19 Great Truths My Grandmother Told Me on Her 90th Birthday

When my grandmother was diagnosed with terminal cancer on her 90th birthday, I sat with her in a hospital room for the entire day, in silence, in laughter, in tears, and in awe. She spoke softly and passionately about her life and all the lessons she learned along the way.

Source: 19 Great Truths My Grandmother Told Me on Her 90th Birthday

“I have seen and touched and danced and sang and climbed and loved and meditated on a lifetime spent living honestly.  Should it all end tonight, I can positively say there would be no regrets.  I feel fortunate to have walked 90 years in my shoes.  I am truly lucky.  I really have lived 1,000 times over.”

Those are the opening lines of the final entry in my grandmother Zelda’s journal—a 270-page leather-bound journal she wrote small entries in almost every morning during the final decade of her life.  In it, she reflected on lessons she had learned, lessons she was still learning, and the experiences that made these understandings possible.

When my grandmother was diagnosed with terminal cancer on her 90th birthday, I sat with her in a hospital room for the entire day, in silence, in laughter, in tears, and in awe.  Although her body was weak, her mind was intensely strong.  The terminal diagnosis inspired her to think about her life, everything she had journaled about over the years, and reflect aloud.  So, I gave her the stage—my undivided attention—from sunrise until sunset.

As I sat beside her hospital bed, she thumbed through her journal one page at a time, reading dozens of specific entries she wanted me to hear.  She spoke softly and passionately about her life, her loves, her losses, her pain, her dreams, her achievements, her happiness, and all the lessons that embodied these points of reference.  It was without a doubt one of the most enlightening and unforgettable days of my life.

My grandmother passed away exactly two weeks later, peacefully in her sleep.  The day after her passing I found out she formally left her journal for me in her will.  Since then, I have read it from cover to cover countless times.

Although I have shared some of her insights and quotes with blog subscribers and course students in the past, today would have been my grandmother’s 100th birthday, so I’d like to honor her.  To do so, I’m going to share excerpts from the journal entries she shared with me in that hospital room ten years ago.  I’ve done my best to sort, clean up, copyedit and reorganize her wisdom into 19 inspiring bullet points.  I hope you find value in them, too:

  1. There are thousands of people who live their entire lives on the default settings, never realizing they can customize everything. – Don’t settle for the default settings in life.  Find your loves, your talents, your passions, and embrace them.  Don’t hide behind other people’s decisions.  Don’t let others tell you what you want.  Design YOUR journey every step of the way!  The life you create from doing something that moves you is far better than the life you get from sitting around wishing you were doing it.
  2. The right journey is the ultimate destination. – The most prolific and beneficial experience in life is not in actually achieving something you want, but in seeking it.  It’s the journey towards an endless horizon that matters—goals and dreams that move forward with you as you chase them.  It’s all about meaningful pursuits—the “moving”—and what you learn along the way.  Truly, the most important reason for moving from one place to another is to see what’s in between.  In between is where passions are realized, love is found, strength is gained, and priceless life-long memories are made.
  3. The willingness to do hard things opens great windows of opportunity. – One of the most important abilities you can develop in life is the willingness to accept and grow through times of difficulty and discomfort.  Because the best things are often hard to come by, at least initially.  And if you shy away from difficulty and discomfort, you’ll miss out on them entirely.  Mastering a new skill is hard.  Building a business is hard.  Writing a book is hard.  A marriage is hard.  Parenting is hard.  Staying healthy is hard.  But all are amazing and worth every bit of effort you can muster.  Realize this now.  If you get good at doing hard things, you can do almost anything you put your mind to.
  4. Small, incremental changes always change everything in the long run. – The concept of taking it one step at a time might seem absurdly obvious, but at some point we all get caught up in the moment and find ourselves yearning for instant gratification.  We want what we want, and we want it now!  And this yearning often tricks us into biting off more than we can chew.  So, remind yourself: you can’t lift a thousand pounds all at once, yet you can easily lift one pound a thousand times.  Tiny, repeated efforts will get you there, gradually.  (Angel and I build tiny, life-changing rituals with our students in the “Goals and Growth” module of the Getting Back to Happy course.)
  5. No one wins a game of chess, or the game of life, by only moving forward. – Sometimes you have to move backward to put yourself in a position to win.  Because sometimes, when it feels like you’re running into one dead end after another, it’s actually a sign that you’re not on the right path.  Maybe you were meant to hang a left back when you took a right, and that’s perfectly fine.  Life gradually teaches us that U-turns are allowed.  So turn around when you must!  There’s a big difference between giving up and starting over in the right direction.
  6. The biggest disappointments in life are often the result of misplaced expectations. – When we are young our expectations are few, but as we age our expectations tend to balloon with each passing year.  The key is to understand that tempering unrealistic expectations of how something “should be” can greatly reduce unnecessary stress and frustration.  With a positive attitude and an open mind, we often find that life isn’t necessarily any easier or harder than we thought it was going to be; it’s just that “the easy” and “the hard” aren’t always the way we had anticipated, and don’t always occur when we expect them to.  This isn’t a bad thing—it makes life interesting, if we are willing to see it that way.
  7. Our character is often most evident at our highs and lows. – Be humble at the mountaintops, be strong in the valleys, and be faithful in between.  And on particularly hard days when you feel that you can’t endure, remind yourself that your track record for getting through hard days is 100% so far.
  8. Life changes from moment to moment, and so can you. – When hard times hit there’s a tendency to extrapolate and assume the future holds more of the same.  For some strange reason this doesn’t happen as much when things are going well.  A laugh, a smile, and a warm fuzzy feeling are fleeting and we know it.  We take the good times at face value in the moment for all they’re worth and then we let them go.  But when we’re depressed, struggling, or fearful, it’s easy to heap on more pain by assuming tomorrow will be exactly like today.  This is a cyclical, self-fulfilling prophecy.  If you don’t allow yourself to move past what happened, what was said, what was felt, you will look at your future through that same dirty lens, and nothing will be able to focus your foggy judgment.  You will keep on justifying, reliving, and fueling a perception that is worn out and false.
  9. You can fight and win the battles of today, only. – No matter what’s happening, you can resourcefully fight the battles of just one day.  It’s only when you add the battles of those two mind-bending eternities, yesterday and tomorrow, that life gets overwhelmingly difficult and complicated.
  10. Not being “OK” all the time is normal. – Sometimes not being OK is all we can register inside our tired brains and aching hearts.  This emotion is human, and accepting it can feel like a small weight lifted.  Truth be told, it’s not OK when someone you care about is no longer living and breathing and giving their amazing gifts to the world.  It’s not OK when everything falls apart and you’re buried deep in the wreckage of a life you had planned for.  It’s not OK when the bank account is nearly at zero, with no clear sign of a promising income opportunity.  It’s not OK when someone you trusted betrays you and breaks your heart.  It’s not OK when you’re emotionally drained to the point that you can’t get yourself out of bed in the morning.  It’s not OK when you’re engulfed in failure or shame or a grief like you’ve never known before.  Whatever your tough times consist of, sometimes it’s just NOT OK right now.  And that realization is more than OK.
  11. Sensitivity can be a super power. – Although sensitivity is often perceived as a weakness in our culture, to feel intensely is not a symptom of weakness; it is the characteristic of a truly alive and compassionate human being.  It is not the sensitive person who is broken, it is society’s understanding that has become dysfunctional and emotionally incapacitated.  There is zero shame in expressing your authentic feelings.  Those who are at times described as being “too emotional” or “complicated” are the very fabric of what keeps the dream alive for a more thoughtful, caring and humane world.  Never be ashamed to let your feelings, smiles and tears shine a light in this world.
  12. Opening up to someone who cares can heal a broken heart. – Deep heartbreak is kind of like being lost in the woods—every direction leads to nowhere at first.  When you are standing in a forest of darkness, you can’t see any light that could ever lead you home.  But if you wait for the sun to rise again, and listen when someone assures you that they themselves have stood in that same dark place, and have since moved forward with their life, oftentimes this will bring the hope that’s needed.
  13. Solitude is important, too. – Speaking to someone can help, but in moderation.  Sometimes the moments you feel lonely are the moments you may most need to be by yourself.  This is one of life’s cruelest ironies.  We need solitude, because when we’re alone we’re detached from obligations, we don’t need to put on a show, and we can hear our own thoughts and feel what our intuition is telling us.  And the truth is, throughout your life there will be times when the world gets real quiet and the only thing left is the beat of your own heart.  So you’d better learn the sound of it, otherwise you’ll never understand what it’s telling you.
  14. Most of the time you don’t need more to be happier—you need less. – When things aren’t adding up in your life, begin subtracting.  Life gets a lot simpler and more enjoyable when you clear the emotional and physical clutter that makes it unnecessarily complicated.  (Angel and I guide our readers though this process of simplifying and getting back to happy in our brand new book.)
  15. Beginning each day with love, grace and gratitude always feels better than the alternative. – When you arise in the morning think of what an incredible privilege it is to be alive—to be, to see, to hear, to think, to love, to have something to look forward to.  Happiness is a big part of these little parts of your life—and joy is simply the feeling of appreciating it all.  Realize that it’s not happiness that makes us grateful, but gratefulness that makes us happy.  Make a ritual of noticing the goodness that’s already yours first thing in the morning, and you will see more goodness everywhere you look throughout the day.
  16. Who we choose to be around matters immensely. – Spend time with nice people who are smart, driven and likeminded.  Relationships should help you, not hurt you.  Surround yourself with people who reflect the person you want to be.  Choose friends who you are proud to know, people you admire, who love and respect you—people who make your day a little brighter simply by being in it.  Ultimately, the people in your life make all the difference in the person you are capable of being.  Life is just too short to spend time with people who suck the happiness out of you.  When you free yourself from these people, you free yourself to be YOU.  And being YOU is the only way to truly live.
  17. Relationship boundaries are life-savers. – When someone treats you like you’re just one of many options, again and again, help them narrow their choices by removing yourself from the equation.  Sometimes you have to try not to care, no matter how much you do.  Because sometimes you can mean almost nothing to someone who means so much to you.  It’s not pride—it’s self-respect.  Don’t give part-time people a full-time position in your life.  Know your value and what you have to offer, and never settle for anything less than what you’ve earned.
  18. It’s during the toughest times of your life that you’ll get to see the true colors of the people who say they care about you. – Notice who sticks around and who doesn’t, and be grateful to those who leave you, for they have given you the room to grow in the space they abandoned, and the awareness to appreciate the people who loved you when you didn’t feel lovable.
  19. New opportunities are always out there waiting for you. – Nobody gets through life without losing someone they love, something they need, or something they thought was meant to be.  But it is these very losses that make us stronger and eventually move us toward future opportunities.  Embrace these opportunities.  Enter new relationships and new situations, knowing that you are venturing into unfamiliar territory.  Be ready to learn, be ready for a challenge, and be ready to experience something or meet someone that just might change your life forever.

