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The main argument about changing healthcare in the US seems to be long lines in England, Canada, and elsewhere but how would you disagree with or refute this claim?

The main argument about changing healthcare in the US seems to be long lines in England, Canada, and elsewhere but how would you disagree with or refute this claim?The above statement is and has been a lie or misstatement about universal healthcare/single payer for years perpetrated by mostly the conservatives [personally I believe it is because Big Pharma, Insurance and Hospital lobby group is so strong]. Which is strange because Mitt Romney when Governor of Massachusetts 10+ years ago instituted a form of universal health care still being used today.Although the below is 10 years old much of it holds true to today. By the By I have used the Canadian system myself, nice!10 Myths About Canadian Health Care, BustedBy Sara Robinsonhttp://TomPaine.comFebruary 5, 20082008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning — and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.I’m both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I’m in a unique position to address the pros and cons of both systems first-hand. If we’re going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.To that end, here’s the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they’re made of.1. Canada’s health care system is “socialized medicine.”False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.The proper term for this is “single-payer insurance.” In talking to Americans about it, the better phrase is “Medicare for all.”2. Doctors are hurt financially by single-payer health care.True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:First, as noted, they don’t have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself in the course of a standard workday.Second, they don’t have to spend several hours every day on the phone cajoling insurance company bean counters into doing the right thing by their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid — quietly, quickly, and without hassle. There is no runaround. There are no fights. Appointments aren’t interrupted by vexing phone calls. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off, and gets home in time for dinner.One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring. You don’t realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who don’t operate under that stress, because they never have to fight those battles at all. Amazingly: they seem to enjoy their jobs.Third: The average American medical student graduates $140,000 in hock. The average Canadian doctor’s debt is roughly half that.Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes a one of a family’s major expenses, expectations tend to run very high. A doctor’s mistake not only damages the body; it may very well throw a middle-class family permanently into the ranks of the working poor, and render the victim uninsurable for life. With so much at stake, it’s no wonder people are quick to rush to court for redress.Canadians are far less likely to sue in the first place, since they’re not having to absorb devastating financial losses in addition to any physical losses when something goes awry. The cost of the damaging treatment will be covered. So will the cost of fixing it. And, no matter what happens, the victim will remain insured for life. When lawsuits do occur, the awards don’t have to include coverage for future medical costs, which reduces the insurance company’s liability.3. Wait times in Canada are horrendous.True and False again — it depends on which province you live in, and what’s wrong with you. Canada’s health care system runs on federal guidelines that ensure uniform standards of care, but each territory and province administers its own program. Some provinces don’t plan their facilities well enough; in those, you can have waits. Some do better. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But that’s just as true in any rural county in the U.S.You can hear the bitching about it no matter where you live, though. The percentage of Canadians who’d consider giving up their beloved system consistently languishes in the single digits. A few years ago, a TV show asked Canadians to name the Greatest Canadian in history; and in a broad national consensus, they gave the honor to Tommy Douglas, the Saskatchewan premier who is considered the father of the country’s health care system. (And no, it had nothing to do with the fact that he was also Kiefer Sutherland’s grandfather.). In spite of that, though, grousing about health care is still unofficially Canada’s third national sport after curling and hockey.And for the country’s newspapers, it’s a prime watchdogging opportunity. Any little thing goes sideways at the local hospital, and it’s on the front pages the next day. Those kinds of stories sell papers, because everyone is invested in that system and has a personal stake in how well it functions. The American system might benefit from this kind of constant scrutiny, because it’s certainly one of the things that keeps the quality high. But it also makes people think it’s far worse than it is.Critics should be reminded that the American system is not exactly instant-on, either. When I lived in California, I had excellent insurance, and got my care through one of the best university-based systems in the nation. Yet I routinely had to wait anywhere from six to twelve weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months. After two years in the BC system, I’m finding the experience to be pretty much comparable, and often better. The notable exception is MRIs, which were easy in California, but can take many months to get here. (It’s the number one thing people go over the border for.) Other than that, urban Canadians get care about as fast as urban Americans do.4. You have to wait forever to get a family doctor.False for the vast