 Updated from Earlier Posting…

Before you go off on the title of this reflection, take a deep breath and read on. If childhood obesity doesn’t scare the hell out of you, you’re choosing to sleep through a crisis. Shame on you…

I hear you say that protecting and advancing the good health of our children is a moral, ethical and economic imperative. I hear you say that you are concerned about the research that shows that fat kids become fat adults. By the way, I’m sorry if you’re offended by the word “fat” but that’s the right word to use, “fat.” It—FAT—causes much more of a visceral reaction than does “heavy,” “large,” “overweight” or “metabolically-challenged.” Fat is the word.  And, if unchecked, fat kids face a lifetime of health risks and social pain that come with diabetes, heart disease, poor self-esteem, ridicule and discrimination. Don’t agree? Just check with an adult who is currently fat or was a fat kid. Ask them if they bear any scars or carry painful memories from growing up fat. There’s no more time for political correctness. I’ve been in the health and wellness field for over thirty-five years and, when it comes to creating healthy cultures, I hear considerably more than I see. Just look around you, there’s way more saying than doing.

When it comes to health and health advocacy most of us are living a life of contradiction. What we do and what we allow—our actions and acceptance—are contrary to what we say. Just look at the data. No, on second thought, scratch that. We don’t need any more data, just look at our kids. Look at what we feed them. Look at what we allow in our school cafeterias and vending machines. Look at the empty playgrounds. Look at the commercial messages our children see and hear hour after hour, day after day and year after year. And, while we’re at it, look in the mirror. Like what you see? Look at what you eat. Look at what we allow in our workplace vending machines and cafeterias. Also, how’s that exercise program of yours working out?

Now, tell me, are we making progress with obesity? Are we taking any meaningful action to help our children avoid the physical, psychological and social pain that comes with being a fat kid who morphs into a fat adult? No? Why do you suppose that’s the case?

No judgment here, no finger wagging, just honest observation. I’m not here to moralize. Judgment and finger wagging just sends us off in the wrong direction. Time to face and accept facts. When it comes to health, we care more about talking than we do about doing. We would rather not offend someone than help someone. We’d rather blame someone else than accept responsibility. We’d rather deny than accept. It’s easier. No pain. Okay, I get it.

Of course, perhaps I have it wrong. Maybe you do care. Maybe you are ready to take action to remove unhealthy snacks from your homes and schools. Maybe you’ll encourage and support fitness education and activities. Maybe you are angry enough to demand that your elected officials watch over our kids by passing protective legislation. Maybe you truly get the fact that you have a responsibility to be a positive role model for children and that behavior is reflective.

Then again, perhaps you just like the sound of it.

And, finally, maybe, just maybe, Grandma and Grandpa, in all of their various guises, can find ways to say, “I love you” that don’t include pies, cakes, ice cream, sugar sodas, candy and cookies. Hey, I’m just saying.

– Grandpa Sam

The Health and Wellness Industry FAQ: Vendors – How Do You Sort Out the Good, Bad and Truly Ugly?

Wellness Exists at the intersection of Contentment and Aspiration.

To live  there, You Must First Choose to Move Out of the Village of Someday…


Over the years I’ve been asked a number of questions about the health and wellness industry. This is question #7 of the top 10 most frequently asked questions. The responses are, of course, neither right nor wrong. They are simply my impressions from over 35 years of field experience.


“We are bombarded with individuals and organizations selling wellness (health promotion, disease prevention and disease management) products and services.  How do you sort out the good, bad and truly ugly?”


Thirty years ago, there were only a handful of quality programs available through national vendors. Choice was not that difficult. Today, with the growth of the Internet and the flood of scientific data, there are hundreds of vendors anxious to sell you their services.

Caution: A “Desk Drawer” wellness initiative will burn out your staff and simply will not work (tweak…maybe…but not transform). Avoid a scattergun or one-off approach. Success requires a dedicated internal project manager working with an experienced and field-tested 360 degree vendor.

Questions to ask include:

  • How long have you been in business?
  • Who are the individuals behind the products?
  • Do you have an advisory board? If so, who are the members?
  • Can you prove net health care and/or productivity cost reductions while improving population health?
  • Any accreditations and/or awards?
  • Are you open to risk sharing or pay-for-performance contract provisions?
  • What are the delivery options?
  • What outcome analytics are in place to track program results?
  • Who are your client references?

A vendor should be much more than a provider of drop-off products and services. They need to be comprehensive, accessible, flexible and experienced. Sound simple? It’s not. Due to limited dollars, you need as much quality one-stop-shopping as possible. You do not have the time, dollars or energy to have multiple contacts for each of your offerings. Find an experienced multi-component provider and stick with them. They will not only help you with paperwork and sanity, they will also help with triage, crossover, data collection, analysis and strategic planning. Like a good pharmacist, they will also help you avoid unhealthy program interactions. An excellent provider will have a pattern, philosophy and support network that is consistent throughout their offerings; this will help you, immensely. A good vendor is, at a minimum, equal to one FTE.

