Hosting the Super Bowl was a forty-year dream come true.  Former Mayor William Hudnut III traveled with a caravan of Mayflower moving vans to Baltimore and picked up the Colts.  The city built a stadium without having a home team.  His predecessor, then Mayor, Richard Lugar, was focused on revitalizing the inner city and stop urban blight.  One strategy to do this was to bring people back to the downtown.  Conventions and sports were the ticket and key to the city.

Indianapolis hosted the Pan American games decades ago – and was successful.  Year by year, mayor after mayor, key their eye on professional and amateur sports as a way of making the city a major league community.  The Super Bowl was the prize secured by a former mayor; this week demonstrated that Indianapolis was no longer IndyaNOplace.

Everyone in the city – current and former residents of Indianapolis, grinned ear to ear with each day’s events during the Super Bowl.  By all accounts, it was a major success.  Even the weather cooperated!

Concurrently, the Indiana legislature was in session.  Indiana became the twenty-third state to pass Right to Work.  A demonstration through Super Bowl village highlighted the event.  Keeping their eye on the prize, the picketers were relatively quiet and did not disrupt the events or game.

As a side note, the football season almost didn’t happen this year because of a labor dispute and walkout.  The unionized players kept up the fight to secure benefits for its players.

One can argue for or against the right to work concept.  At the end of the day, it isn’t positive for unions.  The other legislative action demonstrated the grassroots nature of the Hoosier state and was the antithesis of Super Bowl hoopla.

The Indiana Senate’ passed a bill allowing Tuesday creationism to be taught in statewide classrooms.  Senate Bill 89 enables schools to teach religiously based perspectives of creation in tandem with evolution. An Indiana Department of Education spokesperson said Indiana would not develop any such curriculum or guidelines for teaching creationism in its public schools.

These three events demonstrate Indiana’s history, it present, and potentially its future.  All three events demonstrate what can occur when you have a single focus, dedication, perseverance, and implement strategies that are clearly designed to achieve a BHAG – big, hairy, audacious goal.  There are some who argue that spending on sports has been at the expense of infrastructure.  Right to work might bring in new business; it might destroy unions.  Teaching religious belief is clearly unconstitutional; proponents don’t care because they are focused on a single outcome.

If you see me riding in the cab of a Mayflower moving van, wearing a Colts hat, Super Bowl 45 jersey, and heading out of Indianapolis, you’ll know Governor Daniels signed this bill into law.  When I drive by, I’ll probably be muttering something like, “I can’t believe I live in Indianapolis!”

ICD-9 Procedure Code – 300.4 – Depression with anxiety.

A young woman – 16 years old, that we know was found in her bedroom by her parents last week.  They found her dead.  After months of diagnoses codes like these, she found it necessary to terminate her life.  Winter mornings during the school year should find young girls texting their friends, cramming for a test later in the day, reading notes left the day before by boys, or trying to decide what to wear for the day ahead.  On this day, this child lay motionless — the impending school day, drive home, or dinner-table discussion would not be an issue.

Clinical definitions of depression, anxiety, bi-polar, or suicide carry with them guidelines for diagnoses, procedure codes for reimbursement, protocols for management.  In a local hospital, social workers cubical, psychiatrist office, and school counselor’s files, undoubtedly there are notes detailing the causation, treatment plans, and medication regimes.  Hours of discussion between caregivers, providers, and family members took place; events of the past 24-hours may have been noted as an option, a potential event, or possibly an inevitable event.

Teachers, friends, family, clergy all will devote a portion of their day to questioning what happened – and why.  Second-guessing a conversation, a meeting, a tweet could have created a different end to this day.  Social media will ensure news of the death gets to all those who need to know – and countless others that don’t need to know.  Close friends will blog, text, tweet their innermost feelings about their friend.  Others who knew of her through a friend, attended the same camp, or were a friend of a friend of a friend will discuss the death as if they were  “BFFs.”

And parents will hug their children tightly without sharing any words.

In healthcare, the world typically is reduced to a series of electronic notes and procedure codes.  The procedure codes characterize an individual; reimbursement, treatment, coverage, care management are all dictated by three or four digits.   A child’s pain is converted to a four-digit description.  The ability of a parent to gain cost-effective care is dictated by a numeric value.  The ability to gain care and access to providers is at the discretion of a single decimal point.

