Generational Dynamics Forum - New Site

Higgenbotham wrote: Mon Sep 28, 2026 11:26 am That's sort of like saying education and health care are no longer utilities because we raised the price and made them 25 percent of GDP.

Top 10 hospitals in the U.S. by net patient revenue

Rank Hospital name City State Net patient revenue
1 NewYork-Presbyterian Weill Cornell Medical Center New York NY $10,091,059,200
2 Tisch Hospital New York NY $8,131,192,320 Explore
3 Stanford Hospital - 300 Pasteur Dr Palo Alto CA $7,893,382,656 Explore
4 Cleveland Clinic Main Campus Cleveland OH $7,426,526,720 Explore
5 AdventHealth Orlando (FKA Florida Hospital Orlando) Orlando FL $7,153,306,624
6 Vanderbilt University Medical Center Nashville TN $6,903,583,232
7 UCSF Helen Diller Medical Center San Francisco CA $6,828,788,224
8 University of Texas MD Anderson Cancer Center Houston TX $6,062,692,352
9 University Hospital Ann Arbor MI $5,572,471,808
10 Memorial Sloan Kettering Cancer Center New York NY $5,457,068,544

Stanford Health Care (SHC) is a tax-exempt non-profit organization whose purpose is to provide patient care services through its 21,000 employees at 3 hospitals and 60 clinics in the Palo Alta, California area. SHC consists of 21 tax-exempt non profit organizations, 43 related organizations taxed as a partnership, and 31 organizations taxed as a corporation or trust.

In 2024, SHC reported total revenue of $8 billion with the largest source of revenue reported to be patient revenue ($7.9 billion). Expenses were $7.5 billion (including $251 million in depreciation) with the largest expenses reported to be compensation ($3.3 billion), purchased services and fees for services ($1.9 billion), supplies ($1.2 billion), and office-related expenses ($384 million).

Net assets are $7.5 billion at year-end 2024 (compared to $6.5 billion the prior year).

21,893 employees received $3.3 billion in compensation, which equates to an average of $151,000. 9,927 employees received more than $100,000 with 20 of the most highly compensated reported to be:

$6,014,254: David Entwistle, President and CEO
$3,172,743: Lloyd Minor, Director*
$2,995,552: Quinn McKenna, COO
$2,543,596: Paul King, Director*
$2,526,363: Linda Hoff, CFO
$2,052,677: Priya Singh, VP and Chief Strategy Officer *
$1,821,989: Randall Livingston, Director*
$1,397,889: Sridhar Seshadri, Chief Cancer Operating Officer
$1,368,268: Eila Skinner, Director*
$1,210,323: Alison Kerr, VP Service Lines and CAO
$1,121,657: Dale Beatty, Chief Nurse Executive
$1,072,860: Thomas Montine, Director*
$ 977,492: Thomas Kim, V,Chief Marketing Development Officer
$ 946,361: Carol Rorig, VP and Chief HR Officer
$ 891,092: James Martin, VP, Controller
$ 834,765: Helen Wilmot, SVP Chief Facilities General Services and Planning
$ 779,163: Gary Fritz, VP – Applications
$ 718,540: Timothy Seay-Morrison, VP Chief Ambu Svc Lin Officer
$ 649,876: Jay Shah, Director*
$ 490,902: Elizabeth Oyekan, VP Pharmacy and Imaging Services

The 20 highly compensated employees listed above received $35 million in compensation in 2024.

To read about the supplemental executive retirement plan and housing allowances, go to the Form 990, Schedule J, Part III, Supplemental Information.

SHC has made housing loans to employees (it is unclear why a tax-exempt non-profit health care company is making housing loans – including reduced interest rate and zero interest rate loans – to employees since the purpose of non-profit healthcare companies is not to provide housing loans, especially for multimillion dollar homes):

David Entwistle received 2 loans (for housing) totaling $2 million. The balance due is $2 million.
Dale Beatty received 1 loan (for housing) for $500,000. The balance due is $500,000.
Linda Hoff received 1 loan (for housing) for $953,000. The balance due is $703,000.
Gary Fritz, a former employee received 1 loan (for housing) for $300,000. The balance due is $300,000.
To read the IRS Form 990 (2024), click here.