The ideal vendor should be able to assist clients with each and every phase of a  “comprehensive” wellness initiative, including:

  • A health awareness component, including health education, preventive screenings and health risk assessments.
  • Marketing and promotion efforts to maximize employee participation and engagement.
  • Research supported programs and methodologies to change unhealthy behaviors and lifestyle choices, including counseling, seminars, online programs and self-help materials.
  • Supportive environment efforts, including assistance with workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity and improved mental health.

Introducing excellent programs without a comprehensive corporate audit (readiness) and indicated culture adjustments ⎯ policies, procedures, senior management visible buy-in and health-driven food services ⎯ is akin to throwing fertile seed on untilled and nutrient-poor soil. It won’t work; you will lose money and credibility.


The Health and Wellness Industry: FAQ Part I

Frequently Asked Questions: Part I

The Health and Wellness Industry

 Wellness Exists at the intersection of Contentment and Aspiration. To live  there, You Must First Choose to Move Out of the Village of Someday



Over the years I’ve been asked a number of questions about the health and wellness industry. This is Part I of a two-part commentary featuring the top 10 most frequently asked questions. The responses are, of course, neither right nor wrong. They are simply my impressions from over 35 years of field experience.

QUESTION #1: Reflecting on your experience as a former senior executive in the health insurance industry, did the industry’s less-than-favorable profile with members adversely impact your ability to deliver health and wellness products and messages?

RESPONSE: While it is true that people often view insurance (of any kind) as a necessary evil, it’s important to remember that living a healthy lifestyle benefits everyone. When the payer is the employer, assuming fully-insured, the return is in the form of productivity and a favorable bargaining position when it comes to renewal discussions. When the payer is an individual, the return is improved quality of life, reduced out-of-pocket expenses, and the potential for marginal annual premium increases.

Quite frankly, I had more of a challenge “selling” the health and wellness message internally than I did to the community at large. In general, the health insurance industry is decidedly conservative and tends to change slowly and with considerable resistance.  Historically (and simplistically), the focus of the health insurance industry is claims processing; a transactional activity centered on collecting premium dollars from payers and using the funds to pay healthcare providers. The insurers retain administrative and reserve dollars to cover operating expenses and to protect against unforeseen and catastrophic future claims.

Wellness (community health promotion and disease prevention) is a relatively new activity with weak controls and questioned/skeptical return on investment. Most, if not all, insurers agree that they should provide these services—if only because members request/demand that they do—but few have applied the rigorous business standards needed to justify and grow “Wellness” as a necessary cost of doing business and/or as an independent profit silo. By and large, the general public understands the value of living a healthy life; it’s the inside corporate folks that still need convincing.

QUESTION #2: Assuming support and commitment to wellness as a cost of doing business and/or a potential profit center, how does an insurance company influence members to make healthy lifestyle choices and to participate in program offerings?   

RESPONSE: In a variety of ways including:

  • Premium discounts for participation in wellness programs, i.e., health risk assessments, tobacco control, weight management.
  • Promoting healthy living in their member communications, advertisements, and promotions.
  • Offering physician incentives based on prevention interactions with patients.

Keep in mind that social marketing (selling an intangible) is, increasingly, just as much about science as it is about art. Study, understand and apply lessons learned from the emerging field of behavioral economics. We are under the false impression that we are rational beings who emote instead of the fact that we are emotional beings with the capacity to think rationally … and even more importantly, meta-rationally.

QUESTION #3: In your opinion, what makes a health and wellness initiative successful and how do you measure the success of health and wellness initiatives?

RESPONSE: The five key features of a successful (sustainable) corporate health initiative are as follows:

  1. High Participation ( > 80% )
  2. Measurable Results Demonstrating either Biometric Improvement or Symptom & Medical Event Stability (Zero Trends)
  3. Alignment with the Corporate Mission & Vision
  4. A Supportive Corporate Culture (infrastructure) including Physical Plant, Cafeteria Choices, Senior and Middle Management Participation and Encouragement
  5. True Transformation and Design Focus from A Corporate Health Initiative Driven by Wellness Programs, Supportive Policies and Management Endorsement to A Population of Healthy People driven by Subjective Wellbeing, Healthy Habits, and Sustained Engagement

Organizations must frame wellness in context and in consort with their corporate mission and margin. Does the “Wellness Strategy” contribute to key employee retention and acquisition? Does it show measurable impact on the claims experience (including that of dependents)? Does it serve to bend the healthcare cost trend? Do employees enjoy the programs and participate in significant numbers? Does it support the company’s mission, vision, and core principals? Keep in mind the fact that subjective, as well as objective, measurements determine success.

