Holy Spirit Hospital Camp Hill Pennsylvania Holy Spirit Hospital Left alone to die? Geisinger has no firm grasp on prosperity, just ideas, regardless of people, Holy Spirit Hospital Camp Hill Pa should be draped in black, the color of death, a huge coffin suspended by Geisinger strings.. How

Geisinger Holy Spirit Hospital, Holy Spirit Hospital, Geisinger, Holy Spirit Hospital Camp Hill Pa, Dr. Ryu, Jaewon Ryu, Harvard, Walmart, 

Geisinger is huge — it has 13 hospital campuses, two research centers, a medical school, and a commercial health plan — and is famously innovative. Its best-practice approaches have been widely adopted, and it is spearheading one of the largest DNA-based precision-health projects in the world. So it’s little surprise that Geisinger is a pioneer in another area, so-called centers of excellence (COE) destination-care programs. In these arrangements, employers such as Walmart, Lowe’s, and McKesson fly employees to selected COEs for complex care — with remarkable results.

HBR’s Gardiner Morse spoke with Dr. Ryu about the benefits and challenges for providers of embarking on COE programs, and their implications for both employers and insurers. Following are edited excerpts of their conversation.

JAEWON RYU

Geisinger Holy Spirit Hospital, Holy Spirit Hospital, Geisinger, Holy Spirit Hospital Camp Hill Pa, Dr. Ryu, Jaewon Ryu, Harvard, Walmart,

Why is Geisinger engaging in these arrangements with employers to fly their employees in for care?

Partly it’s about growth. Being a destination-care provider for employers like Walmart allows us to reach a patient population that isn’t already getting its care within Geisinger and is beyond our backyard. So it’s a good way for us to expand the scope and reach of what we’re doing.

But it also aligns really well with how we deliver care. We’re big believers in developing best-practice protocols and then designing workflows to deliver them. We have developed care protocols for many clinical scenarios, including areas like cardiac surgery, spine surgery, chronic obstructive pulmonary disease, diabetes management, and many others, and they yield the best combination of quality and patient experience. It’s a program that began years ago, and we’ve been refining the protocols and adding new ones ever since. It’s a chassis, if you will, that these new centers-of-excellence programs can easily build on. We have the resources, culture, and processes already in place to develop, say, a joint-replacement bundle with an employer. And doing that reinforces our culture and processes. There’s a positive feedback loop.

Where does the destination-care program fit in that feedback loop, reinforcing how people work?

We’ve seen that sometimes after you go live with a protocol you can get what we call “beach erosion,” where over time people can become less diligent or deliberate about making sure everyone follows the protocol. Being one of the centers of excellence for employers in programs like these helps prevent that erosion because it’s yet another area where the protocols are applied. It keeps us on top of our game, as employers are paying close attention to how we perform. So the program reinforces their consistent use.

What would you say to other providers who maybe don’t have smooth-running protocols like Geisinger’s about the risks of these types of programs?

That’s the ultimate question for any system that wants to embark on this journey. For us, it made sense because it was already ingrained as our approach to care, so there weren’t the same start-up costs and culture-change challenges that you might see in an organization that didn’t already have the culture and protocols in place. Also, we like reimbursement models like bundles where we’re taking risk, because we tend to do better with those in driving overall value than we do under an episodic, per-widget model. But that’s part of the calculus for any provider. Do you have the culture and operational programs and processes in place to succeed with this kind of model?

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There’s a huge opportunity for a provider that doesn’t yet have these capabilities fully in place to pursue direct arrangements with employers as a way to jump-start the shift. Delivering value is the direction that health care is going — whether to patients, employer groups, the payers you’re partnering with, or the government. Building the chassis I’ve been talking about positions any health system better for what’s coming in the future, and what is in many ways already here. In time, every system is going to need to have this capability, and this kind of program is a way to get started.

I’m assuming doing programs like these reflects well on a provider?

Well, it can help the provider tell the story about the value they’re offering. For instance, we work hard at making sure that we’re not doing unnecessary procedures, so we find that a significant number of patients referred to us for a surgical procedure actually don’t need it after all. We take a lot of pride in that because it shows that we’re focused first and foremost on determining what is the best care rather than on how many procedures we can do. Data from Walmart shows that more than half of their employees referred to centers-of-excellence programs like ours for spine surgery end up not needing it. It can be more work to convince a patient that they don’t need a procedure, but doing that results in the best care.

Let’s talk about the challenges. This can’t be easy.

That’s right. Make no mistake — even if you have the chassis in place there’s still a lot of work you need to do on the culture to go live with a program like this. We were lucky — we had a running start, if you will. But even so, it’s not something you turn on overnight. We’ve been on this journey for more than a decade. It takes constant work and vigilance. For instance, even when you recruit physicians you need to make sure they are brought along into our organizational approach and don’t introduce unwarranted variation into how we approach care.

It also requires constant attention to make sure your protocols are up-to-date and to assure that everyone’s aligned with them. It turns out that if you follow evidence-based best practices reliably, great things happen for patients. So you need physician leadership that is committed to pursuing these protocols and tracking performance, and updating them as the science changes.

What’s an example?

Well, the conventional wisdom that many doctors were taught in medical school was that patients should have nothing by mouth in the hours preceding surgery, and should be eased back on a clear liquid diet after surgery. So essentially you’d starve them before and starve them after surgery.

But so-called enhanced-recovery-after-surgery, or ERAS, protocols showed that patients do better if you give them enriched-nutrient shakes before and after. Complication rates go down, length of stay goes down, and they’re up and mobile more quickly. It runs counter to the traditional teaching and so it makes some physicians uncomfortable, but we incorporated this into our own protocols and it’s how we do many elective procedures now. It’s easier to launch an approach like this systematically when your culture embraces the need to continuously seek better ways to do things and to do them more consistently.

Making sure everyone is on board and aligned must require real transparency about performance. How does that work at Geisinger?

We’re firm believers in transparency. Data is probably more visible here than you’d see at just about any other health system.

