As a result, I was gratified to see an incredibly incisive and thoughtful article on this subject by Dr. Atul Guwande of Harvard Medical School in the August 2, 2010, issue of The New Yorker. The subject of end-of-life care for individuals with terminal illnesses or diseases is not a new one, but Guwande brings new insight to it.

For example, he points out that many people have the mistaken belief that more intensive hospital-based care generally prolongs life, whereas hospice care shortens it.  Hence, many people make the decision to employ all possible life-prolonging measures for themselves or their loved ones, believing that, in so doing, they are buying time for something else to work on their behalf.  Yet Guwande states:

“Like many people, I had believed that hospice care hastens death, because patients forego hospital treatments and are allowed high-dose narcotics to combat pain.  But studies suggest otherwise.  In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure.  They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer.  Curiously, hospice care seemed to extend life for some patients; those with pancreatic cancer gained six weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.”

The second point Guwande makes is that there is often a trade-off between extending life and being mentally alert: those who receive hospice care are often able to manage their affairs without losing mental alertness, and are able to make plans for themselves and others with competent professional assistance.  Those who receive hospital care are often in situations in which they are removed from loved ones, lapse into unconsciousness, and experience completely debilitating pain and discomfort.

We tend to think of end-of-life issues mostly in terms of the elderly, but Guwande’s story focused on the terminal illness of a woman who was delivering her first child.  What none of us can know is whether, by opting for more aggressive treatments, she and her husband missed opportunities to discuss longer-term questions about the dying mother’s preferences as to how her daughter would be raised.  I lost a wonderful cousin to breast cancer 22 years ago when she was 41 years old.  She left behind a husband and a 4-year-old daughter when she died.  However, she had ample time and alertness to have many discussions with her husband that enabled him to gain the value of her insights on raising a daughter to adulthood as a single parent. The value of those conversations was incalculably large, but, in many instances, aggressive hospital care makes these conversations almost impossible to have.

The question Guwande’s observation begs is: why, if the more aggressive treatments shorten life, reduce the quality of life, and reduce the ability of patients to spend valuable time with loved ones, would patients choose more aggressive treatments?  He gives two answers:

• Every prognosis for a terminal disease contains a traditional bell-curve distribution with an average life expectancy for the patient, but with wide variations from a few weeks to years or even decades.  Although the size of the curve for those with the disease living a very long life indicates that few people survive for a long time, many people convince themselves that they will be the exception, rather than the rule.  When they opt for aggressive, expensive treatment, they are effectively buying a lottery ticket for the biggest jackpot of all, a long life, but often with the odds associated with buying a lottery ticket for a $200 million lottery prize.
• Physicians, either out of desire to keep up hope for patients, or out of the desire to keep patients from going elsewhere for treatment, or because they simply do not know the appropriate life expectancy, routinely overestimate survival times, often by over 500%.

Guwande pointed out that people seem willing to explore hospice options, as long as more aggressive treatment options are not foreclosed to them.  He cites a Johns Hopkins pilot program that reduced hospital care and costs for patients who opted for hospice care, but knew that they could receive hospital care at any time.  He recommended that Medicare and other health plans eliminate the irrevocable either-or decision for terminally ill patients.

He also has an interesting set of recommendations for changing the decision criteria and process for patients opting for end-of-life decisions.  Clearly, getting individuals to discuss their options with physicians and loved ones in advance is preferable to getting decisions made when a person is already terminally ill. That recommendation is not new.

However, the insight he brings to it is that the dialogue is as much about giving reassurance to the loved ones as it is to getting a particular decision from the patient.  Even loved ones who want to respect the wishes of the patient will feel guilty using less than the most aggressive treatments.  The discussion that, in advance, addresses their deepest concerns of guilt is extremely productive.  Similarly, a discussion between the patient and the physician, which helps the physician understand when being overly optimistic or recommending the most aggressive treatments is not helpful to the patient, is also desirable.

How do policymakers avoid getting caught up in the “death panel” trap?  The simplest answer is to broaden the dialogue beyond end of life treatment discussions.  There are many circumstances in which individuals are incapacitated and unable to register their preferences when a situation is not life threatening, but decisions have to be made quickly.  For example, the physician often encounters something unexpected during a surgical procedure when the patient is under a general anesthetic.

There are also many situations in which all treatment options are imperfect, and in which there is no ability to get a better answer even after all medical risks and probabilities are assessed.  This is the current situation with prostate cancer treatment options.  The discussion about the patient’s broader values and preferences is probably one that cannot be handled fully at one time or in one circumstance.  It would be most helpful for health plans and Medicare to cover an annual discussion that is free flowing and that simply enables a physician to get to know the patients far better than he or she can in the context of individual office visits designed to diagnose, treat, or decide on a treatment option.

Although many people legitimately criticized those who raised the “death panel” argument, the “death panel” advocates’ concerns could have been addressed, and the right kind of dialogue could have taken place if it had been framed as a way of increasing patient empowerment, as opposed to a piece of a larger program to increase government control over the health care system.

Nevertheless, the biggest conceptual breakthrough toward which Guwande takes us is that more aggressive care is not better care, and, in many end-of-life situations, it may actually shorten life and worsen the quality of the life that is led immediately before death.  Moreover, because of the inability of patients to engage with loved ones on transitional issues, it may have negative long term consequences.

Government officials have become more risk-averse over time, and less effective as a result, precisely because, in varying degrees, they are judged by different standards from private sector employees.  Over a decade ago, I had dinner with an executive who had been fired by the U.S. Postal Service, after he had worked in the private sector for a good part of his career.

