In a paper recently published by the Federal Reserve they begin to consider what actions the FRB should take to drive the further adoption of P2P electronic payments and the reduction in paper checks.

http://www.bos.frb.org/economic/ppdp/2010/ppdp1001.pdf

Their introduction speaks to the differences in adoption of electronic payments in the USA and Europe.  Intriguingly they include privacy concerns as a key issue.  This being said, having lived in Europe for 15 years, I am not sure the desire for privacy is greater in America.  What can be said is that the moment when the underlining infrastructure was developed defines the ideas and feature sets.  Newer systems learned grew as other economies embraced and proved the viability of innovative ideas.

They go on to discuss the fate of eCash (Mondex, VisaCash) and the need to create ubiquity in order to assure success.    Clearly, as they outline, the major adoption issue in the field of payments is achieving a density of merchants willing to accept a particular means of payment  and simultaneously demonstrating a significant number of consumers willing to employ said means of payment.

Unfortunately for the inventors of neat solutions the reality is that without figuring out how to assure ubiquity the new idea they will not be a success.  If we look at contactless, MasterCard clearly recognised this reality and funded the initial investment in equipment.  Without this investment one wonders if PayPass would have reached the low levels it has.

The interesting thought that emerges from this paper is that the wide spread deployment of mobile phones means that an infrastructure that both merchants and consumers have is in place and if one can find an intuitive means of exploiting this installed base, part of the deployment problem is mitigated.

In my heart, I believe mobile will allow the establishment of new ways of paying,  The next question can today’s infrastructure support P2P payment instructions and will the issuers and acquirers figure out how to make money without cannibalizing existing revenue streams.

http://newsroom.blogs.cnn.com/2009/10/05/unemployment-what%e2%80%99s-to-blame/

Unemployment: What’s to Blame?

Posted: 08:44 AM ET

Former Federal Reserve Chairman Alan Greenspan predicts U.S. unemployment could hit 10%.  Currently the nation’s unemployment rate is at 9.8%.

So, what do you think is most responsible from the worsening employment picture: a failed stimulus package, an economy much worse than we knew, employers cutting deeper and hiring more slowly than expected, or something else all together.

Leave us a comment. We’ll share some of them on air in the CNN Newsroom, 11am ET — 1pm ET

 

So there we are.  A picture and a set of points on why we are where we are with unemployment.  Now what about this idea.

First, there is an issue of Greed.  A small percentage of the global population has accumulated a massive amount of wealth.  I am not here to judge the right or wrong of how they or their ancestors acquired the wealth.  I am here to suggest looking forward. 

  1. 100 million dollars a year as a salary to hedge the price of gasoline and contribute to raising the profits and consumer costs associated with oil.
  2. $17.2 million to successful sell Visa inc, to the market, earning bankers a significant return.
  3. Numerous excesses that programs like Nip/Tuck mimic for Wall Street millionaires.
  4. A stock market that has a curve that simply should not have been allowed.  Long term prudent economic management is essential.

 Ponder this.  If equities is suppose to represent the inherent stability of the corporations that employ our neighbors; what happened starting in 2000 and culminating in the bear Stearns collapse in 2007.  Is Wall Street unravelling the growth that began in 1982 and went into a hyperactive phase in 1995, and simply correcting itself. 

What next should represent a step change in how we think about governance, compensation, risk, responsibility and morality.

 What I think a lot of us forget is that our society evolved over millennium and here we are thinking we are so important.  What is important, is being faithful to a common morality, and making sure that we leave something better for our children. 

I agree with the Dali Lama, all we want is peace and happiness.

So what next?

  1. Cap salaries for the rich at 2 million per year.
  2. Institute a managed health system that still uses the concept of insurance and hedging risk to fund our healthcare system.  
  3. Introduce a health management system, with a basement for those that cannot afford even the most basic plan.
  4. Re-introduce exercise in the school system and subsidize community gyms and recreational facilities.
  5. Re-introduce the luxury tax for non essentials over $30,000 and on things that are not good for you or are excessive.  Say anything not associated with your food,  transportation and housing.
  6. Focus on better educating the family practitioners, gynecologists, internist and pediatricians so that they do a much better triage and assessment of appropriate care given available resources with fear of reprisal for taking risks.  If necessary, require an additional year of service at a teaching hospital earning a reasonable income say $120,000.
  7. Do a lot of what Congress is already talking about
    1. Strengthen the VA hospital and medical care system
    2. Do not mess with Medicare or Medicaid, until the new system is in place.  Let the people move to the free market approach.
    3. Do not create a Government run insurance system.  Yes to creating a open market, knock down state borders and promote re-introduction of the original Blue Cross Blue Shield concept of a co-operative not for profit solution
  8. Focus on regulating the quality of care with a no one left behind principle.
  9. Keep the insurance companies out of setting fees.  Manage thje cost of the healthcare system by focusing on competition.  The patient is the client and is to be saught after without offensive advertising.
  10. Mandate a National Id card keying off the social insurance number.  Combine it on the Drivers license, as a day one requirement.
  11. Focus as a corporate priority on employment being the key indicator of success.  Begin discussions on Right to Work legislation and stimulating more humane approach to managing down costs in a period of economic recession.  Reduce executive wages well before the first person can be let go, without cause.
  12. Merge all the work in the fields of governance, risk and regulation into a replacement bill.
  13. I could go on.

