(Readers: Please note the blog about the 5^th revolution in the US is constructed as a story. While not all chapters are linked, I think the story will be more meaningful by starting at the beginning.)

Scene: POTUS Office, who called Jordan about plans for rebuilding neighborhoods in Detroit

POTUS:  “Jordan, thanks for coming by. Appreciate you changing your schedule.”

Jordan: “Mr. President my schedule is much more flexible than yours.’

POTUS:  “I understand you have a proposal to help rebuild Detroit. And I understand the central theme is ‘Rebuilding the Heartbeat of America.’ I like the theme even if you did steal it from an old Chevrolet ad campaign.”

Jordan: “I’m sure Chevy won’t mind. Besides the program will be good PR for them.”

POTUS:  “Tell me more about the plan. How are we going to make this work?”

Jordan: “Glad you emphasized the word we. The problems Detroit is facing are much more widespread than Detroit. And the solutions need to include more groups than just in Detroit.”

POTUS:  “Part of the problem is having the US populous understand the solution is not just Detroit. Detroit and the solution are really national issues.”

Jordan: “I agree but I am not certain how many people outside southeast Michigan understand that.”

POTUS:  “You’re right. For right now, let’s stick with plans for Detroit. So, tell me Jordan, old wise man, how are you going to make this work?”

Jordan: “Detroit has a strategic plan…more of a framework than a real plan. But the idea is to rebuild employment, improve housing, and make the city more livable by expanding parks and some ancillary programs that reinforce the core efforts. What the plan lacks is specifics.”

POTUS:  “You think Heartbeat of America will work with the general plan?”

Jordan: “Yes. Detroit’s strategic plan could become the model for many cities. The Heartbeat program provides a rallying cry and begins to put meat on the bones.”

POTUS: “Good. My experience, and I think yours as well, is that most people need details and examples, not an abstract general plan. What have you got? Let’s start with housing.”

Jordan: “If you think outside the box, some of Detroit’s biggest problems can become a major asset.”

POTUS: “Jordan, I agree but you sound like some politician.”

Jordan: “It’s really true. For one there is a lot of open land. Two there are many industrial buildings currently unoccupied but in reasonable shape. And many of the larger building could be turned into housing.”

POTUS: “Is converting an industrial building to residential housing practical? Seems like a lot of work and expense.”

Jordan: “Depends on how you approach rehabbing the building. If you think about the building as a shell with just a roof and a floor, then a number of options become available.”

POTUS: “What do you mean?”

Jordan: “Take an old assembly plant. Trying to build apartments using the existing interior space would be difficult and expensive. Using the space to house a module for living or a module for an office changes the equation.”

POTUS: “How so?”

Jordan: “You’ve seen Russian dolls, where one doll fits inside another.”

POTUS: “I’ve seen a lot of Russian dolls. But different kind. But I got the picture.”

Jordan: “The building is the outside doll. Then the next doll is a fixed space within the building. Then the next doll fits inside the fixed space. The point is one fits inside the other.”

POTUS: “So the smaller doll can fit inside even if the larger doll has some bumps and imperfections. You want to use most of the space but do not have to use all the space.”

Jordan: “Exactly. You can make different size dolls and different looking dolls. The point is that one fits inside another.”

POTUS: “Where do you build the units?”

Jordan: “Units can be built in a factory and delivered as a nearly completed modules or built as partially assembled units with final assembly on site.”

POTUS: “Which approach is better, or does it matter?”

Jordan: “Quality with factory built probably slightly better. The real issue is constraints of the building. The design concept needs to be flexible enough to allow conversion of as many buildings as possible to residential or attractive offices.”

POTUS: “I agree. Don’t limit the opportunity to convert many older buildings. The structures are usually sound and the buildings help keep the character of Detroit…or whatever city.”

Jordan: “Glad to hear you support linking the future to the past, at least in some regard.”

POTUS: “I am no architect, but what I do know is a very high percentage of people like the look and feel of older buildings. But the same buildings need to have up-to-date wiring, plumbing and other conveniences.

Jordan: “The design allows upgrades over time as well so the unit can be up-to-date 50 years from now.”

POTUS: “Great. I have another question. Are you really talking about modular housing?”