After the child’s death, the digits are reduced to one – number of deaths.  The family will move through the necessary steps of bringing a life to its end.  Concerned teachers, family, clergy will gather the child’s friends; using the death an opportunity to avoid a similar fate occurring in the life of another child.  Within days, new discussions will fill the digital world of Facebook and friends will move on to the next event that fills an emotional void.

For a few short moments, electronic medical records and appointment schedules, social media and support groups, will be replaced by real human emotion.

Fortunately there is not a CPT or MSDRG procedure code for raw emotion.

"Dammit, Jim. I'm a doctor not a bricklayer"

The Association of American Medical Colleges recently released a statement that by 2015, there is a predicted shortfall of physician supply in the United State of 62,900 physicians.  Deemed a “critical shortfall” by the authors(1), the shortfall includes primary care physicians, specialists, and sub-specialists.

1. Distribution of physicians by geography.  Working toward a national access of consumer to physician standard in urban and rural areas.
2. Better articulate the role of primary care physician and specialist.  The role function in a medial home model, in a world dominated by EHR, or reduced reimbursement is vastly different than today’s standards.
3. Define a new business model for physician AND physician extender.  To support #1 and #2 above, physician in-fighting for patient panel size, solo-management by specialist of patient needs, and provider inability to document, record, bill easily must be wiped out of the industry.

I was watching a movie from the 1950′s recently on TCM.  The family practice physician lived comfortably, not wealthy and not poor.  Their lifestyle was difficult; essentially 24/7 coverage.  The physician’s son went to medical school and chose to be a hospital-based specialist becuase it was more lucrative, better hours, and a sense of reimbursement for the skills and competencies he brought to his patients.  The industry has experienced change and the providers have adopted and morphe into different business models.

Our challenge is to imagine a commencement address in 2021 calling on the new cadre of physicians entering the market to recall the purpose of their profession, understand the financial ramifications of this decision (perhaps more akin to teachers versus corporate giants), and the need to work collaboratively.

(1)  Source:  (c) 2010, Association of American Medical Colleges.

Toward the end of the calendar or fiscal year, the phrase “hope is not a plan” echoes through conference rooms, hallways, offices, and performance review sessions.  In a world of data, analytics, predictive models, strategic plans, and business plans, there is an overwhelming (and endless) pool of data elements.  The hordes of MBA’s in leadership have formalized and institutionalized decision-making based on data; success is measured by translating all outcomes into specific values.  Case in point:

• Patient satisfaction measurement is based on a weighted scale.  The metrics used by NCQA for patient satisfaction have been designed to correlate with a numeric value or weight as its outcome.
• Personnel are measured based on objective criteria that is aligned with a weighed numeric value.
• Resource deployment and investment (e.g. adding a new physician, deploying an ambulatory site of care) must be supported by projections and return on investment.  The trend is almost always based solely on a historical average that is pushed forward versus building into the model change based on non-age and gender criteria.  The introduction of disruptive technology, care delivery patterns, reimbursement, legislative or regulatory change – all impact the trend and rarely introduced into the financially driven model because it is considered soft science, aka hope.

The reality is not all bad.  Healthcare and other industries historically would/have make/made decisions based on who yelled the loudest in a meeting, who nagged the longest, who carried the most political capital or weight, etc.  The migration to decision making based on analytics has been a slow process with many bumps along the way. 

When I joined an integrated health system in a strategy and planning function, it became evident that staff and leadership would request data for a project; yet, the decision was often already made.  The purpose of the data request was to have something in the appendix or to acknowledge that a conclusion was reached with more than a gut or single-minded perspective.  The analysts rarely, or barely, scoped out a problem or questioned a data request.  Requests would come via telephone, email, or administrative assistant.  Success was measured by how fast the data request was met.  Value was measured by the alignment of the information presented with the perspective or intent of the individual making the request.

This is not a good situation. 

The current environment is a cross-section of the window dressing data, pivot tables, weighed averages, and dozens of Excel worksheets.  It is rare when a staff person will walk into a meeting and present a recommendation based on what they believe or feel.  Perhaps their personal belief is costumed within a PowerPoint deck of charts and graphs, an attempt has been made to make the committee or board believe the recommendation was gleaned from objective data and predictive modeling. 