majority of Canadians, but True for a few. Again, it all depends on where you live. I live in suburban Vancouver, and there are any number of first-rate GPs in my neighborhood who are taking new patients. If you don’t have a working relationship with one, but need to see a doctor now, there are 24-hour urgent care clinics in most neighborhoods that will usually get you in and out on the minor stuff in under an hour.It is, absolutely, harder to get to a doctor if you live out in a small town, or up in the territories. But that’s just as true in the U.S. — and in America, the government won’t cover the airfare for rural folk to come down to the city for needed treatment, which all the provincial plans do.5. You don’t get to choose your own doctor.Scurrilously False. Somebody, somewhere, is getting paid a lot of money to make this kind of stuff up. The cons love to scare the kids with stories about the government picking your doctor for you, and you don’t get a choice. Be afraid! Be very afraid!For the record: Canadians pick their own doctors, just like Americans do. And not only that: since it all pays the same, poor Canadians have exactly the same access to the country’s top specialists that rich ones do.6. Canada’s care plan only covers the basics. You’re still on your own for any extras, including prescription drugs. And you still have to pay for it.True — but not as big an issue as you might think. The province does charge a small monthly premium (ours is $108/month for a family of four) for the basic coverage. However, most people never even have to write that check: almost all employers pick up the tab for their employees’ premiums as part of the standard benefits package; and the province covers it for people on public assistance or disability.“The basics” covered by this plan include 100% of all doctor’s fees, ambulance fares, tests, and everything that happens in a hospital — in other words, the really big-ticket items that routinely drive American families into bankruptcy. In BC, it doesn’t include “extras” like medical equipment, prescriptions, physical therapy or chiropractic care, dental, vision, and so on; and if you want a private or semi-private room with TV and phone, that costs extra (about what you’d pay for a room in a middling hotel). That other stuff does add up; but it’s far easier to afford if you’re not having to cover the big expenses, too. Furthermore: you can deduct any out-of-pocket health expenses you do have to pay off your income taxes. And, as every American knows by now, drugs aren’t nearly as expensive here, either.Filling the gap between the basics and the extras is the job of the country’s remaining private health insurers. Since they’re off the hook for the ruinously expensive big-ticket items that can put their own profits at risk, the insurance companies make a tidy business out of offering inexpensive policies that cover all those smaller, more predictable expenses. Top-quality add-on policies typically run in the ballpark of $75 per person in a family per month — about $300 for a family of four — if you’re stuck buying an individual plan. Group plans are cheap enough that even small employers can afford to offer them as a routine benefit. An average working Canadian with employer-paid basic care and supplemental insurance gets free coverage equal to the best policies now only offered at a few of America’s largest corporations. And that employer is probably only paying a couple hundred dollars a month to provide that benefit.7. Canadian drugs are not the same.More preposterious bogosity. They are exactly the same drugs, made by the same pharmaceutical companies, often in the same factories. The Canadian drug distribution system, however, has much tighter oversight; and pharmacies and pharmacists are more closely regulated. If there is a difference in Canadian drugs at all, they’re actually likely to be safer.Also: pharmacists here dispense what the doctors tell them to dispense, the first time, without moralizing. I know. It’s amazing.8. Publicly-funded programs will inevitably lead to rationed health care, particularly for the elderly.False. And bogglingly so. The papers would have a field day if there was the barest hint that this might be true.One of the things that constantly amazes me here is how well-cared-for the elderly and disabled you see on the streets here are. No, these people are not being thrown out on the curb. In fact, they live longer, healthier, and more productive lives because they’re getting a constant level of care that ensures small things get treated before they become big problems.The health care system also makes it easier on their caregiving adult children, who have more time to look in on Mom and take her on outings because they aren’t working 60-hour weeks trying to hold onto a job that gives them insurance.9. People won’t be responsible for their own health if they’re not being forced to pay for the consequences.False. The philosophical basis of America’s privatized health care system might best be characterized as medical Calvinism. It’s fascinating to watch well-educated secularists who recoil at the Protestant obsession with personal virtue, prosperity as a cardinal sign of election by God, and total responsibility for one’s own salvation turn into fire-eyed, moralizing True Believers when it comes to the subject of Taking Responsibility For One’s Own Health.They’ll insist that health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to an abstemious regime of careful diet, clean living, and frequent sweat offerings to the Great Treadmill God, you’ll never get sick. (Like all good theologies, there’s even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, it’s a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They can’t complain. It was their own damned fault; and it’s not our responsibility to pay for their sins. In fact, it’s recently been suggested that they be shunned, lest they lead the virtuous into sin.Of