Jordan: “Yes, sort of. I know modular has such a negative connotation. But in a way it is higher tech. Skyscrapers are being built using modular construction. Look at this YouTube video, Skyscraper in 15 Days.”

POTUS: “Wow, that’s impressive. When I hear the word modular, even after watching the video, I think double-wide.”

Jordan: “The irony is quality of factory-built housing is superior to traditional stick-build. However, even if people understand if modular has superior quality, there is a negative connotation to modular.”

POTUS: “Reminds me of the problem we have in this country with public transportation. Higher income, highly educated people have no problem whatsoever taking a train. But a bus? Not a chance. Even if the bus is faster and cheaper, ridership is not the same as a train. A train is OK but not a bus.”

Jordan: “I confess, I fall in that category. I will take almost any train and avoid almost any bus.”

POTUS: “So you are the problem!”

Jordan: “I have a lot of company. Seriously, to begin overcoming the negative perception of modular housing, we need a few showpieces constructed using modular. And Detroit would be a good place to start.”

POTUS: “Have you got a target in mind?”

Jordan: “Yes, an auto plant that is currently unoccupied. The plant has a lot of history and is interesting architecturally.”

POTUS: “Any major problems?”

Jordan: “Building is generally sound. Couple of structural repairs. There are some environmental remediation issues. All solvable based on what we know now.”

POTUS: “There is a super fund that should pay for most remediation costs, especially if the building can be converted to a livable site. What other problems?”

Jordan: “The project seems to dovetail nicely with the strategic plan adopted by the City of Detroit. The project could be a showpiece for the City…but it needs support both in concept and financially.”

POTUS: “Is the general approach adaptable to other sites, or is this just a one-off, thank you very much program?”

Jordan: “Highly adaptable to different building configurations and interior spaces. The approach will work throughout southeast Michigan – Detroit, Pontiac, Flint, Lansing and points in between. It will also work in virtually any other US city…and worldwide.”

POTUS: “Now we’re talking. Give me three major selling points. I’ll make some phone calls for you.”

Jordan: “Three key points: (i) rehab will be the foundation for neighborhood redevelopment without changing neighborhood character (ii) rehab creates local employment, including suppliers (iii) rehab design can link to and complements other neighborhood efforts.”

POTUS: “Here’s the deal. I call three people: (i) head of HUD (ii) senior senator from Michigan (iii) senior representative from SE Michigan. You meet with each of them and get reaction to the proposal. If they support, we proceed. If not, you are on your own.”

Jordan: “Thanks. I owe you one.”

POTUS: “I’ll keep that in mind. You’ve helped me. Glad I could return the favor. Rehabbing cities is a big problem and a long-term problem. Whoever is in office is going to need lots of help.”

(Readers: Please note the blog about the 5^th revolution in the US is constructed as a story. While not all chapters are linked, I think the story will be more meaningful by starting at the beginning.)

Want a PDF version for Entries #1-10 and 11-20 formatted for tablets and e-books?  Click links for download.  America’s 5th Revolution Volume I (Entries 1-10)  America’s 5th Revolution Volume II (Entries 11-20)

Scene: Jordan in Doctor’s Office following annual physical

Doctor: “Thanks for sticking around after your physical.”

Jordan: “My thanks to you for taking time to meet.”

Doctor: “Let’s continue.”

Jordan: “Gene, with the revolution, we…and as I keep reminding everyone ‘collective we’…have a chance to make improvements in many programs, including healthcare. No more $89,000 for shots.”  (14 02 11 Charlotte (NC) Observer Article re Cost for Snake Bite)

Doctor: “We definitely need some changes, starting with more focus on health and less on politics.”

Jordan: “Here’s an idea that seems to have a high payoff potential and is less political.”

Doctor: “I’m all ears.”

Jordan: “The idea is not new but seems the implementation has been lacking. The plan is to use technology to help people stay at home as long as possible.”

Doctor: “We use technology to keep some patients at home but probably could do much more. What prompted the idea?”

Jordan: “Personal experience. My father-in-law lived probably 10 years longer because of some low-cost, relatively simple outpatient programs.”

Doctor: “What medical facility?”

Jordan: “Veteran’s Administration Hospital, central Illinois.”

Doctor: “If it is the VA hospital I’m thinking of, they’ve done a very good job at extending lives and quality of lives for veterans.”