Afterthoughts & Promises

As I’m wrapping up this short tribute to my grandmother, I’m reminded of a poem by Christian D. Larson that she used to have hanging on her refrigerator when I was a kid.  As soon as I was old enough to understand the poem, my grandmother made a photocopy of it for me, and, nearly 30 years later, I still have that same photocopy laminated and hanging on my office bulletin board.  These are words I do my best to live by:

“Promise Yourself…

To be so strong that nothing
can disturb your peace of mind.
To talk health, happiness, and prosperity
to every person you meet.

To make all your friends feel
that there is something in them
To look at the sunny side of everything
and make your optimism come true.

To think only the best, to work only for the best,
and to expect only the best.
To be just as enthusiastic about the success of others
as you are about your own.

To forget the mistakes of the past
and press on to the greater achievements of the future.
To wear a cheerful countenance at all times
and give every living creature you meet a smile.

To give so much time to the improvement of yourself
that you have no time to criticize others.
To be too large for worry, too noble for anger, too strong for fear,
and too happy to permit the presence of trouble.

To think well of yourself and to proclaim this fact to the world,
not in loud words but great deeds.
To live in faith that the whole world is on your side
so long as you are true to the best that is in you.”

Which firms profit most from America’s health-care system – Schumpeter

Source: Which firms profit most from America’s health-care system – Schumpeter

It is not pharmaceutical companies

EVERY year America spends about $5,000 more per person on health care than other rich countries do. Yet its people are not any healthier. Where does all the money go? One explanation is waste, with patients wolfing down too many pills and administrators churning out red tape. There is also the cost of services that may be popular and legitimate but do nothing to improve medical outcomes. Manhattan’s hospitals, with their swish reception desks and menus, can seem like hotels compared with London’s bleached Victorian structures.

The most controversial source of excess spending, though, is rent-seeking by health-care firms. This is when companies extract outsize profits relative to the capital they deploy and risks they take. Schumpeter has estimated the scale of gouging across the health-care system. Although it does not explain the vast bulk of America’s overspending, the sums are big by any other standard, with health-care firms making excess profits of $65bn a year. Surprisingly, the worst offenders are not pharmaceutical firms but an army of corporate health-care middlemen.

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In crude terms, the health-care labyrinth comprises six layers, each involving the state, mutual organisations and private firms. People and employers pay insurance companies, which pay opaque aggregators known as pharmacy-benefit managers and preferred provider organisers. They in turn pay doctors, hospitals and pharmacies, which in turn pay wholesalers, who pay the manufacturers of equipment and drugs. Some conglomerates span several layers. For example on March 8th Cigna, an insurance firm, bid $67bn for Express Scripts, a benefit manager. A system of rebates means money flows in both directions so that the real price of products and services (net of rebates) is obscured.

To work out who is stiffing whom, Schumpeter has examined the top 200 American listed health-care firms. Excess profits are calculated as those earned above a 10% return on capital (excluding goodwill), a yardstick of the maximum that should be possible in any perfectly competitive industry. For drugmakers the figures treat research and development (R&D) as an asset that is depreciated over 15 years, roughly the period they have to exploit patents on discoveries. The data are from Bloomberg.

Total excess profits amount to only about 4% of America’s health-care overspending. But this still makes health care the second biggest of the giant rent-seeking industries that have come to dominate parts of the economy. The excess profits of the health-care firms are equivalent to $200 per American per year, compared with $69 for the telecoms and cable TV industry and $25 captured by the airline oligopoly. Only the five big tech “platform” firms, with a figure of $250, are more brazen gougers.

Everyone hates pharmaceutical firms, but their share of health-care rent-seeking is relatively trivial, especially once you include the many midsized and small firms that are investing heavily. Across the economy, average prices received by drug manufacturers have risen by about 5% per year, net of the rebates. But their costs have risen, too. As a result, even for the 15 biggest global drugs firms, returns on capital have halved since the glory days of the late 1990s, and are now barely above the cost of capital. As employer schemes get stingier, employees are being forced to pay more of their drug costs; they are price-conscious.