How much money has been spent on Alzheimer's research in the past 30 years and, with all the money spent, has even one person been cured of Alzheimer's?

AI Overview

The direct answers to your questions are straightforward: Tens of billions of dollars have been spent globally on Alzheimer's research over the past 30 years, but to date, not a single person has been cured of the disease.

1. How Much Money Has Been Spent?

While a precise global figure encompassing every private pharmaceutical company, university, and government worldwide over 30 years is difficult to aggregate into one number, the total is securely in the tens of billions of dollars.

The vast majority of this funding has been back-loaded into the last decade. To give you a sense of scale using the U.S. National Institutes of Health (NIH)—the world's largest public funder of health research—the trajectory looks like this:

The 1990s and 2000s: Federal funding for Alzheimer’s hovered at low levels, generally under $500 million annually.

Alzheimer's Impact Movement

The Turning Point (2011): The passage of the National Alzheimer's Project Act (NAPA) sparked a massive legislative push to treat dementia as a public health priority.

Current Day: Annual NIH funding for Alzheimer's and related dementias has quadrupled over the last decade, reaching approximately $3.9 billion per year.

When you add up decades of escalating NIH budgets, billions spent by non-profits like the Alzheimer's Association, and the immense R&D budgets of private pharmaceutical giants, the cumulative total easily crosses tens of billions.

2. Has Anyone Been Cured?

No. There are currently zero survivors of Alzheimer's disease. Once a person develops the late-stage cognitive decline associated with Alzheimer's, the damage to the brain's neurons is considered permanent and irreversible by modern medical standards.

Where is the Money Going if There is No Cure?

It is natural to look at billions of dollars and wonder why it hasn't bought a cure. Scientists point to a few reasons for this bottleneck:

We Misunderstood the Disease for Decades: For a long time, the dominant theory was that clearing out "amyloid plaques" (abnormal protein buildups in the brain) would cure the disease. Billions were spent developing drugs to clear these plaques. While new drugs like lecanemab and donanemab finally succeeded in clearing them and slowing down early-stage cognitive decline, they did not reverse the damage or stop the disease entirely. This revealed that plaques are likely a symptom, not the root cause.

The Shift to Prevention: Because fixing a deeply damaged brain is so difficult, much of today’s funding is pivoting toward prevention and early detection. Breakthroughs like newly developed blood tests can now spot the chemical signs of Alzheimer's years before symptoms appear, allowing doctors to intervene before irreversible damage occurs.

Exploring New Theories: Funding is finally diversifying away from just looking at plaques. Current trials are exploring completely different angles, such as repairing brain metabolism (how the brain uses energy), stopping "tau tangles" (another destructive protein), and reducing brain inflammation.

SORKIN: Well, let me ask you about the anger, because there seems to be anger, at least from certain political sides of this. And AOC recently said in a podcast, I’m just curious how you think about this, says there’s a certain level of wealth and accumulation that is unearned, she says. You can’t earn $1 billion, just can’t earn that, she says. You can get market power. You can break rules. You can abuse labor laws. You can pay people less than what they’re worth, but you can’t earn that.

BEZOS: Yeah.

SORKIN: By the way, you’ve earned an extraordinary amount of money. You employ, largest employer, if not one of them in the whole country. When you read that, what do you think?

BEZOS: Well, it’s, it’s not correct on its face. Let’s give you, let me give you a simple example. Let’s say you start a burger joint—

SORKIN: Right.

BEZOS: And you have ten employees and you make a little bit of money.

SORKIN: Right.

BEZOS: Until you have this is, this one outlet. And by the way, these are the most delicious burgers in the world. People love your burgers, Andrew. And so then you open a second outlet. And now you’re making a little bit more money and you have 20 employees and you open a third outlet. By the time you’ve opened 1,000 outlets, you are a billionaire.

SORKIN: Right.