In the first year of a wellness strategy, success may be measured by participation alone. However, beginning as early as year two, a successful program needs to show value beyond participation. What percentage of smokers kicked the habit? Relative to claims data, do you see positive trending (or zero trending) in the areas of obesity, hypertension and high serum cholesterol? Is there a correlation between employee performance reviews and participation in the wellness program offerings?

It’s important to note that with a comprehensive initiative (designed with long-term mission and margin objectives in mind) you will actually see an increase in healthcare costs during the first couple of years. This is due to increased awareness, growing medical self-responsibility (age and gender appropriate screenings), early detection and early intervention. After three full years of operation, data shows that a comprehensive wellness initiative will provide a return in the area of 2:1 (two dollars saved for each dollar invested in the initiative). However, if the wellness strategy simply broke even, the company wins, everybody wins (accept the healthcare system that depends upon all of us presenting with illness early, often, and with increased complexity).

QUESTION #4: Is it possible to measure ROI?

RESPONSE: Yes, but it is also possible to measure DNA. DNA is a “Do Nothing at All” strategy. Since the year 2000, the cost of insuring a family of four has risen 114%. A “Do Nothing at All” strategy is simply not tenable. Primordial prevention and primary care cost pennies; secondary care and prevention costs dollars, and tertiary care ¾ associated with chronic illness ¾ cost bags of gold. This is another variation of the “Pay me now…or, pay me later” question.

To measure ROI, you need a 5Ws framework. You must ask and answer these questions:

  1. What’s Happening? – Current State Analysis
  2. So What? – Trends and Consequences
  3. What Do We Do Now? – Triage & Emergency Action Plan
  4. What Do We Do Next? – Strategic Intent and Tactical Plan ***
  5. What Difference Does it and Will it Make? – Continuous objective and subjective evaluation involving lifestyle-related claims monitoring, employee acceptance, participation rate, and measuring the correlation between participation and employee work performance evaluations.
*** Including:
  • attitude and interest surveys
  • personal health assessments
  • incentive and culture transformation strategy and plan
  • program component development/selection
  • launch rollout plan including promotion campaign

 Caution: Office politics are critical and numbers are slippery.


The CEO (or worse, the CFO) doesn’t buy into the basic intuitive logic or accept the published economic findings supporting the value of health promotion and disease prevention…


Middle management considers your initiative bothersome and counter-productive to their mission…

Your battle is doomed to fail. In fact, it maybe advisable to scrap or delay rollout until the “C” Suite and middle management are on-board.

QUESTION #5:  Nationally, are H&W programs starting to be considered core business (as opposed to “nice-to-have-but expendable” activities)?  If the answer’s yes, what’s driving this?  Health reform and its emphasis on prevention?  Group demand?  Other reasons?

RESPONSE: Yes. Reasons are many, including:

  • Employees expect worksite wellness programs as part of an insurance bundle (often at no additional fee).
  • Credible data supports health promotion, disease prevention initiatives.
  • Among the few areas of bipartisan agreement in the new Patient Protection and Affordable Care Act (PPACA; P.L. 111‐148) are measures aimed at constraining the growth trend in medical treatment spending and costs through health and wellness promotion and prevention initiatives.

Essential Benefits, Elimination of CoPayments for Screenings and Preventative Care – Starting back in September of 2010, employer‐sponsored (and other) group health plans and health insurance issuers were prohibited from requiring co‐pays for all preventative services recommended by an independent expert panel, the United States Preventative Services Task Force. Co‐pays were also eliminated for certain recommended immunizations, breast cancer screenings, and other preventative care/screenings for women and children. However, this requirement does not apply to “grandfathered” health plans, which are defined in PPACA as any plan in which at least one individual was enrolled in as March 23, 2010.

Additionally, Congress put in place beginning in 2014 “essential health benefits requirements” that most individual, employer and Health Insurance Exchange plans must cover. The Secretary of Health and Human Services (HHS) is tasked with defining the essential health benefits, however such benefits are required to include certain general categories, including: emergency services, hospitalization, maternity and newborn care, prescription drugs, laboratory services, mental health services, preventive and wellness services and chronic disease management.

Employee Wellness Discounts – Previously, a provision in the 1996 Health Insurance Portability and Accountability Act (“HIPAA”) permitted employers to reduce the cost of health insurance premiums for employees practicing healthy behaviors. The provision, which provided for a reduction of up to 20% of the employees’ regular premium cost, allowed employers to reward workers who met certain criteria “reasonably designed to promote health and prevent disease.” This typically includes employees who refrain from smoking, maintain a healthy weight, and keep blood pressure and cholesterol levels low.

