What do the coronavirus
and Navy ships have in common? For that matter, what do our military
spending and our healthcare spending have in common? More than you might
think, and it boils down to this: we spend too much for too little, in large
part because we tend to always be fighting the wrong wars.
I started thinking about this a couple weeks ago due to a WSJ article about the U.S. Navy’s “aging and fragmented technology.” An internal Navy strategy memo warned that the Navy is “under cyber siege” by foreign adversaries, leaking information “like a sieve.” It grimly pointed out:
adversaries gain an advantage in cyberspace through guerrilla tactics within
our defensive perimeters. Once inside, malign actors steal, destroy
and/or modify critical data and information.
If you are not an IKEA
fan, or haven’t been spending any time in Dubai, you may have missed the
chain’s marketing campaign to help promote its second store in the area.
Titled “Buy With Your Time,” customers got store credits for how long
they spent getting to the store.
Gosh, that’s something
that should make any self-respecting critic of the U.S. healthcare system perk
up. Count me as intrigued.
The campaign involved
checking the customer’s Google Maps’ Trip tab to determine how long it took
them to get to the store. IKEA benchmarked the average hourly wage in
Dubai, and converted the travel time into how much credit they’d
generated. It works out to about $29/hour, or $0.48 per minute.
Spend long enough getting there and you could get a free coffee table or even a
bookcase. Prices in the store include the equivalent time currency.
Tesla is now, by market cap, the second largest auto manufacturer (after Toyota). Its market cap exceeds U.S. auto makers Ford, G.M., and Fiat/Chrysler — combined. This despite selling less than 400,000 vehicles in 2019, a figure that is more than the prior two years combined.
Tesla has made its bet on the future of electric cars. It didn’t invent them. It isn’t the only auto manufacturer selling them. But, as The Wall Street Journalrecently said:
Investors increasingly see the future of the car as electric—even if most car buyers haven’t yet. And lately, those investors are placing bets on Tesla Inc. to bring about that future versus auto makers with deeper pockets and generations of experience.
A recent analysis
suggested a big reason why, and its findings should give those in healthcare
some pause. Tesla’s advantage may come, in large part, from its supply
The term “moral
injury” is a term originally applied to soldiers as a way to help explain
PTSD and, more recently, to physicians as a way to help explain physician burnout.
The concept is that moral injury is what can happen to people when “perpetrating,
failing to prevent, or bearing witness to acts that transgress deeply held
moral beliefs and expectations.”
I think healthcare
generally has a bad case of moral injury.
Melissa Bailey, writing for Kaiser Health News, looked at moral injury from the standpoint of emergency room physicians. One physician decried how “the real priority is speed and money and not our patients’ care.” Another made a broader charge: “The health system is not set up to help patients. It’s set up to make money.” He urged that physicians seek to understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”
Facebook CEO Mark Zuckerberg believes “at some point in the 2020s, we will get breakthrough augmented reality glasses that will redefine our relationship with technology.” He went on to elaborate:
Instead of having devices that take us away from the people
around us, the next platform will help us be more present with each other and
will help the technology get out of the way. Even though some of the early
devices seem clunky, I think these will be the most human and social technology
platforms anyone has built yet.
We’re pretty proud of
modern medicine. We’ve accumulated a very intricate understanding of how
our body works, what can go wrong with it, and what are options are for
tinkering with it to improve its health. We’ve got all sorts of tests,
treatments, and pills for it, with more on the way all the time.
However, there has been
increasing awareness of the impact our microbiota has on our health, and I
think modern medicine is reaching the point classical physics did when quantum
physics came along.
pictured the atom as kind of a miniature solar system, with well-defined
particles revolving in definite orbits around the solid nucleus. In
quantum physics, though, particles don’t have specific positions or exact
orbits, combine/recombine, get entangled, and pop in and out of
existence. At the quantum level everything is kind of fuzzy, but quantum
theory itself is astoundingly predictive. We’re fooled into thinking our
macro view of the universe is true, but our perceptions are wrong.
So it may be with modern
medicine. Our microbiota (including both the microbiome and mycobiome) both provide the fuzziness and dictate a significant portion of
We’ve been spending a
lot of time these past few years debating healthcare reform. First the
Affordable Care Act was debated, passed, implemented, and almost continuously
litigated since. Lately the concept of Medicare For All, or variations on
it, has been the hot policy debate. Other smaller but still important
issues like high prescription drug prices or surprise billing have also
received significant attention.
As worthy as these all
are, a new study suggests that focusing on them may be missing the
point. If we’re not addressing wealth disparities, we’re unlikely to
address health disparities.
It has been well
documented that there are considerable health disparities in the U.S.,
attributable to socioeconomic status, race/ethnicity, gender, even geography, among other
factors. Few would deny that they exist. Many policy experts and
politicians seem to believe that if we could simply increase health insurance
coverage, we could go a long way to addressing these disparities, since coverage
should reduce financial burdens that may be serving as barriers to care that
may be contributing to them.
Universal coverage may
well be a good goal for many reasons, but we should temper our expectations
about what it might achieve in terms of leveling the health playing field.
really follow FinTech — I can’t even keep up with HealthTech! — but it caught
my eye when Visa announced that
it was acquiring FinTech company Plaid for $5.3b; a 2018 funding round valued
the company at $2.65b. A 100% increase in valuation within a year suggests
that something important is going on, or at least that people think something
there may be some lessons for healthcare in there somewhere.
of you who are equally as unfamiliar with FinTech’s terrain, Plaid has been described as
the “plumbing” that supports many other FinTech companies.
Launched in 2013, one in four people with a U.S. bank account are now believed to
use Plaid to connect with 2,600 FinTech developers connected to more than
11,000 financial institutions. Its customers include Acorns, Betterment,
Chime, Coinbase, Gemini, Robinhood, Transferwise, and Venmo. Plaid claims
it connects with 200 million consumer accounts.
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.
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,”
Now that health reform at the federal level seems to have hit an impasse, Congress and the Administration are scrambling to see if anything can be salvaged this year. Although both the House and Senate bills are severely flawed, each falling short both on true health reform and on fiscal responsibility, it would be a shame if we walked away from these efforts with nothing to show for it.
Doing something about those “evil” insurance companies remains a primary target, with brave talk still coming out about removing the ability of health insurers to consider pre-existing conditions in accepting new applicants.
This singular focus ignores two important facts – first, that this problem is primarily in the individual market, since such use of medical underwriting/preexisting conditions exclusions is largely absent from the predominant group health insurance market, and second, that such restrictions will inevitably lead to higher costs. The latter statement is not fear-mongering; it is Economics 101.Continue reading…