Dana Blankenhorn

Health Care Mystery Solved

Around the time Barack Obama became President, I ran a health IT beat for ZDNet.

One point hammered home to me was that 75% of America’s health care bill relates to chronic conditions. These are things like heart disease, diabetes, and complications from smoking or drinking.

The way to cut the bill is through preventive care, I learned. Make sure people see a doctor regularly. Use those visits to monitor their condition, to hector people about their choices, and to get us to take our medicine. Keep us out of the hospital and everyone wins.

Obamacare covered that, for most people, especially those on Medicare. It also covered the cost of computerizing clinics and hospitals. While too many people are still forced to fill out too many forms, there are now electronic records on most of us. Hospitals can find out what patients are supposed to be doing and (through test results) whether we’re doing it.

The Alzheimer’s Scam

A decade ago, when I first returned to the business beat, a company called Dendreon began pushing a non-cure for prostate cancer called Provenge. 

The idea was to fit a therapy specifically to a patient’s DNA. This cost a lot of money. While Provenge did extend life, it was only by a few months. For this Dendreon wanted $93,000. 

If I had all the money in the world, I’d pay that. But if every prostate cancer patient could force insurers and government agencies to pay that, the system would go broke. You can’t have an unlimited draw from a limited pool of funds. (To the right, at the upper right, is my late mother. I learned recently she taught the first "integrated" second grade class in California history, in 1947. I am very proud of her.)

Fast forward to today. Eli Lilly and Biogen have developed drugs to treat Alzheimer’s Disease.

That 2002 Feeling

The last tech crash began in 2000 and I was in the center of it, a mid-career writer with a specialty called Internet Commerce.

That year saw denial and bargaining.

The next year saw anger and depression.

It was only in 2002 that acceptance came.

We know what followed. Talented programmers worked on open source projects and standards bodies created what became the Cloud. When proprietary advantage became worthless, and there seemed there was nothing to do, people worked together with technical goals in mind rather than just financial ones.

It was a slow build. In 2002 my gross income was zero dollars. In 2003 it was zero dollars. I got interested in what’s now the Machine Internet, which I christened the World of Always On, and in 2004 I finally made a few dollars. The next year I was asked to cover Open Source, and my career took off. For a time.

I’ve mentioned before how, in every photo of a stock market crash the people in it look similar. Similar age, similar backgrounds. They’re different people. Those who watched the 1987 crash were different from those who saw the 2000 crash, different from those who saw 2008, different from those who saw 2022.

Where Computing Happens

I met my first computer in 1976, in the basement of Herman Brown Hall, on the campus of Rice University in Houston.

The computing happened in a big room, separated from me by a window. I passed a stack of punch cards, tied with a rubber band, through the window. They came back along with my output. Which usually said the program had died on Line 3.

By the time I got out of journalism school, two years later, computing was moving to desktops. A neighbor bought a $20,000 Cromemco machine that could run 3 terminals. She hired friends to work at the terminals, transcribing court records. I think they got 50 cents a page. Computing had come home.

The Limits of Senior Power

If I were around 100 years ago, I would be dead. Instead, I’m rich. (Pictured are my grandparents, May and Edmund O'Donnell, in 1918.)

It’s a demographic and economic transformation that is destroying hope for change in America and (perhaps) making us the last generation.

Until recently, people lived their first 20 years dependent on parents, the next 20 as parents, the next (if they were lucky) 20 as grandparents and anything past that dependent on the children. Most of the world still lives this way.

But starting with Social Security in 1934, and continuing through general prosperity to today, America has turned this on its head. Seniors aren’t just living to an average age of 83, we’re doing it with money. I’m just a 68-year old journalist but, thanks in large part to a wife who works in tech, I’m a millionaire. We own our house. We have enough invested to guarantee a fine retirement, God willing. There may even be something left when we’re gone.