Meanwhile the effectiveness of R&D seems to have fallen. Richard Evans of SSR, a research firm, tracks the number of high-quality patents (defined as those cited in other patent applications) that drug firms generate per dollar of R&D. This metric has dropped sharply over the past decade. Shareholders may groan, but for the economy overall the system seems to be working. Big pharma is still splurging on R&D but not making out like a bandit.

As the drug industry has come back down to earth, the returns of the 46 middlemen on the list have soared. Fifteen years ago they accounted for a fifth of industry profits; now their share is 41%. Health-insurance companies generate abnormally high returns, but so do the wholesalers, the benefit managers and the pharmacies. In total middlemen capture $126 of excess profits a year per American, or about two-thirds of the whole industry’s excess profits. Express Scripts earns billions while having less than $1bn of physical plants and no disclosed investment in R&D. This year the combined profits of three wholesalers that few outsiders have heard of are expected to exceed those of Starbucks.

The dark view is that pockets of rent-seeking have become endemic in America’s economy. Wherever products are too complex for customers to understand, and where subsidies and complex regulation add to the muddle, huge profits can opaquely be made. Remember mortgage-backed securities?

In the case of health care, consolidation has probably made things worse by muting competition. There are now five big insurance companies, three big wholesalers, three large pharmacy chains and three big benefit managers. The current vogue is for “vertical mergers” in which firms expand into different layers. As well as Cigna and Express Scripts, Aetna, another insurer, and CVS, a pharmacy and benefits manager, are merging. All these firms insist competition will be boosted. But they are also projecting the deals will boost their combined profits by $1.4bn.

Amazon and the health-care jungle

Yet perhaps capitalism is not broken and new contenders will eventually be tempted in. Amazon has acquired wholesale pharmacy licences in multiple states. It is also teaming up with JPMorgan Chase and Berkshire Hathaway to create a new health system for their staff. These initiatives are at an early stage, but investors are sufficiently worried that they value the intermediaries on abnormally low multiples of profits, suggesting earnings may fall. People often get upset when conventional industries are hit by digital competition. Few would lament it in the case of health-care middlemen.

A healthcare algorithm started cutting care, and no one knew why – The Verge

Source: A healthcare algorithm started cutting care, and no one knew why – The Verge

What happens when an algorithm cuts your health care

For most of her life, Tammy Dobbs, who has cerebral palsy, relied on her family in Missouri for care. But in 2008, she moved to Arkansas, where she signed up for a state program that provided for a caretaker to give her the help she needed.

There, under a Medicaid waiver program, assessors interviewed beneficiaries and decided how frequently the caretaker should visit. Dobbs’ needs were extensive. Her illness left her in a wheelchair and her hands stiffened. The most basic tasks of life — getting out of bed, going to the bathroom, bathing — required assistance, not to mention the trips to yard sales she treasured. The nurse assessing her situation allotted Dobbs 56 hours of home care visits per week, the maximum allowed under the program.

For years, she managed well. An aide arrived daily at 8AM, helped Dobbs out of bed, into the bathroom, and then made breakfast. She would return at lunch, then again in the evening for dinner and any household tasks that needed to be done, before helping Dobbs into bed. The final moments were especially important: wherever Dobbs was placed to sleep, she’d stay until the aide returned 11 hours later.

Dobbs received regular reassessments of her needs, but they didn’t worry her. She wouldn’t be recovering, after all, so it didn’t seem likely that changes would be made to her care.

When an assessor arrived in 2016 and went over her situation, it was a familiar process: how much help did she need to use the bathroom? What about eating? How was her emotional state? The woman typed notes into a computer and, when it was over, gave Dobbs a shocking verdict: her hours would be cut, to just 32 per week.

Tammy Dobbs.

Dobbs says she went “ballistic” on the woman. She pleaded, explaining how that simply wasn’t enough, but neither of them, Dobbs says, seemed to quite understand what was happening. Dobbs’ situation hadn’t improved, but an invisible change had occurred. When the assessor entered Dobbs’ information into the computer, it ran through an algorithm that the state had recently approved, determining how many hours of help she would receive.

Other people around the state were also struggling to understand the often drastic changes. As people in the program talked to each other, hundreds of them complained that their most important lifeline had been cut, and they were unable to understand why.

Algorithmic tools like the one Arkansas instituted in 2016 are everywhere from health care to law enforcement, altering lives in ways the people affected can usually only glimpse, if they know they’re being used at all. Even if the details of the algorithms are accessible, which isn’t always the case, they’re often beyond the understanding even of the people using them, raising questions about what transparency means in an automated age, and concerns about people’s ability to contest decisions made by machines.

Planning for the cut in care, Dobbs calculated what she could do without, choosing between trips to church or keeping the house clean. She had always dabbled in poetry, and later wrote a simple, seven-stanza piece called “Hour Dilemma,” directed toward the state. She wrote that institutionalization would be a “nightmare,” and asked the state “to return to the human based assessment.”

The change left Dobbs in a situation she never thought she would be in, as the program she’d relied on for years fell out from below her. “I thought they would take care of me,” she says.

The algorithm that upended Dobbs’ life fits comfortably, when printed, on about 20 pages. Although it’s difficult to decipher without expert help, the algorithm computes about 60 descriptions, symptoms, and ailments — fever, weight loss, ventilator use — into categories, each one corresponding to a number of hours of home care.

Like many industries, health care has turned to automation for efficiency. The algorithm used in Arkansas is one of a family of tools, called “instruments,” that attempt to provide a snapshot of a person’s health in order to inform decisions about care everywhere from nursing homes to hospitals and prisons.

The instrument used in Arkansas was designed by InterRAI, a nonprofit coalition of health researchers from around the world. Brant Fries, a University of Michigan professor in the school’s Department of Health Management and Policy who is now the president of InterRAI, started developing algorithms in the 1980s, originally for use in nursing homes. The instruments are licensed to software vendors for a “small royalty,” he says, and the users are asked to send data back to InterRAI. The group’s tools are used in health settings in nearly half of US states, as well as in several countries.

In home care, the problem of allocating help is particularly acute. The United States is inadequately prepared to care for a population that’s living longer, and the situation has caused problems for both the people who need care and the aides themselves, some of whom say they’re led into working unpaid hours. As needs increase, states have been prompted to look for new ways to contain costs and distribute what resources they have.

States have taken diverging routes to solve the problem, according to Vincent Mor, a Brown professor who studies health policy and is an InterRAI member. California, he says, has a sprawling, multilayered home care system, while some smaller states rely on personal assessments alone. Before using the algorithmic system, assessors in Arkansas had wide leeway to assign whatever hours they thought were necessary. In many states, “you meet eligibility requirements, a case manager or nurse or social worker will make an individualized plan for you,” Mor says.

Arkansas has said the previous, human-based system was ripe for favoritism and arbitrary decisions. “We knew there would be changes for some individuals because, again, this assessment is much more objective,” a spokesperson told the Arkansas Times after the system was implemented. Aid recipients have pointed to a lack of evidence showing such bias in the state. Arkansas officials also say a substantial percentage of people had their hours raised, while recipients argue the state has also been unable to produce data on the scope of the changes in either direction. The Arkansas Department of Human Services, which administers the program, declined to answer any questions for this story, citing a lawsuit unfolding in state court.