From Nothing Something

In an apologetics I was asked to question the idea that something came from nothing.

This is what I have to believe if I am going to listen to the Atheists and ACLU.

Then I thought about Creation and Intelligent Design.  Oh how much simplerit to believe than these Macro Environmental facts that cannot be backed up with data explains it all.  There is much to accept if you are going to believe out of the Big Bang and Chaos; time would produce a single cell.  Then from that single cell produce the abundance of life forms that have and do exist.

255 proteins must magically appear in one place at the exact right time,

Before we can start thinking about things like DNA

The New York Times, in the previous post, looks at the issue from the obvious perspective.  The result is as one would expect.  Remember when France first introduced smart cards 1984or mandated then back in 1992 and the acceptance nightmare.

In the past I have written on the idea - 

Push PCI/EMV into one coherent electronic and secure smart card reader and PIN Pad. 

Mandate all new 1 July 2010; with the understanding that the reality -  every piece of equipment will be replaced in a reasonable period, say 7 to 10 years. 

VARs should easily be able to do that.

The incremental ($8/device) on the device side goes down over time, as equipment becomes more affordable.

On the system side, most international providers have a solid EMV implementation they can port over to the US platform over that same 7 year time frame. 

At the Network switches, gateways and IPSPs; data formats should be changed sooner, say three years from day one.

Issuers can then decide, when to embrace one  global two factor authentication solution; using contact and contact-less EMV  cards to support card authentication [Factor 1] and card holder verification processes (eg. Chip and PIN) [Factor 2] . 

Biometrics were understood when EMV was created.  The mechanisms are in place to introduce an agreed, more secure, biometric verification process [Factor 3].

The NYTimes understands what EMV is

So why not go ahead, do contact ISO7614 and contactless cards ISO14442 for 1.75 a piece.  then merge 15+ cards to a few. Save 11*$.025 = 2.75 per person. or 1.100 Billion less cards as pollutants

Could U.S. consumers spur adoption of EMV in U.S.?

Tracy Kitten

• 01 Oct 2009

As the rest of the world wraps its migration to EMV/chip-and-PIN technology, Americans traveling overseas are running into mag-stripe disadvantages.

This week, travel reporter Michelle Higgins of The New York Times writes that U.S. cardholders traveling abroad are getting turned away by some merchants, since mag-stripe readers are quickly becoming things of the past in every corner of the globe except the United States.

Though EMVCo., which oversees and spearheaded the EMV shift, has said from the beginning that all chip cards and readers would continue to also read mag-stripes, many merchants are reluctant to accept mag-stripes, since they can be held liable if card information is skimmed or compromised. And because magnetic stripes are relatively easy to copy compared with chip-and-PIN technology, accepting mag-stripe transactions potentially opens the door for fraud.

The problem is that most U.S. consumers have not been informed by their financial institutions about potential transaction problems when traveling overseas. Most, in fact, have no idea what EMV or chip-and-PIN technology is.

Twenty-two countries, including most of Europe, Mexico, Brazil and Japan, have adopted EMV technology, according to the Smart Card Alliance. About 50 other countries, including China, India and most of Latin America, are in various stages of migrating over the next two years.

Last year Canada began rolling out chip-and-PIN cards and plans to stop accepting mag-stripe cards at ATMs after 2012 and at POS terminals after 2015.

False Prophets and False Profits

Last night, 11 September 2009, I watched hours of material on 9/11. 

 

I saw the planes as the flaming arrow of the False Prophet. 

 

I saw the two towers as the symbol of the moral decay of the False Profit. 

 

Both clashed in a period of 102 minutes we will long remember.