Starting January 1, 2014, the PPACA enhances such wellness discounts by permitting group health plans to give reductions of up to 30% of the cost of premiums to employees who participate in such wellness programs. This may be expanded to 50% subject to the discretion of the Secretary of HHS.

Employee Wellness Grants to Small BusinessThe law established $200 million in wellness grant funding to be distributed to eligible small employers for fiscal years 2011 to 2015. Eligible employers are defined as those who employ less than 100 employees that work 25 hours or more per week, and also who did not have a wellness program in place as of March 23, 2010 (the date of enactment).


“When it comes to Wellness … Are You Committed or Just Involved: A Call for Leadership”

There isn’t a day that goes by without a dozen or so clicks to this posting. Something is resonating, so here it is again…just click, below.

Wellness: Are You Committed or Just Involved?

SATURDAY MORNING REFLECTIONS: What is it About New Year’s Resolutions?

New Year’s Resolutions

“New Year’s Day: Now is the accepted time to make your regular annual good resolutions. Next week you can begin paving hell with them as usual.”

– Mark Twain

YouTube Video Introduction

What is it about New Year’s Resolutions?

I guess, maybe, ironically, we create this entrapment to feel good about ourselves. You know,   “This time…and, I really mean it!” kind of self-righteous-good. The time when we look in the mirror, stand a little taller, stare the stare of determination and raise one arm followed by a series of quick little fist pumps.

“There, I did it, I made my resolutions! What a good boy am I!”

“…now, let’s get back to life and living.”

Why is it that I don’t have to make an annual commitment to take long walks in the woods, love my family, watch more movies at the Michigan Theater in Ann Arbor, enjoy a glass of red wine, buy the latest new toy at the Apple store, or eat more peanut butter?


Hey, maybe, just maybe, it’s because I anticipate and look forward to the payoff. In the moment—at least to the person doing it—all behavior is considered good, it scratches a self-interest itch. And, as long as the actions don’t hurt innocent bystanders, that’s okay.

  • I love the woods; the smells, solitude, insights, critters, and the random questions and answers that suddenly appear tucked inside the sounds of  crunching snow and snapping twigs.
  • I love my family beyond words. My feelings are spiritual, sacred, unbounded and absolute.
  • I look forward to the thought-provoking films shown on campus and the lively discussions/debates served afterward as a side-dish at the Red Hawk.
  • I enjoy sharing a bottle or two of rich, velvety, red wine with friends who are never guests.
  • I love the little-boy-at-Christmas feeling that comes when I take a new Apple product out of the package.
  • I like peanut butter; I just do, always have…always will.

I guess what I’m saying is that It isn’t the woods…it’s the treasures I find in the woods. It isn’t an obligatory sense of family strangled by “shoulds” … it’s a humbling, revered, fulfillment of “wants” and “needs.” It isn’t the Michigan Theater…it’s the intellectual challenge and passionate conversation it spawns. It isn’t the wine…it’s the uncorked flow of friendship. It’s not the computer, touchpad, speakers, wireless keyboard, tablet, or phone…it’s the promise of discovery, creativity, and adventure that shakes my bones and lifts my spirit. And, it isn’t the peanut butter…it’s the taste in the jar!

Shakes my bones and lifts my spirit…shakes my bones and lifts my spirit.


Maybe, just maybe, that’s it! Perhaps our annual Brick-Laying-Party-to-Hades renews because we focus on the path to personal rewards and not the personal rewards, themselves. By the way, I’m talking about your rewards, not your mom’s, partner’s, or Oprah’s. Seek passionate change that takes you to a state where your bones shake and your spirit soars!

Reframe and repackage your resolutions. Losing weight is not the goal…the goal is freedom from emotional and physical discomfort coupled with new options and opportunities. Exercise is not the goal…the goals are energy, self-confidence and, in some cases, social interaction and athletic accomplishment. Quitting smoking is not the goal…the goal is a long, healthy life of engagement with friends and family. Cutting back on the booze is not the goal…the goals are clear thinking, dignity, and self-respect. Getting out of debt is not the goal…the goals are sleeping well at night, economic freedom, pride, and self-reliance.

Take a close look at the resolutions you’ve made for 2012. Ask yourself, “Who am I making this resolution for?” “Beyond, the science of life, how does the resolution advance my art of living?”

The mechanics of behavior change are relatively easy and well defined. I can show you the color templates. However, personal passion and personal motivation—not as easy to define and kick-in-gear—are the keys to sustained, meaningful change. Focus on “Why?” and “So What?” These questions tap into your passion. If the resolution doesn’t pass the bones-shaking and spirit-lifting test, odds are you’re focusing on the process, not the true goal, and, maybe—just maybe—you are channeling someone else’s desire for you to change.