Let me give you a snapshot of what that transparency looks like. A few years ago, we launched a primary care redesign program that focuses on closing gaps in care. If you’re due for your mammogram or a colonoscopy, how often are we making sure that you get those preventive services? We track this at the level of individual providers. If you walk into any one of our primary care sites today, there would be a whiteboard where the whole team huddles every morning and the name of every provider in that clinic is listed on it. It has information about their appointment availability and also a score for how they’re doing on closing care gaps, including any missed opportunities they might have had. Nurses are also listed there, with information about how effectively each is setting up patients for those care-gap actions. It’s taken some work to get us to this point, and admittedly the transparency can be uncomfortable at first. But it helps us reinforce and support each other in driving for the best outcomes. And I think we could do even more.

How do you manage the discomfort that this transparency must cause? If a doctor isn’t performing well, and it’s visible to the team, that must create tension all around.

Well, partly there’s a socialization that makes it acceptable. Transparency is part of our culture, but it does take a little time to get used to it. We really try not to do this in an embarrassing or “gotcha” kind of way. There’s a lot of pre-processing and vetting with the clinical leaders and the teams around what we’re going to measure and how we will track it, so people are more aware of the process and reasons for it. We try to do it in a very objective way — we’re asking, “What can we do to learn from each other and improve the overall game?” We look at data such as the rate at which patients within a given primary care panel are landing in the emergency room or how often our emergency medicine physicians are ordering CT scans for non-serious head trauma, and look for outlier behavior. Sometimes the outlier behavior is justified. But shame on us if we’re not asking why there are outliers.

Of course, from time to time you have differences of opinion about the accuracy of the data or to whom they’re attributed. And if there’s any question about their applicability at the level of individual providers we’ll focus instead on the team. So we might identify teams that are behaving differently than others. That might be a good thing, or it might indicate a need for change — but let’s have that discussion. I think that’s the key: The data isn’t the be all and end all, but it can serve to start the discussion, and framing it that way helps get acceptance.

Let’s move on to the bigger picture. What kind of impact do you think programs like yours, where employers contract directly for care, will have at a national level?

I think programs like these are going to grow because they address the cost and quality problems employers are struggling with. But destination care for defined episodes like spine surgery is only a piece of where I think the industry is migrating. The broader approach that I expect we’ll see a lot more of is employers directly partnering with providers for the totality of care for their employees — taking care of the whole person, and the whole employee population. In other words, an employer contracting directly with a provider in a prepaid model to take care of a population. We’re already seeing some movement in this direction.

There will be some tension between employers seeking high-value care in these types of programs and consumers’ desire for choice. You may get better value when an entity like Geisinger partners directly with an employer like Walmart, but, to get that, employers need to direct their employees to a smaller network of providers selected based on performance. If an employer wants to preserve employees’ ability to have a phone book of providers to choose from, there’s going to be a trade-off between employee choice and better value, since a lot of providers may not be as focused on quality and value in the ways we’re talking about here.

How are commercial insurers responding to all this? I’d think they’d see it as a threat — but there’s probably an opportunity in this for them too.

I think that’s right. On the surface, it looks like a threat because it disintermediates them from the role they currently play in the relationship between employers and health care providers. But the opportunity for them is that insurers are good at identifying and contracting with quality provider networks. And they’re good at pricing. Those capabilities will be very important as the industry moves this way. Even if the traditional role of the commercial insurer changes, employers still need to rely on someone to identify high-value providers and negotiate prices and develop contracts. Currently, third-party administrators do this, but it’s a space commercial insurers are well positioned to move into.

What do you think the employer’s role should be in moving employees toward higher-value networks?

I think they should be encouraging that shift, and some like Walmart are, for instance, by giving employees a broad choice of providers but telling them they’ll need to pick up more of the cost if they choose a provider that’s not a Walmart center of excellence. A challenge is that employees’ and even employers’ perception of quality and value aren’t always aligned with reality. Sometimes people equate fancy facilities with great quality, and of course those things aren’t always correlated. But employers need to be looking at providers’ data and driving people toward the best ones.

What’s next for Geisinger?

We’re looking to expand the centers-of-excellence, destination-care model to make it available to other employers as well. There’s a scattering of local employers that are potentially interested in going down this path. That’s the beauty of how the model was built. It can be adapted to serve local markets, and we get the opportunity to deliver care in the way we think is best, and we grow. The employer and employee/patient get value. I think that’s a nice win-win-win.

Any final words of advice for employers?

Employers have an important role to play in getting better value out of their health care dollars. They have a tremendous opportunity to reward providers that deliver value. The more employers seek out and contract directly with the best providers, the more traction these types of programs will get — and everyone benefits.THE BIG IDEA

About the author: Gardiner Morse is a senior editor at Harvard Business Review.

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Brown University, Columbia University, Cornell University, Dartmouth College, Harvard University, the University of Pennsylvania, Princeton University and Yale University -- have enormous resources at their fingertips, including endowment funds (money raised from donors) in 2015 exceeding $119 billion. Take that total and split it up among Ivy League undergrads and it comes out to $2 million each.

 Brown University, Columbia University, Cornell University, Dartmouth College, Harvard University, the University of Pennsylvania, Princeton University and Yale University -- have enormous resources at their fingertips, including endowment funds (money raised from donors) in 2015 exceeding $119 billion. Take that total and split it up among Ivy League undergrads and it comes out to $2 million each.

With the combination of Negro White looks and intelligence he "Barack Hussein Obama" is the actor and a practicing Black National Radical. Vanessa has seen and can prove that she has seen and studied the college records of Barry Soetoro AKA. Barack Hussein Obama the President of the United States

Vanessa has seen and can prove that she has seen and studied the college records of Barry Soetoro AKA. Barack Hussein Obama the President of the United States .

With the combination of Negro White looks and intelligence he "Barack Hussein Obama" is the actor and a practicing Black National Radical.

Vanessa has a story to tell and she is a recent graduate from the University of California at Los Angeles and you're going to think it's a fiction movie from Hollywood. Andy Ledger FBI Special Agent has verified some, but not all of this confidential FBI file.