 

The terrorist is acknowledged and the false prophet stands accused. 

 

Yet the False Profit continues to bring harm to many and shame to those of us who seek to know God and the work Jesus’ expects of us.

 

When will the False Prophet “Profit” finally be recognized as the work of the devil?

American Banker Reports

Europe to Eye Mag-Stripe Ban

Cardline Global  |  Friday, June 26, 2009

European banks may consider banning the use of magnetic stripe credit and debit cards, according to Gerard Hartsink, the chairman of the European Payments Council.

Hartsink, who is also a senior executive vice president at ABN Amro in Holland, said that European financial companies will have largely completed the transition to the EMV Integrated Circuit Card Specification by 2011, and the council, which is driving the transition to the Single Euro Payments Area, could then advise its members to stop accepting magnetic stripe cards, which are considered less secure than those that use EMV.

“My feeling is, although it has not yet been decided, the [council] will take a decision in 2011, maybe 2010, to only use chip cards,” he said in comments during a presentation this week at the Contactless Cards and Payments conference in London.

The council has no enforcement power, but if banks in Europe went along with such a decision, it could leave U.S. cardholders in the lurch when they traveled to Europe and tried to use cards for purchases or ATM withdrawals.

“If [Americans] visit Europe, it’s not such a problem; their institution could issue an EMV card,” Hartsink said.

Payments council members will probably debate the issue in 2010 or 2011, he said.

Hartsink is not the only person suggesting a ban on magnetic stripe cards, according to Dave Birch, a director at the U.K. research company Consult Hyperion. In a recent blog post, he cited comments from a financial regulator in Singapore pressing for a “concerted, global effort to phase out magnetic stripe technology entirely.”

Recently I came across an article that spoke to an idea that i had back in 1996 when I envisioned a personal device that allowed the consumer to merge their leather wallet, Filofax, mobile phone, walkman and PDA into a single light weight device.

http://www.andreae.com/presentation/Wallet_Pockets/my_dream_Start.htm

The author of this article talks to the need to create a secure mechanism to authenticate, identify and as appropriate verify that it is I.  When we looked to smart cards that was what we where looking to do and the SIM that is inserted into a GSM capable mobile phone is able to offer the security that Kurt Marko seeks.

Has the time come to move forward with my dream?

 

That was part of the dream that drove the creation of  EMV. 

Personal Portable Security Devices

 
Are Pocket-Sized, All-In-One Security Devices Ready For Prime Time?

Key Points

• Personal portable security devices integrate cryptographically strong user authentication, such as OTPs (one-time passwords) and public key certificates with ample hardware-encrypted flash storage, all housed in a compact USB device.

• The functional integration enables new usage models for secure mobile computing, such as standalone portable applications, browsers, or complete desktop environments.

• PPSDs are a relatively new and evolving technology that suffers from hardware costs substantially higher than those of point products, such as encrypted storage or OTP tokens, complex deployment processes, and necessary additional management software.

 

USB thumb drives have become the sneakernet’s backbone, the result of plummeting prices and burgeoning capacities for flash memory. These tiny wonders are spacious enough to store an OS installation with room to spare for user data; however, they are also inherently insecure. Although vendors have addressed this shortcoming with drives incorporating hardware encryption chips, these haven’t yet achieved mass acceptance. Small USB devices have also become a common vehicle for delivering secure, two-factor user authentication.

Wouldn’t it be nice if secure storage and authentication features were combined into a compact Swiss Army knife of security? A relatively new class of products, PPSDs (personal portable security devices) “combine the flash storage of universal serial bus thumb drives with the access control and secure storage capabilities of the smart card,” says Burton Group Senior Analyst Mark Diodati. “PPSDs leverage the USB form factor, use hardware cryptographic processing to provide smart card and one-time password device services, have secure storage capabilities, and reside in a tamper-resistant container.”

The real security magic comes from the synergistic integration of the two sets of capabilities; for example, users cannot access the flash memory without first providing strong authentication. Diodati adds, “The PPSD overcomes two issue— the limited storage capability of smart cards and the relative insecurity of USB flash drives. Larry Hamid, CTO of MXI Security, says the combination allows “a device that serves multiple security functions.”

PPSD Features

Furthering the theme of convergence, PPSDs also incorporate several strong authentication technologies. Like traditional USB tokens, PPSDs embed a certificate-based smart card in hardware; however, they add a software-based OTP (one-time password) generator. Unlike SecurID tokens, most PPSDs don’t sport a display; thus, to generate and view the password, users must plug into a PC’s USB port and run an embedded application. This makes PPSDs problematic for use on public kiosk PCs where the ports are usually disabled. Like USB security tokens or smart cards, PPSDs can hold any number of certificate-based credentials for Windows login or PKI (public key infrastructure).