course, this is bad theology whether you’re applying it to the state of one’s soul or one’s arteries. The fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us — even the most careful of us. The economics of the Canadian system reflect this very different philosophy: it’s built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other as our numbers come up.This difference is expressed in a few different ways. First: Canadians tend to think of tending to one’s health as one of your duties as a citizen. You do what’s right because you don’t want to take up space in the system, or put that burden on your fellow taxpayers. Second, “taking care of yourself” has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if you’re contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while they’re still small and cheap to fix.Third, there’s a somewhat larger awareness that stress leads to big-ticket illnesses — and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, there’s a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use. You can have them if you want them; but reasonable and compassionate people should be able to take the larger view.The bottom line: When it comes to getting people to make healthy choices, appealing to their sense of the common good seems to work at least as well as Calvinist moralizing.10. This all sounds great — but the taxes to cover it are just unaffordable. And besides, isn’t the system in bad financial shape?False. On one hand, our annual Canadian tax bite runs about 10% higher than our U.S. taxes did. On the other, we’re not paying out the equivalent of two new car payments every month to keep the family insured here. When you balance out the difference, we’re actually money ahead. When you factor in the greatly increased social stability that follows when everybody’s getting their necessary health care, the impact on our quality of life becomes even more signficant.And True — but only because this is a universal truth that we need to make our peace with. Yes, the provincial plans are always struggling. So is every single publicly-funded health care system in the world, including the VA and Medicare. There’s always tension between what the users of the system want, and what the taxpayers are willing to pay. The balance of power ebbs and flows between them; but no matter where it lies at any given moment, at least one of the pair is always going to be at least somewhat unhappy.But, as many of us know all too well, there’s also constant tension between what patients want and what private insurers are willing to pay. At least when it’s in government hands, we can demand some accountability. And my experience in Canada has convinced me that this accountability is what makes all the difference between the two systems.It is true that Canada’s system is not the same as the U.S. system. It’s designed to deliver a somewhat different product, to a population that has somewhat different expectations. But the end result is that the vast majority of Canadians get the vast majority of what they need the vast majority of the time. It’ll be a good day when when Americans can hold their heads high and proudly make that same declaration.Next week: More mythbusting on common conservative canards about efficiency, innovation, and competitiveness.Physicians for a National Health Program29 E Madison Suite 602, Chicago, IL 60602Phone (312) 782-6006 | Fax: (312) 782-6007 | email: [email protected]© PNHP 2009Privacy Policy ¤ Find us on a map

Why does the United States Veterans Administration have its own health care facilities and provide its own healthcare?

The Mission, Benefits, Scope, Services of the VA Administration is quite vast, and is the 2nd largest funded GOV agency, next to the DOD or Pentagon.I’m not going to discuss all of the History and Mission statement for the VA, as you can just go to it’s own link right here and find out for yourself:U.S. Department of Veterans AffairsThere are approximately 20 Million Veterans (about 7% of the US 325M Population), and at least 50% if not more access the VA Administration for their healthcare and many other associated benefits.My own experience in the PAST, as both Civilian & Military, involved typical, free-standing Civilian Clinic’s, PHS, and Military Hospital’s > of course during my years in service. After my Discharge’s (Army & later Navy), I was notified that I was eligible to receive medical benefits and other awards, BUT, choose not to as I was on a strict 24/7 menu of Hard Work + pursuing a University degree (doctoral), and also felt that there were many other struggling or Homeless Veterans who needed it more than myself. Years later, as a DAV veteran, I have been receiving my health & medical care services, since 2004, in Hawaii … and I’m pretty Happy with my care.Is it Perfect? Hell No … But then I’m not a 1%-er who can purchase a $10 Million dollar MD Concierge Program, with UN-limited Benefits, and Special Riders …The Pro’s about the VA Health Care System, in Hawaii:Our VA CBOC (Community Based Out-Patient Clinic) is in a very modern building, across from the largest state hospital on the island.Our CBOC (pronounced Sea bok’) … THE VIBE - is Very Quiet … serene at times. No Yelling - No loud Chatting on mobile - Baby crying is rare. - - The Demographic’s of our Staff & Veterans on my island - are mostly Asian, or Pacific Islanders, so that may “affect” SOME People that have moved here from the TV show town like “Mayberry, NC” … Just saying … It’s Hawaii … Not Gilligian’s Island!Services include: Primary Care Physicians (Family Practice + Internal Medicine) + Behavioral Health Team ( Psychiatrist’s MD’s) + Behavioral Specialists (PhD’s) / Counselor’s). And/or, a veteran & their family may elect to also use the Veteran’s center, in the same town.Specialty & sub-specialty medical / surgical services - are available from either Oahu or Locally. Staff makes all approval’s, arrangements and notifies the Veteran. There’s also