The Only Known Photograph of Special Agent FBI Andy Ledger (right)

Let us first say that her I.Q. demonstrates that she remains one of the best students of the University system and her grades held up against any critic makes her outstanding 4.0 GPA a perfect performance leading to her doctorate challenge.

Vanessa is an African American graduate and is a delight to know and watch and is highly accomplished.

Secret Lover of Barack Obama Barry Soetoro

English Teacher Occidental College

Author Control Through Poverty

Her I.Q. is in the genius class and she is expected to join Harvard University on full scholarship with other young people with the same attributes.

Vanessa has seen and can prove that she has seen and studied the college records of Barry Soetoro AKA. Barack Hussein Obama the President of the United States and stands with others as the legitimate witness standing against Barack Obama and Hillary Rodham Clinton.

"I had no idea," says Vanessa recalling the encounter with the actual records of Barack Obama "but I can tell you one thing the President is a hard core Communist and his Bull Shit is mistaken for brilliance", which is a direct quote from a professor at Occidental College.

"Barack Obama is not a Wiz Kid" she explains "He is a leopard and his greatness has been staged."  Vanessa explains "In the intellectual sense he is constantly theorizing and analyzing the play which means he never really hits the field."  Vanessa explains that Barack Obama is really very innocent regarding experience but he is provocative and smart so he pushes hard against weaker people.  With the combination of Negro White looks and intelligence he "Barack Hussein Obama" is the actor and a practicing Black National Radical.

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The Harvard pollster got another assignment. Part Two Hot News from Oval Office Hillary Clinton Throws Fit at Barack Obama "Slavery is like a flytrap, it's the same as lying, you always get caught. Hillary Clinton and Harvard University and her Private Underground Secret Email Server while at State

Some may remember this story, it was never published as expected in the New York Times or the Wall Street Journal but the stillness of their printing presses tells the story very clearly and very loudly. Now we know that Hillary Clinton got into a fight with Barack Obama, inside the Oval Office at the White House concerning her secret underground shadow government computer email server.  Hillary knows that Barack Obama wants Joe Biden to carry his flame of progressive socialism and not Hillary.

The tobacco smoke had been cleared from the room before Hillary Clinton was scheduled to arrive.  The room wasn't cleared out because of fondness it was all done out of fear as the group became silent watching the clock, watching the road, waiting on the column of black S.U.V's carrying Hillary Clinton to upstate Maine to have a private meeting with the Harvard Professor Dorothy Sanger Long. 

The advance team for Hillary Clinton spent millions of taxpayer dollars keeping her happy and what the U.S. taxpayer couldn't pay the Bill, Hillary and Chelsea Clinton Foundation paid the rest.  Two billion dollars of mostly foreign money was stashed away with Bill and Hillary the only two human beings with signature cards.  Donald Trump and Hillary Clinton are Billionaires.  Donald Trump earned his and Hillary Clinton sold American government influence and secrets for her.  Dorothy Sanger Long,  the almost famous Harvard Professor knew all about Hillary and Bill as they hired her almost constantly for the last twenty years. 


The story began a few day's ago as the Harvard Professor accepted the polling assignment task from the Bill, Hillary and Chelsea Clinton Foundation.  This was a secret just like the shadow government emails found by the FBI on the wiped Clinton server.  

Why was Donald Trump winning and could Hillary Clinton take him down.  Did Carly have any chance at all in beating Donald Trump, so many questions and they were willing to pay for the answers, would Ben Carson fall off the cliff?

At her makeshift desk in her living room she ponderously thought about the 12 questions that could discover the amazing following of Donald Trump.  The Harvard Professor was well known inside the DNC Democratic Party and even the White House.  Dorothy also had a bonus poll question to ask at least 1,200 registered voters.  Question 13 was really big and really out of the norm but Dorothy thought the question would answer the most important questions about Donald Trump.  She called it the cash question.  If Hillary Clinton wanted the results, she would have to write another check. 

Dorothy had a way with words, that created the exact questions to get the exact response Hillary Clinton, Joe Biden, Barack Obama and even Jeb Bush wanted.  During the presidential campaign season money flowed and she could easily earn a million dollars, one poll at a time.  You can lead people to think certain things at certain times which means you can almost control the response.  Document the results, toss into her graphing software and cash the check.  Her pollster business was booming and her checkbook had been expanding for years.

Jeb Bush, Marco Rubio, Hillary Clinton and others had sent their operatives to buy her time and get her help.  Cash and Carry were always the terms as even Karl Rove called her last week, needing some schooling about polling the American voters. Karl was having some trouble calculating how the GOP could defeat Donald Trump because their idea about using FOX News debates failed, and failed big. 

Nothing made sense this time around.  Donald Trump was winning big and the so-called RNC GOP elite Jeb Bush was stuck in the mud, Hillary Clinton might go to jail, everything upside down that had to be sorted out, what were people thinking?   If you understand what people are thinking you know what they may do under certain circumstances.  Now that the insiders at the FBI have confirmed that the deleted Clinton emails are being recovered Hillary Clinton was having a fit.

Dorothy knew that people became what they thought about and what they think about drives all their actions.  Her polling was so good it was always published in the New York Times, the Boston Globe, Wall Street Journal the L.A. Times and seemingly every blog in the world.  The T.V. hounds at CNN, ABC, CBS, NBC, MSNBC and even FOX News would show her numbers, she was big time. 

She was a little cold as the weather turned chilly in upstate Maine so her hand was shaking as she looked at the check payment from the Clinton Foundation.  It was a lot of money so she held the check for a while in some intimate way that made it hers alone.

This was not her first foundation assignment but this was the first $100,000 check that demanded a quick turnaround time.  In a rush they had contacted her and wanted a rush job and willing to lay out cash money, she had 24 hours to start and finish, maybe she should put down the check and get started.  It was the first day of fall and it was cold outside but her fireplace kept her old bones cozy. 

She had bumped a few other customers out of the way to put this Clinton work first so one hundred thousand dollar wasn't that bad of a price, the Clinton foundation has a lot of cash and many say millions more arrive every week.