Recently, a client contacted me and questioned the forecast for current volume of new and established visits.  Their disbelief was based on the low market penetration resulting from a comparison of current volume and predicted volume.  Their disregard of the model value was questioned because it could not be broken down and attributed to specific, objective, measures.

My initial reaction was to support the predictive model.  Rather then question the caller, I began to probe and understand what the cause of the disbelief.  This was a model, a predictive model, a forecast.  It was a value based on a series of objective data points, research driven assumptions, and mathematical calculation.  The value was crafted from the use of neural network technology and went through various stages of validation, tweaking, and computation.

The predictive model was a best guess – a hope. 

Early in my professional like I assumed the mantle of data driven decision making.  Marketing was too soft; strategic marketing was based on objective criteria.  Operations based on a budget target were insufficient; a multi-year, measureable, analytic strategic business plan was the right way to go.  After three decades, I find myself relying as much on experience, feeling, and hope as I do on the measures.  Today, a scan of the information will create a sense of right or wrong.  Hoping we will reach an objective has some level of objective criteria involved; it is still hope.

Hope is personal.  It is emotion.  It is in your face belief for no tangible or tangential reason or purpose.  Hope comes from your heart and the experiences which have shaped who you are.  Hope is messy.  Hope is not black and white.  Hope is an enigma, without shape, without form.  Hope is grounded in the human senses very numeric values or equations. 

And, hope is an emotional driver that pushes, prods, pokes, and encourages when rational, data driven actions tell you to go in a different direction.  Hope can stimulate or depress.  Hope creates a force that can be harnessed to overcome the greatest of barriers or the darkness of failure.

I want to hope.  I want to believe that success is always possible.  I want to hope for a future akin to what brings me happiness.

Planning for hope requires setting aside the measures, dashboard, the analytics at a given point in the decision making process.  Planning for hope requires an emotional investment in your actions.

Hope is not a plan.  Hope is that special something extra, the secret sauce, that propels a plan to success.

ac·count·abil·i·ty.  noun \ə-ˌkau̇n-tə-ˈbi-lə-tē\. ..the quality or state of tə-ˈbi-lə-tē\. ..the quality or state of being accountable; especially : an obligation or willingness to accept responsibility or to account for one’s actions <public officials lacking accountability.  (Source:  http://www.merriam-webster.com/dictionary/accountability)

Accountability appears destined to travel the same journey as HIPPA.  Current HIPPA regulations barely resemble its intent — protection and security of personal health information. The last time I went to my physician and pharmacy, after signing countless HIPPA forms, I “signed in” by writing my name on a clipboard.  In plain sight were the names of everyone who had been in the office or picked up a script before me on that day.  Where was the privacy and protection?

Quality of care, efficiency, and cost containment is the rationale for increased accountability of care.  Laudable (and necessary) goals are the underpinning of regulatory and legislative reform that emphasizes greater coordination, integration, and alignment of care delivery.  Building a medical home, integrating electronic health information, and aligning physicians, payers, hospitals have saturated industry discourse. The final regulations for CMS Shared Savings Program and accountable care organizations in October flooded industry chatter, C-suite agendas, and even blog sites.

One on one dialogue with colleagues indicates the journey is grounded with a strong belief the result of integration, shared knowledge, and coordination is a solution for industry ills.  The barriers – real and perceived, are mammoth.  The information technology and operational realignment required to support the discourse are financially impossible and resource improbable.

This is not advocating abandoning the vision of accountability.  It is a plea for a reality check.  The ACO comment period recently concluded evidenced the investment – resource, financial, human, technology, concerns of healthcare enterprises.  If the decision on the board room table is to apply for ACO or a decision to employ the full medical staff, leadership and governance may not be taking into consideration the need to build a foundation that supports these new structures.  Transformational change is not akin to a joint replacement.  The organizational transformation envisioned requires operational and cultural investment, clearly defined strategic vision, and informed resource investment within an abbreviated timeline.