Tele-medicine + Home Visits for eligible Veterans.Some Specialty Referrals to Local, Civilian clinics - Like ‘Audiology’ can be a total Waste Of Time, because their Civilian Providers (& some Staff )… Do Not Know Shiat, Nor, even have a basic Understanding about Exposure to Military trauma, combat environments, 105 howitzers, etc … I have stories to tell … and therefore, you may end up with the WRONG Diagnosis!CBOC - offers Immunizations (Individual schedules) + some Pharmacy + Med Injections, if or when needed.Update - In 2015, there was a New Directive from VA-DC, that all or most CBOC’s, “phase-out” their In-house, Basic to mid-level Acute care (like Abscess I&D, Simple Lacerations, Asthma/ COPD Rescue Inhalation services) , and Pharmacy services. INSTEAD, all CBOC’s have been “directed” to TURF all Veterans … to the nearest Civilian Hospital ER!!!! My immediate question was … WHOSE’s the Moron’s in DC that came up with this brilliant idea of INCREASING the Cost of Services to Veterans???? No answer.Lab & Radiology - the CBOC obtains approval’s and then Faxes the order to the nearest Lab or Xray facility (civilian).GUESS WHAT PEOPLE? In 99% of the time that I have been referred to CIVILIAN Diagnostic or Specialty Facilities, I have always had some Level of Issue or Problem, as someone in the Front or Back Office, will have a different “interpretation” as to what the request is for! AND, now some Moron’s (again) “believe” that ending the VA and “Transferring” into a Corporate HMO … is a Solution!Pharmacy Refill’s + Medical records - may be accessed on your own, personal, secure account, on-line, and much more. Takes 2 minutes for a refill, since it includes your present Menu of meds. Simple …Group Priority Number Assignment - every Veteran, regardless of past medical history, or a service-connected Disability, or a Purple Heart or no awards, is Eligible to receive care, but, ONLY if he or she qualifies under the VA’s Criteria. So there is Priority Group 1, 2, 3 and so on, which also “affects” how high the CBOC jumps on your behalf. This system work’s better if and when you have received a Disability Rating; than without one (I’ve experienced on both sides) … But, is also ‘Location-Dependent’ … Even within the same City, State or Region … as other Veterans have pointed out here …EEOC Governance - Service is provided to eligible members of the military and Veterans, without regard to Gender, Color, Disability, Religion, etc. - THAT makes it about as FAIR as any System … can be in Real World environments. NOT so in Civilian environments …US Military Records Transfers to and from the VA - are conducted by your CBOC.Dishonorable or BCD (Bad Conduct Discharge), or a General Discharge veterans - you may be on your own.Any or all of your VA medical records - copies can be requested anytime, just requires a simple form + signature. Deliver it in-person or by Fax.Appointments - Vary by Provider (PCP, Behavioral health, etc), but most times it’s been only 30 to 45 days out, or you can elect to be on a “call-back”, in case of any Cancellations.Walk-in’s - if you need to be seen (Non_Emergency), you may call -in to get a same day appt or next day. This has NEVER failed me, on a few occasions.Urgent or Emergencies - Call your CBOC 1st, Or Have your GF or Wife or SO, or Family member, then, they will get an Emergency Pre-Apporval for the nearest Hospital ER … And FAX it to the ER. Haven’t had to use this ER service, but that’s the scheme.Quality of my CBOC’s Medical Team - I give them an Absolute 5-Star Rating! Now before you veterans jump up and say that I’m way off … Then, you should also know that our OTHER CBOC here only gets 2-Stars / 5, and I would give it 0, if it wasn’t for 2 staff that work there.Communication - via Phone and email is really good.Appointment Check-in Process - Simple. You flash your VA ID Card in the Reader. Done!Billing or Invoices or statements - ZERO!The Con’s about the VA Health Care System, in Hawaii:A huge, complex, slow-moving Octopus - with the Head in Honolulu.A Government Bureaucracy - by de fault, especially in Honolulu. Things don’t “operate” that Efficiently, there’s a lot of Fubar, Mis-communication daily events, benefit failures, egg-head dipshit’s, etc.Caveat #1 - Every Veteran in each State should check to see if their VA Hospital is FEDERAL or STATE-operated. THERE IS A DIFFERENCE. You’re Welcomed.Caveat #2 - Every State provides “different levels of Additional Benefits” to Veterans. Some are extraordinarily Generous, Others are in the middle level, and some have turned their back on you. You’re Welcomed.Documents - I’ve learned to send any document by Express + Signature-Requirement. They must have a massive File 13 Shredder, that eats any and all documents. Make sure that you have have multiple CERTIFIED COPY’s for each document.Documents 2 - The VA monster Lives and Breathers on “paperwork”, let that be a Warning. Must KNOW each VA-Form’s # … and Specific Request Use.Medical - Health - Behavioral Evaluations in Honolulu - the medical is Ok (C- to B grades), but the “Behavioral jockey’s” was a bunch of amateurs …Travel From Outer Island (akak Inter-island) - is very good, I must point out.The VA Center or Hospital Faculty & Staff - 50& seem to know what they are doing, the other 50% are either Newbie’s, on OJT status, or just don’t give a fuck (just collecting a check). Many CIVILIANS are collecting a check there.The VA Center (Honolulu HQ) - is a A Government Bureaucracy. Yes, it HAS improved in some area’s, and has declined in others.The VA & Military - provide highly-specialized Services, that apply ONLY to the Military and Veterans, that the Civilian World, will NEVER catch up, Nor Deliver … THIS FACT has already been Proven … in the field.Comparisons - I would rank my Best-To-Worst experiences with medical facilities in this order: VA Hawaii >Military Hospital’s > USPHS, and then Regular Civilian facilities.IMO, the biggest problem’s with Civilian healthcare