[Graeme]

5 things you should worry about in 2014

1. The retirement crisis.

2. Climate change. CINCPAC — America's commander-in-chief of all Pacific forces — worries daily about China, North Korea, and cyber attacks. But the biggest long-term threat to U.S. national security? Climate change, says Admiral Samuel Locklear III.

His analysis is simple: Rising sea levels are beginning to impact the 80 percent of the world's population that lives within 200 miles of a coast. Locklear fears this will lead to disruption and political instability. There's evidence that this has already happened: rising bread prices in parts of the Middle East (sparked by hotter temperatures, wildfires, and drought in wheat-producing Russia, China, and elsewhere) helped fuel the Arab Spring in 2011.

What about here in the U.S.? You're already paying billions as businesses, cities, states, and Uncle Sam react to sea levels that have already risen sharply, particularly along the East Coast. And that's not all: Global warming is also contributing to your higher grocery bills, and your allergies.

Perhaps folks can stop viewing all this as a left/right, Republican/Democratic issue, and call it what it is: a growing threat that needs to be addressed by all.

3. America's slowing entrepreneurial culture.

4. Our shrinking water supply.

5. Land of the…dumb?

theweek

[rollin]

In a land where you can get your eyes, heart, hips, knees, cancers and many other things fixed I think we need to worry about the state of the medical industry. I know in my state the changes have forced many doctors to leave and the ones that are staying are not happy at all with the many new costs and tasks added to their practices.

Medical practices and hospitals have been re-organizing for a while to meet the new demands and get around some of the new policies. Independent physicians and hospitals are disappearing.

From a survey of American physicians:
Key findings of the survey include:
Over three quarters of physicians – 77.4 percent – are somewhat pessimistic or very pessimistic about the future of the medical profession.
Over 84 percent of physicians agree that the medical profession is in decline.
The majority of physicians – 57.9 percent -- would not recommend medicine as a career to their children or other young people.
Over one third of physicians would not choose medicine if they had their careers to do over.
Physicians are working 5.9% fewer hours than they did in 2008, resulting in a loss of 44,250 full-time-
equivalents (FTEs) from the physician workforce.
Physicians are seeing 16.6% fewer patients per day than they did in 2008, a decline that could lead to
tens of millions of fewer patients seen per year.
Physicians spend over 22 percent of their time on non-clinical paperwork, resulting in a loss of some
165,000 FTEs.
Over 60 percent of physicians would retire today if they had the means.
Physicians are not uniform in their opinions – younger physicians, female physicians, employed physicians and primary care physicians are generally more positive about their profession than older physicians, male physicians, practice owners and specialists.
Over 52 percent of physicians have limited the access Medicare patients have to their practices or are planning to do so.
Over 26 percent of physicians have closed their practices to Medicaid patients.
In the next one to three years, over 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
Over 59 percent of physicians indicate passage of the Patient Protection and Affordable Care Act (i.e., “health reform”) has made them less positive about the future of healthcare in America.
Over 82 percent of physicians believe doctors have little ability to change the healthcare system.
Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now.
Over 62 percent of physicians said Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs or that that any quality/cost gains will not be worth the effort.
Physicians are divided on the efficacy of medical homes, and many (37.9 percent) remain uncertain about their structure and purpose.
Over 47 percent have significant concerns that EMR poses a risk to patient privacy
Over 62 percent of physicians estimate they provide $25,000 or more each year in uncompensated care.

See the whole study at: http://www.physiciansfoundation.org/upl ... Survey.pdf

The whole system is becoming test oriented, observational diagnosis is being lost and independent decision making is fading. Maybe we should worry about the our medical care and what all these new laws and policies are doing to the system and to employees outside the medical system.
http://www.nationalreview.com/article/3 ... ew-johnson

[Don35]

Rollin, I teach middle school and a high percentage of your stats seem to fit current teacher attitudes.

More paperwork, more teachers quitting or retiring early, agree it is in decline, etc. Some is because of new management with poor people/management skills, some related to Common Core. It does fit the cycles listed in "The Fourth Turning". Interesting!

[Paulo1]

@ Don and Rollin

re: "77.4 percent – are somewhat pessimistic or very pessimistic about the future of the medical profession.
Over 84 percent of physicians agree that the medical profession is in decline.
The majority of physicians – 57.9 percent -- would not recommend medicine as a career to their children or other young people."

Don beat me to it. However, I would like to expand on what he said. The only trade/profession that I have heard any optimism and enjoyment in these days are engineering and electrical...provided you are connected to the energy sector and appreciated for what you do....plus, paid well for it.

