Telemedicine in some form has existed for decades. The basic premise is fairly intuitive - “I conduct lots of business remotely, why not healthcare?” Despite that, the adoption rate has remained persistently low until very recently and it is largely only used for primary care.

Historically, one barrier to widespread adoption was the lack of reimbursement parity. Insurers would often pay less for remote care on the basis that it cost less to deliver (I’m not paying for an office you don’t need for this visit). Unsurprisingly, providers responded to that incentive and largely avoided telemedicine. Laws requiring “reimbursement parity” have been passed in a growing number of states over the past decade, providing a major catalyst for telemedicine. There’s money it in now.

Concurrently, the ACA pushed up deductibles such that lots of routine care would likely be paid for out of pocket, especially for the younger people who more often go for high deductible plans. If people are paying for care themselves, they start acting like consumers and want to be treated as such. Cost, convenience, and user experience matter more if care is paid for out of pocket and telemedicine fits nicely with that.

Suddenly the pandemic is blowing that up even more and providers are scrambling to move their practices to telemedicine-first or telemedicine-only to provide care while maintaining social distancing. Telemedicine can help keep them and their patients safer than in-person care.

Insurance set the stage and COVID created the urgency.

Telemedicine 1.0: optimizing patients

The first, simplest phase of telemedicine largely address problems faced by patients. Getting to a doctor is inconvenient under the best of circumstances and most people aren’t in the best of circumstances. If you live in a dense city and can schedule an appointment, you might reasonably travel 20 minutes each way, hang out in a waiting room for 40 minutes, and sit in an exam room for 20 minutes all for a 15 minute visit with a doctor.

You’ve spent over an hour and a half for a 15 minute visit. That means the total time efficiency of the visit is just a measly 15%. And the real averages are almost all much worse on each of those underlying estimates.

Moving that visit to a phone call means spending less time getting care overall. You could pretty reasonably get to 75% efficiency even if the care you receive is itself unchanged.

The first known telemedicine visit of this type occurred in 1879. The standard operating procedure basically hasn’t changed since then. This is what our health system is rushing to adopt as we try to cope with the pandemic. Other than the phone, the doctor is not using any tools differently than she otherwise would have. The direct cost to her practice is functionally unchanged.

Telemedicine 2.0: optimizing providers

Starting in the 1990s, the internet offered the chance for “store and forward” telemedicine. Store and forward, as the name implies, means information is recorded (stored) and sent (forwarded) to a doctor who then reviews it later. The doctor-patient interaction is “asynchronous” (not at the same time) versus a phone or video call which is synchronous.

Asynchronous is only just now starting taking off, in no small part because of recent changes allowing doctor patient relationships to be established over store and forward (asynchronous) mediums.

This creates opportunities to add more technology to the administration of healthcare, not just the delivery mechanism. Parts of the patient journey like intake forms can be productized without the need for large administrative staffs.  Scheduling can largely be obviated for much of routine care if patients and doctors can message asynchronously. If communication is tied directly to medical records systems, charting can be (semi-) automated and data can be originated in structured, machine-readable formats. 

Mixing synchronous and asynchronous communications can help practices better triage and allow providers to spend more time with more acute patients. That also means enabling them to spend less time doing the things they hate doing (charting, admin, etc.), the biggest factor in provider burnout. 

In all, telemedicine 2.0 takes much fuller advantage of the technology at its disposal. It is healthcare built for telemedicine with the effect of scaling doctors, rather than just trying to port in-person care onto a new medium to make it more convenient for patients. That in turns means making healthcare dramatically more available and affordable.

Telemedicine 3.0: what comes next?

Everything described thus far represents clear advantages to patients and providers but comes with very obvious limitations in both the scope (what can you treat this way) and the benefits (why would you bother). No, we’re never going to eliminate all in-person care nor should we even want to. But even as telemedicine 2.0 makes healthcare more available by optimizing throughput, it still does not fully realize the vision of digital-first healthcare.

That is, the 2.0 scheme is still digitizing and modifying analog practices rather than building digital health tabula rasa and with an eye to the newly possible.

The long term opportunity for telemedicine is not to ignore its limitations (home surgery by an on-demand robot!) or pump vaporware (AI for fully autonomous primary care!) but to provide substantively better outcomes and experiences where it can by doing things that in-person care cannot.

