By KIM BELLARD
The conflict between Ukraine and Russia has been called many things. To most of the world, of course, it’s considered an invasion, a war between the two countries. To Russia, it’s a “peacekeeping” mission. The description that I can’t get out of my head, though, is one that I believe The Washington Post first used: it’s the world’s first crypto war.
“There is something about the war in Ukraine that feels different,” a former U.S. intelligence official told Nick Bilton. “We’ve seen wars documented on Twitter and images shared on the internet before, but this time it isn’t just bombs and bullets; this war is digital from the top to the bottom.” And, Mr. Bilton says: “At the center are cryptocurrencies.”
If crypto has come to war, can healthcare be far behind?
By KIM BELLARD
You may have seen the news that Kaiser Permanente has signed on to be an organizing member of Graphite Health, joining SSM Health, Presbyterian Healthcare Services, and Intermountain Healthcare. Graphite Health, in case you missed its October launch announcement, is “a member-led company intent on transforming digital health care to improve patient outcomes and lower costs,” focusing on health care interoperability.
That’s all very encouraging, but I’m wondering why it isn’t a DAO. In fact, I’m wondering why there aren’t more DAOs in healthcare generally.
By KIM BELLARD
Not familiar with Schumpeter’s gale? You may be more familiar with the term “creative destruction.” Schumpeter’s “gale of creative destruction” is the inevitable “process of industrial mutation that continuously revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one.”
We need a Schumpeter’s gale in healthcare.
By KIM BELLARD
America, like most cultures, claims to love and value children, but, gosh, the reality sure seems very different. Three recent reports help illustrate this: The Pew Research Center’s report on the expectation of having children, Claire Suddath’s searing look at the childcare industry on Bloomberg, and a UNICEF survey about how young people, and their elders, view the future.
It’s hard to say which is more depressing.
Pew found that the percentage of non-parents under 50 who expect to have children jumped from 37% in 2018 to 44% in 2021. Current parents who don’t expect to have more children edged up slightly (71% to 74%). The main reason given by childless adults for not wanting children was simply not wanting children, cited by 56% of those not wanting children. Among those who gave a reason, medical and financial reasons were cited most often. Current parents were even more likely – 63% – to simply say they just didn’t want more.
This shouldn’t come as a huge surprise. Earlier this year the Census Bureau reported that the birthrate in America dropped for the sixth consecutive year, the largest percentage one year drop since 1965 and the lowest absolute number of babies since 1979. It’d be easy to blame this on the pandemic, but, as sociologist Phillip N. Cohen told The Washington Post: “It’s a shock but not a change in direction.”
In many ways, having children seems like ignoring everything that’s going on. We have a climate change/global warming crisis that threatens to wreak havoc on human societies, we’re still in the middle of a global pandemic, and our political/cultural climate seems even more volatile than the actual climate. One Gen Xer told The New York Times: “As I think of it, having a child is like rolling dice with the child’s life in an increasingly uncertain world.”
By JEFF GOLDSMITH
When I first appeared in The Health Care Blog fourteen long years ago, it was to decry the policy community’s obsessive search for bad news about the health system: https://thehealthcareblog.com/blog/2007/10/03/the-perpetual-health-care-crisis-by-jeff-goldsmith/. So while we struggled with the COVID pandemic, we continued hearing regularly about pharmaceutical price gouging, anti-competitive hospital mergers, bad labor relations, and provider burnout. Thus, we can expect to hear nothing whatsoever about the failure of the health system to participate in the current outburst of inflation in the US economy.
The Washington think tank Altarum Institute tracks such things, and in its November 16 report https://altarum.org/sites/default/files/uploaded-publication-files/SHSS-Price-Brief_November_2021.pdf, we learn that healthcare prices rose by an annualized rate of just 2% in October 2021 compared to the Consumer Price Index’s 6.2% and the Producer Price Index’s 8.6%. Altarum commented that this was “surprising given that many of the same factors impacting economywide prices (labor shortages, supply chain issues, and increased demand for economywide services) would be expected to impact health care as well.”
By KIM BELLARD
Shira Ovide, who writes the On Tech newsletter for The New York Times, had a thoughtful column last week: Tech Can’t Fix the Problem of Cars. It was, she said, inspired by Peter Norton’s Autonorama: The Illusionary Promise of High Tech Driving. The premise of both, in case the titles didn’t already give it away, is that throwing more tech into our cars is not going to address the underlying issues that cars pose.
It made me think of healthcare.
What’s been going on in the automotive world in the past decade has truly been amazing. Our cars have become mobile screens, with big dashboard touchscreen displays, Bluetooth, and streaming. Electric cars have gone from an expensive pipedream to an agreed-upon future, with Tesla valued at over a trillion dollars, despite never having sold a half-million cars annually before 2021.