I started out my adult career(s) by dropping out of university to become a bush pilot and working construction off season earning a red seal carpenter ticket. I got in at the tail end where bush flying was actually fun and full of freedom, plus I was paid well. This was in the 70's and early 80's. From that point on, due to deregulation and the shrinking economy, (which we talk about now...but when you fly the first thing that goes is the company plane or excess flights so we saw the changes coming back then). In construction, quality and enjoyment suffered at the hands of speed and profit. The most rewarding work in construction, for me, has been renovations, but everyone knows that most homeowners are tight for funds. Thankfully, renos work well in the underground economy. I am retired now, but still doing small renos for cash and new tools. At any rate, in the early 90s I finished off university and became a teacher thinking that teaching high school carpentry would be rewarding. Not. Parents shuffled off their kids into the university stream and except for a few engineer types I was often left with classes of dummies and/or the lazies. After moving around the school system looking for satisfaction, it took about 15 years to realize I was wasting my time, that it was in decline. For those parents who were and are supportive, thank you so much. But I would never never never recommend anyone go into education because the job has evolved into something terrible. In BC we are pretty well paid if you have a masters degree (which I do), but the profession is under constant attack because of Govt restraints, and economic constraints. It is simply a fact of life.

And why would medical be any different? There are only so many dollars to go around and ultimately the patient is a customer with limited funds, be it private US coverage or through our Govt universal system in Canada. I have noticed that in our clinic the older doctors are seeing fewer patients and actually taking holidays and time off. This was never the case when they were younger. And it is the same for teachers. When I started it was common to see teachers retiring with 300+ sick days in the kitty, (we don't get paid out for them like administration), but many felt that if they didn't get the job done it wouldn't get done and that what they did was important. Also, parents reinforced that school was important. That seemed to really change about 10 years ago. Nowadays, the martyr complex has been replaced with pragmatism and anger. It seems to have coincided with other societal changes such as constantly battling with kids to turn off their 'phones', and that actually attending class is a requirement to pass your course. I could go on and on, but there is one point I wish to make.

There is a lot of decline out there and angry changing attitudes. I have seen and heard doctors run down with their wages published in local papers. Lawyer jokes are a separate category. TV news programs are talking heads with eye candy. Newspapers are good for starting the fire. Teachers are constantly attacked in the media. Nurses get the same at contract negotiation time. Politicians are....Bankers? Clergy are either conning the uninformed or checking out your kid. The neighbourhood grocer no longer exists. Military? Law enforcement? Even firemen get hammered for their wages and pensions. And so on.

There is someting different out there in attitudes and behaviour and as I get older I am thankful I have the refuge of family and friends to nurture and support who we are and what we stand for. It is plain to see that in broad strokes everyone and every profession has been pulled of their pedestal and is being scraped off society's shoes. Everyone seems to hate everyone these days and no one is taken at face value. Perhaps this is simply a result of being in that race for the bottom we have all become part of.

regards...Paulo

[AndyA]

1, 2, 3 and 4 can all be tied back to 5. Still a pretty un-scary list of things to be worried about, and not really relevant to 2014 in a significant way. Long term trends playing out to a natural conclusion, nothing dramatic will change this year. The Chairman informally known as Printz can take care of the financial side in his spare time, sea levels wont rise by a significant amount this year, a few front yards may get a little brown as watering is restricted, two thirds of new business fail within 3 years anyway.
As for knowing American history being the test for dumbness here is a quote from George Carlin.

"This country was founded by a group of slave owners who wanted to be. Am I right? A group of slave owners who wanted to be free! So they killed a lot of white English people in order to continue owning their black African people, so they could wipe out the rest of the red Indian people, in order to move west and steal the rest of the land from the brown Mexican people, giving them a place to take off and drop their nuclear weapons on the yellow Japanese people. You know what the motto for this country ought to be? 'You give us a color, we'll wipe it out.'"

[Pops]

Nice rant Paulo.

It really feels like a race to the bottom with the brass ring the latest smart phone. My 14 y/o granddaughter received one of the new iphones for christmas and was just as pleased as could be, she was really beaming and so was her mom for being able to give it to her. I was talking about how cool they were, how it (and other "phones") know exactly where in the world it is and knows it's attitude exactly using accelerometers and compass and gyro and gps, how the retina display at 300PPI makes pixels just about invisible, and all the apps that can do crazy things like show you the seasonally correct path of the sun simply by pointing the phone at the sky and looking at the display.

She is a smart girl but she probably didn't get why I thought all of that was amazing, since none of it has anything to do with texting and selfies. She was just as pleased as her mom was at the same age to receive jeans with the fashionable label. I can't remember what I was pleased to receive at that age, certainly it was something of true and lasting value (LOL).

Christmas has always been a big deal in our family. My wife and I were both from relatively poor families, not so poor as to be hungry often but poor enough that when we had our own family our Christmas tree needed the bottom limbs pruned up to fit all the presents, even if they were homemade. I like to buy stuff, I like to own stuff, I haven't been able to shake the habit and in fact I don't think the biggest thing I worry about is the urge to acquire stuff. It's in our genes just as dolling up the boudoir with the gaudy and sparkly is instinctual to the Bower Bird, we just can't help it.