Jordan: “My thought is to combine what the VA is already doing, at least in one location, with what major manufacturing firms are doing.”

Doctor: “What do you mean?”

Jordan: “Earlier you talked about focusing on health. Maintaining health is really a systems approach – diet, exercise, sleep, etc. Manufacturing companies use a systems approach to solve problems and increase productivity.”

Doctor: “I agree a systems approach would be more effective. What about the technology? Medical equipment always seems so expensive.”

Jordan: “That’s where some new thinking can really help. Clearly I am not the medical expert, you are. But let’s think about what might cause people health problems – not taking medicine, spoiled food, undiagnosed emerging issues, a fall or injury…and many others that I’m not aware of.”

Doctor: “Each one of those is a problem for almost everyone, especially the elderly. What are you proposing?”

Jordan: “My idea is to use existing, affordable, off-the-shelf technology to help address these issues. But use technology in a way that might be different from current medical practice.”

Doctor: “Give me a specific example?”

Jordan: “Let’s take sensors. A wide variety of commercial sensors is available at relatively low-cost. The sensors can track everything from movement to coloration to chemical content…virtually everything.”

Doctor: “Tell me more about tracking movement. Are you talking GPS?”

Jordan: “No, although a mini-GPS system will help locate people in a defined area. Panera, for example, has kiosks for ordering and then uses a mini-GPS system to find your table.”

Doctor: “What are you thinking about?”

Jordan: “Are you familiar with the Segway — sort of an upright platform with two-wheels?”  (http://www.segway.com/)

Doctor: “I’ve seen it but never been on one.”

Jordan: “The sensors in the Segway measure when the rider is leaning forward or backward and adjust the angle of the platform automatically. The Segway also remains upright when the rider stops.”

Doctor: “I did not realize it was so sophisticated. Is the idea to use sensors from the Segway or some other device to measure whether people are having trouble walking, getting up or when they fall?”

Jordan: “Yes. The sensors would measure the rate of change of movement to predict when something might happen.”

Doctor: “Interesting. What else?”

Jordan: “Sensors could measure temperature – of water, of the refrigerator, of the oven tops. Sensors could also measure CO². Data from all these measurements can be transmitted and read remotely. Adjustments to settings can be made remotely. Turning down the oven temperature, for example, could be done remotely or linked to an algorithm and the adjustment made automatically if the temperature falls outside a range…no pun intended.”

Doctor: “You can do better, Jordan.  So someone, the individual, the caregiver, medical staff could set the parameters for highs and lows. Now we are making progress. Keep talking.”

Jordan: “No surprise, sensors can measure body temperature.”

Doctor: “What about analyzing urine and stool samples? Both are excellent early indicators of problems.”

Jordan: “Take the sensors currently used in the lab for these measurements.  Repackage for home use. The accuracy might not be quite as good but it will be close.”

Doctor: “Then, if the results fall outside a certain range, the primary care physician and/or caregiver could be notified. If the results indicate a dangerous situation, ER could be notified.”

Jordan: “You’ve got the idea. We could also add chips to make sure medicine is being taken in proper doses.”

Doctor: “The list seems almost endless. We could even have regular Skype calls with patients and/or caregivers.”

Jordan: “The goal is to keep people in their home or apartments longer. Years ago I belonged to an association that designed products for seniors.”

Doctor: “You were a little young for that organization weren’t you?”

Jordan: “During my auto days we had a car that sold well among seniors and I joined to learn more about seniors. People in the organization for seniors used to comment that the last thing that you saw before someone was transferred to assisted living or a nursing home was fingernail marks on the front door.”

Doctor: “I understand that. Many of my patients would live longer, healthier lives if they could be at home.  Virtually everyone wants to be at home. How do we implement your ideas?”

Jordan: “Don’t know exactly. But I will put some ideas together and then try to get someone to spearhead the effort. Could you be a consultant to the group?”

Doctor: “Definitely. Would be an honor to help. Now we need to end this conversation. I have more patients to see.”

Jordan: “Gene, thank you very much.”

Doctor: “Jordan, thanks for asking.”

(Readers: Please note the blog about the 5^th revolution in the US is constructed as a story. While not all chapters are linked, I think the story will be more meaningful by starting at the beginning.)