This has changed political incentives. There’s no better example than Florida where The Villages, a huge retirement town of 150,000 (almost all of whom vote), has turned the state’s politics on its head. Add them to those already living up-and-down the state’s east, west and south coasts, and you get a huge state entirely devoted to short term thinking. Education, the environment? Fuck ‘em. We’ll be gone.

The Word for 2023 is Efficiency

If you can save costs, in business or consumer markets, you can make money.

This is technology’s big opportunity in 2023.

The cloud has already transformed how people interact. It’s now going to transform how machines interact.

Sensors and network software can be applied everywhere. Thanks to falling chip prices this can now be done cheaply. There is labor available to write the software, build the companies, and reap the rewards.

Consider the water system. Why aren’t sensors monitoring the condition of pipes, warning of potential failures, and identifying leaks the moment they occur? Why are water authorities still depending on people finding cracks in the street with water coming out of them on their own?

The Trouble with E-Bikes

A month ago, I bought an e-Bike for the family. The Lectric 3 is a great value at $1,000. It folds to fit into a trunk, gets 20 miles of hills on a charge. It can do our shopping, my son’s commute, and even get me back to Stone Mountain next year.

Meanwhile, one of Atlanta’s city councilmembers has introduced an e-Bike rebate program. It’s an effort to accelerate uptake, which barely needs the stimulus.

But before the revolution, we need to talk. There’s trouble coming to River City.

You can already see it if you ride the Beltline, which Atlanta advertises as its ticket to the future. The Beltline is a long sidewalk that sits on old railroad right of way. By the end of the decade, it’s supposed to run all the way around intown Atlanta, 22 miles in all.

I love the Beltline. I love the idea that the city is building paths leading to the Beltline. I love the idea that e-Bikes could force planners to assume less inner-city car traffic.

But…

Positives of a Tech Recession

Despite some stunning investment losses, I’m enjoying the latest tech recession.

No one likes a recession, but sometimes it’s like spring cleaning, necessary to clear the excess. There were a lot of zombie technologies, zombie companies and zombie assumptions that have been overrun since the Fed decided that money should cost money and there should be less of it around.

Web3, the metaverse, and crypto were all fake from the jump. Advocates for streaming and podcasting didn’t understand that the gating factor is time, not money. A lot of companies were selling themselves based solely on sales growth, ignoring the need for profit.

This means there’s now opportunity, in the form of talent, for new ideas that will power the economy forward. The main trends I described in 2019 – the end of oil, the Machine Internet, and DNA as a Programming Language – they’re still on. But there’s a lot more, too.

Urban Game Changer

I’ve been a bicyclist my whole life. My present one dates from 1981, and it works great. (Here it is in Centennial Olympic Park last year.)

I know most people aren’t me. Bicycling remains a niche activity. Bike lanes are rare because there is little demand. Rail lines scale, but they’re inflexible. Cars offer comfort, but roads don’t scale. The urban environment is little changed from when I came to Atlanta in 1981.

I’m getting older. At 67, the heart rate needed to maintain a good speed for a half hour is near my limit. All I’m good for at the end of 10 miles today is a nap.

But electric bikes are a game changer. I finally bought one this week, a Lectric 3.0. It unfolded from its box in about an hour and took no tools to set up. The battery runs 20-40 miles between charges, for which you use a 3-prong wall plug and a power supply just like your old laptop. Anyone can get it to go 10 mph, even over hills. You can buy a passenger seat or grocery baskets.

The Time to Buy

The time to buy a bear market depends on your time horizon and your risk appetite.

If you’re in your early 30s, for instance, it’s a great time to buy the U.S. stock market. Stocks are at pre-pandemic levels, including some companies that still have great growth prospects. Most of the Cloud Czars fall into this category, as well as cloud applications like Salesforce.

If you’re in your late 60s, like I am, you should probably hold off. You still want to maintain enough cash to get through if things turn south, as the ultra-bears insist that they must. But ultra-bears are wrong. Markets do bottom, and they do go back up. If we’re about to have nuclear winter, cash won’t save you.