PPSDs pair their strong authentication features with gigabytes of flash storage. Hardware-based encryption is accomplished via a symmetric algorithm such as AES, and, while standard USB flash drives can be encrypted with software, they are arguably less secure. In addition, PPSDs are tamper-resistant because they use their internal smart card to store encryption keys and an embedded chip to execute the encryption. Some PPSDs also support biometric authentication via an integrated fingerprint reader for added security.

Advantages & Usage Scenarios

Like plain-vanilla flash drives, PPSDs have benefitted from dramatic increases in flash memory density and are available in capacities from 1 to 16GB. Such abundant storage enables some intriguing applications, according to Diodati. He sees PPSDs as an ideal way to protect mobile professionals via solutions such as hosting a complete virtual desktop OS, “hardened” business applications, Web browsers, or SSO (single sign-on) systems.

For example, using software, users can carry a fully customized Windows Desktop environment on a USB stick. Similarly, some let users install and run individual applications directly from a USB drive while leaving no traces behind on the host PC. PPSDs enhance these portable application environments by running them within a much more secure framework.

PPSDs look like the perfect security multitool, so what’s not to like? Unfortunately, according to Diodati, “the functionality of the PPSD comes with a price.” He explains that extensive processes are required to initialize devices for a particular organization, customize and personalize them for users, and bind their security credentials to internal directories. Although vendors provide administrative tools to automate these tasks, Diodati notes these often aren’t the end of the story. “Additionally, a smart card management system is required for most deployments, adding to the cost of the PPSD deployment.”

Cost vs. Alternatives

Aside from the administrative overhead and costs of ancillary software such as a CMS and OTP system, PPSDs themselves aren’t cheap. For instance, 2GB devices run around $150 with 4GB devices pushing $200. Compare that to a 4GB flash drive bundled with software encryption for less than $30, and it’s tough to justify the PPSD’s six-to-one price disadvantage if all one needs is secure storage.

The mobility of today’s workforce opens enterprises up to more security risks, according to Hamid. “You either have to compromise security [or] compromise functionality.” He sees PPSDs as a technology that can make security simpler, more portable, and less burdensome. Hamid believes carrying applications or entire desktop environments on a secure PPSD could emerge as an important new security model for mobile users.

Diodati is equally enthusiastic about the market potential of PPSDs but believes they need further development. “While the PPSD has the opportunity to be a stronger authentication market disruptor, the price must come down.” He’s also concerned about the complexity of PPSD deployment. “The orchestration of smart card management systems, key management/recovery, Active Directory, and PKI will remain a daunting task for most enterprises in the foreseeable future.” Hamid agrees that costs are a problem but promises new product lines “with drastically reduced pricing.”

Although the integration of strong authentication credentials and copious encrypted storage in a key fob-sized device promises to enhance and simplify mobile security while giving new meaning to the notion of a “mobile desktop,” the nascent state of PPSD technology means that it’s more appropriate for evaluation and prototyping than large-scale deployment. As hardware costs continue to plummet and management software matures, PPSDs could revolutionize the mobile security landscape.

by Kurt Marko

Key Features Of PPSDs

• Strong authentication via public key certificates or one-time passwords

• Native, hardware-based file encryption

• Portable single sign-on via the ability to carry both a user’s SSO credentials and an on-demand enterprise SSO system

• Ability to securely host a complete portable desktop environment

• Ability to securely carry portable applications, particularly a hardened browser with a restricted operating environment and secure configuration

Source: “Postcards from the Enterprise: The Authentication Experience”; Mark Diodati; Burton Group

America needs to embrace the Future

Back in 1993 I had the opportunity to help in forming the working group who developed and ultimately published the EMV Smart Card Specifications for Credit and Debit Cards.  Since then, as a member of the Europay and Visa Canada executive teams I promoted the virtues of smart cards and the business case for EMV. 

As a consultant, one of the focuses of my practice is EMV.  In both Europe and Canada I counseled executives on the what, how, when, business value and future opportunities of EMV, smartcards. mobile payments and internet payments

One question has always been asked of this American – “when will the USA migrate”.  Up until recently I was stuck, giving bland answers.  I suggested that we would have to wait until after fraud migrated to the USA,  away from EMV protected countries.  I tried to explain to people, committing comparable sums of money, that  the size of the investment required of US Issuers, Acquirers and Merchants is enormous and frankly cannot be justified. 