She wondered what Huma Abedin, Cheryl Mills and Susan Rice really wanted and she also wondered if Barack Obama knew about her secret work for the Clinton Foundation trying to backdoor the President, Joe Biden and most importantly Donald Trump.  Insiders know that Hillary and Barack don't get along and Michelle Obama hates Hillary, most likely more than Oprah.  Dorothy was focused and she worked non-stop.

Hillary was having a lot of trouble turning away from her past deeds and they were many but to her knowledge they have never written a bad check. Rumors had it that Sanders the Socialist was kicking her ass and Bill Clinton was still whoring around while Hillary was on the road running for President.  In the mean time, Donald Trump was saving America. 

Donald Trump was in the middle of a feud with FOX News as Megyn Kelly hurt his feelings and Bill O'reilly pissed him off.  Donald Trump had no problem kicking a chair out from under some talking head at CNN or Fox News, in fact he enjoyed battle.

Was Barack in the know about these secret Hillary Clinton polls?  Did Valerie Jarrett, Samantha Summers, Joe Biden, Nancy Pelosi, Harry Reid and the rest of them understand the secret polling being requested to jump start Hillary Clinton?  

John Boehner the Republican cry baby called her yesterday and wanted some work done but she had to tell him no for now.  She had told John that another client had bought up the next couple of days and they had prepaid for a very specific result.

Now her eyes rested on her old manual keyboard, of a real typewriter, it was the place where she would type the 12 questions and that one bonus question that could produce another Harvard Presidential Poll.

 Producing positive results for Hillary Clinton and her den of what-evers could create a great fall income.   Dorothy didn't like the Clinton's and she never liked Barack Obama but oddly enough she did her most powerful work for the people she didn't like much so working for Hillary was nothing new. 

She had noticed that Michelle Obama had trouble with her vowel sounds which always bothered the Harvard English teacher but most of all Michelle was hiding her past from Americans, just like her husband.  

Political Consulting and Polling was a great business for a Harvard Professor and the hotel was full down the road waiting for her results, they only gave her 24 hours.  

For $100,000 she would work late and perfect the questions that would point the answers and the voters to Hillary Clinton for president.  

Once the poll results were released the main stream media would push the content, always desperate for news that created a solid narrative for Hillary Clinton.  

Donald Trump wanted to make America Great Again so this survey poll had to produce a better result than the last one.  

How in the world did a Real Estate Billionaire White guy become the front runner in the Presidential elections in the socialist progressive era in America?

What made millions of American's flock to the real estate, hotel and builder?  

How could Hillary Clinton defeat the bastard? 

After the last presidential debate Donald Trump took a dip and Hillary Clinton thought there was some negative magic, even though black magic.  The Muslim slip up on Donald Trump's part caused him to drop in the polls and the Clinton's smelled blood as they needed the help dodging Black Lives Matter, Muslim Brotherhood and of course the blank email secret server that the FBI has now recovered.  The DOJ position by Lynch was going to be a big deal, bigger than Benghazi so Hillary was frantic and afraid. 

Donald Trump didn't make any comments when the nut job during live T.V. asked Donald about the Muslim president Barack Obama and the detention centers that FEMA operates this very day.  

Donald Trump, without doing anything, fell through the trap door.  Even at CBS, using 60 minutes, they wanted a pound of Trump Ass on a platter but, something wasn't right even when Donald Trump might have acted in error by saying nothing. There was something really big in America and it had nothing to do with Hillary Clinton or Jeb Bush but everything to do with Donald Trump - the deal maker. 

The Harvard Professor looked up to the skylight over her desk and the dark sky reminded her that it was two fifty in the morning.  It was going to be a very long day. Governor Walker had just quit the campaign, she hoped his last check wouldn't bounce, he had been a customer for a long time. 

There was no noise in her home except she could hear her white and black cat scratching at her food bowl and wanting some warmth and pets.  Rubbing her palms together she placed her fingers on the keyboard and typed the first presidential poll question;

It was truly a million dollar question;

What is Donald Trump afraid of?

As the moon went down the sun came up and the distracting noise from her cat went away a long time ago.  She looked across the room and noticed that the fire had gone out a long time age, she hadn't even noticed except for a slight chill in the air. 

She got up from her chair and looked out the front window and noticed one of the Clinton security guards sitting on her north fence, most likely a sober Secret Service guy with big arms and a big gun.

She wondered if the guard wanted coffee as she wandered into the kitchen and struck a match to her grandfathers old gas stove that was still clinging to life after forty some years. Her home was well over a hundred and thirty years old and had a few cracks here and there but her great grandfathers homestead was the place of her birth and she called it home. 

Her grandfather had been overburdened with stories of the past and he shared all of them with his granddaughter over the years.  He would tell the story and she would transcribe them as she got older, it was the background for her first published book as a Harvard Professor over thirty years ago. 

She needed a good nap but she had written the 12 polling questions and as if she heard her grandfathers voice whispering in her ear she paused to look at his portrait hanging in the dining room.  

He would teach her many things in her early years but his teaching and her learning never stopped.  Even now at seventy three years old she still chatted with her grandfather now gone for many years.  

He would tell her " you don't understand how it was in those days Dorothy"  "they told  us where to sit, where not to stand, where to work and even where to eat"  

"it was in that state of mind Honey that the black folks like me said enough was enough" 

"when you have had enough the dribbling stops and the shooting begins"  and always to her astonishment he roamed through history with her and proved every point he was making.  

He told the stories of the run-a-way slaves hiding with the Indians during the trail of tears and the settlements and black only towns in Oklahoma, the place where his grandparents had been born as he would pause and tell me their names.

"Shall we go to the park Dorothy?"  and often times he would just walk outside and expected me to follow, which she always did as he continued to teach her.