That means taking full (fuller?) advantage of connectivity to do things like passive monitoring to track integrated health and lifestyle data. It means continuous patient monitoring and longitudinal data for both better patient experiences and easier, faster clinical trials. It means unlocking whole new modalities for care delivery and coordination build on top of interoperable medical records (eventually). Imagine all that health data from all those different sources and providers coming together into integrated medical records hubs that can surface conditions or direct patients to care proactively. Missing out on the opportunity to find unexpected issues through more casual patient interactions is a legitimate criticism of telemedicine and will always be part of any sober cost benefit analysis.

It means building adherence and retention directly into patient-facing products and provider-facing tools. It means putting even more process automation behind and products in front of providers to scale knowledge and expertise. It means rather than bolting telemedicine onto a physical world practice, going the other way around to build digital-first full service practices. Imagine starting a patient-provider relationship online and directing a patient to in person care only when necessary and where remote care isn’t enough.

What will all this mean for the health systems’ lock in and pricing power? How will it change the physical and operational needs of providers, and in turn the organization of provider groups? How does the slow shift towards value-based care affect (or even effect) this and vice versa? How will we measure the impacts on individual health? On population health? There is certainly more that we don’t know than what we do.

Whatever digital health 3.0 will look like, it seems clear that that timeline has just gotten pulled forward. It’s happening.

Huge shout out and thank you to Nikhil Krishnan for his excellent post detailing the new HC infrastructure and for giving feedback on this post.  If you’re interested in this kind of thing, go subscribe to his newsletter Out Of Pocket.

As I’m sure you all are, I’ve been thinking a lot about “what comes next.” Or at least I’ve been trying to as I deal with the distraction and existential dread brought on by every sunrise and push alert.

One idea in particular that I’ve been noodling on has been how surging unemployment today might lead to structural labor shortages tomorrow.

The US is facing unprecedented levels of unemployment and even with extended UI, people are going to be hurting for work. That will create tons of interest in sharing/gig economy work just like after the last recession even if many of the mainstays (rideshare especially) are seeing their businesses crash and burn. Across the board, this is a great time to be hiring - even in highly skilled professions, the power dynamics have completely reversed overnight.

But that’s just today. Further out, the picture seems murkier.

The median age of the American worker is 42 years old. 37 million working Americans are at or near retirement age. (BLS) Even a temporary loss of income will likely push some of them out of the workforce altogether and into retirement, if for no other reason than the fact that unemployment last much longer for older workers. Still more will probably have to find work in other fields without being able to go back into their original profession. Over a 40% of tax preparers, commercial drivers, appraisers, HVAC mechanics, engineers, opticians, CFAs, funeral managers, construction managers (just to name a few categories) are approaching or above retirement age. (BLS)

Most of these categories (in total there are 46 such categories employing over 6 million people) are either skilled labor that is difficult to quickly train (bookkeepers and opticians, e.g.) or family-run businesses where a younger generation evidently did not want to take over (funeral homes and farms, e.g.). As some portion of the older workers are pushed out from or semi-voluntarily exit the workforce/their field, the supply shortages could prove very persistent. There’s not some new crop of precision instrument and equipment repairers just ready to turn on overnight.

Even if the overall labor force participation rate for older people goes up as retirement savings get decimated (it happened in 2008), that won’t be unevenly distributed by profession. So whether it’s opting for an early retirement or needing to find work elsewhere (the bookkeeper becoming a warehouse worker to make ends meet), these fields may get seriously hallowed out.

If certain professions exit the labor force in droves, we might return to some form of full employment but productivity will be constrained by the undersupply of whole categories of workers.

Every category that suffers from this kind labor force participation decline should present opportunities for 1) automation and tooling to help the reduced supply become productive enough to meet demand and 2) supply-side aggregation as the extant supply becomes a more highly sought-after commodity. If it’s departure of older workers causing these shortages, that theoretically means the remaining (younger) workers will be more open to using new technology and services…

So I guess this is a request for startups for a vertical labor marketplace for morticians?

For those of you fortunate enough to not know or not care, Marc Andreessen wrote an essay. People lost their shit. It’s Time to Build is a call to action to innovate coming out of the CV19 crisis and focus on bigger, more ambitious projects.