Why they ask,  simple economics I answered.  I explained that when one looks at the  quality of the fraud management systems in place, the level of on-line authorization and the losses incurred; it simply does not make sense.

Debit is the real reason to Migrate to EMV

In 2007 I was working with “The Exchange”, a Canadian network that supports sharing of ATM services such as deposit, bill pay and account to account transfers.  The focus of my work was to help them to understand the implications of EMV and to work with them to develop their go forward strategy. 

Part of the research led me to talk with the Fiserv, the Brand owner and their strategic partner.  While discussing what the Canadian entity needed to do with the America responsible for the USA Exchange and Accel network; the conversation drifted to when will the USA move to EMV.

What sat front and center inour discussion is the American banks that issue PIN Based Debit Cards have a much stronger rational to migrate to EMV than the credit card and signature based Debit issuers.  In the PIN Based Debit arena the “reputational risk” has and will continue to be the real justificationfor the migrate from magnetic stripe to Chip and PIN.

Why you may ask.  My answer is simple.  The cost to a criminal to install a fascia and PIN hole camera on an ATM, capture the magnetic stripe and PIN; offers these international criminals a very rewarding business case.  They are also funding aggressive operations that embed people into factories that produce magnetic stripe and PIN Pads with the imbedded capability of capturing and transmitting the magnetic stripe and associated PIN to the Mafia

Reputational Risk is the catalyst

 

So how does this affect “Reputational Risk”? 

1.       When the criminal perpetrates debit card fraud, they focus the attack at ATMs the cardholder would probably visit.  The Issuers’ fraud management systems are finding it hard to differentiate between a valid transaction and a fraudulent transaction, so out pops the cash, 100% fungible no need to fence the goods and cheaper and more profitable than robbing the bank

2.       Weeks later the cardholder notices that there is not as much money in their checking account as they expect and they call the Bank’s call center.  The argument follows – But only people who know your PIN can withdraw funds from your account, who did you tell your PIN to, your ex, your children …

3.       Eventually after a lot of time explaining, crying, shouting and generally getting on each other’s nerves; the Bank’s customer service agent will final accept that the cardholder did everything to protect the PIN and card; so the bank will reluctantly restore the funds to the cardholders account.

4.       Bottom line the cardholder feels that the bank does not care; their systems are not safe and the cardholder is now afraid to use their debit card.  The Bank and its ATM network are now at “Risk”.

No one should be surprised at this form of attack.  I knew and teh media presented the realtities of such attacks back in 1994.  As the size cost of the equipment shrinks and the capabilities of technology expands the incidence simply increase and proportional to the rewards.

To put a point on my analysis; when most countries decide to migrate to EMV it is not the Credit side of the cardholder relationship that seals the deal for the CEO and senior executives.  It is the Debit side that pushes the bankers to say yes we must migrate to EMV.  MasterCard and Visa,  who participant in both credit and debit, want the publicity.  Whereas the debit networks would prefer to not talk about the problem.   End result we are left thinking credit cards drive the migration to EMV.  Compounded by the reality that for credit cards in the USA, there is simply not a business case.

For the US banks to come together to decide that EMV is the right thing to do; there must be a place where the Issuers and Acquirers can come to terms with the cost and agree on an equitable way to fund the investment required.  For the debit card side of the Banks there is not an obvious place to have this discussion.  Most PIN Debit networks are either regional or owned by publicly traded organizations.  There does not appear to be a common forum capable of bringing the executives together to agree and commit.

Migration to EMV is expensive – YET really it is not

 

Everyone talks about how expensive it would be for America to migrate to EMV. 

Yes if we are to approach the migration with the Big Bang theory it will be ridiculously expensive.  Instead what the powers that be should agree is that all cards and terminals will be EMV by say 2019, ten years.

Let’s acknowledge that most of the major acquirers and processors have already implemented EMV on their international platforms; so the implications are understood and if they where intelligent when upgrading for Canada, England, Europe, Latin America, Middle East and Asia, they should have considerted how to cost effective assure the inclusion of EMV on their American platforms, someday. 

So now they simply have to add it to the list of requirements that will be included in one of the yearly upgrades, or, as part of their technology replacement plans.  Remember we are saying EMV in 10 years. 

Ten years is a long time when we think about technology.  Therefore they have no justification to argue it is punitive to force them to implement EMV.