"Slavery is prehistoric Honey"  "Strong men held the weak men down"  "Slavery had nothing to do with color, it was about brute force and it became overgrown and spread all over the world, including the Kingdoms inside the Islamic Nations" 

"Slavery is like a flytrap, it would grab you and hold you until you grew tired and surrendered"  "In time the screams were not heard, the sound of pain disappeared and the slave masters became stronger than before"  

"this is why you must learn Dorothy and learn that appearance is a simple shield that people spray on in the morning and wash off at night"  "The slaves always rise up and kill their masters"  "The slaves rub their hands together and make plans just like the slave masters"  The slaves huddle together just like their masters"  

The Harvard Professor understood that the Hillary Clinton wardrobe would never get her elected.  She was a mistake just like her husband, the impeached Bill Clinton.  

The American voters had put up with half-truths long enough, illusions about equality and peace on earth by allowing open border and millions of illegal aliens inside America,  and the embellishments about ObamaCare, Iran Nuclear deals, Syria, Soviet Russia and down right lies about everything like Lois Lerner IRS, Johanthan Gruber her M.I.T. pal from seminars and a host of others.   

The American slaves were rubbing their hands together and they were going to kill the masters. The American way of killing was to vote them out or if in a really big hurry impeach the bastards. 

She wanted to sleep but she poured two cups of hot coffee and walked outside into the cold air and toward the white skinned guard.  It would have been funny to her grandfather that a white guard was guarding and old black Harvard professor to help a White Privileged Hillary Clinton to get elected, at least she hoped he would have found the humor in all the reality of America.

The hot coffee was offered and a feeling of triumph for the both of them as they drank their steaming coffee and watched their breath make fog around them.  

She bent down and picked up the cigarette butt he had tossed into her grass during the long night and smiled at him.  Even in the half light she could see him smile with a sorry look on his face as a car pulled up to the fence and three men got out.

As an English Teacher at Harvard University her punishment was to listen to the poor choice of words coming from the lead man from the security car.  

"Freaking too cold out here!"  the security team leader had been hidden all night inside the warm motel down the road had suddenly discovered the cold air.  Dorothy was not really listening to him but she was forming a true fascination with his mastery of the English language. 

He was also shedding ash from his cigarette that was a constant agitation as he continued to brush ash off his jacket and shoes while he spoke to his guard.

"This ain't ushering Dizzy!"

"What's the doctor doing outside!"

The Harvard professor noticed the security team leader toss his cigarette in her grass and also noticed her coffee friend pick it up instantly.

Shifting around the professor turn away and walked back to her home as they were all waiting for Hillary Clinton now as minor and insignificant players in her life.

The sudden intrusion of the security team leader upset Dorothy and it was a shame she couldn't finish her coffee with the night time guard, even now she worried that he was in trouble because she was outside.

This place called home was built in 1879 by her great grandfather given to her grandfather and then her father and now her.  The railway bridge was only about fifty yards away so she grew up with cows and train whistles and the dramatic river marked the other side of the farm.  The old barn was feeling a lot of pain but the red paint made it look a lot better but the home was in fine shape for its age.

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What is Donald Trump afraid of? It was truly a million dollar question; Hillary Clinton Hired the Harvard Professor - The Pollster Shocked the Clinton Foundation - She Knew the Secret of Donald Trump's Victory

The story began a few day's ago as the Harvard Professor accepted the polling assignment task from the Bill, Hillary and Chelsea Clinton Foundation.  This was a secret just like the shadow government emails found by the FBI on the wiped Clinton server.  

Why was Donald Trump winning and could Hillary Clinton take him down.  Did Carly have any chance at all in beating Donald Trump, so many questions and they were willing to pay for the answers, would Ben Carson fall off the cliff?

At her makeshift desk in her living room she ponderously thought about the 12 questions that could discover the amazing following of Donald Trump.  The Harvard Professor was well known inside the DNC Democratic Party and even the White House.  She had a way with words, that created the exact questions to get the exact response Hillary Clinton, Joe Biden, Barack Obama and even Jeb Bush wanted.  During the presidential campaign season money flowed and she could easily earn a million dollars, one poll at a time.  Jeb Bush, Marco Rubio, Hillary Clinton and others had sent their operatives to buy her time and get her help.  Cash and Carry were always the terms as even Karl Rove called her last week, needing some schooling about polling the American voters. 

Nothing made sense this time around.  Donald Trump was winning big and the so-called RNC GOP elite Jeb Bush was stuck in the mud, Hillary Clinton might go to jail, everything upside down that had to be sorted out, what were people thinking?   

She knew that people became what they thought about and what they think about drives all their actions.  Her polling was so good it was always published in the New York Times, the Boston Globe, the L.A. Times and seemingly every blog in the world.  The T.V. hounds at CNN, ABC, CBS, NBC, MSNBC and even FOX News would show her numbers, she was big time. 

She was a little cold as the weather turned chilly in upstate Main so her hand was shaking as she looked at the check payment from the Clinton Foundation.  This was not her first foundation assignment but this was the first $100,000 check that demanded a quick turnaround time.  She wondered what Huma Abedin, Cheryl Mills and Susan Rice really wanted and she also wondered if Barack Obama knew about her secret work. Was Barack in the know about these secret polls?  Did Valerie Jarrett, Samantha Summers, Joe Biden, Nancy Pelosi, Harry Reid and the rest of them understand the secret polling being requested to jump start Hillary Clinton?

Her eyes rested on her keyboard, it was the place where she would type the 12 questions that could produce another Harvard Presidential Poll that could produce positive results for Hillary Clinton and her den of whatevers. Consulting was a great business for a Harvard Professor and the hotel was full down the road waiting for her results, they only gave her 24 hours.  For $100,000 she would work late and perfect the questions that would point the answers and the voters to Hillary Clinton for president.  Once the poll results were released the main stream media would push the content, always desperate for news that created a solid narrative for Hillary Clinton.  

Donald Trump wanted to make America Great Again so this survey had to produce a better result than the last one.  How in the world did a Real Estate Billionaire become the front runner in the Presidential elections?  What made millions of American's flock to the real estate, hotel and builder?  How could Hillary Clinton defeat the bastard? After the last presidential debate Donald Trump took a dip and Hillary Clinton thought there was some negative magic, even though black magic.  