The problem is desire. We need to *want* these things. The problem is inertia. We need to want these things more than we want to prevent these things. The problem is regulatory capture. We need to want new companies to build these things, even if incumbents don’t like it, even if only to force the incumbents to build these things. And the problem is will. We need to build these things […]

Every step of the way, to everyone around us, we should be asking the question, what are you building? What are you building directly, or helping other people to build, or teaching other people to build, or taking care of people who are building? If the work you’re doing isn’t either leading to something being built or taking care of people directly, we’ve failed you, and we need to get you into a position, an occupation, a career where you can contribute to building. There are always outstanding people in even the most broken systems — we need to get all the talent we can on the biggest problems we have, and on building the answers to those problems.

Cool. Like so much by tech luminaries, the essay reads like something written by someone who's never taken a social studies class or paid attention to politics or history except insofar as it relates to Great Men of Business.

Andreessen is right that accomplishing huge breakthrough projects requires an ambition and risk tolerance that we presently seem to lack. It’s very much in the vein of “we were promised flying cars and all we got was 140 characters,” and even acknowledges that. But the essay lacks any consideration of the structural factors or incentive problems getting in the way beyond the plea to "demand more" of various types of leaders.

Want a specific actionable suggestion? Provide 10x more funding for basic research.

The Apollo Mission and the Human Genome Project are incredible feats of human ingenuity and we are still reaping their benefits. They were also only possible with massive, unthinkable infusions of taxpayer support.

To understand why, look at the difference between “basic” and “applied” scientific research. Applied research has measurable ROI, focuses on direct (commercial) applications, and generally operates on relatively short timelines and budgets. Think of Ford-employed engineers and scientists working to make a car 10% more fuel efficient by studying wind resistance and weight distribution. Worthy and valuable.

Basic research, on the other hand, is generally tedious and fruitless. 1000 researchers in 100 labs might spend a decade each on the thermodynamics of batteries with nothing to show for it. But maybe the 101st lab on the first day of the 11th year will run into a physics or chemistry problem their model cannot solve. They’ll need to rework that model and in so doing, maybe they’ll discover something novel about battery construction. Maybe that novel thing will stand up to scrutiny and peer review. Maybe it will be reproduce-able in other labs. Maybe then it will lead to a new way of thinking about batteries which in turn might spur a surge of new research that could lead to a novel battery altogether potentially paving the way for 10x more efficient electric cars in another decade. But maybe not.

See the difference?

Basic research needs to be publicly funded because it requires massive scale and has unclear/unpredictable benefits on indeterminate timelines. Understandably, corporate shareholders don’t love that. Even if they did, private companies don’t have the capital to fund enough basic research and wouldn’t have the incentives to put its results in the public domain. If basic science is guarded as trade secret rather than shared publicly, its potential impacts are severely hampered; basic research can only be as groundbreaking as the applications it eventually spurs. The one private entity with a real track record of funding and sharing basic research was Bell Labs, which eventually led to the failure of its parent company.

Without basic research, scientific progress runs into natural limits and technological progress faces diminishing returns eeking out percentage points of efficiency rather than making great leaps or paradigm shifts. To unlock the next phase of technological and social progress, we need the desire and ambition but we also need the funding.

We are falling down miserably on this front.

Exhortations to service are great and we should certainly demand more from our political and business leaders. Nothing will actually change until we recognize the structural causes beyond just laziness, lack of ambition, or shortterm-ism. Why do we have ample military funding, Andreessen asks, when we can’t fund public projects?

Is the problem money? That seems hard to believe when we have the money to wage endless wars in the Middle East and repeatedly bail out incumbent banks, airlines, and carmakers. The federal government just passed a $2 trillion coronavirus rescue package in two weeks! Is the problem capitalism? I’m with Nicholas Stern when he says that capitalism is how we take care of people we don’t know — all of these fields are highly lucrative already and should be prime stomping grounds for capitalist investment, good both for the investor and the customers who are served. Is the problem technical competence? Clearly not, or we wouldn’t have the homes and skyscrapers, schools and hospitals, cars and trains, computers and smartphones, that we already have.

But this is ass backwards. We have the money to fund things when there are people to advocate for them. People can advocate for them when they stand to profit and benefit directly. Of course those fields attract private investment but where specifically the money goes and to what end is colored by the demands of private capital - namely timely ROI. And as for those smartphones and cars and buildings, they are all relying on basic research done decades ago. We have refined and enhanced but we have not replaced. Until or unless we fund research at a huge new scale, we will be stuck on our present loops and limited by the boundaries of our basic knowledge. We will feel like we are making progress but we will be living in basically the same world with basically the same rules.