Operationally, accountable care becomes action through a medical home model, value based purchasing, bundled pricing, accountable care organization, and other programs, processes, and models that create linkage from one provider to the next, one site of care to the next.  Any consumer or provider is quick to point out the need and relative value or increased sharing between care givers and sites of care.  Decades of specialization and sub-specialization have resulted in greater life saving efforts.  Concurrently, the ability to retain the knowledge and rationale from one healthcare decision to the next is virtually impossible.

The need for technology solutions that parallel accountability of care are at the forefront of resource requests, investments, and staff focus.  Standardization and extensible data models allows the gap between our current and future state lessen – most often the barrier is the ability to provide sufficient capital to fund these investments.

The cultural change required supersedes the financial investment.  A lesson learned from the HIPPA journey is that inherently we do not like to share information.  Under the veil of confidentiality, the notion of sharing outcomes, decision making, or clinical indicators is guarded.  When the information is shared, the barrage of questions regarding integrity, standardization, and decision making input occurs.

Case in point – prior to knee replacement, an MRI was conducted.  The results of the MRI could not be sent directly to the patient.  Results were to go to the primary care physician and ordering physician; not to the patient.  The cost of the MRI was borne by the patient, the MRI was of the patient, and the results impacted the health of the patient.  Obtaining the results (including a copy of the scan) was at the discretion of the ordering physician.

The cultural change required to adapt to greater accountability in care must be industry-wide.  It is improbable that greater accountability can occur unless the system is completely transparent.  Pilot programs or unique sub-sets of the care delivery system are insufficient to build the integration and responsibility required.

Your death at fourteen carries with it no rationale explanation.  The journey you have been on the last few years with cancer prematurely moved the boy into a man; making decisions decision that belies the burgeoning physical change to adulthood.  The parents left to mourn and imagine what could have been,  The friends who, like you, had to grow up quickly to understand what has happened, are forever changed.

I know you so well; but really never spent any time with you.  Your dad, the Old Man, and I are colleagues and friends.  For a decade we worked together.  We moved from colleagues to friends immediately.  Sharing a passion for our work in healthcare was matched by our passion for family.  The result was time spent together in discussion over physician engagement, the need for new technology, or strategy for neurosciences — always included were updates, stories, or anecdotes about you, your mom, and my family.

The Old Man and I are co-workers, colleagues.  First and foremost, fathers.

News of your death stopped time.  My immediate response was to provide support to your family.  Impossible.  There is nothing to be said or done that could fill the void or lessen the pain.

The next impulse was to call Eddie and Miles, my sons.  Again, there is no rationale explanation for this.  Hearing their voices was comforting.  Knowing they were okay was important and at the same time ironic.  Texting and calling my sons meant I wasn’t experiencing the pain your mom and dad were going through.  I apologize for such a selfish act.

Your dad and I collectively have over sixty years in healthcare.  We understand the process, clinical decision making, and options available for patient and family.  We both have made decisions based on financial resources, patient needs, and family needs.  We sat through countless seminars and workshops devoted to caring for the whole family versus the patient.  We participated in budget sessions where purchase of a disruptive technology and investment in a clinical protocol was bypassed due to financial constrains or prioritization.  We often used the phrase “the patient first” and use the “patient experience” as reasoning for decision making.  But, it was all in the third person.

I would like to think that we are caring and compassionate individuals.  Yet, once a decision was made or budget approved, we moved on to the next issue at hand.  Once the meeting concluded, we moved on and rarely thought about the potential impact on a patient or family member.

The next time your dad and I meet for breakfast, the world will be changed.  I’m sure we will discuss work a little and catch-up.  Then, the conversation will move into more important matters – you, Eddie, and Miles.

The next time I pour over an Excel spreadsheet or a predictive model,  I want to think about you.  Knowing you humanizes the data.  Your life is a constant reminder that at the end of the day, every decision made changes a life, a family, our world.

Be good, Che.  I look forward to sharing stories about you and your accomplishments with your dad again very soon.

Brandon

Two articles caught my eye in the last couple of days.  One from the Washington Postand the other from a blog posting.  The first dealt with the need for data transparency and the second with convergence.  Healthcare may be the one venue in which the combination of data transparency and convergence is greater than the sum of its parts.