Want a PDF version for Entries #1-10 and 11-20 formatted for tablets and e-books?  Click links for download.  America’s 5th Revolution Volume I (Entries 1-10)  America’s 5th Revolution Volume II (Entries 11-20)

Scene: Jordan in doctor’s examining room for annual physical

Nurse: “Jordan, blood pressure looks good. Job must not be too stressful (laughing). The doctor will be in shortly.”

Jordan: “Thanks Kathy. Nice to see you, as always.”

Doctor: (Knock and door opens slowly) “Jordan, how are you?”

Jordan: “Gene, I’m fine. At least I think everything is OK. No major problems.”

Doctor: “You’ve become the BMOC, or should I say BMIW – big man in Washington. What is it like in Washington? Understand you met the president.”

Jordan: “Yes, I did. He’s trying to keep the country together. And fortunately, DC is becoming more rational after the special election. Still a lot of confusion about what to do, a lot of angry people and an incredible amount of work to be done.”

Doctor: “Think the revolution is finished?”

Jordan: “No. I would view the current pause in the fighting as a positive.”

Doctor: “What is it going to take to satisfy the rebels?”

Jordan: “The so-called rebels are now mainstream and in control of congress and most state legislatures. But the real challenge is execution.”

Doctor: “Execution of what?”

Jordan: “A number of laws and/or regulations need to change. And all that takes time, especially with a new congress.

Doctor: “And you have an impatient electorate.”

Jordan: “We probably have one year grace period to implement the changes.”

Doctor: “One year? I would find the one-year expectation humorous if it weren’t so ridiculous. The same people demanding changes in government within 12 months are willing to give a new football coach 2-3 years before expecting significant change.”

Jordan: “Do you have the same problem with patients?”

Doctor: “Absolutely. People neglect their health for years, come here with a problem and then expect a miracle cure. Oh, well, such is the real world.”

Jordan: “Irrational, yes. To change their thinking maybe we should begin telling people a doctor is like a football coach and do not expect an immediate change in your health.”

Doctor: “Maybe we should. Any way I can help with some of the issues?”

Jordan: “Yes but let’s get through the physical first. I have some questions about issues that I do not understand.”

Doctor: “Let me make sure I have time in the next hour or so. (Confirms with Cathy.) Now let’s continue the exam. Bend over.”

Scene: Physical completed.

Jordan: “Well, Gene, any issues?”

Doctor: “Fortunately, no. Jordan, I do not want to inflate your ego any more but you are probably the healthiest patient of your age in my practice.”

Jordan: “Glad to hear it. All the exercise and watching the diet seems to have some positive effect.”

Doctor: “Alright, what is the first issue?”

Jordan: “Hospital charges for procedures. How do hospitals calculate what to charge?”

Doctor: “Give some examples and I might be able to help.”

Jordan: “A case in Charlotte, NC where a man was bitten by a snake. The hospital gave him four injections of serum. The charge was nearly $90,000 — $89,000 actually. That’s crazy.”  (14 02 11 Charlotte (NC) Observer Article re Cost for Snake Bite)

Doctor: “He didn’t pay the full amount did he?”

Jordan: “No. The insurance company negotiated a reduction to about $20,000. His co-pay was $5,000+. If the guy had no insurance, he would be stuck with nearly $90,000.”  

Doctor: “I hear you. Doctors are as frustrated as patients. But are you sure this wasn’t an isolated case?”

Jordan: “It was not isolated. I do not follow the medical field daily but another family near Charlotte was charged $125,000 for rabies shots. Think about that, $125,000 for shots. I remember as a kid having to get rabies shots. Probably cost my folks a few hundred dollars.”

Doctor: “That was a long time ago – inflation. (Laughing) Unfortunately, I cannot really answer the question. I’m not even sure what we charge you. The hospital owns this practice and sets the rates.”

Jordan: “Here’s what I know. When an industry is that much out of control, whether healthcare, automotive, mining, financial or whatever, government has a responsibility to step in and fix the problems. What’s seems even worse in healthcare is that many of the hospitals are tax exempt.”

Doctor: “Are you suggesting we expand the Affordable Care Act and nationalize healthcare?”

Jordan: “What do you think? $90k or serum and $125k for rabies shots. The hospital executives are living in another world and no one is controlling their behavior.”

Cathy: “Pardon me for interrupting. Doctor, two patients are waiting to see you.”