His observation about being a government executive was that the highest risk situations for a government employee were either unwanted media scrutiny, the threat of a government investigation, or the threat of a Congressional hearing.  There was another long-term Postal Service executive who was fired a few years later because of a relocation package he received, which received excessive media scrutiny, even though it had been approved by the Postal Service’s Office of the General Counsel, its chief ethics officer, and the Inspector General.  One thing I learned about the Postal Service is that, after a 1992 scandal involving vendor-related events at the Barcelona Olympics, it operated at the highest ethical standards.  The firing was unfortunate, but the Postal Service apparently felt that it had to eliminate even the appearance of ethical problems.

The trouble with the Sherrod firing, as well as other incidents like it, is that as Mr. Jones put it most eloquently:

“Life inside the Beltway has become a combination of speed chess and Mortal Kombat: one wrong move can mean political death. In the era of YouTube, Twitter and 24-hour cable news, nobody is safe. Even the lowliest staff member knows that an errant comment could wind up online, making her name synonymous with scandal.

The result is that people at all levels of government are becoming overly cautious, unwilling to venture new opinions or even live regular lives for fear of seeing even the most innocuous comment or photograph used against them, all while trying to protect and improve the country.”

Not only is he right, but, unfortunately, the Sherrod incident will be remembered for a long time, and will affect behaviors all over all levels of government.  Government officials and employees will attempt to figure out not only whether what they said or did could get them into trouble, but whether someone could misinterpret and distort words or actions to hurt them.  They will refrain from doing or saying something, rather than doing something that needed to be done.

I had that experience a few times while I served as CEO.  It was unnerving.  People literally heard something different from what I said, and, on two occasions, an otherwise competent and well-meaning attorney told me that the company could get into trouble not only for what I said, but for what people incorrectly thought I said.

Having people live in perpetual fear is a bad way to run government, business, a non-profit organization, or any other grouping of people.  It is a bad way to force people to live their lives.  The notion that people should be held accountable for distortions that other people might create or project on to a situation is dangerous.

The Obama Administration has to realize that it did severe and probably irreparable damage to the effectiveness of government at all levels, and needs to pull back from knee-jerk behaviors based on appearing to defend the highest standards of ethics and race relations.  It actually achieved the opposite effect: individuals will be scared to talk constructively about race issues in situations in which a dialogue could help race relations.  Moreover, the impact will be felt in a wide range of other situations and on a wide range of other issues.

The President should take the step of framing how he thinks about the level of initiative he wants from government employees, and have a concrete set of actions, which he should announce in a prime time nationally televised address.  He should then follow through on his commitments, and make it clear to government employees that a misinterpretation and distortion by someone else will never again subject an employee to disciplinary action.

I may come across as an alarmist, but I really think this situation has far more serious consequences than might first meet the eye.

Wooden won the NCAA championship with a very small, fast team in 1964 and 1965, with two dominant centers, Kareem Abdul-Jabbar (then called Lew Alcindor) and Bill Walton, between 1967 and 1973, and with a team of physically strong forwards and guards in 1970 and 1975.  He made his team the center of attention rather than himself.

What were his secrets?  Every successful college coach has to be a great recruiter, a great team builder, a great teacher, and a great game coach.  However, what struck me most about Wooden was a quote about him in the June 14, 2010, issue of Sports Illustrated, in an article by Alexander Wolff entitled “Remembering the Wizard, ” as well as a quote on a sign he posted on his office wall.

The quote about him was “His great strength was a knack for knowing when and what to change, and when to leave things be. He let sands shift, but only over bedrock.”  The quote on his office wall was “It’s what you learn after you know it all that counts.”  The combination of these two statements is the essence of a great human being: someone who continuously learns and tests his or her ideas, and, through continuous learning, discovers what changes, as well as what is unchangeable.

The stakes for continuous learning have been raised by the scientific research summarized by David Shenk in his book The Genius in All of Us. The research to which Shenk refers us makes it increasingly clear that what we thought were genetically-determined traits in ourselves and our children and grandchildren may very well be changeable, based on our behaviors and attitudes. Shenk’s point is that, by our actions to learn, grow, and become healthier, we can alter the genetically-expressed traits in future generations, especially for future offspring or for children still under our environmental control.

In this stage of my life, I have transformed myself from a secure corporate executive to a person who is engaged in a number of entrepreneurial pursuits.  Although my life is at a more frantic pace than ever before, I feel more energized and healthier than ever.  I am making mistakes left and right in my new pursuits, which include investments in health care companies, charity service providers, a reality TV incubator, and even two full-length feature films, one of which is fully produced and is Fog Warning, and the other of which is at the pre-production stage through a newly-formed production company called Gyre Entertainment.

The words describing John Wooden ring true to me because virtually every transformational success that occurred in my life happened because I broke the rules and followed a path different from those who seemed to have mastered conventional paths to success that were no longer working predictably.  I am particularly finding that today in the film industry.  No one in their right mind would say that anyone in the film industry has a working formula for success.  Most films fail, andmost investors never get their money back.

The most successful film industry people with whom I have spoken are respected because they have a less poor record than others, and, perhaps, had a single blockbuster hit or a single Academy Award nomination that validates them.  There is an old (and, as expressed, politically incorrect) statement that “In the land of the blind, the one-eyed person is king.” However, I aspire to be consistently successful, not to get a hit 1 in 10 times, so I know that I need to use a radically different approach to making and distributing a movie.  Similarly, the person who is successful 10% of the time is a failure in my book.

The movie industry reminds me of the direct mail business, in which direct mailers celebrate a 1% response rate as an exceptional success in an industry in which the average response rate is .25%. To me, a 1% response rate is an abysmal failure. It means that 99% of the people threw the mail into the wastebasket without responding.

What do these two industries have in common and how is John Wooden’s wisdom relevant to both?  What they have in common are a lot of relatively successful and wealthy people who depart from Wooden’s maxim that it’s what you learn after you think you know it all that matters.  These industries are dominated by people who stop learning after they “know it all” because they achieve a certain level of success.