Watch for more about discovering your passion and cultivating your motivation in a future edition of “Saturday Morning Reflections.”


“Your success and happiness lies in you. Resolve to keep happy, and your joy and you shall form an invincible host against difficulties.”

– Helen Keller



The full five-part article on THE CHRONOLOGICALLY SUPERIOR is now available in PDF at no charge. If interested, just click…

Samuelson Article – The Chronologically Superior



Position Statement:

Wisdom is the sum of the reflective and reflexive understandings that settle deep in one’s soul after a long journey — a life adventure  peppered with laughter, tears, fear, foolishness, joy, doubt, amazement and wonder. Pay attention to those who have traveled before you. Ask questions and listen with your whole being. Like echoes in a canyon, the lessons will continue whispering their meaning.


What follows is the Summary of this essay on health and wellness for seniors.

The Chronologically Superior: Part V – VIDEO Summary (So What?)

We’ve all done it. Certainly, I have. You know what I mean: spoken a little louder, perhaps a little slower, maybe, with the same affect used when talking to small children. We somehow-for some reason—assume that as the hair lightens/thins/disappears, and the shoulders stoop, cognitive thinking is slowly washed out by the inevitable bright light that holds vigil at the end of the tunnel. Oh, it’s done with the best of intentions. We want to show respect, show deference, reduce the load and clear a path to green pastures. “Take it easy,” “Can I get you anything?” “Oh, Sweetie, I’ll get that,” “Have a seat, Honey…you’ve earned.”


Nice. Polite. Moms all over are proud. Right? I mean that’s how we were taught to treat our elders. Remove responsibilities, assume control, open the door and help them in and out of the backseat. Nice. Polite. Moms all over are proud. Right?

Not so fast. I like the intent, truly I do, but we need to rethink our assumptions regarding “old age.”

Old Age Isn’t What it Used to Be

In 1935, when President F.D. Roosevelt sent his “Economic Security Bill” to Capital Hill, a white male child born in that year could expect to celebrate his 63rd birthday, and a male person of color had a life-expectancy of around 52 years. A white woman was expected to live until 67, and a non-white female, about 55 years. Renamed, “The Social Security Act,” the title was amended so as to read:

“An act to provide for the general welfare by establishing  a system of Federal old-age benefits, and…”

Given that—in 1935—life expectancy was somewhere between 52 and 67, “old” seems like an appropriate descriptor for someone in this age range. However, a child born today, in general, can expect to live somewhere between 71 – 81 years. On the high side, this is a 14 year, or a >20%, gain in longevity.


One of the dangers of advancing outdated notions of what it means to be 65 and older is that these lowered expectations are quickly assimilated. Older people are the same as everyone else; if you set the bar lower than their ability, they will pick up on your cues and tend to underachieve. Conversely, set a stretch-goal and people—of all ages—tend to reach or exceed the mark. Psychologists refer to this as, “Priming Behavior.” We prime behavior in a variety of ways including signals we send with our physical posture, gestures, vocabulary, facial expressions, and the tenor, tone and volume of our speech. When it comes to the senior population, if we are not careful, we will transform our otherwise sharp, productive, energetic, and engaged senior population into shuffle-board-playing, slow-moving, disengaged, crabby, self-absorbed, sickly, afternoon-matinee-attending, 5’o’clock Denny’s Dinner Special-eating “old” folks. AND they will stay that way for a long, long, time!

The More Senior You Become…The More Senior We Become

There are a number of factors contributing to expanded life expectancy. Reduced infant mortality, improved disease prevention, and better medical treatment for all age groups are key, well-known, factors. The one factor we’ve neglected to consider and plan for is, aging. The older we get, the older we get.

When my great grandfather Jeremiah Madden was born in 1846, his life expectancy was just over 38 years. When he reached 10 years of age, his life expectancy jumped all the way to 58 (the impact of infant and childhood mortality). When he made it to 20, his predicted age at death was pushed out another two years to 60. At 30, he was looking at 64 and, when he reached 40 years of age, statistics projected my great grandfather out for another four years to 68. When he reached his Jubilee year, he was given three more years to the age of 71. At 60, he could look forward to seeing his 75th birthday and, when he reached 70, the stone mason made the statistical folks look real smart when, chisel in hand, he finished the bookend dates on either side of my great grandfather’s tombstone dash with the year “1926.” Jeremiah Madden died at the age of 80. The older he got…the older he got.