When similar health care systems have been automated, they have not always performed flawlessly, and their errors can be difficult to correct. The scholar Danielle Keats Citron cites the example of Colorado, where coders placed more than 900 incorrect rules into its public benefits system in the mid-2000s, resulting in problems like pregnant women being denied Medicaid. Similar issues in California, Citron writes in a paper, led to “overpayments, underpayments, and improper terminations of public benefits,” as foster children were incorrectly denied Medicaid. Citron writes about the need for “technological due process” — the importance of both understanding what’s happening in automated systems and being given meaningful ways to challenge them.

Critics point out that, when designing these programs, incentives are not always aligned with easy interfaces and intelligible processes. Virginia Eubanks, the author of Automating Inequality, says many programs in the United States are “premised on the idea that their first job is diversion,” increasing barriers to services and at times making the process so difficult to navigate “that it just means that people who really need these services aren’t able to get them.”

One of the most bizarre cases happened in Idaho, where the state made an attempt, like Arkansas, to institute an algorithm for allocating home care and community integration funds, but built it in-house. The state’s home care program calculated what it would cost to care for severely disabled people, then allotted funds to pay for help. But around 2011, when a new formula was instituted, those funds suddenly dropped precipitously for many people, by as much as 42 percent. When the people whose benefits were cut tried to determine how their benefits were determined, the state declined to disclose the formula it was using, saying that its math qualified as a trade secret.

In 2012, the local ACLU branch brought suit on behalf of the program’s beneficiaries, arguing that Idaho’s actions had deprived them of their rights to due process. In court, it was revealed that, when the state was building its tool, it relied on deeply flawed data, and threw away most of it immediately. Still, the state went ahead with the data that was left over. “It really, truly went wrong at every step of the process of developing this kind of formula,” ACLU of Idaho legal director Richard Eppink says.

Most importantly, when Idaho’s system went haywire, it was impossible for the average person to understand or challenge. A court wrote that “the participants receive no explanation for the denial, have no written standards to refer to for guidance, and often have no family member, guardian, or paid assistance to help them.” The appeals process was difficult to navigate, and Eppink says it was “really meaningless” anyway, as the people who received appeals couldn’t understand the formula, either. They would look at the system and say, “It’s beyond my authority and my expertise to question the quality of this result.”

Idaho has since agreed to improve the tool and create a system that Eppink says will be more “transparent, understandable, and fair.” He says there might be an ideal formula out there that, when the right variables are entered, has gears that turn without friction, allocating assistance in the perfect way. But if the system is so complex that it’s impossible to make intelligible for the people it’s affecting, it’s not doing its job, Eppink argues. “You have to be able to understand what a machine did.”

Cash, Arkansas.

“That’s an argument,” Fries says. “I find that to be really strange.” He’s sympathetic to the people who had their hours cut in Arkansas. Whenever one of his systems is implemented, he says, he recommends that people under old programs be grandfathered in, or at least have their care adjusted gradually; the people in these programs are “not going to live that long, probably,” he says. He also suggests giving humans some room to adjust the results, and he acknowledges that moving rapidly from an “irrational” to a “rational” system, without properly explaining why, is painful. Arkansas officials, he says, didn’t listen to his advice. “What they did was, in my mind, really stupid,” he says. People who were used to a certain level of care were thrust into a new system, “and they screamed.”

Fries says he knows the assessment process — having a person come in, give an interview, feed numbers into a machine, and having it spit out a determination — is not necessarily comfortable. But, he says, the system provides a way to allocate care that’s backed by studies. “You could argue everybody ought to get a lot more care out there,” he says, but an algorithm allows state officials to do what they can with the resources they have.

As for the transparency of the system, he agrees that the algorithm is impossible for most to easily understand, but says that it’s not a problem. “It’s not simple,” he says. “My washing machine isn’t simple.” But if you can capture complexity in more detail, Fries argues, this will ultimately serve the public better, and at some point, “you’re going to have to trust me that a bunch of smart people determined this is the smart way to do it.”

Shortly after Arkansas started using the algorithm in 2016, Kevin De Liban, an attorney for Legal Aid of Arkansas, started to receive complaints. Someone said they were hospitalized because their care was cut. A slew of others wrote in about radical readjustments.

De Liban first learned about the change from a program beneficiary named Bradley Ledgerwood. The Ledgerwood family lives in the tiny city of Cash, in the Northeast of the state. Bradley, the son, has cerebral palsy, but stays active, following basketball and Republican politics, and serving on the city council.

When Bradley was younger, his grandmother took care of him during the day, but as he got older and bigger, she couldn’t lift him, and the situation became untenable. Bradley’s parents debated what to do and eventually decided that his mother, Ann, would stay home to care for him. The decision meant a severe financial hit; Ann had a job doing appraisals for the county she would have to quit. But the Arkansas program gave them a path to recover some of those losses. The state would reimburse Ann a small hourly rate to compensate her for taking care of Bradley, with the number of reimbursable hours determined by an assessment of his care needs.

Legal Aid attorney Kevin De Liban.

When the state moved over to its new system, the Ledgerwood family’s hours were also substantially cut. Bradley had dealt with the Arkansas Department of Human Services, which administered the program, in a previous battle over a dispute on home care hours and reached out to De Liban, who agreed to look into it.

With Bradley and an elderly woman named Ethel Jacobs as the plaintiffs, Legal Aid filed a federal lawsuit in 2016, arguing that the state had instituted a new policy without properly notifying the people affected about the change. There was also no way to effectively challenge the system, as they couldn’t understand what information factored into the changes, De Liban argued. No one seemed able to answer basic questions about the process. “The nurses said, ‘It’s not me; it’s the computer,’” De Liban says.

At the time, they knew it was some sort of new, computer-based system, but there was no mention of an algorithm; the math behind the change only came out after the lawsuit was filed. “It didn’t make any sense to me in the beginning,” De Liban says. When they dug into the system, they discovered more about how it works. Out of the lengthy list of items that assessors asked about, only about 60 factored into the home care algorithm. The algorithm scores the answers to those questions, and then sorts people into categories through a flowchart-like system. It turned out that a small number of variables could matter enormously: for some people, a difference between a score of a three instead of a four on any of a handful of items meant a cut of dozens of care hours a month. (Fries didn’t say this was wrong, but said, when dealing with these systems, “there are always people at the margin who are going to be problematic.”)

The Ledgerwood family.

De Liban started keeping a list of what he thought of as “algorithmic absurdities.” One variable in the assessment was foot problems. When an assessor visited a certain person, they wrote that the person didn’t have any problems — because they were an amputee. Over time, De Liban says, they discovered wildly different scores when the same people were assessed, despite being in the same condition. (Fries says studies suggest this rarely happens.) De Liban also says negative changes, like a person contracting pneumonia, could counterintuitively lead them to receive fewer help hours because the flowchart-like algorithm would place them in a different category. (Fries denied this, saying the algorithm accounts for it.)

But from the state’s perspective, the most embarrassing moment in the dispute happened during questioning in court. Fries was called in to answer questions about the algorithm and patiently explained to De Liban how the system works. After some back-and-forth, De Liban offered a suggestion: “Would you be able to take somebody’s assessment report and then sort them into a category?” (He said later he wanted to understand what changes triggered the reduction from one year to the next.)

Fries said he could, although it would take a little time. He looked over the numbers for Ethel Jacobs. After a break, a lawyer for the state came back and sheepishly admitted to the court: there was a mistake. Somehow, the wrong calculation was being used. They said they would restore Jacobs’ hours.

“Of course we’re gratified that DHS has reported the error and certainly happy that it’s been found, but that almost proves the point of the case,” De Liban said in court. “There’s this immensely complex system around which no standards have been published, so that no one in their agency caught it until we initiated federal litigation and spent hundreds of hours and thousands of dollars to get here today. That’s the problem.”

