When you think of it, every day is the end of the world as we know it because everything, and I do mean everything, changes.

There is an old myth that every cell in our body dies and is replaced within a seven- to 10-year period. Some of that is true. For example, of our 50 to 75 trillion cells, each one has its own lifespan, but there’s no clock ticking off seven or 10 years. Some die within days, but some take weeks or months. White blood cells, for example, live for more than a year while our skin cells only make it for two or three weeks. The only cells that typically last a lifetime are brain cells, but there are plenty of those know-it-alls that get damaged when we drink too much.

Nevertheless, things change all the time, and the good news is that we human beings have been very adaptable to most changes. Yes, of course, cockroaches are better at survival than us, but we’re still here. And when it comes to the number of already extinct species, that’s a pretty big deal.

The predominant question that we have now is what is going to change dramatically enough to impact us as human beings? Will it be the extra 3 billion people who will be joining us on Earth over the next decade or so? If they have a standard of living like we do here in America, it would take four more Earths just to meet their consumption wants and needs.

Will it be global warming, aka climate change? There’s a new documentary out by Leonardo DiCaprio titled “Before the Flood” that hits this problem square on. Even if you’re convinced that man doesn’t have anything directly to do with it, it’s happening. The temperature has reached a point now where we’re getting mega-storms, giant tornadoes, Category 4 and 5 hurricanes, tsunamis, floods, droughts and melting ice caps, and we haven’t really scratched the surface of where things are heading.

If you’re trying to breathe in the Carolinas right now or you want to take a very long shower in San Diego or make it to your storm cellar in time to avoid joining Dorothy in Oz when the tornado hits in the Midwest, it’s a little more frightening.

What else is changing? Clearly the politics of our country have changed, and if you’re African-American or Muslim, or an immigrant from almost anywhere, things probably feel a little less safe. It’s also more intimidating for the LGBT community, for women seeking medical attention and for those individuals who are not fully employed orwho have minimum wage jobs. Truthfully, except for the things we’re seeing on television every day, that fear is pretty much based on previous negative personal experiences or campaign rhetoric.

We might also have a sense of uneasiness when it comes to the 12 million insured who might not continue to be insured in the future or the 10,000 of us who are going on Social Security and Medicare every day. But for now that is all just apprehension of the unknown.

Finally, there is some trepidation when it comes to wars that are currently covering most of the Middle East and terrorists who are sneaking into Western countries.

Bottom line? Everything, and I do mean everything, is changing in lots of ways. Consequently, we can either get used to it, adapt to it, embrace it and recognize it, or we can hide under the table and pray that it will pass over us.

I, for one, am hoping that some very smart people address the majority of the issues listed above in ways that are better for the entire gang. Either way, we have to find some way to begin to listen to each other, to try to work together and to find common ground or only the roaches will be left.

Almost every small business owner with whom I have come in contact over the past few months has expressed deep disdain about the same thing, Obamacare.  They say things like, “Obamacare is keeping me from expanding, from growing my business, and from making any money.” What went wrong? Why did this effort to do so right end up going so wrong for the small business owner?

Dr. Donald Berwick, one of the primary architects of the Act, had a long history of working for the people.  It was my honor to meet Dr. Berwick while he was the President and CEO of the Institute for Healthcare Improvement, a not-for-profit organization dedicated to utilizing evidence-based medicine and research to improve the quality, safety and cost of healthcare. He is a genuine, caring physician who has dedicated his life to attempting to fix the most expensive, and in some ways least effective, healthcare system in the world.Before you get upset about the last statement, let me explain that we are great at what I call train wreck medicine. There is no country in the world that is better at dealing with major traumas, heart attacks, neonatal births, brain surgeries and the like. Where we fall down is in the area of population health. We do not emphasize wellness and prevention. That is one reason why nearly one-third of the United States is either diabetic or pre-diabetic.

In 2010, Barack Obama appointed Dr. Berwick to serve as the head of the Centers for Medicare and Medicaid Services. The ACA had three main objectives: expand access to health insurance, protect patients against capricious activities by insurance companies, and reduce costs. The State of Massachusetts under their Republican Governor Mitt Romney, had introduced a health insurance program that was a compromise between a single payer, socialized medicine-type program and a managed care, insurance-company-based program. The Obama administration believed this compromise would result in two distinct opportunities: 1. The Republicans would support it. 2. The insurance and pharmaceutical companies would not attempt to block passage of the program.

On December 2, 2011, Dr. Berwick resigned because of substantial Republican opposition to his appointment and his probable inability to be confirmed by the Senate. As of 2015, twenty-two states are locked into the politics of opposition, states that primarily have Republican governors who have rejected Obamacare.  This political decision has left millions of their own people uninsured.

The only way this program will work is similar to the manner in which car insurance works. Here’s the formula. Everyone has to have car insurance to drive. The majority of accidents are, however, caused by younger drivers. Consequently, older drivers are subsidizing the costs of those accidents. In Obamacare, the reverse is true.  If there aren’t enough younger people in the Obamacare program, the risk pool will not be large enough to sustain the program and the costs will continue to escalate.

Because twenty-two states didn’t participate, and the Supreme Court ruled to allow states to reject Medicaid for their poorest (roughly 7 percent of the population or 5.9 million people), the anti-Obamacare states (red states and some swing states) are able to deny health insurance to their constituents and thereby make the law seem very unfavorable.  Add to that the health insurance companies that are now dropping out of the program because the pool is not big enough.

What’s good about it?  Insurance companies can’t keep you from getting insurance because of a preexisting condition. Your children can stay on the family policy until they are 26, and millions of people who never had insurance can now get insurance. The bad news is that it needs more work and co-operation to get it right. And that is one reason why Obamacare is struggling and why costs are skyrocketing. Because of redistricting over the past thirty years, politicians don’t have to work together anymore. And that is sick.