To put it another way, when my great grandfather turned 65 in 1910, his 65+ cohort represented 4.3% of the total population. When my grandfather turned 65 in 1947, he and his buddies were 8.1% of the total. When my dad turned 65 in 1974, his group made up 10% of the population. Should I make it to 65 in 2013, my baby boomer friends and I will consume more than 13% of the population pie. Our children begin turning 65 in 2041 and they and their group will represent 21% of the total population, and our grandchildren in the year 2075, will represent 23%. As you can see by the graph below, starting with my grandchildren’s generation—the Echo Boom progeny—it’s projected to start leveling out.

However, in the meantime…

Are you (we) ready for an older population? Who will benefit? Who will suffer? How so?

The 5 Ws

Years ago I realized that the only way I could attack an issue—an opportunity— was to break it down using what I call, “The 5 Ws Model.” ™

  1. What’s Happening? – Current Status
  2. So What? – Trends & Consequences
  3. What Now? – Triage & Emergency Action Plan
  4. What Next? – Strategic Plan & Intent
  5. What Difference Does it And Will it Make? – Personal/Organizational ROI

Let’s apply this model to the question at hand:


Our Aging Population

(a.k.a., “What Are We Going to Do About Grandma and Grandpa?”)

What’s Happening  (Current Status)

  • In 2010 the top three federal spending categories were:
  1. Social Security
  2. Defense
  3. Medicare
  • Since the turn of the 20th century, the percentage of the US resident population, 65 years of age and older, has grown three-fold, from 4% to 13%.
  • The current unfunded debt obligation for Medicare is $24.8 trillion. Let me write that out for you:


So What?  (Trends & Consequences)

  • In 1962, 13% of the federal budget was spent on Social Security and Medicare. According to the OMB, by 2020 these two programs will account for 36% of the total spend.
  • From 2000 – 2010, Medicare spending jumped 81% (OMB data).
  • The high cost of Medicare pulls dollars away from other needed programs. As seniors age, we must find a way—healthwise— to keep them younger as they grow older.
  • Overall, the top-heavy spend on unnecessary medical treatment, error, and redundancy has drained away much-needed primary prevention dollars. Dollars that could advance and ensure affordable, full access to the social determinants of health. These include health literacy, general education, basic nutrition, neonatal care, early childhood development, healthy infrastructure, screenings and early intervention.
  • According to the 2010 Trustees Report, the year that Social Security will begin to spend more in benefits than it receives in payroll taxes is 2015—one year sooner than predicted in last year’s report. In the year 2037 “trust funds” will be exhausted.

What Now? (Triage and Emergency Action Plan)

  • Pull your head out of the sand. Begin facing the hopes and fears, obstacles and opportunities that come with aging. It is the quintessential approach/avoidance dilemma.
  • As a relief-reaction to the horrible and historical mismanagement of your tax dollars, go to a window, open it, stick your head out and echo the cry of Howard Beal: “I’m mad as hell and I’m not going to take it anymore!”
  • Look in the mirror and ask yourself,  “Down the road, who’s going to have to pay for my lifestyle-related health issues? My children? My grandchildren?”  Take steps, today, to reduce future economic and emotional debt for your (and our) loved ones.
  • Intellectually, emotionally, spiritually and economically embrace the concept and value of compressed morbidity.

What Next? (Strategic Plan and Intent)

  • Write your representatives in DC and demand administrative reform at CMS and SSA. It doesn’t matter if you don’t have a plan…it does matter that, they (House and Senate), know that you hold them accountable and that you VOTE. Do the same when it comes to state and local issues that impact senior populations.
  • As Steve Jobs would say, “Think Different” when it comes to seniors. Treat them with respect, not deference. Our seniors want/need to feel relevant and engaged. Encourage activities, include them in your discussions, ask for their advice and pay attention to the life lessons they have to share. Sense of purpose is a beautiful thing.
  • If you are an employer, consider phased retirement for key people. Thirty years that ends with a cardboard box and a pat on the back hurts everyone. Consider such things as mentoring positions, advisory boards, focus groups, open ended consulting relationships, and confidential no-oblique-speak lunch and learns with senior workers and senior staff.  Mine the treasure wrapped in gray. You don’t even have to dig…it’s sitting right in front of you begging to be noticed!
  • If you are a vendor of products and services, don’t miss the senior market opportunity. They are a large group with significant discretionary dollars to spend and they expect to be around for decades to come.
  • When you turn 60 and—assuming you’re in good health—the odds are very strong that you will be around for your 75th birthday. If good health finds you turning 75, 85 looks good to go. And, if you’re doing okay at 85, welcome to your 90s! Can Willard Scott be far behind?! Is this good news or bad? Will the years ahead bring gold or rust?
  • When it comes to aging, PLAN FOR THRIVAL NOT SURVIVAL!
  • Plan on spending less time at Denny’s.