It came out in the court case that the problem was with a third-party software vendor implementing the system, which mistakenly used a version of the algorithm that didn’t account for diabetes issues. There was also a separate problem with cerebral palsy, which wasn’t properly coded in the algorithm, and that caused incorrect calculations for hundreds of people, mostly lowering their hours.

“As far as we knew, we were doing it the right way,” Douglas Zimmer, the president of the vendor, a company called the Center for Information Management, says about using the algorithm that did not include diabetes issues. New York also uses this version of the algorithm. He says the cerebral palsy coding problem was “an error on our part.”

“If states are using something so complex that they don’t understand it, how do we know that it’s working right?” De Liban says. “What if there’s errors?”

Fries later wrote in a report to the state that about 19 percent of all beneficiaries were negatively impacted by the diabetes omission. He told me that the swapped algorithms amounted to a “very, very marginal call,” and that, overall, it wasn’t unreasonable for the state to continue using the system that allotted fewer hours, as New York has decided to. In the report and with me, he said the diabetes change was not an “error,” although the report says the more widely used algorithm was a “slightly better” match for Arkansas. One item listed as a “pro” in the report: moving back to the original algorithm was “responsive to trial result,” as it would raise the plaintiffs’ hours close to their previous levels. It’s not clear whether the state has since started counting diabetes issues. As of December, an official said he believed they weren’t. The Department of Human Services declined to comment.

But in internal emails seen by The Verge, Arkansas officials discussed the cerebral palsy coding error and the best course of action. On an email chain, the officials suggested that, since some of the people who had their hours reduced didn’t appeal the decision, they effectively waived their legal right to fight it. (“How is somebody supposed to appeal and determine there’s a problem with the software when DHS itself didn’t determine that?” De Liban says.) But after some discussion, one finally said, “We have now been effectively notified that there are individuals who did not receive the services that they actually needed, and compensating them for that shortcoming feels like the right thing to do.” It would also “place DHS on the right side of the story.”

The judge in the federal court case ultimately ruled that the state had insufficiently implemented the program. The state also subsequently made changes to help people understand the system, including lists that showed exactly what items on their assessments changed from year to year. But De Liban says there was a larger issue: people weren’t given enough help in general. While the algorithm sets the proportions for care — one care level, for example, might be two or three times higher than another — it’s the state’s decision to decide how many hours to insert into the equation.

“How much is given is as much a political as a service administration issue,” Mor says.

Fries says there’s no best practice for alerting people about how an algorithm works. “It’s probably something we should do,” he said when I asked whether his group should find a way to communicate the system. “Yeah, I also should probably dust under my bed.” Afterward, he clarified that he thought it was the job of the people implementing the system.

Kevin De Liban after a visit to Tammy Dobbs.

De Liban says the process for people appealing their cuts has been effectively worthless for most. Out of 196 people who appealed a decision at one point before the ruling, only nine won, and most of those were Legal Aid clients fighting on procedural grounds. While it’s hard to know, De Liban says it’s very possible some had errors they weren’t aware of.

Eubanks, the author of Automating Inequality, writes about the “digital poorhouse,” showing the ways automation can give a new sheen to long-standing mistreatment of the vulnerable. She told me there is a “natural trust” that computer-based systems will produce unbiased, neutral results. “I’m sure it is in some cases, but I can say with a fair amount of confidence it is not as descriptive or predictive as the advocates of these systems claim,” she says.

Eubanks proposes a test for evaluating algorithms directed toward the poor, including asking whether the tool increases their agency and whether it would be acceptable to use with wealthier people. It doesn’t seem obvious that the Arkansas system would pass that test. In one sign officials have been disappointed with the system, they’ve said they will soon migrate to a new system and software provider, likely calculating hours in a different way, although it’s not clear exactly what that will mean for people in the program.

Dobbs has done well up until now. Her house sits off a winding road on a lakeside hill, dotted in winter with barren trees. When the sun sets in the afternoon, light pours in through the windows and catches the plant collection Dobbs manages with help from an aide. A scruffy, sweatered dog named Spike hopped around excitedly when I visited recently, as a fluffy cat jockeyed for attention. “Sometimes I like them better than humans,” Dobbs says. On the wall was a collection of Duck Dynasty memorabilia and a framed photo of her with Kenny Rogers from when she worked at the Missouri building then known as the Kenny Rogers United Cerebral Palsy Center.

Dobbs with Kenny Rogers.
Outside Dobbs’ home.

For the time being, she’s stuck in limbo. She’ll soon come up for another reassessment, and while it’s almost certain, based on what is known about the system, that she’ll be given a cut, it’s hard to say how severe it will be. She’s been through the process more than once now. Her hours were briefly restored after a judge ruled in the plaintiffs’ favor in the federal lawsuit, only for them to be cut again after the state changed its notification system to comply with the ruling and reimplemented the algorithm. As she went through an appeal, the Department of Human Services, De Liban says, quietly reinstated her hours again. This, he says, was right around the time the cerebral palsy issue was discovered. He says this may have been the reason it was dropped: to save face. But as many people grappling with the changes might understand, it’s hard to know for sure.

The Wild Pizzas of Southern Italy Have to Be Seen to Be Believed

A restaurant critic and two chefs go on a pie-in-the-sky adventure to find exactly how far you can stretch the idea of pizza.

By

Richard Vines

Source: The Wild Pizzas of Southern Italy Have to Be Seen to Be Believed

Pizzas at Di Gesù, a popular bakery in Altamura, Puglia.

Photographer: Carol Sachs for Bloomberg Businessweek

When do dough, tomato sauce, and mozzarella stop being mere ingredients and become pizza?

It’s a philosophical question that has divided chefs and diners for decades. For some, only pies in the Neapolitan and Roman styles are acceptable—Sicilian, at a stretch. Others extend the goal posts as far as Chicago deep dish.

But pizzas have been eaten in southern Italy for hundreds of years, and the rainbow of variations that can be found there—if you know where to look—rivals the rest of the world’s best efforts. Its proximity to North Africa means that flatbreads have been popular for centuries. Forget calzones—I’m talking about pizzas and pittas created specifically for breakfast, or marvels the size of entire tables, or baked spirals of crust begging to be torn into satisfying, savory chunks.

Francesco Mazzei (center), with locals from the town of Cerchiara di Calabria.

It’s not easy to discover these secret pizzas in the towns and villages; the economically troubled region doesn’t yet enjoy the number of tourists you find elsewhere in Italy. If you don’t speak Italian, you’re likely to struggle. When I go, I bring a guide: chef Francesco Mazzei, arguably the world’s leading ambassador for the cuisine of his native Calabria. His London restaurants include Fiume, Radici, and Sartoria, and he’s the author of Mezzogiorno (Preface Publishing, 2015), a celebration of southern Italian cooking. Even better, on this occasion he’s suggested bringing along Pierre Koffmann, the three-Michelin-starred French chef whose protégés include Marco Pierre White and Gordon Ramsay.

We pile into Mazzei’s Maserati for a road trip that starts in Calabria, winds through Basilicata, and ends in Puglia—the three southernmost provinces on Italy’s mainland. Our quest? To find the wondrous pizzas of his home culture, some of which have never been seen outside the region. We cover 250?miles over four days, sampling perhaps 20?versions. I’ll ultimately gain five?pounds. Koffmann will tell me later that it took him months to get the weight off. “The pizzas were so good, I kept on eating,” he says. “We think we know all about pizza, but I’m still surprised by the variety.”