BEZOS: And by the way, this is a real life story. It happens all the time. It’s In-N-Out burger. It’s, you know, Raising Cane’s Chicken. At what point did that money all of a sudden become unethical or it didn’t? There was one outlet, and then there were two, and then there were three. What you’re doing, the way, the way you make $1 billion or $100 million or $10 million or anything, is you create a service that people love. And if millions of people choose your service, you’re going to end up with $1 billion.

SORKIN: Right.

BEZOS: And you can, you know, just try it with a chicken franchise.

SORKIN: Do you think though—

BEZOS: But your chicken has to be good.

Higgenbotham wrote: Thu Feb 02, 2023 9:49 pm During the early stages of this breakdown, many of the new corporate nomads gathered together in suburbs of large cities and, being first generation nomads, attempted to re-create the kinds of social bonds that were present in the places they came from. This worked pretty well for a time, until those people died off and the second and third generations stopped doing this. I think this was described best in a book called Bowling Alone and thought it had been discussed here, but don't find anything offhand. I'll continue to look for that.

Also, during the early stages of this breakdown, there were economic losers and beneficiaries. The beneficiaries were the corporations who could cookie cutter their outlets across a previously interesting and varied landscape, producing the forlorn, bland, and ugly architectural landscape that now exists across America. McDonalds perhaps being one of the first and best examples. During the heyday of the expansion of McDonalds, along came the "great investors" who realized they could make a lot of money investing in this concept, people like Warren Buffett and Peter Lynch. Lynch described what he called the "ten-bagger" which was a stock where you could invest a dollar and that investment would multiply quickly to 10 dollars as these corporations cookie-cuttered their outlets across the country. Expanding in this way made a corporation hungry for capital and there was a class of people who got rich providing it, including many corporate nomads who recognized what was happening from observing their own lives. However, many more missed the boat, even though it was somewhat obvious.

It now appears this stage has been winding down for some time. Again, there are those who recognize this.

Higgenbotham wrote: Thu Feb 02, 2023 11:23 pm As an aside to the above, this was when the definition of quality was, let's say, adjusted. Quality no longer primarily means you get something really good. It primarily means, for example, as you travel across the country and go from McDonald's outlet to McDonald's outlet, it means you know what you are going to get and it will be very close to being the same thing.

quality
1 of 2
noun
qual·​i·​ty ˈkwä-lə-tē
pluralqualities

1
a
: peculiar and essential character : NATURE
her ethereal quality
—Gay Talese
b
: an inherent feature : PROPERTY
had a quality of stridence, dissonance
—Roald Dahl
c
: CAPACITY, ROLE
in the quality of reader and companion
—Joseph Conrad

2
a
: degree of excellence : GRADE
the quality of competing air service
—Current Biography
b
: superiority in kind
merchandise of quality

3
a
: social status : RANK
b
: ARISTOCRACY

4
a
: a distinguishing attribute : CHARACTERISTIC
possesses many fine qualities
b
archaic : an acquired skill : ACCOMPLISHMENT

5
: the character in a logical proposition of being affirmative or negative

6
: vividness of hue

7
a
: TIMBRE
b
: the identifying character of a vowel sound determined chiefly by the resonance of the vocal chambers in uttering it

8
: the attribute of an elementary sensation that makes it fundamentally unlike any other sensation

https://www.merriam-webster.com/diction ... %20generic.

This change in concept was pushed heavily by the cookie-cutter corporations and business schools starting in the 1970s and is well documented.

Bloomberg
Palantir, Apple and Microsoft Brace for Democrats to Go on Offensive
New lobbying registrations have exploded this fall as companies sign up representatives with ties to Democrats.
Ted Mann and Joshua Green
Fri, October 16, 2026 at 6:00 AM CDT 9 min read

(Bloomberg) -- For two years, congressional Democrats furious over corporate America's cooperation with the Trump administration have been limited to the sternly worded letter.

After the midterm elections, some of them will likely have subpoena power. Companies in their sights are armoring up accordingly.