What Difference Does It and Will It Make? (Personal/Organizational ROI)

  • It’s not enough to simply—or, not so simply—increase awareness, education and action. Without measuring effectiveness and personal meaning (passion), we are doomed to repeat history. We need to monitor both the objective as well as subjective impact of our interest and energy.
  • Stay informed by reading and studying both sides of an issue and listening to the interpretations and evaluations of both vested and disinterested parties.  Depending upon who is in the White House and who is controlling Congress, Republicans and Democrats will tell you that things are getting better or that Chicken Little was right. Libertarians will simply tell you and everyone else to just leave this, and virtually every other issue, alone. Get involved and stay involved.

In Conclusion

I’m just starting this CS journey, but as it progresses—and God willing it will be a long and healthy journey—you can call me “Honey,” “Dear,” and “Sweetie.” You can open every door, offer to carry every heavy package and even speak a little louder and slower if it makes you feel better to do so. These are nice things to do, well-intended, and I’m sure your mother would be proud. I appreciate it, I really do. But, please—and, I speak for all those with light/thinning/transparent hair and stooping shoulders—please respect my dignity and intelligence, support my independence, ask for my advice, benefit from my experience… including my mistakes, let me drive my car for as long as it’s safe to do so, share your time (the most precious gift you can give me) and don’t, I beg of you, feel a need tell me about the early-bird dinner specials at Denny’s. 😉

THE CHRONOLOGICALLY SUPERIOR: Part IV – Caution: Your Workforce and Consumer Base are Ageing

Position Statement:

Wisdom is the sum of the reflective and reflexive understandings that settle deep in one’s soul after a long journey — a life adventure  peppered with laughter, tears, fear, foolishness, joy, doubt, amazement and wonder. Pay attention to those who have traveled before you. Ask questions and listen with your whole being. Like echoes in a canyon, the lessons will continue whispering their meaning.


What follows is Part IV of a five-part essay on health and wellness for seniors.

As I begin writing this section, the US population is 312,805,052. Of these residents, 13% are 65 or older. By 2020, that percentage will jump to 16.1%, a gain of 1.2%, while those under 20 will drop by .05% and those in the 20 – 64 cohort will drop by 1.2%. And, according to the US Census Bureau, by the year 2030 (closer than you think), seniors will comprise close to 20% of the total US population.

In just 18 years, one in every five US residents will be over the age of 65.


“…As  The baby boomers moved into the older age groups, beginning in 2011, the  proportion aged 65–74 is projected to increase. The majority of the country’s older population is projected to be relatively young, aged 65–74, until around 2034, when all of the baby boomers will be over 70. As the baby boomers move into the oldest–old age category, the age composition of the older population shifts upward. In 2010, slightly more than 14% of the older population will be 85 and older. By 2050, that proportion is expected to increase to more than 21%. The aging of the older population is noteworthy, as those in the oldest ages often require additional care and support.”  (US Census Bureau)


Are you ready? Ready as an employer? Ready as vendor? Ready as a taxpayer?


If you are an employer keep in mind the fact that as the baby boomers grow older, so does the US workforce. Three decades ago the median age of the labor force was 35 years in 2008 the median age was estimated to be 41 years. By 2030, 23% of the US labor force is projected to be ages 55 and older, compared with13% ages 55 and older in 2000. Much of this is due to the elimination of mandatory retirement age, improved medical care (living longer), elimination or reduction in pension payouts, extended age eligibility for social security benefits, and—in the case of higher income workers—erosion of 401k plans. Take a look at your workforce and ask yourself:

Am I ready for an increasing older workforce?


Great news for you. Everyone—other than those writing the checks—will benefit from an ageing population. Retirement villages, long-term care facilities, healthcare providers, wellness professionals, and the recreation industry all stand to gain from an ageing population. Vendors, take a look at your product line and ask yourself:

Am I ready for an increasing older consumer base?


Of course, that means most of us. I needn’t waste digits by re-hashing the red ink associated with funding Social Security (employee-contribution savings) and Medicare (legislated entitlement). Pick up a newspaper or turn on the television. Legions are forming at the checkout line. Each day, over 10,000 baby boomers become eligible for Medicare and Social Security. And consider this: In 1950, as Social Security ramped up, there were 16 workers per recipient. Today there are 2.9 workers per recipient, and by 2041, the Social Security Association says there will be just 2.1 workers per recipient. Taxpayer, take a look at our obligations and promises to these older Americans and ask yourself:

Are we ready … ?

I can answer the third readiness question. The answer is “No” with further comments to come in a later white paper. As for you employers and vendors, here’s my advice:

Be Aware of & Beware of …


Coming Up…

Part V:                     Summary – So What?


Position Statement:

Wisdom is the sum of the reflective and reflexive understandings that settle deep in one’s soul after a long journey — a life adventure  peppered with laughter, tears, fear, foolishness, joy, doubt, amazement and wonder. Pay attention to those who have traveled before you. Ask questions and listen with your whole being. Like echoes in a canyon, the lessons will continue whispering their meaning.