What if the real sophon block was defunding the NSF?

Anyone who is really interested in this should read two books:

1. The Structure of Scientific Revolutions by Thomas Khun. It’s the precursor to the oft-quoted by rarely understood Innovator’s Dilemma by Clayton Christensen. Funny enough, Christensen was effectively applying Khun’s theoretical work on the field of science to the field of business - thereby reproducing the exact dynamic they were each describing.

2. Three Body Problem and Dark Forest by Cixin Liu.

Early last year I wrote a bit about some of the ideas I was most interested in learning about and exploring. Now I want to refresh that exercise with this non-exhaustive list of spaces and problems I’m (still) thinking about.

I hope there’s some value in just putting this out there both to force myself to commit my ideas to paper and hopefully to start some conversations with anyone (interested in) building these kinds of things.

If these are things you also care about or if these wrinkle your brain, I’d love to hear from you.

Financial services for bottom 50%

Most Americans are not in good financial shape. We know this. We know that 40% of Americans can’t afford a $400 unexpected expense and that household debt is higher than ever. Yet, for the most part, the “solutions” startups keep proposing don’t make basic sense. For people making $35k a year with $40k in debt, managing their finances is not an optimization problem. You can’t engineer your way to financial security by skimming dollars here and there if the inputs are just insufficient.  We’re not going to solve a consumer debt crisis with more consumer debt and predatory loans, no matter how pretty the packaging.

The only way to fix the problem is to actually transfer wealth and/or increase income. I see a ton of potential for companies that can help people file for bankruptcy (especially student loans), reduce predatory fees, and, most importantly, increase their income through either job training/switching, better negotiating, or even collective bargaining.

Homeownership/building equity

How do we protect communities and let the longtime residents not just avoid being hurt by but actually benefit form development? How can begin to make up for the wealth gap that renter/owner disparities have worsened over the past decade since the global financial crisis?

We need to create better, more accessible paths to building equity and somehow turn renters into owners without just increasing household debt or creating shitty loans for unqualified buyers. This likely means dramatically rethinking what homeownership can look like and most likely divorcing the concepts of house as residence and house as savings account.

Affordable housing

For as long as I’ve been writing anything, I’ve been writing about affordable housing. The housing market is even more punishing for those that aren’t in the market to buy at all (see: building equity above). As cities increasingly become playgrounds for the rich, working people who actually make things run are pushed to the margins. I remain really committed to the idea of co-living, if executed properly, can be a low-cost way to bring new affordable housing stock onto the market. Beyond that, there’s opportunities to lower the cost of new development through pre-fab and other innovative construction methods, to keep putting more downward on brokers, improve public transit and city planning (which has knock-on effects on housing), and so on and so on. 

If we can’t find a solution our housing affordability crisis soon (likely a multitude of solutions from government and the private sector), this will be the defining political and social crisis of the next decade.

Identity and privacy

Cambridge Analytica. Russia hacked the election. Data breaches at Marriott and Target and Equifax and everywhere else. These all get wrapped up into one big flashing red warning light. Now I think there’s beginning to be enough awareness, fear, uncertainty, and doubt about data privacy and security that regular people may be getting the point where they’re willing to pay for it. At this point it seems clear that there’s opportunities for better governance and data/privacy within companies, for users to secure themselves through more private alternatives to traditional technologies and services, and for some whole new paradigm of identity management and how we permission our PII.

Sure VPNs and adblockers and password managers are a good starting place, but when surveillance is the primary operating model of our economy, the change to put users back in control of their own data and safe in their digital lives will have to be profound. We haven’t even begun to scratch the surface on what this can really mean. Whether its better data governance, decentralized identity management, privacy-forward products and services, and/or consumer-friendly cybersecurity tools, I honestly have no idea what this will look like but I’m excited.

Aging

Americans are getting older. Obviously. The portion of (for now) retirement age Americans has already doubled in the past 50 years and could nearly double in the next 30. We’re looking down the barrel of a demographic crisis that will force us to completely re-shape every level of our social organization and challenge its basic operating principles. Some of that is already starting to play out as Baby Boomers come into retirement, often without adequate savings or support. So we’ll need to rethink everything from retirement homes/communities (see co-living above) to how we provide social services to how keep people productive longer and engaged in retirement. How do we export innovations for the young to older generations?