facilities - has always been > a lack of Services Consistency, Office & waiting room Chaos, ETOH/Opiate Drama, SPECIAL Designated favors, Chronic gossip, Rumor Mill’s, Appointment time constraints, Streaming Error’s, MD & Staff turn-over, Disruptive waiting room patients, their “Guests”, etc, etc. THIS IS the purest definition of an UN-controlled Medical Environment …Elite Class Exceptions - the best Civilian health & medical facilities are the ones for the Elite + Wealthy Population … Top-tiered University-based Hospital’s & Clinic’s … like Stanford, UCSF/Berkeley, Seattle, Mayo, Johns Hopkins, Harvard, Yale, etc. That’s where they have the World-class Physicians and Services.A Disaster In The Making - There is some Political “movement” to Change/Move/Transfer the VA Administration Hospital’s, en bloc, to the Civilian Industrial Complex.IMAGINE - HMO’s like Humana, Kaiser, Kaiser-Permanente, Cigna, BC/BS, or worse … Trump Medical Centers, or his Billionaire Krouch Cronies … getting their liver-spotted, scraggly, ‘Gordan Gecko’ Fingerings into the pot … It will / would be nothing but a Barnum-Baily Shit_show of Epic proportions!Converting a FEDERAL Health Care Delivery System - that was especially created for US Veterans … is a System that any 3rd-party Civilian Healthcare System will CHOKE ON & SCREW UP … into a monumental Disaster.Any Veteran that is supporting this shitty 3rd-party CON-version “idea” … needs to leave the VA System, and go get Obama care … Try that for 10 years and then come back and report … Got It?TBC … I’m dam sure of it …

What are the rarely talked about downsides of angel investing?

One thing a lot of people cite is that the holding periods for companies are generally pretty long, because it takes a while for a startup to develop the kinds of things strategic acquirers or IPO investors want like lots of revenue or EBITDA, or customers or market share, or a strong brand or a good strategic position in an industry, etc. But for me the one thing that you just don’t fully appreciate going in is that it’s a ton of paperwork. I have developed some hacks to manage it over the years, but it is just a whole mess of paperwork.Before I became a full time angel, I spent much of my early career as a corporate lawyer working in-house for a NASDAQ listed enterprise software company. The pace of customer and strategic deals and corporate housekeeping activities in those jobs was unrelenting. So I know first hand the value of getting and staying organized. As a prolific angel, a fund manager, and an angel network manager, I have learned to adapt those organizational skills to tame the paperwork associated with the large portfolios I oversee.First of all, what kind of paperwork are we talking about with angel investing?Here’s a sketch of the kinds of things an angel investor’s organization system needs to cope with:Meeting notes from meetings with companiesCompany pitch materials and other company information from companies seeking fundingDiligence materials and diligence work product from companies you have evaluated in detailCorrespondence of various kinds and in various forms (paper and electronic)Deal documents including debenture agreements and share certificatesInvestor reports from portfolio companies or companies you follow closely as a non-investorOption agreements, restricted stock grants, warrant grants1099-DIV and 1099-INT notifications regarding dividends or interest paymentsDelaware Section 228 Notices and similar legal noticesRequests for shareholder consents and shareholder waiversBoard materials409A ValuationsCapitalization TablesPaperwork relating to any funds you manage or belong toThat’s a lot of categories. And when you consider that some categories involve a lot of materials in any one distribution, many of categories repeat regularly with additional financings and regular periodic reporting and you are typically dealing with a large number of companies at any one time, it amounts to a massive amount of material, rolling in at a steady pace. Weekly for a moderately active angel, daily for a very active angel.What are angels expected to do with all that material?In addition to organizing and filing all that material, you need to be able to retrieve pieces of it regularly for various reasons:Paying taxes,Comparing past predictions to current results,Reviewing historical deal terms to check investor treatment in future rounds or exits,Returning original stock certificates or debenture agreements andDoing any kind of portfolio or returns analysis.And you are regularly called on to sign and return documents when you receive requests for items including:Consents or waivers for situations where anti-dilution or pro-rata rights are waived orOption pools need to be enlarged orAny number of other situations requiring shareholder approval.These situations typically call for relatively fast response, so you need to be able to lay your hands on the underlying information relatively quickly and painlessly so you can review the request and get the signatures back.So what are the kinds of systems I have developed?Some are “systems” and more are hacks or just behaviors relating to the four main areas: paper documents, computer organization, communication and personal productivity and others are actual systems. Here is a list of the major ones, with some explanatory rationale for each one:Productivity and Organization HacksI keep a special “tax box” on my desk (a cool old antique metal biscuit tin)The end of year paper chase is miserable. If you set aside a special place and are religious about tossing in receipts for deductible expenses and all other tax-related notices and paperwork throughout the year, you save major pain later.I am fanatical about grabbing mobile numbers and email addresses the minute I am exposed to them for anyone who I might later need to meet or communicate with.Having an additional person in your contacts costs nothing, but allows you to recognize them by