Entrepreneur Yuri Milner believes that in any 48-hour period, there is more data created than the totality of humanity’s efforts in the past 30,000 year.  His forecast is that by 2020, the same amount of data elements will be created in one hour.  Data is often masked as proprietary data.  One need not go any farther than the HIPPA regulations of 2012.  They share nothing with the original intent and origins of healthcare privacy regulation and legislation. 

Convergence is viewed as a subset of innovation. The brining together of disparate services, resources, programs, or parts into a single, unique and different product is the outcome of convergence.  The authors dealing with convergence stated that convergence has “gone wild.”  Citing a shirt that was laced with bug replant, convergence in our modern society as negative and without value.

“Convergence gone wild” is an oxymoron.  If the objective of innovation is to provide a strategic benefit, the determination of a good or bad strategy will come with time and in consumer response.  While the example you cite is a far stretch from the iPhone, iPad, or even Diet Coke Lime® or the ability to purchase only muffin tops – consumer demand will be the final determinant.

Convergence is deeper than consumer will or strategic proliferation.  Implementation of convergence strategies is closely aligned with efficiency and effectiveness.  Incorporating management theories de jour – Deming in the 70s to Lean in the 90s, convergence supports the notion of integration, collaboration, efficient investment of resources, and most importantly the opportunity to provide a new resource that the consumer didn’t realize was possible.  In some cases, convergence is the operationalization of a vision or the what if conversation.  Other times, convergence is the response to that’s simple…why didn’t I think of it. 

Convergence is the result of new and/or disruptive technology applies to the status quo.  The opportunity of millions of data elements for decision making coupled with the technology to mold those data elements into information that the human mind can comprehend, is amazing.  Our ability to understand the value in this type of information and the rationale for investing in data warehouse to support transparent data integration, is either our hope for the future or our barrier to continued growth.

Convergence ultimately is an advance; bolding going where no person has gone before*.   The value a convergence solution offers is measured in its change quotient as much as its financial impact.

*Homage to Gene Rodenberry, Star Trek.

Winona Memorial Hospital.  1956 – 2012.

Winona Memorial Hospital died on 10 October as demolition began.  Vacant for seven years, the deceased was a short-term care facility with 317 licensed beds.  The cause of death was reported in a statement released 2 September 2004 by board chair Robert  E. Mehl, MD, was lack of operating funds.  The autopsy will find the cause of death was not recognizing a changing industry, financial mismanagement, and the lack of a clear mission and vision.

“Despite our loss of investment, we are proud of our attempt to save the hospital, and equally proud and thankful for the support of the hospital staff and those in the community who worked hard to keep Winona Hospital’s doors open and to offer excellent medical care,” Board Chiar, Dr. Robert Mehl

Mehl led a group of physician investors who assumed responsibility of the patient at a time when it was struggling under the weight of mismanagement, lack of direction, a changing healthcare environment and industry, and lack of focus.  Up until the end, a consistent murmur of hope could be heard. 

Winona Memorial Hospital was born in 1956.  Founded by Joseph Walther, M.D. as Winona Memorial Clinic, Winona was the first private, for-profit hospital in Indianapolis.  In a constant battle with the larger health systems for market share, the small Clinic grew into a 280 bed facility in 1966.  Over the years, physicians found Winona actively meeting the needs of its neighborhood, offering a series of specialty services – always with patient care at the forefront.

Through the years, Winona’s beds filled with short-term surgery, cosmetic surgical patients, wound care, psychiatry, and weight loss programs.  Like parents of a child growing up, physician and administrative leadership were constantly trying to determine what Winona should be when it grew up. 

The size, scope, and desire to remain financially profitable led to unique, boutique clinics evolving within a system that could barely support them; yet, drew specialty audiences.  The strategy was to build a series of boutique services that could be accessed easily on site.  One of its greatest successes – financially and clinically, was its surgical weight loss program.  Built at the beginning of surgical weight loss’ resurgence in the 1990’s, the program boasted outstanding outcomes and a patient base from multiple states.

The bariatric weight loss program’s success was the catalyst for larger systems in the community to take note.  One health system recruited the surgeons and senior staff of the program to leave the financially strapped, low income neighborhood of Winona and move to a suburban hospital whose community resided on one of the fastest growing and richest counties in the nation.  Winona’s response was in the form of legal action.  This was endemic of its organizational culture and lack for leadership direction.