I am not wired that way.  I strive to succeed all of the time, although I know that is impossible, simply because I know that striving for continuous success means that I will approach a problem radically different from the mainstream people in an industry.  I also know that many of them will ridicule me, and tell me that what I am trying to do will not succeed.  Their deep skepticism often is grounded less in logic or facts, but in a deep-seated need to believe that their approach is unassailable, even if it fail 90% of the time (as it does in entertainment) or 99.75% (as it does in direct mail).

How do we distinguish between what must change and what is foundational, something John Wooden understood in the context of basketball coaching and educating?  First, anyone who tells me that they have a consistent playbook or formula for success that has worked for several decades is automatically suspect.  Similarly, anyone who tells me that all the rules that have governed the past no longer apply is also suspect.  The current and future environments will always be a mix of the new and the time-tested.

Second, I am immediately suspicious of someone who tells me that a product or service that depends for its success on the stupidity and irrationality of the public is also suspect.  As Abraham Lincoln once said: “You can fool some of the people some of the time, all of the people some of the time, and some of the people all of the time, but you can’t fool all of the people all of the time.”

Third, I get suspicious of anyone who tells me success is totally random or totally formulaic and predictable.  Fourth, I get suspicious of anyone unreceptive to my ideas because I am new to a field. Someone who judges me based on my track record rather than the strength of my ideas will undervalue what I am saying or proposing. Finally, I value entrepreneurs or thinkers who continually test out their thinking and adapt, based on what they learn. Transformative thinkers are highly secure people who are not scared to admit they might have been wrong.

John Wooden has left this earth, but, fortunately, his example and his teaching will stay with us and be available to inspire and teach us forever.

“Good-paying jobs don’t come from bailouts.  They come from start-ups.”  Will start-ups address our structural unemployment problem?

Yes and no.  They will be a great solution for well-educated, enthusiastic young people who are currently unemployed and perhaps discouraged about prospects for jobs and careers.  Without some additional interventions, they are not a good short-term or even medium-term solution for older workers who have lost their jobs at big companies or government agencies.  As the former CEO of a big company and the current chairman of one start-up business, Dossia, and a board member or investor in several other start-ups, big company or government and start-up jobs and work situations are radically different.

Job Scope and Definition

Government and large companies attempt to create and manage well-defined jobs with clear accountabilities and boundaries between jobs.  They do not particularly like to have people take on work beyond their job description and like the comfort of evaluating people against fixed responsibilities.  Likewise, people who gravitate to government and large company careers like predictability and clarity in their responsibilities.  This is especially true in most unionized public sector organizations, which not only have a bias toward clarity and specialization that arises from the collective bargaining environment, but have the added component of bureaucratic rules established under civil service guidelines.

In the start-up environment, the needs of the business overwhelm the tasks defined in a job description.  Employees do whatever it takes to get the job done, and have to be flexible in how they do their jobs.  They tend to be paid for organizational results, so role clarity is irrelevant.

Unfortunately, our society has bred and developed a mindset among many older people that they should stay within the four corners of their job descriptions and the work rules associated with them. In fact, the territoriality of many big-company or government workers causes people to be criticized if they try to do someone else’s job. They are initially very poorly equipped to work within a start-up environment.

Doing Tasks Directly or Delegating Them

Governments and other big organizations breed in their employees a fear of taking on tasks that experts or specialists are assigned to do.  This is especially true of professional functions like IT, finance, engineering and technology, law, and now even HR.  The more specialized the body of knowledge, the more people in big organizations are taught to believe they must seek help beyond what they can do themselves.  As a result, they delegate to the “experts” and add a lot of cost to an organization.

Government and other big organization managers also believe that being able to delegate tasks is a status symbol.  I remember an older manager telling me as the CEO that I should never take notes at a meeting because that was what secretaries were for. Of course, he remembered less of what happened at the meeting than I did, because I had good notes and he didn’t, and I had a much better ability to diagnose and strategize because of the superior insight a review of my notes yielded.

Start-up employees think in exactly the opposite way.  They do tasks themselves if they believe they can, seek free help as much as possible, and outsource relatively narrow tasks to experts to keep costs down.

I found that when we transferred sales managers from the U.S., our largest market, to small overseas operations, there was an inverse relationship between the level of managers we transferred and their success level.  The first-line supervisors or even individual sales professionals we transferred overseas were generally successful because they were used to doing tasks themselves, which was required in small international operations.  The more senior sales managers had a far more difficult time because they had gotten out of the habit of doing things themselves, and were intimidated by the prospect of relearning hands-on tasks in a foreign country.

I question whether someone who has comfortably worked in a big company environment and who has been actively discouraged from doing tasks themselves and been encouraged to “delegate” to others can quickly adapt back to being hands-on.

The Degree of Formality and Standardization of Tasks and Processes

People in government and big companies are schooled to believe that standardization and process uniformity are critical, and that auditable, standard ways of doing things are preferable to more informal and variable ways of doing things.

In start-up companies, tasks are accomplished based on speed, flexibility, low cost, and revenue enhancement.  People are rewarded for the end result of what they do, and generally are less concerned with its auditability and formalization.

One example of the difference is how big and small organizations handle travel arrangements.  At Pitney Bowes, we use a single travel agency, HRG North America, to make all of our arrangements.  HRG, which was unsurpassed in providing travel services to large organizations, secured discounts and committed to do business with a handful of global air carriers, hotels, car rental agencies, and other travel service providers.  Even if someone could do better on their own by going to an online site like Travelocity.com or Hotels.com, they were actively discouraged from doing so.

Our travelers in the start-up businesses use online auction sites to find the lowest price, change arrangements from trip to trip to maximize flexibility and lower cost, and absolutely do not want to make a commitment to a small number of vendors.  They manage overall operating expenses, not travel savings against a specific procurement target set with an outside agency.

Older employees who suddenly have to make their own arrangements take time to learn how to be most cost-efficient, because they have been kept away from these processes in the bigger organization of which they are a part.