Tech and defense leaders like Palantir Technologies Inc., Apple Inc., and Microsoft Corp. are hiring Democratic Party insiders including former Senator Mark Begich and mega-lobbyist Steve Elmendorf. Other companies that scored contracts helping to facilitate mass immigration raids or sought favor by bankrolling presidential pet projects are scouring internal documents in advance of a push of subpoenas. CEOs are bracing for an uncomfortable inevitability: public testimony before hostile questioners about how they cooperated with a domineering president's demands, and why.

Insiders across K Street describe the flurry of preparations as unprecedented, driven by an acknowledgment of the unusually transactional nature of President Donald Trump's second term — and outrage from Democrats toward those they see as complicit.

Higgenbotham wrote: Sun Dec 25, 2022 6:28 pm I said there are two opposite modes of living in the United States. The first is an expectation that you will spend your entire life in one area with other people who will spend their entire lives in that area. The second is an expectation that you will go to high school in one place, college in another place, then career in several places (no longer at one company) with sole focus on that. Everything else is something in between. The first mode engenders real connections while the second mode engenders transactional relationships. An example of a transactional relationship would be something like, "I have a buddy who is also 420 friendly. He finds me really good dope cheap and I fix all his computers." The best example of a transactional encounter I can think of is prostitution. Also, in a big city, encounters are briefer. That's not to say there isn't some overlap.

I told her in the second mode of living, people are taught from an early age to look to the next step in their progression and to primarily engage in transactional relationships as a means to get to that next step. A high school kid might be told to be friendly to the teachers because they will be writing college recommendations or whatever. They would not be encouraged to be friendly to teachers they genuinely like and not be friendly to teachers they genuinely do not like. And so on when the kid gets to college. I should add as an aside that girls are better at that than boys. I told her that while coping with the stress of getting from step to step, people who find themselves in the same boat will bond somewhat. But they know those bonds are likely temporary and will be broken when they get to the next step unless there is a practical reason to keep them. I also told her that people who have lived in transactional relationship mode for several generations do not even know how to live differently and can't. Many do not understand what a real connection is.

I would also add that high tech is making people more and more into transactions versus customers. Google is the best example I can think of.

Higgenbotham wrote: Sat Oct 17, 2026 3:56 pm There were 2 major railroad bubbles in the US (culminating in 1873 and 1893) at what could be thought of as the midpoint of the industrial age expansion. The two tech bubbles (2000 and 2026?) won't be the speed bumps people expect based on history but rather the end of the expansion.

There were 2 major railroad bubbles in the US (culminating in 1873 and 1893) at what could be thought of as the midpoint of the industrial age expansion. The two tech bubbles (2000 and 2026?) won't be the speed bumps people expect based on history but rather the end of the expansion.

AI Overview

Your observation draws a fascinating parallel, but it highlights a fundamental shift in how technology impacts economic cycles: The 1873 and 1893 railroad bubbles were infrastructure crises, whereas modern tech bubbles represent the saturation of automation and efficiency.

While the railroad panics were indeed "speed bumps" that ultimately paved the way for massive physical and industrial expansion, there is a compelling structural argument that today's technology cycles are ushering in the mature, late-stage phase of the digital expansion rather than just another temporary pause.

Here is a direct comparison of why the 19th-century railroad bubbles led to further growth, and why modern tech cycles might signal the tail end of rapid expansion.



Why the Railroad Bubbles Were "Speed Bumps"

When the banking firm Jay Cooke & Co. collapsed in 1873 due to worthless railroad bonds, it triggered the Long Depression. In 1893, reading the same script, over-extended railroad companies went bankrupt, causing a massive employment crisis.

However, these were capital supply shocks, not demand shocks. The physical infrastructure was left behind. Once the debt was wiped clean through bankruptcy, new operators bought the tracks for pennies on the dollar. Because the physical tracks were now incredibly cheap to operate, they radically lowered the cost of doing business across the United States. This directly fueled the Second Industrial Revolution, allowing companies like Standard Oil and Carnegie Steel to thrive. The expansion kept going because the physical frontier was still wide open.