name rather than strange number if they call, text them if you are running late to a meeting, or reach out if you need to communicate with them later.I treat LinkedIn as an extension of my contactsI tend to accept all reasonable connection requests from professionals (i.e. excluding headhunters, sales people and spammy accounts). LinkedIn is also a really handy way to pull up details and a picture before you meet with someone you’ve never seen before.I organize my computer filing system to always make a folder for any company I have meaningful interaction with.It only takes a second, but if you get in the habit of tossing key attachments into a folder for each company, you avoid the dreaded email search for something you need to reference many months later.Inside each company folder on the computer I keep sub-folders organized by event (which are typically rounds of investment), and those folders have the dates of the event in their name (e.g. “Seed 1 Round June 2016”)If it is the first interaction with a company, that earliest event folder might have subfolders for diligence and review of the company, development of the termsheet, deal documents, financial models. Etc. And I always rename files more descriptively than they arrive.I set up my email client to organize my email so that email from all of the key people are highlightedThe key here is to get your email client to do work for you behind the scenes flagging important mail and demoting unimportant email. I make extensive use of smart folders that are like standing searches to elevate certain categories of mail, demote other categories, set aside anything with an attachment, etc. (Email workflows is a large topic probably worthy of its own discussion.)Whenever I get any paper from a company (stock certificates, original convertible notes, option or warrant grants) I immediately create a new manila paper folder for that company and file it alphabetically in a safe place.Certain categories of paper sent to you by companies need to be retrieved and sent back. It is essential to have a good filing system so you can easily find negotiable instruments like stock certificates and original convertible notes and send them back quickly as part of a closing. Pro tip: it is not a bad idea to scan or photograph key things like stock certificates in case of fire or flood - you can always file a lost certificate affidavit, but it is more efficient if you have a picture of what is lost.I keep termsheets handy and accessible because they can be a very quick reference to remind me of major terms of rounds.CAUTION: do not rely on the termsheet for important non-headline details. Termsheets are just a non-binding high level summary done before the definitive deal documents. Always check the deal documents if you need accurate detail or the topic is not a major headline summary topic such as pre-money, board structure, etc.I am fastidious about using a password manager and tracking accounts for systems that companies require me to use for signatures (e.g. Docusign), investor updates (e.g. Basecamp), or electronic stock certificates (e.g. Carta)Everyone fortunate enough to have an accredited investor’s net worth ought to be terrified of identity theft. It is essential to use good and unique passwords for all your sites, and it is impossible to do that without a good password manager. (I happen to use Dashlane, but 1Password and LastPass are good too.)I leverage cloud document storage (for all my files - both shared files and all routine personal files)This is not to be confused with a proper backup (which you should do as well - like email, backup strategies are a whole other article), but it does make switching computers much easier. It also allows remote access to files from your phone or tablet to look at or send.I am relentless with pestering until I get updated cap tables after each roundLooking at the company cap table is the only way to track where you actually stand in the company capitalization and where you’ll come out in an exit, and to make sure there have been no errors. If your transaction records don’t match the company’s, it is much easier to fix contemporaneously than several years and rounds later.I try to get copies of any 409A valuations the company doesAside from reassuring yourself that the company is complying with Section 409(a), having company valuations is key for valuing your investments if you are using a self directed IRA. It is also hugely important in the trusts and estates context. If you pass away and need to have your investments valued by your estate attorney, it will be a costly disaster for your family if updated valuations are not available. Note, a well done 409a will have a waterfall table that indicates the value of your securities under different exit scenarios. Having a 409a also helps me determine whether the warrants / options I am thinking of exercising are in the money or not.Perhaps the biggest aid of all is that I use Seraf for portfolio tracking and analysis, deal document storage, investor updates, date reminders, and performance management.Stored records are analogous to data or maybe knowledge. The insights you get from Seraf are wisdom. Seraf gives me the ability to step back from the day to day grind amidst all the trees, and see my portfolio as a forest - trends, performance, insights, analysis. Like a personal dashboard.I invested the time to learn how to sign documents electronically on the computer and on the mobile (and store the resulting signed documents).The value of this should be self-evident. You are living like an animal if you are tied to a desk and a printer in order to turn around the many signatures that a large portfolio requires.I carry a cellular iPad with plenty of data almost everywhere I go so that I can always be productive and never have to mess around with trying to find usable wifi.I use that same iPad and data plan for tethering my laptop, again so I am not tied to wifi.I use an