What follows is Part III of a five-part essay on health and wellness for seniors. 

The beauty of this club, The Chronologically Superior Club, is that membership is open to all and it’s never too late to qualify.

Are you, or is someone close to you, CS qualified? Review the following criteria:

  1. Always takes time to look for the good in others
  2. Does not judge
  3. Perpetually intellectually curious
  4. Has learned to let go of both guilt and blame
  5. Accepts that the “Golden Years” are sprinkled with some lead shavings
  6. Actively advances personal health
  7. Has a positive life-perspective that grows stronger even as the body grows weaker
  8. Comfortably says, “I don’t know”
  9. Would rather laugh & giggle with children than whine & complain with adults
  10. Gives with grace and accepts with humility
  11. Knows that “Respect Your Elders” does not give anyone a license to be rude
  12. Nurtures joyful memories and looks forward to new adventures
  13. Committed to lifelong learning
  14. Knows that pleasure is more than the absence of pain
  15. Sees more with fading sight…hears more with fading hearing
  16. Embraces healthy ageing but fights growing old




My Mother, Mary: A Personal CS story…

After giving a speech to local civic leaders at Brooklyn College in September, 1997, I was approached by a woman from the audience, a distinguished looking woman from the Caribbean. She sensed, she said, that I was a very spiritual person. She wondered: what was the physical source of my spiritual nature? With an intuitive tilt of her head and the questioning furrow in her brow, she leaned forward and asked, “Was it you mother?”

The quick answer was, and is, “Yes.”

In the face of many challenges, my mother always saw beyond hardship and focused on the promise and beauty of life.  Uprooted at age 50 from a town where she had lived all her life, she endured my father’s alcoholism, his decade of disability, his cancer, his death; the sad life and early death of her daughter; her own lingering battle with emphysema.

Some people would see her life as difficult, filled with disappointment and worry. Others would feel sorry for her and wonder how she got through the days. Some would pray for her as they counted their own blessings. They would view the cards she was dealt, shake their heads, and thank God they did not have to suffer those years.

Fortunately, the life they saw was not the life she lived.

Yes, of course she felt pain and heartache; but for every dark moment, she lived a thousand love-filled hours. For every misfortune, she saw a hundred reasons to rejoice in the treasures of life. For every physical pain, she found countless moments of bliss. For every fear she experienced today, she knew the promise of tomorrow.

Toward the end of her life, she needed the full-time attention of a nursing home. I remember visiting her one cold, rainy day in March 1995, a few months after she had settled in. I came into her room and saw her: lying on her side, shriveled from osteoporosis; still, a lovely, eighty-three-year-old lady. Recently awakened from her nap, but not having yet retrieved her teeth from the bedstand, she smiled at me and said, “My cup runneth over. I am the luckiest person alive. I have good people to take care of me, a nice place to live, and friends and family who love me.” And she meant every word. Broken and bleeding paper-thin skin, multiple fractures from too many years of medication, emphysema, living in a nursing home—and she believed she was the luckiest person on earth! This was the way she lived.

My brothers and I called her every day, usually in the evening, to see how she was feeling. One day I called about midmorning. She wanted to know why I was calling. I reminded her that I spoke with her just about every day. She said, yes, but why now? I explained that I would be away during the early evening hours and wanted to make sure I spoke with her today. She seemed couriously concerned that I had called when I did. She said she was tired and wanted to rest; would I please call her tomorrow? As always, we said, “I love you,” then goodbye.

That was our last goodbye.

That evening, my mother’s cousin called me to say that my mother had died peacefully around 7 PM—about the time I usually called. My heart was broken. I told my wife and our three children, and we held each other and cried. Later that night, I took off all of my clothes, sat in a hot tub of water, and howled at the moon till I could only whimper like a lost pup.

Three young women, attendants from the nursing home, came to the funeral—something they usually did not do. They wanted to tell me what happened after I last spoke with my mother. They said she took a nap, and when she awoke and saw all three of them in the room, she told them she was going to die later that day. They had never heard her speak like this; my mother was a very “up” kind of person. They all said, “Mary, you’re fine, you’re not going to die.” She said she was but it was okay. Earlier that day, she told him, she had seen my father, 19 years deceased; my sister, 21 years past; and her mother, 28 years gone. They came to her, held out their hands, and said it was time to go.

The young women said my mother was at peace as she told them this.

We should all live such a life, and die such a death.

Who are the CS folks in your life? What lessons are they teaching you? What lessons will you pass on to the the next generation?

Coming Up…

Part IV:                    Caution – Your Workforce and Consumer Base Are Ageing

Part V:                     Summary – So What?