Adherence to Budgets and Plans

Governments and big companies are heavily driven by annual budget and planning cycles, and reward employees for adhering to the discipline of a budget and plan.  Compensation programs are organized around annual plans or multiple-year programs built from annual plans.

In start-up businesses, budgets and plans are starting points and they are modified rapidly and frequently as conditions change.  By the nature of the environment in which start-up businesses find themselves, their ability to predict the environment one quarter out, much less one year out, is nonexistent.  People get rewarded for how they respond to emerging conditions, not by how well they adhered to a budget or plan established at the beginning of a year under very different conditions.

Once again, I wonder how people schooled in a more static budget and annual plan driven environment can function in a much more dynamic situation.

Accounting vs. Cash

Governments and big companies are heavily driven by the way they are reporting their financial results to the outside world, which means that their behaviors are heavily driven by the predominant influence of the way accounting rules reshape financial results.  Even a metric like free cash flow is determined by accounting conventions that distort cash-flow-based financial thinking.  For example, since cash flow is determined as of the end of periodic reporting periods, like the end of a calendar quarter, there is very little attention to day-by-day cash flows, except in the organization’s treasury department, which has to secure cash to pay daily expenses.  In the Fall of 2008, a lot of attention was paid to liquidity because financial services firms borrowed daily and did not have matching incoming cash flows.  When their daily borrowings were interrupted, these firms suddenly started paying a lot of attention to daily cash flow, but a big industrial firm or a government agency usually is not built on a culture of top-to-bottom daily cash management.

In a start-up business, every employee recognizes the concept of “burn rate,” which is the daily, weekly, and monthly gap between expenses and revenues.  They have to pay attention to timing differences between when expenses are paid and revenues are received during a month or week.

Guaranteed Pay versus Pay Contingent on Results

People who work in big organizations want guaranteed wages or salaries.  Even when they get incentive pay, they want to know what the target pay range might be, and when they could expect to receive the incentive pay.  They want predictable cash flows in their personal lives.

Start-up businesses usually operate with well-below-market guaranteed wages and salaries, but offer significant upside through options and stock grants.  Employees in start-ups are not anxiety-ridden by knowing when or where their next paycheck will come.  People from big companies definitely are.

Overall Adaptation

As my blog indicates, these are major differences in the way large organization and start-up organizations function.  Everyone is capable of adapting to some degree to enable them to work in start-ups, but for older employees who have been used to operating in a particular environment for several decades, it is like getting a divorce and being asked to date people in an environment that is not only completely different from the one in which they functioned during their marriage, but also completely different from when they were last single.

It is psychologically traumatic for people to make this transition.  They have to go through a change process similar to what those who lose a loved one experience.  They have to get through denial, anger, grieving, fear, and toward acceptance of the new environment.  This is not a task that is accomplished solely through job retraining programs or through creation of make-work public sector jobs.  This requires a personal transformation of which development of new skills is only a small piece.

Lawmakers who are empathetic to those displaced in this economy do them no favors by offering quick fixes or stimulus-led projects.  These are stopgap and transitional packages at best, and ways for people to remain stuck in denial at worst.  Blaming the companies that displaced these people is also a stupid, shortsighted strategy.

Even when more steady big company jobs return, they will look very different and people will need to function more like they did in the start-up businesses.  The sooner we recognize that, the better.

Thomas Friedman has rendered a valuable service in pointing us toward the need to support the creation of start-up businesses, but that’s just the beginning of what we will ultimately need to do.

In it, George Clooney plays an executive named Ryan Bingham, who works for a company that enters into contracts with large employers that have neither the will nor the skill to handle mass terminations themselves, so they outsource them to Bingham’s firm.  The subject matter is painful because the devastation of losing a job has hit so many households. I had this type of experience back in1978 when my law firm told me I would not be offered a partnership.

However, the more interesting aspect of the movie is the way Bingham leads his life.  He travels over 320 days of travel a year, and has built a life in which he gets treated exceptionally well by airlines, hotels, and other service firms, and he has temporary relationships on the road that require no deep emotional commitments.  He has successfully avoided having to deal with the messiness of a family life or maintaining a substantial home base.  In fact, his one-bedroom apartment in Omaha, Nebraska, appears unoccupied, because it is so sparsely furnished.

Not surprisingly, one subtext of the movie is how messy reality intrudes itself into his antiseptic, perfect life.  The first intrusion comes from a young female manager who attempts to dismantle the whole process of having executives travel to terminate employees, by substituting termination conversations by video teleconference. Although she first appears to be a person who needs no emotional support, she ends up requiring significant support from Bingham as her relationship with her boyfriend sours.  The second intrusion comes from Bingham’s two sisters, one who is getting married and the other who is separating from her husband.  The third intrusion comes from what initially looks like a casual relationship with a woman named Alex, for whom Bingham develops a deeper emotional attraction, but whom he discovers is uninterested in a deeper relationship.

My life bears no resemblance to what Bingham is experiencing.  However, I ponder why Bingham would find the life he leads attractive, and I can understand it at some level:

• We all want others to function in a way that makes our life as easy as possible.  Because of the growth of corporate loyalty and rewards programs over the last 30 decades, we get predictably exceptional care from people in organizations to which we have given a lot of business. People treat us with great care because it is in their financial interest to do so, and because, within their sphere of activity, they have been well trained to do so. In the home or community environment, as well as the workplace, higher loyalty is not predictably rewarded.  Some of the people who have to treat others with great deference in service occupations get burned out, and manifest their burnout by lashing out at family and friends outside of work. One of the ironies of Up in the Air is that Bingham expects loyalty because of a long history of rewarding corporations with his business, but he destroys the predictable link between loyalty and reward in the corporations for which we works for the employees he terminates.
• Aside from wanting to be rewarded for our loyalty and patronage, we want a manageable and predictable level of demands from those around us. Stress comes to our life from highly demanding or unpredictable environments, especially when our capacity to meet those demands does not match what is demanded. Bingham creates stress in the lives of those he terminates, and then gets stressed by being forced to intervene with his sister’s fiancé just before their wedding ceremony.  He is thrown into a situation in which he is expected to act almost as a marriage counselor.