app to allow me to access and operate my computer remotely for times when I need the full desktop experience but only have the iPad. Pro Tip: network diversity - by deliberate choice, my cellular iPad is on a different network (Verizon) than my phone (AT&T) so that no matter where I go, I can always tether to the stronger signal.I invested the time to get really efficient at scanning documents with the smartphone camera.The fax machine may be dead, but there are still many times when you need to store or move a paper document electronically. I use and like an application called Scan+ by Smile Software - I can scan a very large document into a PDF very quickly, then email it and store it in the appropriate Dropbox folder. That’s not the only app; there are many great scanning apps out there.I heavily utilize news aggregation apps and sites to keep on top of industry news, and analysisAggregation sites which allow you to follow topics and people and also learn your interests over time, can save a lot of time and surface key material you would not otherwise have seen. Some people use Twitter sort of like this, but I’m not a fan - signal to noise ratio is too low. Pro tip: I check Techmeme 2-5 times a day, every day - first check is always the “Top News” column, subsequent checks are just a quick scan of “Newest” column.I use a bookmarking service to track and store useful web articles I may want to refer back to laterI am a fan of Pinboard, which is cheap, simple, reliable, has a good mobile interface, allows very granular tagging, and makes and stores an archival copy (!) of every article you save in case the original article ever disappears from the web.I am "religious" about marking key investment related dates on calendars or in a reminder system (convertible note maturity dates, escrow release dates, option and warrant expiration dates)I used to use my personal calendar, but for years now I have used Seraf’s “Reminders” system.I keep a database of companies I have met with because you are always wondering “what was the name of that company with that thing?”For this I run a simple custom Google web form that has an icon on my smartphone home screen. I pull it up, fill out a few quick questions like founder, company, short description and then a few sliders for how well I liked the team, market, product, etc. Takes 30 seconds and then the entry is dumped into a time-stamped entry in a Google spreadsheet I can go back and search any time.I record the details of every investment the moment I send the wire or checkIt is really easy to forget you made an investment and get your records totally out of whack.I write down and track soft-circle commitments when I make them.There can be long delays between soft-circles and closings. For me at least, it is almost impossible to remember precisely what you committed to any given round, so I just keep a simple note on my phone of what I committed to whom.I am fastidious about calendaring appointments the minute I agree on them so that I don’t forget and accidentally blow someone off (did that once a long time ago, and I am pretty sure they are still mad about it.)For calendaring, I always use a specific format for the entry: “Call From [Name] re: [Company or topic] per [person referring or requesting]” or : “Meeting With [Name] re: [Company or topic] per [person referring or requesting]”. That way, the first thing out of my mouth does not have to be “remind me, who suggested we meet?”I am organized about using reminders and using to-do listsLess is more here - simple text based to-do list which syncs between your phone and PC are fine. For reminders, I am especially fond of using Siri on my watch to make reminders (“Hey Siri, remind me to call xyz at 2pm tomorrow”) and I am a really big fan of using geo-fenced reminders which automatically pop up and tell you to buy stamps if you pass near the post office, or milk if you pass near the market or do something when you arrive home.I regularly reconcile bank records to make sure wires went through and checks were cashedNipping problems in the bud is much easier than discovering them way later, or not at all.A couple times I said “check or wire.” What is the practical difference - are there any pros/cons to wires vs. checks?Probably worth a special discussion of this because there are some important gotchas with each method.The advantages of using wires are:You can send them right from your computer with no tramping around to find checks, stamps, envelopes, and mailboxThey are also very fast for last minute procrastinatorsThey can be cheap for people who plan ahead (whereas a fast wire might be $25, a 3 day ACH is typically free or very low fee)They leave you with an electronic record and confirmation number you can easily file and share with the entrepreneurYou can send a wire from anywhere, including vacation, without needing to have your checkbookThe disadvantages of wires are:You need to take a moment to enter the banking details of the recipientThey do cost more than a stampMost importantly, now that the insurance companies for law firms urge law firms not to act as escrow in deal closings they oversee, the money often goes directly into the company’s main bank account where it is commingled with the general funds. This gives rise to two separate issues: (1) the funds might be accidentally or intentionally spent before the minimum needed to close is met, or (2) the funds might accessible to a bankruptcy trustee if the company goes insolvent (see advantages to checks below).The advantages of using checks are:It is familiar and easy and you can make a quick entry in your check register as you write the checkYou can include a receipt and a self-addressed return envelope in with your check so that the company can easily sign and mail it back to you to confirm receiptYou can scan or photograph the check before you mail itUnlike wires which tend to get commingled (as described in disadvantages above), in the days