Chronicle of a hospital visit in Buenos Aires

Category : Personal Thoughts
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It was a little after midnight and we’d just finished a great dinner of Argentinian steak in Buenos Aires.  We were walking to a bar to have some after dinner drinks when all the sudden, my friend missteps on the broken sidewalk.  He goes tumbling to the ground.  We’re all laughing, including my friend who’s just fallen over.  He tries to get up, but quickly realizes there’s something wrong.  His arm is hanging there and he can’t move it.  Luckily, someone in our group had some medical experience and evaluated the situation and told us that we should go to the hospital.

We hail a cab and the cheerful driver told us he’d take us to the closest hospital.  He regails us with tales about how dislocated shoulders are somewhat common in Argentina because polo is a popular sport.  He doesn’t seem to concerned about my friend’s pain as we zoom around Buenos Aires’ curvy and somewhat bumpy streets.

We arrive to a run down, but very functional public hospital to find about 20 people sleeping outside the front door.  Unlike US hospitals, there is no long queue.  As we enter, I immediately speak to the person at the door who takes my friend’s information and tells us to wait in the first patient room.  The room is spacious, dimly lit, and filled with old style medical equiptment.  There were used medical supplies that hadn’t been thrown out, open razor blades on the counter and there didn’t seem to be much organization.

Hospital staff workers kept entering and exiting and we quickly realized that our room doubles as a supply closet.  A cheerful physicians assistant arrives and asks us what happened.  He does a few tests, then prescribes an xray.   My friends and I carry/drag our friend to the xray room, which uses machines that look like they were from the 80s.  My friend is unable to pose correctly because he is in too much pain and the ornery orderly gives up petulantely after two tries.  I try to convince her to try once more, but she refuses.

We’re sent back to our room and the cheerful assistant comes back and is not pleased that the xrays hadn’t worked.  He tells us he’s going to try to pop the shoulder back in.  He tells us to leave the room, then tries for 15 painful minutes.  The waiting room is dingy, has hardly any chairs and is filled with the typical people you’d see in any emergency room around the world.  There are the drunk/drugged out kids, elderly chronic care patients, car accident victims and their friends and family.  Everyone gets a number fairly quickly, but then has to wait for their care.

After awhile, the PA invites me back into the room, and asks me to help.  He rolls up a bedsheet, puts it under my friend’s arm, then tells me to pull as hard as I can while he pulls on my friends arm in the other direction.  We’re pulling REALLY hard, to the point where if I let go, the physicians assistant would go flying into the medical supplies closet.  I never thought I’d get to be a part of the medical treatment, but here I am, in Buenos Aires, attempting to help reinsert a shoulder into a socket.

After 20 minutes, we’re both exhausted.  The PA says he is going to find help and returns with reinforcements: two burly orderlies.   I’m sent out of the room and the three of them manhandle his arm.  Nothing’s working and my friend’s in pain.  The hospital staff is getting more frustrated by the minute.  Without saying anything, the orderly gives my friend a shot in his back to knock him out.

After he was out, the three orderlies spend the next hour twisting, pushing, pulling, cursing and smashing.  A friend and I are sitting outside of the room the entire time and keep hearing loud screams from the room, sometimes from our friend, other times from the frustrated orderlies.  It goes on forever.  Finally, the shoulder is back in its socket

Finally, his arm is back, but he’s completly knocked out.  The orderlies tell us to hang out in the room and 10 minutes later, our friend will wake up and will need an xray.  An hour later, he is still completely out.   Nobody comes to check on us, nobody gives us any info when we ask.  After an hour and a half, we decide to take matters into our own hands and attempt wake him up.  He is in a deep sleep.

We put both of our cell phone alarms next to his ear and splash water on his face.  Nothing.  We try again.  This time some rumblings, but mostly incoherant ramblings from the sedative and pain killer.  We decide to wait another 20 minutes.  We use our same tactics again and this time are able to rouse our friend.  We carry him to the xray room where the sullen tech takes xrays while I hold my unsteady friend up to make sure he doesn’t pass out and dislocated something new.  We search for an hour, but can’t find anyone to look at the xrays. It’s shift change and everyone is busy.

Finally, the xray tech says everything looks ok, but she doesn’t really know and that if our friend feels ok, we can leave.  There’s no organized discharge process.  We just walk out the front door with our still heavily sedated friend, xrays in hand, then find a taxi and head home.  We take the intake form with us for our records.  The hospital does not issue discharge papers or have any sort of record that we’d been there, other than my friends name at the front door.