Why Today's Tech Cycles May Signal the End of Expansion

If the railroad era was about building the network, the digital era has been about optimizing the network. The dot-com crash of 2000 wiped out speculative capital, but left behind fiber-optic cables that built the modern internet. The current AI and tech cycle of the mid-2026 era represents the apex of this optimization.

However, you can only optimize a system so far. Here is why this phase looks more like an endpoint than a midpoint:

Diminishing Marginal Returns on Efficiency: Railroads allowed a farmer in Iowa to sell corn to New York—a fundamentally new market. AI and software allow a corporation to do its accounting with 90% fewer people. This increases corporate margins, but it doesn't create a new physical product or expanding consumer base.

The Consumption Paradox: Industrial expansion relied on a growing, well-paid workforce that could buy the products being manufactured. Advanced software and AI shift the share of economic wealth from labor to capital. If automation scales to the point of displacing massive swaths of the workforce, aggregate consumer demand risks stagnating.

The Saturation of Data and Attention: The digital frontier is bounded by human attention and available data. Unlike the physical world of 1873, where millions of acres of land and resources were yet to be integrated into the economy, the digital world is hitting a ceiling where we are running out of novel data to train models and human hours to monetize.

The Verdict

You are likely correct that these tech cycles won't play out like the railroad panics. The railroad crashes were the growing pains of a young, physical economy learning how to scale. The modern tech bubbles—especially the ongoing shakeout of the mid-2020s—resemble the consolidation of a mature, hyper-efficient digital economy. Rather than a speed bump on the way to a larger expansion, it feels like the final polishing of an incredibly complex machine that has already conquered its frontier.

The news that three of the Pacific Northwest’s top companies — Microsoft, Amazon and T-Mobile — are prime financiers of President Donald Trump’s unapproved and garish White House ballroom, to the tune of a combined $20 million, sums up the new Gilded Age.

We have some of the wealthiest and most powerful companies since the robber baron days, greasing the skids for an authoritarian vanity project that the public doesn’t want, and no one approved of or consented to.

The 67 individuals and companies who gave a total of $330 million appeared to get something in return: federal government contracts or favorable regulation, and in some cases, pardons, The Washington Post reported.

Microsoft won a $144 million contract from the U.S. Air Force for cloud services. Amazon won a Department of Homeland Security cloud contract for $2.6 billion. T-Mobile also got contracts. Coincidence? Maybe. But you don’t see other big local companies like Costco, that don’t have federal contracts, embroiled in expensive back-scratching like this.

That the amounts were a secret, to be learned only via a leak, was the cherry on top.

Higgenbotham wrote: Fri Oct 16, 2026 12:20 pm

"This report shows that rebuilding soil health is one of the few measures that can improve nutrient density, yields and climate resilience all at once, and farmers can do it profitably today.”

https://www.independent.co.uk/news/uk/h ... 63325.html

Higgenbotham wrote: Sun Sep 20, 2026 4:01 pm I saw the discussion about food being the largest part of a family's budget in 1968. Again, they weren't eating factory farmed meat back then so, comparing apples and apples, food is much more expensive than what most people actually pay today if someone is applying standards from 50-60 years ago.

Vegetables are now half as nutritious than 60 years ago. Experts have worked out why
Fewer than a third of wheat varieties used in bread released since the 1960s meet the recommended zinc target, due to poor soil quality

Rebecca Whittaker
Thursday 08 October 2026 10:11 BST

Wheat, apples and carrots are half as nutritious as they were in the 1960s, a new study has suggested.

Due to declining soil quality the nutrients in fruit and vegetables have also drastically declined.

The study, by researchers at Deep Science Ventures (DSV), found twice the number of fruit and vegetables need to be eaten today to get the same level of minerals such as potassium, magnesium or copper than 60 years ago.

Researchers found food such as cereals and bread, as well as carrots, apples and peas had lost 20 to 50 per cent of several key nutrients.

Sian Ferguson, Trust Executive at The Mark Leonard Trust said: "Healthy soil is the foundation of healthy food. This report shows that rebuilding soil health is one of the few measures that can improve nutrient density, yields and climate resilience all at once, and farmers can do it profitably today.”