Calabria

Our journey starts in the rugged and parched province that provides the toe of the Italian boot. It’s a wild region of mountains and remote villages that bear little resemblance to the sophisticated cities and resorts most visitors know. Mazzei grew up here and learned to make gelato in his uncle’s shop. His family owns a tiny cottage on a hillside, with views across sun-scorched land to the Mediterranean. “Mezzogiorno means noon, half-day, or lunchtime,” Mazzei says. “But for me, it just means home.”

When we visit, a forest fire is raging so fiercely, the billowing smoke brings traffic to a standstill on the highway. We join other travelers standing outside cars, watching the flames in awe.

Mpigliati con le sarde

An mpigliati con le sarde pie at the Petite Etoile hotel consists of dough coated with a mash of sardella, a rich fish sauce with red peppers, and tiny fish cured with salt and paprika.
Photographer: Carol Sachs for Bloomberg Businessweek

Deep in the countryside, at the Petite Etoile hotel in the town of Spezzano Piccolo, Gemma Constantino cooks us a salty, beautiful pie that looks like a bundle of bread roses. It consists of strips of dough coated with a mash of sardella, a rich fish sauce with red peppers, and pilchards (small, herring-like fish) cured with salt and paprika. The strips are rolled and stuck together before baking; to eat, you just tear off one of the rolls, which are great with an aperitivo. There weren’t many other patrons, but the staff laid out a feast for Mazzei, who’s a celebrity in the region. This pizza is a good example of the cucina povera of southern Italy, where humble local ingredients are used to create deeply flavored dishes. The sweetness of the bread and the spiky fish flavors make this a favorite of Mazzei’s. “You’ll find a lot of the best cooks we meet are women,” he says.

Cullura

Cullura uses dough made with pig fat, which is stuffed with broccoli raab; it’s generally served cold.
Photographer: Carol Sachs for Bloomberg Businessweek

The team at Petite Etoile also serves up a pizza dough made with pig fat, layered with cime di rapa (broccoli raab), rolled a bit like a strudel, and then formed into a circle. Cullura is generally consumed cold and works as an everyday snack for farmers to take up into the mountains. “This is like a meal in itself,” Mazzei says. “We Italians usually don’t eat breakfast, so around 10:30 a.m., you are just ready for something to keep you going until lunch time.”

Pitta

Pitta is a Calabrian flatbread that’s crunchy on the outside and soft on the inside; it includes toppings such as tomato, peppers, and herbs. We sample slices from one monster loaf served at a bakery in Castrolibero. When we arrive in the small town, the mayor and some residents turn out to greet us. About 25 people join us as we walk the narrow streets before finding ourselves in a room for a reception with pitta, cakes, and wine.

The city of Matera in Basilicata.
Photographer: Carol Sachs for Bloomberg Businessweek

Pizza al taglio

This square pizza has a variety of toppings. It can be baked for a whole family to share, or bought by the slice. The one we devour is from the Pan Caffè in Fontanesi-Santa Lucia, near Castrolibero, where large groups gather to share giant pies. “This is street food at its best,” Mazzei enthuses. “You go out with your friends and eat all you can eat.” Although remote, the room is filled with happy diners dividing their time between the food and the soccer match on a big screen. Mazzei steps into the open kitchen at one end of the room and rustles up a spaghetti dish with garum, an anchovy paste, and basil. Several diners abandon the match to film and photograph Mazzei on their phones. The wine flows: It’s party time.

Falagone

This half-moon-shaped treat, like a small calzone, is usually eaten cold, but we sample some fresh from the oven at a new roadside bakery, Il Forno dei Sapori di Martorano Vincenzo, outside the hillside town of Cerchiara di Calabria. It’s unusual to find such a spotless and well-equipped bakery beside a road out here, where your best hope in another country might be for a gas station with a convenience store. The owner greets us and describes his food with pride, though (as keeps happening) the actual chef is a woman. Falagones are popular in Calabria, where they’re allowed to rest so the juices seep into the bread. Parents pack them for a seaside trip or for children going to school. Ours are filled with Swiss chard, onion, and sweet paprika. Another one comes with roasted peppers, potato, and onion.

Pitta rustica

A pitta rustica with prosciutto, caciocavallo cheese, and salumi between pitta-style bread.
Photographer: Carol Sachs for Bloomberg Businessweek

Also at Il Forno dei Sapori di Martorano Vincenzo, we discover prosciutto, caciocavallo cheese, and salumi sandwiched between two discs of pitta-style bread. It’s popular for parties or as an afternoon snack. “This is a simple pizza made with whatever you find in the fridge,” Mazzei says. “Every mum makes this for the kids.” I retreat to a corner to drink some crisp, light wine made locally from the ancient Greco bianco grape. The Calabrians are so hospitable, it’s an all-you-can-eat pizza fest, over and over.

Pasta da forno

Pasta da forno, a popular breakfast food at Panificio Mauro in Calabria, has no tomato sauce, no mozzarella, and no onion—just crushed tomato with salt, oregano, and olive oil.
Photographer: Carol Sachs for Bloomberg Businessweek

Forget the “pasta” name; this is a pizza, and it’s popular for breakfast. There’s no tomato sauce atop the dough, no mozzarella, no onion. It’s just crushed tomato with salt, oregano, and olive oil. This one is served to us at the smart Panificio Mauro, also in Cerchiara di Calabria. (In Italian, panificio means bakery.) Traditionally, pasta da forno comes in a round, black tray and is served cold. The absence of sauce helps keep the base crispy, making this a perfect snack to carry to school or to work.

Puglia

The heel of Italy is developing a reputation for its wines, and the food isn’t far behind. Again, we’re struck by the beautiful countryside and the ramshackle historic towns, such as Altamura, with its narrow alleyways and medieval city wall. And then there is Bari, a buzzy port city second only to Naples in the south of Italy.

Focaccia altamurana

The thick focaccia altamurana is studded with tomato and green olives.
Photographer: Carol Sachs for Bloomberg Businessweek

We enter Di Gesù, a popular bakery in Altamura, to try this pizza with dough made only with semolina flour and baked in the city’s oldest oven. Di Gesù is a thriving business now but traces its history to a small shop that opened in 1838. You can sense the pride put into the bread as it’s pulled from the oven. This is thick, like a deep-dish pie, with tomato, green olives, and extra virgin olive oil. “People who haven’t spent time in the south of Italy don’t know how good the food is,” Mazzei says. “We have the best fish, the best meat, the best fruit. You don’t need fancy cooking or luxuries like foie gras. You need to keep it simple and cook from the heart.”

Basilicata

Basilicata, the instep of Italy’s boot, straddles two coastlines. It’s absolutely charming, for both its splendid beaches and ancient towns in which Greek, Spanish, French, and Arabian influences from the times of traders and invaders still remain.

Panzerotto di carne and panzerotto fritto

Panzerotto di Carne at Luale
Photographer: Carol Sachs for Bloomberg Businessweek

These two pie pockets look like calzones but smaller. The first is filled with minced pork and spices, then baked and seasoned with thyme, rosemary, and oregano while the melted fat is still hot. It’s popular as a street food and also comes in a fried version, panzerotto fritto. The one we wolf down contains rich strands of mozzarella, sweet tomato, and basil. Luale, a bakery on the edge of a shopping mall in Policoro, serves both. It looks like a fast-food joint, but the store is clean and efficient, the food rich and layered. It’s the kind of modern store you might easily pass as you hunt for?charm.