If I were to describe my past year relative to these points, I would make the following observations:

• Like Bingham, I like the idea of having a specific level of loyalty being rewarded with a predictable level of service.  Unlike the Bingham character, I actually get uncomfortable with too much luxury service. Exclusivity and isolation make me extremely uncomfortable.
• While I was fully prepared to accept much higher demands on my time and resources than Bingham, I, too, discovered my limits.

I found that leaving the Chairman and CEO positions reduced some demands on me, but spawned many others, and that I was unevenly equipped to deal with them.  I expected that some people would approach me to serve on boards, to make charitable contributions, to invest in their businesses, or to give them career advice.  To a degree, these demands were manageable.

However, I learned that my post Pitney Bowes life was not one in which I could substantially control the demands made on me:

• Demands for political support and contributions were far more complicated to manage when I left Pitney Bowes.  At the Company, I evaluated every request for support by the degree to which it furthered the Company’s goals.  As a private citizen, I have to make choices among good, but obviously imperfect candidates, without the simpler criteria I could apply as a CEO.  Deciding among friends and multiple candidates I respect is not fun or easy.
• With respect to charitable contribution requests or investments, I lack the very capable community investments and corporate development teams that did a great job evaluating charitable or investment proposals.  Moreover, there are many more desperate people today with more fragile organizations, so every contribution or investment decision is higher risk than it would have been two years ago.
• Similarly, many more good, desperate, unemployed friends come to me for advice and help. My ability to help, and their willingness to take my advice, is harder to assess in this more complex and challenging employment environment.  For example, the whole world of posting recommendations on Linked.in for someone is totally foreign to my experience.
• Political advocacy is more complicated, because, for whatever reasons, the task of seeing my work bear fruit, particularly on

health care issues, is far more complicated. I thought it was because I lacked a power base in terms of money, size of organization that I led, or political connections, especially when I watched CEOs, union leaders, lobbyists, and trade association presidents get face time with government officials.  However, many of these high-powered people have expressed extreme disappointment that their efforts were wasted, unless they intended to make sure nothing happened.

• Finally, like many people who have been in positions of significant responsibility in a large business, I am distressed by the indiscriminate anger and resentment directed at successful business people.  There are certainly many legitimate targets of public anger in the business world, but our elected officials have fostered an environment of indiscriminate anger directed at even very decent CEOs or other people who have been successful.  That’s wrong!

I am very energized by the many exciting things on which I am working, including my evolving effort to become a broad and deep expert in health, particularly the social determinants of health, and my efforts to break into the entertainment industry.

Nevertheless, there are times when the Ryan Bingham world seems very attractive because of its simplicity, its clear linkages between behaviors and rewards, and its lack of pressure. I would never want that world, but I can understand better the psyche of those who seek it out.

Baskin & Robbins has gotten the public to patronize its stores because it has offered 31 different flavors of ice cream.  The 31 flavors attempts to capture the full range of the public’s potentially diverse tastes for ice cream.  In addition, many flavors come and go over time.  So the 31 flavors reflect both diverse and changing preferences.  Baskin & Robbins has stayed in business because it consistently has reinvented and recombined flavors to appeal to new generations of ice cream lovers.

Because we are so near Valentine’s Day, there have been many articles about successful marriages. Couples attribute the longevity of their marriages to compatibility of values and interests, the ability to resolve differences, the ability to create space for each of them to grow and develop, and a variety of other explanations.

For my wife Joyce and me, the explanation lies in the “31 flavor” metaphor, both in the diversity of the interests we have pursued, the number and range of friendships we have had, and the frequency with which we have reinvented ourselves.

In 1979, right after getting married, we took our first big step, moving to the East Coast, and each getting new jobs.  In 1981, we took another radical step, selling our Darien home, moving to New York City, and, within two years, having Joyce leave her law career behind and become a real estate professional.

In 1986, we become parents for the first time, and, after our second child was born, moved back to Connecticut in 1990.  Joyce encouraged me to expand beyond law to human resources, and then, in 1993, to leave both staff jobs behind and become an operating division President.  That decision paved the way for me to become Chairman and CEO in January, 1997.

Probably the most pleasant surprise in both our lives has been the way Joyce caused our children’s passions to take us into worlds we never would have explored on our own. Our older son was attracted to the performing arts as early as age 10, and, today, is an aspiring screenplay writer in Los Angeles, after having graduated from the University of Southern California.  I could not have imagined the degree to which we have learned so much about the film, TV, and theater and stand-up comedy industries because of him.  I have seen linkages between entertainment and political and social advocacy that would have never been obvious to me.  We have a large and growing group of friends in California because of him.

Our younger son took us into the worlds of town and school sports and Boy Scouts, but also drew us into the wonderful subculture of both scholastic and professional chess.  We met some of the best and most famous chess players in the world, and took him all over the United States and to six different countries to play chess. More recently, as he became an online seller of books, consumer electronic items, and other odds and ends, we learned a great deal about the world of online commerce, including the use of online auctions for charitable fund-raising.

Our daughter took us into the worlds of Mandarin Chinese, music, and, more recently, science research.  She also studied Spanish and Arabic along the way. While I studied piano for 10 years as a child, seeing our daughter do one of her first public performances as a harpist at age 12 at the Stamford Visiting Nurses and Hospice Care Tree of Life ceremony over four years ago was more pleasing than anything I personally accomplished as a musician.  The two of us had our own wonderful shared experience over many years skiing every February in Vail and building relationships with family and both new and old friends in Colorado.  Today, she has gotten me very interested in neurological research because of our shared interest in finding a cure for Alzheimer’s Disease.