I don’t think we can lump “old people” together into one bucket. Segments have to be understood by cohorts; the elderly and the aging couldn’t be more different. I think I’m generally more interested in the former (new models for healthy, pro-social aging) than in the latter (improvements to convalescent aging/care). Better aging is more a preventative and all-encompassing problem and solution set, as opposed to focusing on the elderly which is largely healthcare-related and corrective.

Climate Change/Resiliency

Ultimately protecting and mitigating the damage from our climate disaster isn’t an individual responsibility. Small consumptive changes aren’t an empty gesture but they also aren’t on the scale we need to be thinking about as a society and a species. Nevertheless there are still important steps to take on the individual level to both improve our carbon footprint and protect ourselves from the ravages of a changing climate. I’m very interested in new approaches to climate-related insurance lines (flood, wildfire, etc.), re-location away from vulnerable areas, and sustainable building techniques and materials (even deconstruction).

It’s deeply problematic that flood and wildfire insurance, for example, require people to rebuild damaged and destroyed homes on the same lots, in the same flood plains and wildfire-prone areas, for example. This is to say nothing of declining utilization of those (federally backed) insurance programs. I’m not an “abandon the coast!” kind of guy but we are going to face migratory pressures within our own borders because of climate change and need to prepare for that. Finally, we need to better build for resiliency and sustainability, both by lowering the outputs of new construction (concrete is a huge contributor to carbon emissions) and by building to better withstand disasters.

These are just the things I’m actively thinking about/pursuing right now. It’s a big world and there’s lots more out there. So tell me what I’m getting wrong, what I’m missing.

2019 was the year that I made a concerted effort to start reading whole books again. In college, it’s relatively easy to lapse as a reader as you struggle to keep up with schoolwork. Entering the work world full time, it’s easy to get sucked into only reading “the trades,” such as they are.

I thought it might be fun to share a bit about what I read this year. Here’s my best attempt at/recollection of chronological order with shout outs to those that recommended each book to me:

Curse of Bigness - Tim Wu

Wu explores anti-trust in the modern economy and tries to lay out a case for a new regulatory and legal regime to promote competition. It’s a quick read and a good primer on the issue but not exactly riveting literature. 

Fifth Risk - Michael Lewis

If you like Michael Lewis you know the drill and you’ll like this. If you’ve never read Michael Lewis, you’ll still probably like series of vignettes on the random parts of our government that handle massively complex tasks and make the world actually work. As usual, Lewis is entertaining and breezy. Given as a gift by my mother.

Ivory Pearl - Jean-Patrick Manchette

Really fun mystery novel set in the ruins of WW2 in Cuba and Europe. In the ultimate cliffhanger, Manchette died before he could finish it. Recommended by Chris and Andy on The Watch podcast.

We Are the Nerds - Christine Lagorio-Chafkin

This in-depth look at the creation and history of Reddit is a good read if you like this sort of thing but it’s just way too long. It would have been better as a longform magazine feature than a 5 page tome. Heard about it from Bradley Tusk.

Snow Crash - Neil Stephenson

Snow Crash is basically The Matrix before The Matrix but way better. It’s got levels, man. At the surface, it’s a cyberpunk mystery adventure. One level down it’s a terrifying picture of a post-internet, late capitalist economy. Beyond that it’s a rich exploration of language and memetic culture and faith. Stephenson is a science fiction maestro and pulls from a tremendous variety of different arenas to build this world and make it feel real. Thanks to Reggie and Christopher Mims for repeatedly pumping this book.

American Gods - Neil Gaiman

Gaiman gets mystical and uses belief in contemporary society along with high fantasy tropes as a vessel to write a hardboiled mystery novel. This book is just a good time. Can’t say the same for the Amazon adaptation. I picked up American Gods in an airport on my way to SF after plowing through Snow Crash much faster than anticipated. Shout out Hudson News!

Gone World - Tom Sweterlitsch

Really killer, thrilling mystery novel in a sci-fi setting. Gone World is super eerie and atmospheric. It follows a detective and she investigates murders across multiple timelines (possible futures and the past), kind of like a near-future version of True Detective with some Minority Report mixed in for good measure. It’s creepy as shit and one of the more compelling time travel mechanics I’ve encountered. Henry Bradley recommended to me and I super strongly endorse it for you. 