Donald Trump didn't make any comments when the nut job during live T.V. asked Donald about the Muslim president Barack Obama and the detention centers that FEMA operates this very day.  Donald Trump, without doing anything, fell through the trap door.  Even at CBS, using 60 minutes, they wanted a pound of Trump Ass on a platter but, something wasn't right even when Donald Trump might have acted in error by saying nothing.

The Harvard Professor looked up to the skylight over her desk and the dark sky reminded her that it was two fifty in the morning.  It was going to be a very long day. Governor Walker had just quit the campaign, she hoped his last check wouldn't bounce, he had been a customer for a long time. 

There was no noise in her home except she could hear her white and black cat scratching at her food bowl and wanting some warmth and pets.  Rubbing her palms together she placed her fingers on the keyboard and typed the first presidential poll question;

It was truly a million dollar question;

What is Donald Trump afraid of?

As the moon went down the sun came up and the distracting noise from her cat went away a long time ago.  She looked across the room and noticed that the fire had gone out a long time age, she hadn't even noticed.

She got up from her chair and looked out the front window and noticed one of the Clinton security guards sitting on her north fence.  She wondered if he wanted coffee as she wandered into the kitchen and struck a match to her grandfathers old gas stove that was still clinging to life after forty some years. 

She needed a good nap but she had written the 12 polling questions and as if she heard her grandfathers voice whispering in her ear she paused to look at his portrait hanging in the dining room.  

He would teach her many things in her early years but his teaching and her learning never stopped.  Even now at seventy three years old she still chatted with her grandfather now gone for many years.  He would tell her " you don't understand how it was in those days Dorothy"  "they told where to sit, where not to stand, where to work and even where to eat"  "it was in that state of mind Honey that the black folks like me said enough was enough" "when you have had enough the dribbling stops and the shooting begins"  and always to her astonishment he roamed through history with her and proved every point he was making.  He told the stories of the run-a-way slaves hiding with the Indians during the trail of tears and the settlements and black only towns in Oklahoma, the place where his grandparents had been born as he would pause and tell me their names.

"Shall we go to the park Dorothy?"  and often times he would just walk outside and expected me to follow, which she always did as he continued to teach her.

"Slavery is prehistoric Honey"  "Strong men held the weak men down"  "Slavery had nothing to do with color, it was about brute force and it became overgrown and spread all over the world, including the Kingdoms inside the Islamic Nations" 

"Slavery is like a flytrap, it would grab you and hold you until you grew tired and surrendered"  "In time the screams were not heard, the sound of pain disappeared and the slave masters became stronger than before"  

"this is why you must learn Dorothy and learn that appearance is a simple shield that people spray on in the morning and wash off at night"  "The slaves always rise up and kill their masters"  "The slaves rub their hands together and make plans just like the slave masters"  The slaves huddle together just like their masters"  

The Harvard Professor understood that the Hillary Clinton wardrobe would never get her elected.  She was a mistake just like her husband, the impeached Bill Clinton.  The American voters had put up with half-truths long enough, illusions about equality and peace on earth by allowing open border and millions of illegal aliens inside America,  and the embellishments about ObamaCare, Iran Nuclear deals, Syria, Soviet Russia and down right lies about everything like Lois Lerner IRS, Johanthan Gruber her M.I.T. pal from seminars and a host of others.   The American slaves were rubbing their hands together and they were going to kill the masters. The American way of killing was to vote them out or if in a really big hurry impeach the bastards. 

She wanted to sleep but she poured two cups of hot coffee and walked outside into the cold air and toward the white skinned guard.  It would have been funny to her grandfather that a white guard was guarding and old black Harvard professor to help a White Privileged Hillary Clinton to get elected, at least she hoped he would have found the humor in all the reality of America.

The hot coffee was offered and a feeling of triumph for the both of them as they drank their steaming coffee and watched their breath make fog around them.  

She bent down and picked up the cigarette butt he had tossed into her grass during the long night and smiled at him.  Even in the half light she could see him smile with a sorry look on his face as a car pulled up to the fence and three men got out.

As an English Teacher at Harvard University her punishment was to listen to the poor choice of words coming from the lead man from the security car.  

"Freaking too cold out here!"  the security team leader had been hidden all night inside the warm motel down the road had suddenly discovered the cold air.  Dorothy was not really listening to him but she was forming a true fascination with his mastery of the English language. 

He was also shedding ash from his cigarette that was a constant agitation as he continued to brush ash off his jacket and shoes while he spoke to his guard.

"This ain't ushering Dizzy!"

"What's the doctor doing outside!"

.

.

The Harvard pollster got another assignment - The Clinton Foundation Writes a Big Check for the Right Answers - Why is Donald Trump Winning Hillary Clinton had to know

The Harvard pollster got another assignment.  A woman, not very young, to remain nameless received another $10,000 commission last night.  

Her job was to again probe the world of voters and discover what they thought about Donald Trump.  

Why was Donald Trump winning and could Hillary Clinton take him down.

At her makeshift desk in her living room she ponderously thought about the 12 questions that could discover the amazing following of Donald Trump.  

She was a little cold as the weather turned chilly in Main so her hand was shaking as she looked at the check payment from the Clinton Foundation.  This was not her first foundation assignment but this was the first $10,000 check that demanded a quick turnaround time.  She wondered what Huma Abedin, Cheryl Mills and Susan Rice really wanted and she also wondered if Barack Obama knew about her secret work.

Her eyes rested on her keyboard, it was the place where she would type the 12 questions that could produce another Harvard Presidential Poll that could produce positive results for Hillary Clinton and her den of whatevers. Consulting was a great business for a Harvard Professor and the hotel was full down the road waiting for her results, they only gave her 24 hours.

Donald Trump wanted to make America Great Again so this survey had to produce a better result than the last one.  After the last presidential debate Donald Trump took a dip and Hillary Clinton thought there was some negative magic, even though black magic.

The Harvard Professor looked up to the skylight over her desk and the dark sky reminded her that it was two fifty in the morning.  It was going to be a very long day.