I cannot even begin to fathom how many worlds into which Joyce has taken me.  Her passions for education reform, for scouting, for children’s environmental health, for providing social services for troubled families, and, more recently, for the Westport Country Playhouse and for women’s health issues have also taken me into worlds I would not have touched on my own.  She also connected with both the University of Southern California and, more recently, Cornell University (where our second son is a student) in ways that I never would done.

Our lives have had stresses and even tragedies, including the loss of a son at birth in 1989, but we have had the most blessed marriage because we have each recognized that marriage is not a static institution, but one in which each partner has to evolve and in which the relationship needs to be reinvented in some way almost every day.  Neither of us has ever taken for granted what we have had, and, therefore, we have been pleasantly surprised by what each phase of our lives has brought us.

This has been a wonderful set of life experiences for us, and the celebration of an anniversary has been a great time to step back and savor our marriage.

One of my favorite TV shows of all time, Rod Serling’s The Twilight Zone, frequently dramatized the message that people who saw the world differently from others often experienced difficulty and, in some cases, tragedy.  Two of my favorite episodes that made this point powerfully were “Terror at 20,000 Feet” starring a young William Shatner as an airplane passenger who sees gremlins trying to take apart an airplane wing while the plane is in flight, and “The Howling Man” in which an American is recounting a story to his housekeeper about why he is imprisoning a man whom he says is the devil.  In both cases, the passenger and the American seem psychotic and their perspective is disregarded.  In both cases, at the end of the show, they are proven right.

Thankfully, no one has ever accused me of being psychotic.  Unlike the William Shatner character, I did not get carted away in a straightjacket, and, unlike the American in “The Howling Man” the consequences of others not believing me did not result in the devil being unloosed upon the population.  Nevertheless, my experiences have been challenging.

In the early 1990’s, when I believed that Pitney Bowes could spend less on health care, increase employee contributions, improve health, and improve employee satisfaction, I was perceived as a naïve person going against several decades of conventional wisdom.  Even today, those who believe we can increase health, reduce costs, provide universal, affordable health insurance and improve quality and decrease government budgets are perceived as unrealistic.

I had to fight conventional wisdom, although there was good research to support me, the Dartmouth Atlas work led by Dr. John Wennberg, just as there is good evidence today.  However, my point of view was so threatening to those who had built careers on marketing services consistent with a different point of view that they fought me and the evidence.  I was right, and I believe that the Pitney Bowes experience is broadly applicable.  I believe that the reason Washington lawmakers have not tried to apply it broadly is that it threatens more deeply-held beliefs about the role of government.

When I believed that Pitney Bowes would need to sue the U.S. Postal Service for violating our contract rights in the 1990’s, almost everyone thought I was misguided, including, in the beginning, my general counsel.  Over time, the management and the board of directors supported me, the lawsuit was filed, we settled, and moved on.  Years later, I spoke with senior postal officials who told me that they felt I had no choice but to do what I did, but that their colleagues did not believe we had the courage to file the lawsuits.  At the time, my view was influenced by the notion that the Postal Service’s actions were based on the perspective that we were simply their agent, and that they should control everything about the mail system.  My position was that they were public servants entrusted with specific responsibilities relative to mail, and had inherently limited powers to go beyond that.  This was not just a test of power; it was a philosophical difference about the role of government-operated services.

In 1999, two start-up companies challenged us with online postage solutions. My chief operating officer, Marc Breslawsky, and I were in a minority among the senior team in believing that these companies posed no threat to us.  Many employees and high-level executives, one or two board members and many shareholders told me that the world had changed and that I was in danger of ignoring potentially disruptive innovation.  The reason Marc and I turned out to be right is that we understood that disruptive technologies are successful only when they are superior to the older technology they replace and when they can be marketed profitably.  Neither condition was met.

In 2003, I had my toughest challenge of all.  I recommended to our management and our board of directors that we exit the non-core financial services business.  The reasons for not exiting seemed compelling: we would experience lower earnings per share, lower net income, lower cash flow and lower investment return immediately after we would complete a sale or spin-off.  Moreover, the exiting process would require audits for 10-20 year-old leasing transactions that would create the risk of having to change the accounting for transactions because they were so old that the documentation might not exist or that people’s memories about why they made certain decisions would have faded.

The only argument in favor of exiting the business was the longer-term, hard-to-measure risk of being in the financial services business.  It took me three years to complete the process, and I had to overcome opposition from many who weighed the risk probabilities differently from the way I did.  We completed the sale in July, 2006, and, fortunately, were out of the business when the financial markets began their collapse a year later.  Those who disagreed with me were not wrong about they believed could happen, but they could not fathom how bad the financial market collapse could be, and what effect it could have on the company’s stock price and prospects.

I could give many other examples of where I took a contrarian position, and was perceived to be on the wrong side of the argument, but, suffice it to say, being visionary is not always a comfortable place to be. All of these situations were different in terms of why I had difficulty, but they had certain common characteristics:

• I was not perceived to have any special knowledge or expertise, so, despite my brainpower and authority position, others felt that they could look at the same situation and have equal or better insight. In each case, I had to get them to reinterpret common facts.
• My position did not lack for clarity or simplicity.  It was not a communication problem.  It was a difference of perspective or philosophy.
• The opposition often sprung from much deeper points.  What was at risk was not just the specific issue, but some bigger fear or anxiety, whether it was upsetting a broad world view, putting stakeholders at risk of being criticized or sued for a wrong turn, or calling into question how people were earning their livelihood, or even just weighing risks differently.

I have concluded that I really could not have done anything differently, except to have understood the difficulty going into these situations. That’s just the way visionaries have to operate.  As I have gotten older, I tend to take these situations, which, fortunately, do not come along as often, less stressfully, and just recognize that seeing the world differently is a mixed blessing.