and weeks leading up to a closing, the physical paper checks tend to be set aside in a separate pile and not deposited until the actual closing - that can improve your chances of getting the money back in the event of insolvency or a failed minimum needed to close.The disadvantages of checks are:You have to put down what you are doing and find the check book, an envelope, a stamp, and, because it is usually a significant amount of money involved, make sure it gets mailedYou are often emailing electronic signatures anyway, so having to use paper in addition to electronic is a pain, especially if you are traveling out of the officeThere is no easy electronic record and confirmation number created, so if you want to let the company know you’ve sent it, you need to create a separate “check is in the mail” email or note in your signatures email.How do I net out these pros/cons? I tend to plan ahead and use inexpensive 3 day wires except in cases where I am concerned about the round getting filled or the company is very low on funds or otherwise financially shaky. In those cases, I tend to mail a check with a receipt that says it can only be deposited if the minimum needed to close is hit and a stamped return envelope for that receipt. Not perfect or airtight, but creates a very good argument in the case of meltdown. Given that we face the risk of total loss on any of our angel investments as a baseline anyway, a pretty good argument is good enough for me given the number of rounds I am juggling.These are all pretty good hacks. But are they worth the considerable trouble I go to? How about a couple war stories to drive the point home:First of all, if these things are established as habits, they really aren’t much trouble at all. They become second nature like driving a stick-shift in traffic - you often are not even aware you are doing it. Second, start-ups are young, understaffed, and moving fast. Mistakes truly do happen all the time, and if you don’t have good records and good confidence in those records, you might not be aware of a mistake or just accept the company’s mistake. Third, good contemporaneous record-keeping is less work not more work - it is also a classic case of “a stitch in time saves nine.”So how has this paid off? Aside from just minimizing the agony of searching for materials at tax time, living in a state of chaos, or never being able to find things when you need them, here are four real life personal stories which I think demonstrate the value of of having organization systems:Glass of water tipped onto the laptop keyboard - enough said. Cloud storage and backup protocols made this painless (other than financially…)Wrong bank account - not long ago a CEO called and said that she never received my money. I was able to show her the wire records so she knew I had sent it. She still couldn’t find it, so I confirmed with my bank that it had gone through. This gave her the impetus to really look, and it turned out because it was an intra-bank transfer (as opposed to between different banks) it had come in directly and was not in the list of wires she was looking at; with some digging she realized it was sitting right there as it was supposed to be.Sudden liquidity opportunity - I was invested in a company that had become very mixed up with a strategic. They had been trying for years to get the strategic to at least just return the invested capital to investors. After a very heated board meeting, the somewhat mercurial division head of the strategic agreed to buy out the angels. The startup CEO put out an urgent note: “we’ve got to sign these consents immediately and tender our certificates and get this deal done ASAP before he changes his mind.” Of course I was traveling. But naturally I was able to sign the consents on the road with the iPad. Because I knew exactly where the stock certificates were and had electronic copies, I was able to pre-fill the paperwork, walk in the door to my house at the 11th hour and drop the certificates in the mail in time for the deadline.Start-up with terrible records - One of my earliest angel investments was in a software company with a very young team. One of the things that attracted me to them was their wildly off-the-wall marketing tactics. Turns out a lot of what they did was off-the-wall, and they ultimately struggled to find success. During the year or so running up to their failure, I was having trouble reconciling my bank accounts. For the life of me I could not figure out what the problem was. As the company finally failed, the CEO called me to apologize, and he made reference to having lost a sum of money that was lower than what I thought I had put in. I said “I thought I had a bit more in there than that? He said he was sure I didn’t and went back through the records with me. Long story short, out of the four checks I had given the company, they had misplaced and failed to deposit the second and fourth of four checks. It turned out that my loss on the company was HALF of what I was expecting because they never processed two of the four checks I had sent them. I whistled all the way back to my computer to put stops on those two checks and smiled at my good fortune, amazed and newly educated at how bad some start-ups are at record-keeping.Those are just a few examples of many. So overall, I feel pretty good about my hacks. It might be partly just a question of doing what it takes to make myself feel comfortable, but these adaptations represent a lot of accumulated wisdom and continuous effort to improve. I recommend you try some, or invent some of your own. Being a large portfolio angel is a big juggling act, and if you are always behind the game and scrambling to keep up, you will lose the all important big picture forest among the trees all over the place.PS: if you want to learn more about angel investing, we’ve done a series on angel fundamentals and a series on key angel skills.

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