There was no noise in her home except she could hear her cat scratching at her food bowl and wanting some warmth and pets.  Rubbing her palms together she placed her fingers on the keyboard and typed the first presidential poll question;

It was truly a million dollar question;

.

College Boy Barack Obama and College Boy Scott Walker - We're all lucky that Scott Walker never finished college so he could grow and prosper, never being held back by teachers, with no experience.

Lucky for Scott Walker that he did not attend Harvard or he would have become an American hating nut job like Barack Obama. Barack Obama is an affirmative action welfare student and his results show it.   We're all lucky that Scott Walker never finished college so he could grow and prosper, never being held back by teachers, with no experience. Look how smart Hillary Clinton pretends to be and then think Benghazi.  How about big brain little action Barack Obama and think about Yemen, Cuba, Ukraine, Syria, Iran, Iraq and Israel.  Smart people really do stupid things because they have no common sense.  Look at the new Obama selfie, jack off. 

Six years deep now into the Obama administration, the militant radical president Obama has been able to keep his college transcripts and records hidden from the American people,  it’s largely because Obama spent millions in legal fees aiming to keep them hidden. His father abandoned him. He was raised primarily by his maternal grandparents in Hawaii. He had few resources. Yet, Barack Obama rose up to become the most powerful man in the world, a stunning achievement. How much the system helped Mr. Obama is unknown as his college records have been kept private. We don’t know the extent of affirmative action. We don’t know how much the government subsidized his climb to the top. It would be very helpful to have that information simply to be fair to the president and his vision. There’s no question President Obama believes his success is partly due to government. That goes to his famous line: “You didn’t build that.”

Harvard University - Harvard University is producing some very dangerous people. Obama

Harvard University - Harvard University is producing some very dangerous people.  Obama. Harvard is a place of shame and socialism now, nothing there worth over a dime.

The History of Scandal Revealed Barack Obama - Records Discovered - Secrets Revealed - The Occidental and Harvard College Records and other Documents concerning Barack Hussein Obama have been acquired and paints the picture of a life based on fear, anger and love and are being sheltered by a College in the city of Detroit Michigan. Doctor Gregory William's, as the director of History for the faculty of the college gained access to the secret documents of Barack Obama, the now President of the United States while he attended Occidental College, Columbia and Harvard University.

Barack Obama - Records Discovered - Secrets Revealed - 

The Occidental and Harvard College Records and other Documents concerning Barack Hussein Obama have been acquired and paints the picture of a life based on fear, anger and love and are being sheltered by a College in the city of Detroit Michigan.

Doctor Gregory William's, as  the director of History for the faculty of the college gained access to the secret documents of Barack Obama, the now President of the United States while he attended Occidental College, Columbia and Harvard University. 

The college records of Barack Hussein Obama while being a student at Occidental College, Columbia and Harvard University have been held in secret.

Doctor Gregory William's is well known for absorbing history and has authored many important books and papers concerning the characteristics of well known people and celebrities.

These secret records concerning the life of Barack Obama entered into the private collectors market and the association of historians joined together and paid the five million dollars, the asking price, to be paid in full over the next five years.

The Natural History of Barack Obama indicates a very slow development which is clearly displayed as an inferiority complex of the President today.  Barry Soetoro aka Barack Obama set out to conquer the world and often bragged that he would become president some day and rid the world of evil people and evil doings.  The inferiority complex is a result of interference.  Barack Obama has the desire but his thinking reveals that other people and their interference has always stopped him from self-assertion.

People with the inferiority complex or interference complex are mostly day-dreamers or braggarts and most interesting Barack Obama clearly displays both classes.

Barack Obama loves to brag and talk big in front of weaker groups and radically acts in different ways in front of different audiences.  His inability to meet the ordinary situations of life explains his constant failures during his adult life.  Working as a community organizer for compensation was only accomplished by the help of other people and their organization.

Barack Obama has a law degree from Harvard University but his individual inferiority and inability to meet daily challenges through honest dealings resulted in him having his license revoked with other unknown penalties.

Every person who suffers as Barack Obama does often tries to make up for failure in some ways.  In his mind a failure is a withdrawal from his self-worth.  This would explain his inability to admit failure in public.  Other people liking him he accepts as compensation but expresses itself in a lack of initiative.  In other words when Barack Obama does a good thing he stops doing anything.  If Barack Obama does something wrong he tries to make it up but mostly he becomes paralyzed, which leads him to some routine distraction (golf) (fund raising) or some other robot like existence.  The distractions from his failures or duties allows him to relax by day-dreaming.

Barack Obama should be a humble shoe store clerk because he sees himself as a very ordinary person that could do great things if other people would not interfere but, in the back of his mind he runs this day-dream distraction that he is truly a remarkable fellow.

He thinks that ordinary men and women naturally don't realize his greatness.  He tends to rescue or take command of a situation when he should sit down and simply listen.

He thinks of himself as a hero and he needs a audience shouting his name.  We understand that make-believe is common among children and adolescents but Barack Obama, boy like, likes to visualize himself as a victorious general returning on horseback, from the wars, as the hero.  At some point in time it will be revealed that Barack Obama was left alone on the front step for too long which caused his fantasies to persist through his adult life.

The bullying and bragging is his way of compensating for his deep-seated lack of self-esteem.  To domineer other people (voters) he will try to impress them and show his importance by lying about accomplishments he never achieved or exaggerating what little he did accomplish.

The college records were held secret by paying cash annuities to other people for their silence.  His attempt at keeping his true life and background secret betrays the fact that he is a coward.  He gets angry when you ask him hard questions because it temps his temper, his internal shouting and the delirious self ranting he lives with daily.

He is fond of the limelight when he can control the crowds but can be subject to great anger. 

B.S. 

CNN is flopping around and about to die in the market. CNN's favorite thing to do today is back up Fareed Zakaria because they approve of plagiarism. CNN is committed to marketplace death as they continue to back up the highly paid Fareed Zakaria because? They approve of Plagiarism. Why would any company (CNN) keep defendings Zakaria after multiple examples of his dishonest work? You could assume that plagiarism must be acceptable at CNN because they refuse to kick Fareed Zakaria to the curb.