We’d spent close to six hours in the hospital and our friend’s arm was popped back in.  We didn’t have to pay a dime.  The process was unorgainzed, the facilities dirty and a bit rundown, but in the end, they got the job done.  It was quite the contrast to the expensive, process and paperwork laden US based health care system that is terrified of being sued.  They got the job done in the end, but in a different way than I would have expected.

In the end, I wouldn’t go to that hospital for anything life threatening if I could avoid it, but I think its amazing that they can do basic medical care for free and at a decent level.  Figuring out how to merge the positives from my Buenos Aires experience with the positives from the US system could create a very compelling health care system.

Investment vs. Speculation: Capital Gains Tax Rates

Category : Political Science & Economics
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The US has a spending problem.  The US also has a revenue problem.  Anyone who believes it’s one or the other and not both is not being intellectually honest.  Our government spends too much on many of the wrong things and has unfunded liabilities in the trillions of dollars for health care and social security.  At the same time, the wealthiest people in the country enjoy the lowest tax rates in decades and over 50% of the population pays no income tax at all.

On the tax side, I see four main problems.  First, the wealthiest are not paying enough.  Second, too few people are paying income taxes and the taxes they do pay, like payroll and sales tax are regressive.  Third, the tax code is far too complex and doles out favors to political contributors.  Fourth, the tax code does not distinguish between investment and speculation.

I’ve blogged about all four problems before, but I want to focus on the fourth problem: capital gains taxes are completely out of whack.  The left focuses on raising income taxes and letting the Bush tax cuts expire so that “the wealthy pays their fair share.”  But they are ignoring that the majority of wealthy people earn their income from capital gains: investing in companies, stocks, property, fine art or anything else they can buy and later resell at a higher price.

Capital gains are broken into two levels, short term capital gains and long term capital gains.  Short term capital gains are things that you buy and hold for less than a year before reselling them.  Short term gains are taxed as normal income, 35% for top earners.  Long term capital gains are things that you buy and then sell after more than a year and are taxed at a 15% rate, a 43% reduction from the normal income rate.

This discrepency is why people like Warren Buffett pay a lower overall rate than his secertary.  I believe that investment is the engine that drives growth and ultimately creates jobs and innovation in our economy, but I believe that one year is way too short of a window.  I would change the capital gains system so that it encourages real, long term investment, not speculation.  Here’s what I would change:

Years                    Rate

0-1                   Normal Income (35%)
1-2                       30%
2-3                       20%
3-4                       15%
4-5                       10%
5-6                       5%
7+                        0%

I want to incentivize people to invest for the long term, not speculate in the short term.  I want to make it more risky to play in the casino that has become our economy and make it more attractive to look for real value, for real innovation and for real job creation.  This system would raise revenue by raising rates on the highest earners, those who are speculating right now.  It will impact the real rich and will actually change the system instead of just raising income taxes, which won’t affect the truly rich.  For example, 1400 millionaires didn’t pay a penny of income tax in 2009 because they didn’t take a salary.  It was all capital gains.

Congress should differentiate between speculation and real investment and push people to invest long term, not short term.  It’s a fix that I believe makes sense and could gain bipartisan support in Congress, but so far, both parties are looking at the red herring that is the income tax rates.  True long term investments are in startup companies, publicly traded companies you truly believe in, alternative energy that pays off in 5-6 years, new buildings, etc. Fix capital gains, then move onto the other three problems.

PS – An added loophole that defies logic?  Hedge fund managers have been allowed to take billions in profits and income as capital gains instead of normal income, saving them billions in taxes.

Combining South and North American World Cup Qualifying Groups

Category : Sports
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I’m have to preface this post by saying that I know this will never ever happen.  But I can dream.

I’ve been sitting here in South America watching the start of another long world cup qualifying campaign and I’m completely jealous.  The games have passion, everyone’s watching and the teams are fielding their best players.  I compare it to the US/Mexico qualifying groups and just shake my head.  Like I said, this will never happen, but roll with me for a minute:

I would absolutely love to see North and South America merge their World Cup qualifying groups to create one large super group. Concacaf, which is made up of USA, Mexico, Canada, Central America and the Caribbean, currently gets 3.5 spots in the World Cup: 3 automatic bids, plus the 4th place team plays Oceania’s champion in a playoff.  The US and Mexico always make it and the qualifiers are completely boring.  Unless something crazy happens, Mexico and the US qualify fairly early on and don’t really have that hard of a road into the World Cup.