Tenet Health Care Corporation purchased the facility in the mid 1980’s from Dr. Walther.  During this period, the leadership changed the name and scope of the institution.  The result was a new name, brand, and expanded clincial service, complete with cardiac services.  The birth of Midwest Medical Center came with lackluster fanfare, physician recruitment, great hopes, and a new branding.  For those of us in Indianapolis, the iconic hospital on the main thoroughfare in the city, referred to the hospital as “the old Winona.”  Soon, the new branding fell and the Winona of yesteryear reappeared.

Quickly, new owners found the small specialty hospital would not garner financial rewards and Winona was searching for new owners.  After three years of hosting a for sale sign, Leland Medical Centers of Plano, Texas purchased Winona in 2002.  Beginning in 2003, Dr. Walther’s clinic went through financial restructuring, lay-offs, and program elimination.  Two years after the purchase, Leland filed for bankruptcy leaving Winona with $6.3 million in unpaid bills, and up to $10 million owed to more than 600 creditors.

The group of eleven physicians was the last in a litany of Winona’s owners.  At the point the physician groups assumed control, local Indianapolis business writers penned Winona was “financially distressed” as a resulting from debts reaching into the millions.  The cause was seen as a short-term cash flow problem and anticipated real estate refinancing had not occurred.

 Life for Winona had become so bad, that Indianapolis Power & Light Company cut off electricity to ancillary buildings on the hospital campus as a result of being owed $400,000.  All the lights were turned off soon thereafter.  Once patients were released or transferred, the hospital owners, leadership, and staff simply walked out of the building.  Left behind were patient charts, records, equipment, medication, and all the resources required to operate a healthcare facility.  For seven years, patient rooms and surgical suites that brought life into the world and healing to the sick were replaced with dirt, theft, homeless, and the blight that comes from neglect. 

The owner an caregivers simply turned off the remaining lights, locked the doors, and walked away.

Pristine hallways and sterile environments were now filled with weeds, graffiti and inhabitants reflecting the urban blight of its surroundings.  The doors that brought the upper north side community hope were an eyesore and a scab on an economically depressed corridor of the community. The drugs, equipment, and documentation were now in the hands of homeless, theifs, and individuals who found a new use for once life-saving resources.

In a strange bit of irony, the lack of focus, direction, and attention to the environment that led to the death of Winona is becoming the lifeblood of its next chapter. 

A few blocks south of the Winona space is The Indianapolis Children’s Museum.  Heralded as one of the largest and leading children’s museums in the world, The Children’s Museum now owns some of the property and is collaborating with the City of Indianapolis to lead redevelopment of the space.  Green space, hosing, retail, and area for Museum development projects will transform this vacant hallways and overgrown campus area into a focal point for the neighborhood.  The pending agreement with the City to redevelop the area will be led by leadership cognizant of its neighbors, the need for direction, focus, planning, and financially sound judgment. 

More importantly, the space inhabited by a clinic named for Dr. Walther’s mother and dedicated to healing will be led by the voices and visions of children.

The patient died and is in the process of burial.  May the memories of those who found hope at Winona, those who shared their gifts of healing, and those who fought valiantly for its health, be for a blessing.

1 October 1971.  Disney World opens to the public.  For years, my family would sit together on Sunday evening for the Wonderful World of Color.  On those lucky Sunday nights, Walt Disney would appear and share the story of a vision of a magical place, a community of the future, a land in which time didn’t exist.  Like Peter Pan, Disney was creating a world in his vision.  From the first steps into the Magic Kingdom, walking past the hidden apartment that Walt Disney designed near the entrance, and then down the pristine Main Street, Disney brought everything that was good — sugar and spice, into one place. 

Disney lived a dream and enabled others to focus themselves on a vision.  Moving slowly against throngs of people speaking over a hundred languages, Disney World, for me, is a world of entertainment and a world of potential.  Disney’s dream of a prototype community of tomorrow, EPCOT, didn’t open until after his death; yet, if you looked closely when passing the huge globe and strolling through the countries, you can see Walt Disney checking things out.  The sorcerer’s apprentice could not have dreamed a better dream.  Imagineers were created by Walt Disney.  When a visit to Disney World was over, amidst allthe packages and pictures, a little imagineer came home with me.