CNN is flopping around and about to die in the market.  CNN's favorite thing to do today is back up Fareed Zakaria because they approve of plagiarism.  CNN is committed to marketplace death as they continue to back up the highly paid Fareed Zakaria because? 

They approve of Plagiarism. 

Why would any company (CNN) keep defendings Zakaria after multiple examples of his dishonest work?  You could assume that plagiarism must be acceptable at CNN because they refuse to kick Fareed Zakaria to the curb. In time, we'll find out more and more about Zakaria, 

We understand that Zakaria is a pal of Barack Obama so CNN is most likely afraid to fire him because of the White House.  Before the 2008 US Presidential election, Zakaria endorsed Barack Obama on his CNN program and the liar in the White House (Barack Obama) likes the guy a whole lot because they're both Muslim.  Fareed, a smart guy, even though dishonest, is from India and has attended the best schools in America, including Harvard.  Sound familiar yet? 

After the 9/11 attacks, in a Newsweek cover essay, "Why They Hate Us," Zakaria argued that Islamic extremism was not fundamentally rooted in Islam just like Barack Obama believes.  As ISIS ISIL KILLS PEOPLE by the thousands CNN will continue to suffer for their total support of Barack Obama and people like Fareed Zakaria.

Obama Holder The evidence for Barack Obama’s Kenyan birth is overwhelming, but somehow his very powerful backers have managed to keep the foreign born usurper in office.

The evidence for Barack Obama’s Kenyan birth is overwhelming, but somehow his very powerful backers have managed to keep the foreign born usurper in office.

In 1991, a literary catalog published by Acton and Dystel identified one of their new authors as:

“Barack Obama, the first African-American president of the Harvard Law Review, was born in Kenya and raised in Indonesia and Hawaii.”

In 2006, prior to his presidential run for office, Obama’s home village in Kenya had a sign declaring it to be his birthplace. Early in Obama’s political career, there was a video in which he mentioned his Kenyan birth and Michelle Obama did the same in another video, but those videos have been wiped from the cyber world.

There is also evidence that when Barack Obama attended Occidental College that he was registered as a Muslim student and a citizen of Indonesia.

The Maricopa County Sheriff’s Cold Case Posse conducted a thorough investigation into the alleged official birth certificate released by the White House and has proven that it is a forgery and that the people involved with creating it and declaring it to be official committed an act of fraud. They also found evidence that Barack Obama’s Selective Service Registration Card was forged or altered and that his Social Security number originated in Connecticut where he never lived.

Obama has spent over $3 million keeping his documentation and records sealed from the general public. This only prompts the question of what he is hiding that is worth that much money and effort to hide?

In 2008, Bill Clinton was publicly questioning Obama’s birth during Hillary’s primary run. Sources revealed that Bill Clinton would not stop until someone connected with Obama threatened the life of his daughter Chelsea.

In 2010, James Orengo, Kenya’s Minister of Lands and a member of the Kenyan Parliament publicly stated:

“If America was living in a situation where they feared ethnicity and did not see itself as a multiparty state or nation, how could a young man born here in Kenya, who is not even a native American, become the president of America?”

There is more evidence of Barack Obama’s Kenyan birth, yet the liberal mainstream media is so devoted to the illegal president that they refuse to push the issue or question his eligibility to hold the highest office in the land.

However, one news correspondent with a very liberal network inadvertently slipped while on the air. During the recent US – Africa Leaders Summit held in DC, MSNBC host Joy Reid was talking with NBC White House Correspondent Chris Jansing. Reid stated:

“The White House clearly, I assume, is hoping that this will be part of president’s legacy given his background.”

To which Jansing responded:

“Yeah, the fact that he’s from Kenya, and that fact that when he was elected there were expectations from the African continent that he would do great things for them. This is a concerted effort by this administration to get American companies to invest.”

Ten minutes later in the interview, Jansing realized what she had said, or someone told her in her earpiece, and she corrected her statement, saying:

“I misspoke at the top before. It is obviously the president’s father who is from Kenya.”

Reid graciously added:

“We, of course, know what you meant.”

It seems that every once in a while a liberal Obama supporting newsperson will make a similar slip. In 2008, very liberal National Public Radio identified Obama, who was still a US Senator at the time, as being Kenyan born and a ‘son of Africa.’ After WND reported the NPR reference, the radio network hastily removed the reference from their archives.

All I can say is that the people behind Obama have to be some of the richest and most powerful people in the world in order to pull off the greatest con and hoax in world history in getting a foreign born person illegally elected to the presidency of the United States. This is also one reason why I look at everything Obama has done, legally and illegally in putting all of the pieces into play to declare a state of emergency, institute martial law and seize dictatorial control of the United States before his current term ends. Everything about him points to this conclusion.

A whistle-blower from Higher Education Services Corporation in Albany New York came forward and advised Attorney Orly Taitz that she personally reviewed Barack Obama's financial aid information, which stated that financial aid was given to Obama as foreign student and as a citizen of Indonesia.

A whistle-blower from Higher Education Services Corporation in Albany New York came forward and advised Attorney Orly Taitz that she personally reviewed Barack Obama's financial aid information, which stated that financial aid was given to Obama as foreign student and as a citizen of Indonesia.

Wendy Davis continues to plead; Public Not Shocked about Liars, Cheats in Power. Hillary Clinton Barack Obama Wendy Davis in the News, joins Liar's Club or Lion's Club

Wendy Davis continues to spin today and millions of American eat government food.  The Liar Lady Wendy Davis doesn't want people to know she left her kids, took her husbands cash and created a brand new life on her own, based on a series of lies and cheats.  Wendy Davis continues to drama.

Wendy Davis continues to plead;  Public Not Shocked about Liars, Cheats in Power. Hillary Clinton Barack Obama Two Harvard Graduates had a tough life, others paying their bills, cheating the system and living for more power and influence.