Our group doesn’t provide a good test to prepare us for the World Cup and doesn’t make our team better.  Don’t get me wrong, I love the fact that the US is pretty much a lock for the World Cup every four years, but I’d rather exchange our quasi-automatic birth for great qualifying trips to Brazil, Argentina, Chile and the rest of South America.  I think the US would still be very likely to make the World Cup each time, but we’d be way better prepared when facing tough competition in international tournaments.  I think the US has about a 95% chance of making the World Cup in its current group and we’d have about an 85% chance if we combined into one group.

Currently Concacaf gets 3.5 spots and Conmebol, South America’s federation, gets 4.5.  I propose that North and South America combine to get 8 guaranteed spots, but teams 8 and 9 would have a one game playoff to see who makes the World Cup.  There are 10 teams in South America and 35 in Concacaf.  I would take the top 14 teams in Concacaf and create a 24 team group, with four groups of six.  Eight of the 24 would make the World Cup.

South American teams would benefit because they would likely soak up 1-2 extra World Cup spots at the expense of teams like Costa Rica, Trinidad and Tobago and Guatemala.  They would also expand their markets into Mexico and the US, likely earning more money and more exposure in foreign markets.

I think Brazil, Argentina, Mexico, Chile, Uruguay and the US would likely make the World Cup pretty much every time.  The other two spots would come down to a fight between Paraguay, Ecuador, Columbia, Peru, Costa Rica, Guatemala and Honduras.  South America would get an extra 1-2 spots in the World Cup and Mexico and the US would have a harder road.

Like I said, I know this will never happen, but it is fun to dream.  At the very least, a combined tournament between Concacaf and Conmebol to compete with the European Championships in off years from Copa America and the Gold Cup would be a welcome addition the world of soccer.

Overcoming Self Deception: Taking a Step Back

Category : Personal Thoughts
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We are all human, we all make mistakes and have strengths and weaknesses. Everyone has areas where they need to improve.  But they are hard to identify and its even harder to make the changes necessary to improve.  It’s hard because of self deception.  It’s part of our automatic human defense mechanism.  It’s there precisely to prevent us from getting hurt. But in order to grow and have success, humans must be able to identify the points in their lives when they’re lying to themselves.  If not, you’ll keep bouncing around in life until shit finally hits the fan and you’re forced to face facts.

Self deception is the fountain of failure, unhappiness and missed opportunities.  Identifying when you’ve been deceiving yourself and then why you’ve been doing it are the keys to improving the situation.  It’s true in all facets of life, from work to friendship to family to learning a new skill.

Let’s start with business.  One of the biggest reasons that startups do not succeed is that founders deceive themselves.  They buy into the hype, they ignore the big problems, the hardest work and don’t learn the right lessons when things go poorly.

For example, when I was running ExchangeHut, we had a very profitable tickets trading marketplace.  We wanted to expand to other universities.  We hired “campus reps,” students at other universities, to help us expand.  We gave them big incentives to push them to establish ExchangeHut on their campus.  After a semester, our most successful new campus had 100 users.  It was a complete failure.

We lied to ourselves and internally blamed our reps for being unmotiveded, not smart or entrepreneurial enough.  In reality, the reason they didn’t succeed is that we didn’t provide them with enough guidance, support and planning.  We continued with new reps the next semester and had the same results.  We wasted time and money because we let ourselves believe that it was someone else’s fault, not our own.

In the early days of Entrustet, back in March 2010, we knew we had a good product, but didn’t understand why people weren’t signing up as quickly as we thought they should.  We thought we were doing the right things: talking to the press, writing blogs and continuing to develop new features.  We kept telling ourselves that if we kept at it, we’d find success.  It took us another 6 months to realize that we were lying to ourselves.  We were not doing the hard work, we were doing the easy, fun work.  Once we made the switch and stopped deceiving ourselves, things started to turn around.

People deceive themselves all the time about all sorts of things: they say “it’s someone else fault, im doing fine,” “I shoulda gotten that promotion, not Larry” “I don’t have time to get in shape,” “I’d take that trip if only I had the time,” “Everythings going well.” Your mind will try to convince you that you’re right.

That’s why it’s hard to notice when you’re deceiving yourself.  Some clues are when things are not going well for you, but you’re not sure why.  Or success and fun aren’t coming easily.  Or when you’re acting with struggle, not with ease. When that happens to me, I try to take a step back and reevaluate.  Pull away from the situation.  Spend a bit of time alone.  Do some exercise.  Reflect on what I was deceiving myself about, and then try to push through and figure out why you were doing it.  I’ve found that the only way to make things better is to remove myself from the situation, then come back with a clear head and start to attack the problem head on again.

What do you do when you realize you’ve been deceiving yourself?  When have you realized in the past?  How do you try to make sure that it doesn’t continue to happen or so that you realize it more quickly?