If we don’t feel like driving, we can use our smartphones to call an Uber or Lyft. Or we can use the various autonomous features already available on many cars, with an expectation that fully self-driving vehicles are right around the corner. Soon, it seems, we’ll have non-polluting, self-driving vehicles on call: fewer deaths/injuries, less pollution, not as many vehicles sitting around idly most of the day. Utopia, right?
By KIM BELLARD
General Mark A. Milley, chairman of the Joint Chiefs of Staff, recently expressed grave concern about China’s reported test of a hypersonic missile: “I don’t know if it’s quite a Sputnik moment, but I think it’s very close to that. It has all of our attention.” Maybe it should be, but General Milley may have missed the real 21st-century version of a Sputnik moment: China has claimed huge breakthroughs in quantum computing.
It’s inside baseball to those of us who are neither computer experts nor quantum physicists, but let’s put it this way: the countries/companies that dominate quantum computing will dominate, full stop. Healthcare included.
I won’t pretend to understand quantum computers or try to explain how they work, but they’re to “traditional” computers as those computers are to, say, a calculator, or to an abacus. They’re much faster – like a quantum leap faster – and can quickly do computations that would take even traditional supercomputers centuries to complete, if ever. For example, think you’ve got an unbreakable code? Unless you’ve got the fastest quantum computer, think again.
By KIM BELLARD
You know we’re living in the 21st century when people are 3D printing chicken and cooking it with lasers. They had me at “3D printing chicken.”
An article in NPJ Science of Food explains how scientists combined additive manufacturing (a.k.a, 3D printing) of food with “precision laser cooking,” which achieves a “higher degree of spatial and temporal control for food processing than conventional cooking methods.” And, oh, by the way, the color of the laser matters (e.g., red is best for browning).
Very nice, but wake me when they get to replicators…which they will. Meanwhile, other people are 3D printing not just individual houses but entire communities. It reminds me that we’ve still not quite realized how revolutionary 3D printing can and will be, including for healthcare.
The New York Times profiled the creation of a village in Mexico using “an 11-foot-tall three-dimensional printer.” The project, being built by New Story, a nonprofit organization focused on providing affordable housing solutions, Échale, a Mexican social housing production company, and Icon, a construction technology company, is building 500 homes. Each home takes about 24 hours to build; 200 have already been built.
By KEN TERRY
(This is the fourth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Many other countries’ healthcare systems outperform ours for one simple reason: They place a much greater emphasis on primary care, which occupies the central place in their systems. “The evidence is that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes at lower cost,” says David Nash, MD, founding dean of the College of Population Health, part of Thomas Jefferson University in Philadelphia.
The evidence that Nash mentions includes studies by Barbara Starfield and her colleagues at Johns Hopkins University. In a 2005 Health Affairs paper, they showed that a higher ratio of primary care physicians to the population is associated with a lower mortality rate from all causes and from heart disease and cancer; in contrast, having more specialists in a particular area does not decrease the overall mortality rate or deaths from cancer and heart disease.
Another study of Medicare data found that states where a higher percentage of physicians were PCPs had higher quality care and lower cost per beneficiary. This factor alone accounted for nearly half of the variation in Medicare spending from one state to another. A separate study found that in the areas of the country that had the most primary care providers, the average Medicare cost per beneficiary was a third lower than in areas with the least PCPs.
One reason for this is that primary care doctors provide comprehensive, continuous care, including preventive and routine chronic care. Chronic illnesses drive 90% of health costs, and some studies show that intensive primary care can reduce ER visits and hospital admissions and improve the health of chronically ill people.
By KIM BELLARD
The New York Times had an article that surprised me: Current Job: Award Winning Chef. Education: IHOP. The article, by food writer Priya Krishna, profiled how many high-end chefs credit their training in — gasp! — chain restaurants, such as IHOP, as being invaluable for their success.
I immediately thought of Atul Gawande’s 2012 article in The New Yorker: What Big Medicine Can Learn From the Cheesecake Factory.
Ms. Krishna mentions several well-known chefs “who prize the lessons
they learned — many as teenagers — in the scaled-up, streamlined world of chain
restaurants.” In addition to IHOP, chefs mentioned experiences at
chains such as Applebee’s, California Pizza Kitchen, Chipotle, Hillstone,
Houston’s, Howard Johnson’s, Olive Garden, Panda Express, Pappas, Red Lobster,
Waffle House, and Wendy’s.
Some of the lessons learned are
instructive. “It was pretty much that the customer is always
right,” one chef mentioned. Another said she learned “how to be
quick, have a good memory, and know the timing of everything.” A
third spoke to the focus that was drilled into all employees: “Hot food
hot. Cold food cold. Money to the bank. Clean restrooms,”