On the terminal side we must remember that for the merchant there are only intangible benefits to implementing EMV.  Yes, like MasterCard Visa etc, EMV can be positioned as the cost of doing business and included in one of the compliance upgrades. 

Or, if we are intelligent, we say to the ATM operators, merchants, ISOs and acquirers, the next time you upgrade your point of sale system - buy an EMV compliant PIN pad and include EMV as one of the requirement for the systems that drives the device and transmits the approval requests and clearing records to the acquirer. 

Any ATM/POS supplier who sells outside the USA has EMV devices in their catalogue.  All the Value Added Resellers who sell international have support for EMV within their software.  NCR, Wincor-Nixdorf, IBM, EFunds, ACI, S1 … all support EMV.

With this plan in place, over time EMV will progressively be enabled at the point of sale. with minimal cost impact.   Yes the vendors will have to be told to play nice and not exploit the opportunity.  Yes for merchants that attact significant International clientele they should migrate sooner.  Yes, locations that are known to be high risk merchants they should be made to implement EMV sooner. 

This leaves the Issuer with an easy question to answer, when do I add an EMV chip to my card.  Well the answer is easy and it is complex.  On the simple side, when they think there are enough terminals to achieve the fraud saving then do it.  Or, we can add the contactless and mobile payment dimension and start talking about Combi cards, embedding EMV into the handset, considering Multi-application opportunities.  I’ll talk about that another day.

Agree to move and give people enough time so that there is no pain

 

Bottom line my message to the US market is the question is no longer about who will pay it is simply about how much time should we allow everyone, so that the incremental cost is irrelevant.

 This Blog was driven by reading a recent review from CTST

U.S. getting squeezed by EMV  Wednesday, May 6, 2009 in News

http://www.contactlessnews.com/2009/05/06/u-s-getting-squeezed-my-emv

With Canada and Mexico both going to EMV and most of the rest of the world doing the same it may be a matter of time before U.S. card issuers are forced to go to chip and PIN. EMV in the U.S. was the topic of a panel at the CTST Conference in New Orleans.

Shortage of Doctors Proves Obstacle to Obama Goals

By ROBERT PEAR 27 April 2007 the New York Times

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

I wonder if Congress should instead focus on improving the income of doctors, reduce the fear of Mal-practive and insisting on deepening their education.  So that people will once again see it as a worthy profession and thus there will be enough doctors to serve our growing population, not simply here, but all over the world.

 As the Grandson, son and brother of doctors, I am driven to suggest to our Congress and the people that we must consider the investment someone must make to becoming a care practitioner and realize that we must encourage people to want to dedicate the time it takes to become proficient.  These dedicated individuals, unlike CEO’s and Wall Street millionaire, must excel in their studies and invest  four years at university, four years at  medical school and then finally before having the skills to serve us, invest an additional three to six years as a journey man (i.e. their their internship and residency).  Hundreds of thousand of dollars later and so much time and study does desire a fair reward. 

I also believe that we should begin to think about training our internist better, so they can be more effective and not simply pass the patient on to a specialist.  they as the gatekeep should have the education and practical training so unlike today thare are able to properly diagnosis the problem we the sick are facing. 

Simply look at the TV series House.  his dedication and effectiveness of his team is what we need.  People who truly think and only turn to specialists when they fibnally accept that the specialists skills are required.  Just to put a value to House.  my father a retired Park Avenue and renowned diagnostician finds this one medical program stimulates his thinking.

The other key issue that Obama and Congress must address is that medicine should be a cottage industry.  Instead corporations and insurance companies now run our health care system, Hillary Clinton’s efforts, although altruistic, probably drove corporations to seek profits at the expense of the real care-takers and unltimately you and I.  These new “medical?” tycoons are more worried about shareholder returns and annual bonuses than the health of the people who should be their focus and are in their care.

Is it a national health system that we need simply to “FIX” the problem.  Or is it a return to a system run by doctors who are properly trained and rewarded. We should think first of investing our taxes on helping the gatekeepers (family practitioners, gynecologist and internists) to be the front line, capable of dealing with most medical issues.  We should encourage their selfless commitment and  drive for education and practical training so they can effectively serve, thus drive down costs by being better at what they do.

Finally thought.  Risk is endemic in any system.  Lawyers drive risk out of the system by pursuing law suits because someone took at risk or was just like the rest of us a made an error.  The net result,t doctors have become overly cautious, dependent on too many tests and unwilling to say this is what I think is wrong and if we don’t do something (however risky) now MY patient will die.