Hurtling through the upper reaches of the atmosphere at 550 mph for 12 or more hours seems pretty darn complex, especially when 3.3 Billion people (equal to 44% of the world’s population) do it every year with an incredible safety record. It’s often easy to hate the airline industry, but if you hypothetically apply the management of the US heathcare industry (serving 10% of the number of people) to air travel, Ryanair, Spirit, Jetblue, and Frontier rise to unimaginable heights of warm customer service, easy and efficient travel, and customer safety.
I’m not a particular fan of Old Testament literality, but Genesis 11:4-9 accurately foretells today’s much discussed and much derided Electronic Health Records and Medical Information Systems:
4 And they said, “Come, let us build ourselves a city, and a tower whose top is in the heavens; let us make a name for ourselves, lest we be scattered abroad over the face of the whole earth.”
5 But the Lord came down to see the city and the tower which the sons of men had built.
6 And the Lord said, “Indeed the people are one and they all have one language, and this is what they begin to do; now nothing that they propose to do will be withheld from them.
7 Come, let Us go down and there confuse their language, that they may not understand one another’s speech.”
8 So the Lord scattered them abroad from there over the face of all the earth, and they ceased building the city.
9 Therefore its name is called Babel, because there the Lord confused the language of all the earth; and from there the Lord scattered them abroad over the face of all the earth.
The only folks who hate today’s hotness, Electronic Health Records (EHR), more than physicians are patients themselves. Log onto the EHR site for each of your potentially dozens of healthcare providers. What you’ll see is a narrow, incomplete, and incredibly inaccurate depiction of some isolated aspect of your healthcare. Have any of your other physicians ever seen it? Is there a billing code for “laughter time?”
EHR systems in the US free-market healthcare system are proprietary, meaning there’s countless different databases, user interfaces, and usage models for patient’s health information. None of them talk to each other in any meaningful way, and most practitioners, who ultimately have a business to run, enter spotty and highly inaccurate records which never are communicated to any other practices which treat the patient. Even if they wanted to share info, EHR has “confused the language of all the earth” and encouraged practices to follow the rule of “garbage in – garbage out.”
And now… a modest proposal that doesn’t involve culinary recipes containing your offspring:
A really useful approach to EHR and medical records systems is a unified national (worldwide?) relational database with a robust set of open APIs, accessible to anyone, and easy ways for future implementers …
We fell in love with his charm and tried our best to ignore the bully which too often surfaced. We admired the qualities of leadership and power which always got the job done no matter how reprehensible the methods. He plowed through struggles with his health and weight. Church and family were his rock, yet he could not resist every opportunity to betray them. Debate usually concluded with: “Shut the fuck up!”
And the media delights in the blurred line between Tony and Chris. We all love the Jersey boy who knows the value of the ends and leaves the means to his henchmen/women. One icon begets another.
A typical soliloquy goes: “All due respect, you got no fucking idea what it’s like to be Number One. Every decision you make affects every facet of every other fucking thing. It’s too much to deal with almost. And in the end you’re completely alone with it all.”
He dismisses someone who’s become inconvenient: “I’m gonna go back in there and be with my guests. Exactly ten minutes, I’m gonna look up, if you’re not here i’m gonna assume that you went to look for whatever the fuck it is that’s calling you out there. And then I will never see you again. If you are still here, then I’m gonna assume that you have no other desire in the world than to be with me. And your actions will show me that every second of every fucking day. You understand me? Don’t answer me. Take the ten minutes, you think about it.” Goodbye Dr. Melfi / Ms. Kelly.
Get up to speed on economic cycles, both short term and long, their relationship to productivity and some balance prescriptions for the American economy. Thanks to Ray Dalio of Bridgewater Associates.…
I’m somewhat taken aback by the elephant in the room in America’s healthcare debate. On one hand we hear from the libertarian position that healthcare choices are purely a personal responsibility and there’s no place for the government interference. Some of the more shrill voices equate universal healthcare to slavery. On the other hand we have the descendants of the moral majority taking the high ground in protecting the unborn from death by abortion, and demanding a strong government role in the pro-life cause.
Ironically, both causes are often championed by the same people. The Evangelical community rails against abortion, yet at the same time promotes the gross inequities of American healthcare. Go figure?
This bizarre juxtaposition begins to hint at the shape of our invisible elephant. On the surface of things, American morality assigns each life an infinite value, whether it’s the life of a fetus, the life of a loved one, or perhaps even one’s own life. No price is too much to pay to preserve human life (red blooded American life, that is.) When your child or parent is dying, no stone must remain unturned, no cost is too much for your insurance company to pay, no cost is too much for the government to pay, and ultimately no cost is too much for a moral American to pay. Life is precious, and this is a good thing.
American libertarianism, an evolution of the frontier ethic of self reliance, is one of the core values in our society, and has enabled us to conquer a vast and wild continent. But there’s also a sinister side to libertarianism, the materialistic side which obsesses on what’s “mine.” It posits that people with material wealth possess it because of their own hard work and efforts, and that those who do not labor successfully are, by definition, slackers. Any attempt to “redistribute” accumulated wealth to the slackers is inherently un-American (aka Socialism, Marxism, etc…) In short, supporting the common good is a personal choice, not something that flows from the elected government.
So we have a faction that vehemently insists on the supreme value of human life and we have another faction that prefers to hold fast to 100% of their material possessions, and specifically that the value of their lives as a group is demonstrably (in terms of health outcomes) greater than the value of the tens of millions of …
Yes, if the media’s obsession with the congressional blame game is what counts. However, delegating blame is not a solution to the fundamental problems of equity in health care, a functioning government, and the sensible choice of operating within a budget vs. arbitrary cuts. Sequestration, shutdown, and threatened default are very much hardball politics, and it is no surprise that the opposing party responds in kind, especially as the end game becomes increasingly clear; that the right wing will be left holding the short end of the political stick.
The assertion that we can pay our debts without increasing the debt ceiling is mathematically feasible, but our interest obligations equal about 40% of the budget’s discretionary spending, or alternatively it is equivalent to approximately 1/3 of our Social Security obligations. The author fails to suggest which of these, and which categories within, he proposes to cut in order to continue servicing our interest obligations on the national debt. Sounds awfully like the economics analog to the neocon chicken hawks. Perhaps he’d have the cojones to put our money where his mouth is.
It is ironic that the author is on the payroll of the Hoover Institute, founded by the President who’s similar austerity policies greatly amplified the effects of the Great Depression. One can only hope that his next editorial elaborates on best practices in constructing Hoovervilles.
It’s not hyperbole to suggest that Hoovervilles would be on the horizon if we were to either cut Social Security by 1/3 or slash discretionary spending by 40%. How much does Sowell propose to cut from spending to continue paying interest? Find $245 billion a year that the Hooverites feel comfortable cutting and that won’t have dreadful consequences for millions of Americans. Hard choices, eh?…