Strazzata

Strazzata, a summer-style pizza with peppers, tomato, and extra virgin olive oil, from Ristorante Pizzeria il Fosso, a small shack in a forest near the Basilicata village of Noepoli.
Photographer: Carol Sachs for Bloomberg Businessweek

We drive so deep into a forest, we feel certain we won’t find our way out, let alone the way to the small restaurant we’re seeking. But we do: Ristorante Pizzeria il Fosso is housed in what looks almost like a shack, yet it’s the most charming of the 20-plus spots we visit. Maria Ferrara is in charge of the kitchen, where children play inside and dogs run amok. Mazzei tucks into the strazzata, a fresh, crispy summer pizza with peppers, tomato, and extra-virgin olive oil, then delivers his verdict. “I love this place,” he says.

Tapes: A Ridiculously-Quick, Frictionless Screencasting Tool for Mac OS X.

Source: Tapes: A Ridiculously-Quick, Frictionless Screencasting Tool for Mac OS X.

AppIcon.175x175-75A while ago I wrote a post covering all the screencasting tools I could think of from expensive-and-complex at one end of the continuum to free-and-simple at the other. Since writing that post, I have discovered another screencasting tool that I am quite enamoured of.

Tapes is the simplest and fastest way to make a screencast I’ve ever seen. It’s quick. I mean really, really, quick to use.

Click on the Tapes menu bar item, choose “Record New Tape” and bang! you are recording. When you choose “Stop and Upload”, it instantly tells you that a link has already been placed on your clipboard. You can immediately paste that into an email or discussion thread, even as the video is still being uploaded in the background! It’s that easy and quick. Watch this little 1 minute demonstration to see what I mean. It’s really quite something.

 

It’s not the tool I’d use to make a full-featured screencast. But for a quick explanation, it just can’t be beat.

Tapes has a one-time purchase price of $12:99, which also gives you 60 minutes of recording each month (ongoing) but if you buy it from this promo code, you’ll get an extra 15 minutes per month.

If you are looking for a free alternative, QuickCast is similar but not so amazing.  For example, unlike Tapes, when you click to record, it gives you a 5 second count-in, whereas Tapes just starts recording.  Also with QuickCast, once you finish recording, you have to wait until the video has finished uploading before a share link becomes available. Furthermore, once your video has finished uploading in QuickCast you have to pull down the QuickCast menu and click on the video, to copy a share link, whereas Tapes does all that for you.

Those shortcomings in QuickCast might seem inconsequential, but they mean you’ll find yourself wasting minutes every time you make a screencast, whereas in Tapes – as soon as you’re finished recording, you can paste the link somewhere, and forget about it, moving on to the next task. That increase in efficiency is noticeable – and since efficiency is the core reason for wanting to use either of these apps in the first place, Tapes is the better choice.

The best screencasting software for teachers

As an edtech consultant, a common question I’m asked by teachers and school leaders these days is “Which screencasting software is best?” In this post I’m going to recommend…

Source: The best screencasting software for teachers

The best screencasting software for teachers

As an edtech consultant, a common question I’m asked by teachers and school leaders these days is “Which screencasting software is best?”

In this post I’m going to recommend the screencasting tool that I think is the best for the majority of teachers.  But first I’ve briefly reviewed each of 15 other contenders, in each case outlining it’s pros and cons – and pronouncing a verdict on it.

There is no single best tool to use.  So much depends on the type of computer you use (Mac or PC*), how comfortable you are with video-editing software, how much time you want to spend making your screencasts and how professional and fancy you want your screencasts to be. There’s also an element of personal preference regarding interface design. So my recommendation at the end of this post is no more than my professional opinion.

I’ve bought and used each of the software titles below, and I’ve run Professional Development workshops on each of them over the years, as well as making screencasts for my own students since 2006 and having students make and publish screencasts as part of their own learning journey.

[*NB. In this post I have focussed on computer screencasting tools – if you are interested in iPad tools have a look at this previous post]

1. Adobe Captivate

Like most Adobe software, this is a tool for über-professionals.  It’s adobeously expensive (@ $435 per license), and its interface and workflow is frustratingly non-intuitive for the uninitiated, and it takes me hours to do what I can do in other software in minutes, but you end up with very slick screencasts, and file sizes that are relatively small.  If you are a professional screencaster (Ie.If you’ve been employed to make screencasts and that is your whole job) then you should probably have a look at it. For everyone else, keep reading.

Verdict:  I don’t recommend it for teachers.

2. Camtasia Studio

Very powerful PC-only software that lets me do almost everything I would want to do in an educational screencast, but I rarely recommend it to teachers who are starting out in screencasting because it costs $179 per license (education pricing) and requires a very steep learning curve.

Verdict:  I recommend it only for teachers who have already done some screencasting, are quite comfortable with a PC and demand a professional result. 

3. Camtasia:Mac

Although also made by Techsmith, Camtasia:Mac is not the same as Camtasia Studio.  It has some really cool, but arguably superfluous features (special effects and filters), is less complicated to use than Camtasia Studio, is less expensive (but still costs $75) and is still somewhat fiddly to use until you get familiar with its tools.

Verdict:  I recommend it for teachers who are fairly comfortable with their Mac, have already made some screencasts and want to experiment with cool effects.

4. Screenflow

Telestream’s Screenflow is my personal favourite screencasting tool (by quite a margin) and the one I most often turn to for my own screencasts, but I seldom recommend it to teachers because like Camtasia:Mac it’s expensive ($110), is Mac-only and is so feature-rich that many teachers are likely to find it daunting and time consuming. However, if you are a Mac user and fairly comfortable with multi-track video editing software, I think it’s worth both the money and the learning curve.  It has a high power:complexity ratio. It punches well above it’s weight in that regard.  

Verdict:  I recommend it for Mac users who are pretty good with a computer, have made some screencasts and now want screencast super-powers.

5. CamStudio

Please don’t confuse CamStudio with Camtasia Studio.  It has almost nothing in common with Techsmith’s powerful offerings (except that it has shamelessly piggy-backed on Camtasia’s good name).  CamStudio is an ugly, basic, kludgy, PC-only, dinosaur.  There are no good reasons to use it. Even if you don’t want to spend a cent, you’ll find better choices below.  Keep reading.

Verdict:  Keep walking, there’s nothing to see here.

6. Screenr 

Screenr is a web-based, Java tool.  As such it doesn’t require you to install anything on your computer (you simply go to screenr.com and click the record button) but the downside is that you have to have an internet connection and it’s slow to use because you have to wait for the video to upload before you can then download and save it.  It doesn’t let you record your webcam, and only lets you record for 5 minutes. This is the sort of software that seems simple to use – but ends up creating frustration.

Verdict:  Maybe if your IT department won’t let you install software … but even then, there are better options. (See Screencast-O-Matic below.)

7. Jing

Jing is another screencasting tool by Techsmith. If you take all the pros and cons of Camtasia Studio and flip them, you have Jing.  It’s completely free, has a super-simple interface (probably the easiest of all the tools to use), but it lacks features: You can’t record your webcam, you can’t annotate your videos. It also has significant limitations: You can’t record for more than 5 minutes and worst of all, it only publishes videos in .swf format which won’t play natively on iOS devices.  That’s a deal-breaker for me.  What’s even worse, the particular .swf files produced can’t be converted to mp4 even with professional file-conversion utilities.  This means there is no way to edit them – unless you buy Camtasia Studio, which can edit Jing files.