The thing that worries me now and really always has, is the continual drift into irrelevance that our lives are taking. It seems to me that more and more people I talk to know relatively little about the world or how it works and merely exist from one vacation or spending spree to the next. My neighbor dropped by yesterday (to ask me if the laptop he had the specs for would serve him to browse the internet) and when I showed him my ongoing pickup project (with engine now totally disassembled and spread around the shop) he said "I'd not know where to start." No big deal, except, he worked for years selling Pennzoil, is a big NASCAR fan and has a couple of classic cars and collects "automobile" stuff. The guy can't change his own oil.


It wasn't all that long ago that folks had some idea how to do at least a few practical things. More and more we are at the mercy of our devices.
.

[Graeme]

The people's agenda—America's priorities and outlook for 2014

The Associated Press—NORC Center for Public Affairs Research has released the results of a major new survey that reveals the American people's list of issues they believe should be the focus of government attention in 2014. The same survey also explores the complex blend of personal, political, and ideological factors that lie behind such a list.


Key findings of the Survey Include:

The public's preferred agenda for the government in 2014 includes a diverse set of policy issues that range from economic problems to social policies to foreign affairs.

Health care reform tops the public's list of priorities, mentioned by 52 percent of respondents as one of the top ten problems, followed by unemployment (42 percent), the economy in general (39 percent), and the federal deficit (31 percent).

Few have faith in the current political system, with the government receiving low marks on its performance in upholding the nation's fundamental principles. For example, 55 percent believe the government is doing a poor job of representing the views of most Americans while only 9 percent say it is doing a good job.

Americans are more pessimistic than optimistic on matters such as the nation's ability to produce strong leaders, America's role as a global leader, and the opportunity to achieve the American dream.

Compared with the early 1970s, 20 percent of Americans feel technology is the biggest change in American life, with specific changes including the Internet, computers, and communications. By contrast, fewer than ten percent cite politics as the biggest change and five percent moral, religious, or social change.

A majority of Americans believe that American institutions such as churches, small and medium-sized businesses, and charitable organizations are doing "the right amount," when it comes to fixing problems the government cannot while similar numbers believe big business, labor unions, and wealthy individuals are not.

phys.org

[Don35]

I would suggest reading "The Fourth Turning" by Neal Howe and Joseph Strauss (Not certain on authors names). It recognizes cycles of 80-120 years (a long lifetime) throughout western civilization from medieval on. Generational attitudes, beliefs, etc. are predictable and cyclical. Tough read in places, but helped me make sense of all this. We seem to be at the end of a cycle and that is NOT a good thing! It's going to get worse!

[Lore]

More like a downward spiral.

[ralfy]

In terms of the global economy, perhaps more social unrest as the effects of high food and oil prices remain.

[kiwichick]

@ pstarr

ocean levels are continually rising

currently at approx. 3mms / year

however on the bau track it could rise by 1 metre / 20 years

[kublikhan]

@Paulo

If you were in charge, what changes would you implement to counter the trends you see developing?

[Lore]

I believe the difference here is on an order of magnitude to the effect. A slow crash in oil will not be as devistatng as that of long term climate change.

[Quinny]

With Pete on this one. If only because it comes first.

[Pops]

I hate to split hairs kchick but a meter of sea level rise compared with a self-reinforcing decline in oil exploration and development give 2 completely different results, one raises GDP and one lowers it.

How much economic activity has been generated by Katrina and Sandy?

How much by BP abandoning it's Mad Dog GOM project?

I hate the GDP measure because of exactly this but the fact is, breaking a window (whether by baseball or tsunami) increases economic activity, it gives the glazier a job. Not so oil depletion, it's not simply lost opportunity in fact it is lost necessity - fewer jobs will result. (At least in the near term, probably decades before ditch digging will return as a viable profession.)


No doubt both PO and GW are speculative, as to PO, we've never replaced something good with something less good so how do we know for sure what will happen? Petroleum is better in all respects than whale oil, bronze was better in most respects than rocks; nothing (so far) is better in all respects than oil, but who knows? Maybe something will come along. Likewise climate science, my knee jerk reaction has always been that the "greenhouse effect" would cause temps to rise, but how much and how fast is just as speculative as how much oil there is that can be profitably recovered and what the timeline might be.

So extreme weather is something I'd worry about in 2014 but not a meter of sea level rise. OTOH, news of a continuing decline in the Bakken, or continuing decline in IOC E&P, or the failure of some offline oil to return, or even, and here is a counterintuitive one, the rapid heating of US, China or the global economy because that would put big upward pressure on oil prices and inevitably crash the economy again.

[AndyA]

Peak oil is now, likely decline rates of 6.7%/year will kick in soon. Our industrial civilization will need four new Saudi Arabia's discovered and produced each year to compensate.

Likely by what measure? Four Saudi Arabia's every year? That's about 40m/bbl/day! I think you need to reassess your methodology. If we all sit on our arse and watch oil production decline, and simply refuse to drill anymore wells then 6.7% decline is still on the high side of most estimates.