Doctor: “Jordan, if you can keep yourself busy for 45 minutes or so, let me see these patients and we can continue the conversation. Cathy, after Mr. Abel gets dressed, could you take him to my office and get him some coffee, please?”

Cathy: “Gladly.”

Jordan: “Gene, see you shortly.”

(Readers: Please note this blog is constructed as a story about the 5^th revolution in the United States. While not all chapters are linked, I think the story will be more meaningful by starting at the beginning. Read a couple of sections per day and you will catch up quickly.)

Scene: Jordan’s Office. Report on taxes as follow-up to an earlier assignment.

Jordan: “Well, well, well. Look who’s back – Queeny and Cleopatra. All well with you two?”

Cleo: “Yes, everything is fine. And look who we brought along – Caesar.”

Caesar: “I’m here to help interpret some of the findings of the workgroup. But I have been informed by these two economic mavens to stay quiet until called upon.”

Jordan: “So what else is new? Don’t they always tell you to stay quiet, Caesar? By the way, are we meeting next week on your recommendations for defense and national security?”

Caesar: “Yes, this week we have a couple of more internal reviews and then we’ll be ready.”

Jordan: “Queeny, any word from King George III?”

Queeny: “Apparently OK health wise but still has not come around. He is being stubborn…and I think stupid. But being stupid is his decision, not mine.”

Cleo: “May we get started, please? We have a lot of ideas to present.”

Cleo: “The first proposal is about the income tax rate. We selected a rate based on four criteria: #1 the rate must be progressive. A flat tax is regressive because those in lower income brackets have such limited discretionary income.

Caesar: “Do you understand what you just said?”

Cleo: “Pardon me, but did anyone ask for your opinion? Yes, I understand. Discretionary income means income left over after paying for such necessities as food, shelter and clothing. If you don’t make much money, you have very little left over. So there.”

Caesar: “An economics professor and I didn’t even know it.”

Cleo: “#2 criteria — the tax rate must be easy to understand. No complicated formulas. #3 is no deductions.”

Jordan: “Did I hear that right? No deductions?”

Cleo: “No deductions. Deductions allow people to game the system. What starts out as a logical deduction gets distorted over time. #4, we need some adjustments for inflation.

Jordan: “What are the proposed tax rates?”

Cleo: To start with “$1-20,000, 0.0%; $20,001-$50,000, 5.0%; $50,001-$500,000, 10.0%; $500,001-$1,000,000, 20.0%, above $1,000,000, 25.0%. With these brackets, most everyone will pay something. Remember all income is subject to tax – payroll, interest, dividends, even Social Security benefits.”

Jordan: “What else?”

Cleo: “No other income taxes. For upper income people, the tax rates are lower than the current rate so the incentive to earn more is increased, not decreased.”

Jordan: “Are there any deductions?”

Cleo: “You know, Jordan, sometimes you are as bad as Caesar. You just don’t seem to listen. I said no deductions. None. Nada. Zero. Understand?”

Jordan: “Interesting proposal. Caesar, as a high-income earner – well, former high-income earner – any thoughts?”

Caesar: “I cringed when I first read the proposal. But it does make sense. The proposal is simple and easy to understand and everyone is treated the same way. You do not have the shenanigans like hedge-fund managers paying a lower tax rate than the clerical staff.”

Jordan: “I’m not sure about eliminating the mortgage deduction.”

Caesar: “I was concerned, too. But the current system is so screwed up we have got to make a change. Besides, house prices seem more aligned with interest rates than tax deductions.”

Jordan: “Keeping interest rates low and keeping inflation low will help the economy more than a tax deduction. As you said Cleo, tax deductions create distortions.”

Caesar: “We also discussed whether people with incomes less than $20,000 should pay some tax. But Queeny and Cleo reminded me this group pays sales tax, property tax as part of their rent and other miscellaneous taxes. I was surprised at how high the effective tax rate really is for lower-income people. They convinced me the brackets make sense.”

Jordan: “I remember seeing this chart before. I was astonished at the effective tax rate for lower incomes. This proposal should help fix the inequities. What’s next? Queeny, you’re at bat.”

Cleo: “May we take a 5-minute break, please?”

Jordan: “Caesar, has she always been like this?”

Caesar: “Always. And you learn to go along with it. We’ll restart in 5.”