Many elected officials do not have the political will to address fundamental structural economic and political issues.  We built an economy after World War II promising middle class wages for all Americans, but without the foundation of skills and educational capabilities to make such promises sustainable.  Public sector labor unions and unions in heavily politicized private sector industries like the automobile industry, successfully negotiated collective bargaining agreements allowing people with very low skills and educational attainment to secure middle class wages and benefits, and protections against downsizings, even as our economy has had to become more globally competitive.

Private sector companies with these less productive and over-staffed workforces are uncompetitive.  The public sector has become too expensive to support for the level of services we receive, as John Donahue of Harvard’s Kennedy School of Government powerfully describes in his book The Warping of Government Work.  So why do we not address these structural problems?

Elected officials do not get re-elected by allowing large numbers of individuals to experience pain. Under-skilled people in private industry or the public sector would either be unemployed or employed at well below middle class wage levels if they freely competed in a globally competitive sector of the economy.

The long-term answer is better education and re-skilling of our population.  Unfortunately, labor unions control much of our education system, and most resist the kinds of education reforms, like aggressive teacher performance management, that would make our education system able to fulfill this mission.

Politicians and labor leaders cannot easily act to address these issues because the highly competent teacher and the teacher who should be downsized have the same voting power. In fact, the more a labor union is comprised of people overpaid relative to the marketplace, the more the union leader will be compelled to resist fundamental change.  Elected officials representing dying communities needing to make structural change have constituents least likely to want change.

So what’s the answer? First, acknowledge the problem openly. Second, recognize that even among labor unions or dying community populations, there are many change champions from whom support can be obtained. Third, craft solutions that minimize the number of losers. Fourth, recognize that not everyone in an overpaid, under-skilled population is motivated to retain their specific compensation and benefit packages.  People are diverse, and there needs to be an effort to take advantage of that diversity, rather than ignoring it.

I am less optimistic than many about the long-term recovery of our economy.  We have difficulty making clean, fast, directionally powerful decisions because we have created big centrally controlled systems with powerful interest groups able to prevent actions that would have adverse effects on them even in the slightest way.  That is why the Obama Administration has had to resort to a lot of ugly political horse-trading to pass a single health care reform bill in the Senate, and why the health care reform process is so ugly.

For the big structural issue I described, there will need to be three broad-based tactical approaches:

• Find ways to dramatize the pathology by personalizing it.  Think about the number of laws that have passed because of the dramatization of a particular victim of a pathology.  We have “Amber alerts” because a girl named Amber was kidnapped.  We have “Megan’s law” to address violent sexual abuse. The public face of government employees that receive excessive pay and benefits is usually a heroic police officer, firefighter, or teacher, not the Massachusetts toll collector who can retire at age 45 with full pension and retiree medical benefits after 23 years of service.  If the public realized how much those retirement benefits cost and how the public is supporting obsolete jobs that could be replaced by automatic toll collection technology that would eliminate toll plaza traffic jams, their attitudes about these benefits could be very different.
• Build grass-roots support through fact-based advocacy.  Our society has been very successful in changing public attitudes with grass roots campaigns on issues like smoking, driving while intoxicated, and seat belt usage.
• Use the power of entertainment.  I am involved with film and reality TV investments because I need to learn about how to use entertainment to change society.  Neil Baer, the executive producer of Law & Order SVU, is a physician who cares deeply about health care reform.  His show is a powerful platform to address many issues associated with sexually transmitted diseases and violence.

Over the next 12 months, I will be doing a fellowship at Harvard University to help myself learn and grow in a way that will enable me to contribute creative insights and to drive actions that will help lead the way in this much more difficult environment.

The only thing that happened as I anticipated was that I would disengage emotionally from Pitney Bowes very rapidly, because that is who I am.  Once I leave an organization, I leave with fond memories, great friendships, and insights of lifelong value, but I leave the organizational responsibilities completely behind.  I am not a person who is nostalgic about what I once had or did, and this was no exception.  Other than that, everything that happened was either a surprise or a disappointment.

• The biggest disappointment was the way the health care legislative process transpired.  As the leader of a coalition created late in 2008 who intended to play a major role in the health care reform debate, I came to the conclusion that any serious advocacy was a waste of time.  The legislation had some good elements, such as an enhanced focus on prevention, thanks to Senators Dodd and Harkin and those colleagues on both sides of the aisle who care about prevention, and there were some modest efforts to improve health care quality and delivery.

However, the entire focus on universal, affordable insurance was misdirected.  First, we cannot give everyone affordable insurance until we attack the fundamental drivers of cost, which was not done.  Second, the designs of the individual and employer mandates were flawed, and will end up taking us in the direction of greater financial insolvency, like Massachusetts.  Third, the public option is nothing more than an extreme expression of distrust a significant minority of our elected official population have toward insurance companies.  Their distrust may or may not be well-founded, but the public option is the wrong way to solve the problem.

It became clear to me early in the year that positions had largely hardened, that the legislative process was about scoring political points at the expense of others, and that many good principles would get sacrificed to get 60 votes in the Senate, which is what has happened.  There was very little interest in listening to new points of view once the legislative battle began.  So I withdrew, other than participating in attempting to get one very sensible amendment put into the legislation.

• My other disappointment was seeing Wyeth, a company whose board I joined in April 2008, disappear as a result of an unsolicited tender offer from Pfizer.  The board did the right thing for shareholders to negotiate the offer we ultimately accepted, and Pfizer will clearly have more capacity and cash to fulfill the promise from the research Wyeth had under way.   However, it is sad to see a great company with great people disappear, and to see some of the best of those people lose their jobs as a result.

• I was surprised how good the technology for doing my work has become.  It is easy to make appointments and to schedule travel.  It is relatively easy to be a mobile worker, and to put together speeches, presentations, resumes, multi-media communications, and research materials.  If I were in charge of any large organization, I would be pushing the IT function far more aggressively to use the technology that is now available and reliable.  I also would use assistants far differently than I did when I was at Pitney Bowes.