Jing is free for a reason. Techsmith has positioned it as a gateway drug – it starts with Jing and before you know it you’re using SnagIt or Camtasia.  

Verdict: Friends don’t let friends use Jing.

8. SnagIt

Techsmith is smart.  They know that Jing is going to frustrate you.  So they provided yet another simple tool that is very similar to Jing in every way but without some of the frustrations: Ie. you can record for as long as you want and your videos are published in mp4 format.  But this time it’s not free. It costs $30.  It’s reasonably good but expensive for what you get.  It punches below it’s weight.  

Verdict: A nice program – but lacking features and expensive for what it is.  I think it’s worth $10, not $30. 

9. Microsoft Community Clips

Community Clips is a Microsoft labs experiment.  It’s available for free from various sites on the web (but not directly from Microsoft, anymore). It does a reasonable job of recording the screen, but that’s all it does. It’s probably about equal to SnagIt – except it’s free. The videos can, of course, be edited in Movie Maker if necessary.

Verdict: If you are a PC user, this is a better choice than Jing – at least the files can be edited in MovieMaker.  Still, there are better choices for features and flexibility.

10. Microsoft Expression Encoder

[Thanks to Thomas Gaffey for reminding me to include this one].  Expression Encoder is more full-featured than Community Clips and is still able to be downloaded from Microsoft. Like Community Clips it’s free – but unlike Community Clips it allows you to record both your screen and your webcam and it affords you basic editing options once recording is finished (you can cut sections out, for example).  The workflow is less obvious than some other apps.  You first record the video and then send it to a separate editor application.  This always feels a bit confusing to new users at first but don’t let that put you off. It’s not difficult to do once you’ve done it once. And doing this will stand you in good stead, should you decide later to upgrade to Camtasia Studio – because that is how Camtasia works, too.  It’s not hard to do once you understand the workflow.

Verdict: I’d recommend this to PC users as a good option. If you are a PC user, currently using Community Clips, SnagIt, Jing, Screenr, or CamStudio, you’d be better off with Expression Encoder. 

11. Apple QuickTime Player

[Thanks to Chris Russell @choirguy_ for pointing out that I had neglected this one in my original post – shame on me! ] QuickTime Player comes installed on every Mac.  What lots of people don’t realise is that it has a screen recording feature built right into it!  Simply go to File > New Screen Recording.  It actually works very well, though it’s fairly featureless – being about equal, feature-for-feature with Community Clips and SnagIt.  But it is free (unlike SnagIt) and a huge boon is that it’s already there on a teacher’s machine, installed and ready to go.  Unfortunately QuickTime Player for Windows does not have this feature – so it’s a Mac-only boon.

Verdict: For Mac users wanting to quickly make a screencast with no fuss and without even downloading / installing anything – QuickTime Player is already there at the ready.

12. Snapz Pro

Snapz Pro (Mac only) has been around for years. It’s the first screencasting tool I ever used. It has similar features to SnagIt or QuickTime Player but even more expensive ($65).

Verdict: Not my choice anymore, and too expensive. 

13. iShowU

iShowU by Shinywhitebox is an evolving platform.  It used to be too feature-poor for the price tag ($30) but now they have added the ability to record the webcam, editing and other power-user features similar to some of those in Screenflow and Camtasia.  So far though I’ve been disappointed with its performance. It seems to crash a lot and is a bit buggy.

Verdict: I think it will eventually be a great choice for Mac users, but I can’t recommend it at the moment – It’s still too buggy.

14. Voilá

I hear a lot of buzz around Voilá but personally I think it’s over-hyped at $32.  It’s a pretty handy screen capture tool (for still screenshots) but that is not what I am really reviewing in this post. As a screencasting tool, Voilá would not be my choice.  It allows you to record your screen like any screencasting tool does, or it allows you to record your webcam – but disappointingly, not both at the same time. So for screencasting I’d say it’s about as useful as SnagIt – at about the same price.

Verdict:  M’eh. 

15. Collaaj

Collaaj does something that no other platform discussed here does. Not only does it work on Mac or PC but there is also an iPad app.  It’s pretty good too – it lets you record your webcam as well as the screen, and all the video is handled by Collaaj’s servers which makes for very easy sharing with your students and vice versa.  It lets you record your webcam (or FaceTime camera on the iPad) – which is something SnagIt and Jing and several others don’t allow.  Unfortunately the free version only lets you record for 2 minutes which is just too short to be useful.  There are a range of paid plans (a subscription model) that range from $5 – $75 per month depending on your needs.  For some schools this might be a good choice but I think the subscription model is probably a deal-breaker for many.

Verdict: I may recommend it, especially in a BYOD school, depending on your budget.

16. Screencast-O-Matic

I think Screencast-O-Matic hits the sweet spot in terms of features, ease of use and price. It’s free. It records your webcam as well as your screen, it couldn’t be very much easier to use, and it has some really nice features that you don’t get in any other free screencasting software. For example, when you click your mouse, it inserts a visible and audible click.  There is a Mac version, a Windows version and you have the option of launching it as a Java applet from screencast-o-matic.com without installing any software on your computer.  This makes it really versatile and useful.  The huge advantage of it being free is that you can ask students to install it on their computers without worrying about hitting the pocket-nerve of their parents.

Screen Shot 2014-02-07 at 4.02.22 pm

Videos can be saved to your computer as an mp4, uploaded directly to YouTube or published to Screencast-O-Matic’s own video-sharing server (useful if YouTube has not yet been unblocked by your IT department).

While Sceencast-O-Matic is free to use, it will limit you to 15 minutes and puts a small “Screencast-O-Matic” watermark in the lower left corner of the final published video.  There is a Pro version which unlocks a LOT more features.  The pro version gives you video editing (delete that cough!), the ability to record system audio, and the ability to record for longer than 15 minutes.  It also records videos in higher definition, allows publishing in more video formats, removes the watermark – and more. I think most teachers will find that the free version is all they need. But for those who want to take it up a notch – without going all the way to Camtasia Studio or Screenflow, the Pro version of Screencast-O-Matic only costs $15/year.

Verdict: I’d recommend it to almost any teacher who is starting out in screencasting. The free version is better than any other free tool i’ve found and it’s even better than most of the paid tools.  The Pro version (for just $15) is better than anything except the really pro tools such as Screenflow and Camtasia, but much more affordable, and easier to use.

[Edit: January 19, 2017 – if you want to purchase Screencast-O-Matic Pro with a 20% discount, you can use this link.

[Edit: December 5, 2017]

17. Screencastify

Another really great, simple screencasting tool that I highly recommend to teachers – especially Chromebook users, is Screencastify.  It’s as easy to use as Screencast-O-Matic, and has many of the same features, but it runs as a Chrome plugin, and saves your recordings to Google Drive. Having said that, it doesn’t just let you record the browser window; you can record your entire desktop and optionally even your webcam (which, like Screencast-O-Matic will appear as a cameo picture-in-picture at the lower right of the video. Screencastify also allows you to annotate over a Tab recording, and has some basic editing features  which you can use in post (if you want to).

The free version allows you to record up to 50, 10 minute videos (which in my opinion is long enough) per month, and watermarks your videos with a Screencastify message.  To remove these limitations, and to enable editing and cropping, Screencastify Pro costs just US$2 per month.

Because it runs as a Chrome extension, you need to have an internet connection to use Screencastify.

Verdict: I’d recommend it to any teacher – but especially to the growing number of teachers who use Chromebooks, for whom Screencast-O-Matic is not a good option.

 These are not the only choices of course.  This is an exploding market. Have you used one that you would recommend?