Annihilation - Jeff VanderMeer

This short sci-fi horror novel will make you confused and scared of trees. The movie, which got me to read the book, is better.

Severance - Ling Ma

Severance is all about millennials’ sense of loss, listlessness, and regret. It tracks the main character across two timelines - working in publishing in NY and trekking across the US as one of a handful of survivors after a viral epidemic. The virus itself triggers a kind of death by nostalgia and the novel is generally focused on the perils looking backward as felt by the main character, who immigrated from China to the US as a little girl. I was recommended this one by an actor in a creepy face mask as a part of a Verizon commercial that went to air over the summer… So that’s weird.

I was dubbed over though, which hurts.

Super Pumped - Mike Isaac

As I make an effort to not just read books but to read fiction specifically, this one stands out as the one of the only BUSINESS AND TECHNOLOGY books I read in 2019. Though Super Pumped didn’t break any new ground for me, it was kind of crazy to back and revisit Uber’s insanity all at once. It’s easy to forget how much Uber dominated the headlines and for how long. Mike is a great reporter but he’s either not a great writer or the book was just so rushed that he didn’t have the time to be. Super Pumped? More like super formulaic! It deals heavily in great men of history/business tropes and makes a pretty naked effort to force everyone into archetypal characters/arks. Frankly, if you’d enjoy reading it you probably already have.

Seveneves - Neil Stephenson

Remember how much I said I liked Snow Crash? Well Seveneves is even better. Across 600+ pages of techno-babble and minutia, Stephenson chronicles humanity’s race against the clock to launch itself into space in the face of an impending meteorological apocolypse that will render the earth uninhabitable for thousands of years. Where the book really shines however is when he jumps forward 10,000 years forward to humans’ efforts to recolonize the planet. All of the tiny details along the way - the science and engineering and politics that Stephenson lays out in often excruciating detail - become key character elements in the future timeline. Stephenson tracks how these decisions made in moments of crisis ripple out across thousands of years. Everything matters. This is the best book I read this year.

Dancing Bear - James Crumley

This is a fun, hardboiled detective thriller about an environmental conspiracy and drug dealers and Haliburton played out across the mid- and pacific northwest. I still don’t necessarily get what actually happened but the boozing and drugs and sex and sense of danger are a good time. Thanks to Bob Greenlee for giving me this after I complained about leaving my book (the sequel to Annihilation) on the flight to SF.

The Wall - John Lanchester

In The Wall, climate change has made much of the world uninhabitable (sensing a theme yet?). The UK has built a seawall around itself to keep out both the rising seawater and the waves of climate refugees seeking safety. The main characters are soldiers tasked with manning the titular wall and stopping those refugees “the Others” from breaking through. It’s fucking intense and it’s timely. The Wall pairs really nicely with Severance but I think it’s generally better. Like Ling Ma, Lanchester explores the disconnect between parents and children millennials but this time through the prism of climate change and the broken world we are set to inherit. Thanks to Henry Bradley for recommending this one as well. You’re on a roll.

Story of Your Life (and Others) - Ted Chiang

This collection of short science fiction stories runs the gamut of topics and themes. Though the collection is most famous for the titular Story of Your Life, which was adapted into Denis Villeneuve’s Arrival, that wasn’t even one of the standouts (the movie was better). I was going to try to name the standout short stories but found the list would include almost all of them. It’s generally hard to find a single through line but it’s evident that he’s supremely curious. He’s just as compelling on neurology as he is on ad-tech. But I think the stories are at their best when exploring the intersection between science, science fiction, and divinity. It’s well worth your time.

Thanks to Zak Kukoff for telling me about this.

2020

Right now I’m reading a collection of short stories by HP Lovecraft. After that, I plan on revisiting some of the best authors I read in 2019, namely Ted Chiang and Neil Stephenson. There’s a few non-fiction books I want to check out as well including Because Internet and Bob Iger’s The Ride of a Lifetime. I usually have a hard time with BUSINESS books and I read enough tech news as is. Overall, I want to keep sticking mainly to fiction and probably mainly to science fiction within that but I am very open to suggestions now or later.