• I was amazed at the creativity, the profit focus, and the productivity of the people at the small, start-up companies with which I had contact.  Dossia, the personal health record business started by eight companies, including Pitney Bowes, has made amazing progress in the past year, although it still has a long way to go, and has a superior offering to its competitors.

• I am watching many large organizations aspire to achieve more entrepreneurial, fast-moving decision-making by downsizing rapidly.  I believe that is an extremely difficult result to achieve.  Pitney Bowes has been an unusually entrepreneurial organization, which generally maintained its ability to innovate, even as it downsized during my tenure.  However, getting acquainted with many large organizations all around the country, I am seeing those who remain inside these organizations getting more cautious as they watch others lose their jobs.  Rather than getting out more with customers and trying to learn more about what works, they are getting more of a bunker mentality, spending more time in internal meetings, and taking more time to make simple decisions at a time when those who move faster get bigger rewards.  I believe many large organizations will fail once the economy improves, simply because they have been too slow afoot when the opportunity for capturing rewards from innovation was greatest, which is the time we are in right now.

• I have become far more resourceful, and have watched our children became far more resourceful, in responding to these difficult times.  My older son had his car stolen when he moved into a new apartment in Los Angeles, but proceeded to buy a less expensive, older car and pocket the difference between his insurance proceeds and the lower selling price of the newer car.  My younger son became far better at online selling, and made significant money during the last few months he was home.  More importantly, he learned a lot about the need people have to buy more high-quality used items, and the way they need to be treated as customers.  My daughter became a much more confident musical performer and increased her ability to earn money and to do community service.  They probably would have found these skills anyway, but the bad economy accelerated their learning curve.

• I also learned to think about new business opportunities in a different way.  For example, could charities benefit from better tools for online auctions to get more unrestricted money?  Would we all benefit from lower-calorie, organic, healthier foods that people eat on the run?  These questions prompted me to make small investments in two start-up companies.

• I came to realize that my real passion is helping improve the health and well-being of people, and that the best way to do that is to work on the non-medical drivers of health.  I believe individual and community interventions on the prevention and wellness side will be key to this.  This insight is leading me to a very different plan for 2010: a fellowship at Harvard, a focus on community health interventions here in Connecticut, and a focus on investments in the performing arts, where the telling of stories changes attitudes and behaviors faster and more permanently.

• Finally, I started to engage in some projects that will be fun, and hopefully, make money and help get me launched in some new directions.  My older son and I completed a film script which we are now trying to market, (and would welcome any reader’s help), I have co-invested in a completed movie called Fog Warning ( a suspense-thriller/horror film), and am involved with a reality TV incubator/production company.

2009 was a crazy year in many respects, but I actually felt liberated by my ability to withstand what it brought and to craft new ways of solving problems and finding opportunities.  2010 should be an even more interesting year.

In my next blog, I will get back to talking about broader political, social, and economic trends that will provide a backdrop for some of my thinking.

• The fact that we had the same number of traffic fatalities in 2008 as we had in 1961, which is remarkable considering the significant increase in the driving population, the number of cars on the road, and the number of miles driven;
• The 50% decline in trans fats in packaged foods since 2006;
• The fact that 71% of our population lives under either a state or local ban on smoking in workplaces and/or restaurants and bars; and
• The fact that the percentage of secondary school that no longer sell soda, candy, or high-fat snacks have each risen to 64%.

I zeroed in on this article for two reasons:

• It reminds us that we are doing many things well as a society, even though the media often choose to focus on things that are going wrong.
• More importantly, there are multiple success stories from which we can learn how to improve overall population health.  Government intervention was a factor in every one of these cases, but it was not the only factor.  There were many forces, including private sector advocacy groups, that influenced human behavior for the better.

Let’s just take the first of these accomplishments, the reduction in the ratio of traffic fatalities to miles driven.  Beck notes that one contributing factor for reduced fatalities is that 84% of Americans now wear seat belts, which resulted from laws mandating seat belt usage and from increased compliance with those laws.

But there are many other factors as well, some of which are related to laws and some of which are the result of private sector initiatives:

• Clearly, the stronger enforcement of laws prohibiting driving while under the influence of alcohol has helped.
• Laws which delay the granting of drivers licenses to younger people until they have completed both classroom and road-based drivers training has put better younger drivers on the road.
• The cars built and driven today are far safer with better transmissions, braking systems, and acceleration than cars on the road in the past.
• Trucks also are far safer in their design than was the case a generation ago.
• Traffic engineers are far smarter in designing road systems to reduce accidents.
• Customs and practices in many communities are less conducive to late-night driving.  For example, in my community, both of our older boys who have gone to proms have shared the cost of a limousine, rather than having each of them drive separately to the prom.

However, much more could be done.  For example, many communities are deploying cameras to catch those who speed or commit other moving violations.  Those communities see significant drops in accident rates and fatalities after they deploy these systems.  Too many lawmakers are too timid in standing up to bogus privacy arguments and back off putting in these systems.  There are well-established ways to protect citizen privacy, while protecting public safety.

We need to have more properly-equipped rest stops for long-haul truckers, since fatigue on the part of truckers is a major cause of horrific accidents, particularly late at night.  We also need to enforce laws against truckers who exceed maximum-hour daily driving limits.  The technology is available to track compliance with these laws.  We should use it.

Finally, we need to reduce the overall number of miles driven by changing our zoning patterns to enable people to walk to stores and to avoid the opportunity to get into accidents.  My sister and her family got into a near-fatal accident in 1966 on a residential street close to their home because a drunken driver failed to observe a stop sign and hit their car at a relatively high speed on the drivers side of the vehicle.  Many accidents happen within a few miles of home, just like this one, often when people are doing driving that, in a differently designed community, would not be needed.

Nevertheless, these are cautionary notes relative to something which we should celebrate.  When our country and our citizens decide that they want to improve health and well being outside of the health care system, they have proven time and time again that they can be successful.