“We want something educational, something to keep the family together — that would be a credit to the community, to the country as a whole.” — Walt Disney

3 October 1961.  The life of a Baby Boomer was formed as ”Ohhhhh Rob” was heard for the first time and the Dick Van Dyke Show debuted on CBS.  Much like the Baby Boomers themselves, Rob and Laura were not an instant hit.  Suburban life was created in the image of Dick Van Dyke and Mary Tyler Moore.  Watching the originals, eating breakfast with a repeat, or working out watching Rob stumble on the ottoman fifty years later, Carl Reiner provided a road map for how every Baby Boomer would live. 

They fought. Friends were part ofyour life.  Neighbors met, had children around the same time, and then watched their children grow up.  Work had its pressures and its successes.  Husbands and wives could disagree.  Couples could even (in the first couple of seasons only) sleep in one bed. Our grandparents knew that Ozzie and Harriet didn’t really have sex…the stork had to have left those boys on their doorstep.  Laura and Rob were passionate (Come on, how could you not be excited by Mary Tyler Moore in Capri pants!). 

The genius of a Carl Reiner was simple.  He wrote the stories of his life.  A life like ours.  A life that we wanted to have.  For fifty years, the Dick Van Dyke Show offered a how-to guide for a perfect marriage, a wonderful job, a terrific lifestyle, and a scrapbook of a generation.

It’s like abird.  If he knew what he was doing, he would fall.  Carl Reiner

 October 1957.    The Soviet Union launched Sputnik I. The world Disney had dreamed became smaller on that day.  The first artificial satellite orbited the earth.  The Earth became smaller on that day and our universe expanded.

It’s extremely important for U.S. history students to see waht came from the Sputnik days of the ate 1950s to the present, and say, 40 to 50 years from now, where are we going to be in space? and these students will be part of that.  Robert Gray

The launch started the space age.  It also was a formidable launch of the Cold War, political unrest, military strikes, and a unique fear in the hearts of those sitting in their living rooms laughing at Dick Van Dyke.

As with the disaster of 11 September 2001, no US intelligence agency had anticipated events. Yet Sputnik was not just a propaganda gesture from Moscow; its launch vehicle, known as the R-7, was capable of carrying nuclear warheads. The Cold War had reached a new level – literally.

America ran scared. Across the country, millions of its citizens held group gazing sessions at night. Meanwhile, international reaction was forthright. China and Egypt, allies of the Soviet Union, were fulsome in their praise.

The launch of a beach ball size structure into space was the catalyst for American investment into both exploration and military spending in space.  The excitement and opportunities of reaching new worlds was marred by fears on Main Street of nuclear attack by the Soviets.  The overwhelming belief of Americans in America was rocked with the thrust of a rocket into space.  American technology, values, politics, and belief that we were unstoppable was shaken. 

5 October 2012.  Fifty years after Disney ushered in a vision of tomorrow, Rob and Laura shared a lifestyle of life and love, a satellite opened the door to new worlds, the child of this era died.  Stgeve Jobs was fifty-six when he died.  The media was filled with a common statement, Steve Jobs created products that we didn’t know we needed.  The iPhone, iPad, iPod changed how we live, think, and act.  In so many ways, Jobs was the ultimate composite of the last fifty years.  He was the sorcerer’s apprentice.  His world was the world of tomorrow.  The experimental community of Disney’s imagination was reality.  Jobs built on technology that thrust us into space.  The expanse of the world was made smaller by the connectivity of his genius.  And at the end, it was home and family that he would retreat to.  Palo Alto was thousands of miles away from New Rochelle; it was ony a stone’s throw away thanks to the world Jobs created.

“That’s been one of my mantras — focus and simplicity. Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains.”  Steve Jobs.

One week.  Fifty years. I doubt if it was coinidence.  A trip to Disney WOrld would not be complete without hearing “Now is the time.  Now is the best time.  Now is the best time of our lives.”  Disney dreamed it.  Dick VAn Dyke lived it.  Sputnik propelled it.  Jobs recreated it.  One week.  Fifty years.