The Gulf's Other Product
5 months ago
Wednesday, May 26, 2010
Tuesday, May 25, 2010
Are we "the mark"?
Pick a bar, any bar...
Interesting piece on gold in Salon.
So here is my question to you, as we should always be honest with ourselves as much as possible:"are you and I are 'the mark' in a global game of Three Card Monte played by TPTB?"
Think about it
Interesting piece on gold in Salon.
So here is my question to you, as we should always be honest with ourselves as much as possible:"are you and I are 'the mark' in a global game of Three Card Monte played by TPTB?"
Think about it
Monday, May 24, 2010
It's bad enough that Rush Limbaugh is our distant cousin...
But now we are literally distant cousins of the slime mold??????
... I'm just saying that some cooperation is going to be a bit tougher than others.
... I'm just saying that some cooperation is going to be a bit tougher than others.
Finally!! I have been wondering this forever.
It's about time!
I mean how long have we been waiting for evidence of this????
... It wonderful when fact and theory come together.
Yet more evidence we live in a fractal world and that the singularity is coming. ;-)
I mean how long have we been waiting for evidence of this????
... It wonderful when fact and theory come together.
Yet more evidence we live in a fractal world and that the singularity is coming. ;-)
Health Care Bubble Ideas
I'm going to start research into the subject of value in health care spending (a moral minefield if ever one existed which actually makes it rather interesting to me). In particular, I'm going to start looking at where I think some of the lowest value spending resides in health care and what public companies/bonds currently exist in these spaces and what/how they are supported by this low value spending.
I'm simply curious to know if any of you have ever had any thoughts on this subject.
For just like everything else, health spending value is non-linear. Some is low value and some is high. And just as low value sub-prime was the first part of the housing system to blow wide open, so too will low value products and services be eliminated in the health care shake out.
Please share any and all thoughts.
PS- One of the nicer things about the internet is how much of the work others have already done for you. ;-)
(This is an Excel file from UK's NHS NICE Website which says where they think the low hanging fruit lie)
I'm simply curious to know if any of you have ever had any thoughts on this subject.
For just like everything else, health spending value is non-linear. Some is low value and some is high. And just as low value sub-prime was the first part of the housing system to blow wide open, so too will low value products and services be eliminated in the health care shake out.
Please share any and all thoughts.
PS- One of the nicer things about the internet is how much of the work others have already done for you. ;-)
(This is an Excel file from UK's NHS NICE Website which says where they think the low hanging fruit lie)
Sunday, May 23, 2010
Friday, May 21, 2010
Why the fractal nature of health care will doom health reform
Health care spending is fractal; I won't belabor this point further.
I didn't always think this way, but as I spent more time in "the numbers" of health care and health care finance, this "fact" has became pretty obvious.
My group staffs 5 different emergency departments within a 125 mile radius which means the two furthest facilities are about 250 miles apart.
250 miles may not seem all that far but it in the world of medicine, it is worlds apart. So while a casual observer might think "they're just emergency departments", e.g. plain vanilla, let me add there is actually a world of difference between various vanillas. Or as a friend of mine who runs two emergency departments in Waco Texas likes to often say "all medicine is local".
Each of our department is unique. Not only are the communities and therefore the patients very different, so too are the facilities' staff, the facilities' capabilities,etc... I mean unique.
And as a medical bean counter for my group, where even my own natural tendency is to make everything "process, process, process", this uniqueness poses particular challenges to policy wonks. I can attest.
With that background in mind, reading Maggie Mahar today will make you smile.
Looks like the policy wonks are catching on to the fact that there are a few more levels to the fractal after all. Not only is the doctor the problem, now it's the region's doctors and how they cooperate with each other. Now its the patients.
... I wonder what they would find if they lumped clusters of regions together as well? Would these differ? You know my own view. ;-)
-"We have met the enemy and he is us."
All I can repeat is "all medicine is local" and we docs have know this for a very long time. Changing one person's behavior (like your own when you want to loose a few pounds) is hard enough. Changing entire communities' behavior is something entirely different. Having personally been down this very road many times (and I am only talking about 5 hospitals 250 miles apart where I know all the providers by first name), I can verify that it is really really really hard changing groups of people.
Here is an example: if people would stop shooting each other, this would save a boat load of money. So why not change this behavior?
Yet somehow they wonks think they can change the health provider behavior of entire regions of the country?
Will they use money to change behavior?
Oooohhhh, money! In our evil "money driven medicine" culture? (Sorry, I had to get that dig in, Maggie can be... I'll let it go) Now we will use the root of all evil to solve "their" problem?
PhD policy wonks are so good at seeing the interchangeable nature of people within their own models. I only wish they would cooperate with a few MBAs so they could see that people are not always as interchangeable as they often would like them to be.
Perhaps the military term that comes to mind to best predict what will happen is "fragging".
... And by saying this I most certainly do not want to imply in any way that I will personally "frag" policy wonks in their attempts to change collective behavior. Indeed far from it, I actually really do support their general goals and will try my darnedest to help them out.
But do I think it will work?
Do I think they will change enough people on a regional basis to change regional differences?
I might again ask if we are still shooting each other? Do we still use plenty of drugs as a society?
Are there regional differences in these behaviors? ;-)
I will be very interested to see if the people of New York or Miami will truly be willing to change their own collective attitudes towards uncertainty. Will they become as comfortable as someone from Minnesota with statement from their doctors like: "yes, you might have heart disease but what are we really going to do about it anyway so don't go looking for something that isn't a problem. If you do, you'll save someone else money."
... Indeed in a kind of twisted version of this logic, why not get rid of screening all together? ;-)
All I can say is that Gallipoli comes to mind. (start at 5:35)
I do not think policy wonks see how providers will frag them on this issue which is a shame. Providers are not their enemies.
Think about your own family, what you would be willing to hear a physician tell you and then tell me what you think?
... Or maybe if the physician tells you a different way. After all, physicians do not really serve you, physicians serve the collective. We all know this. ;-)
I didn't always think this way, but as I spent more time in "the numbers" of health care and health care finance, this "fact" has became pretty obvious.
My group staffs 5 different emergency departments within a 125 mile radius which means the two furthest facilities are about 250 miles apart.
250 miles may not seem all that far but it in the world of medicine, it is worlds apart. So while a casual observer might think "they're just emergency departments", e.g. plain vanilla, let me add there is actually a world of difference between various vanillas. Or as a friend of mine who runs two emergency departments in Waco Texas likes to often say "all medicine is local".
Each of our department is unique. Not only are the communities and therefore the patients very different, so too are the facilities' staff, the facilities' capabilities,etc... I mean unique.
And as a medical bean counter for my group, where even my own natural tendency is to make everything "process, process, process", this uniqueness poses particular challenges to policy wonks. I can attest.
With that background in mind, reading Maggie Mahar today will make you smile.
Looks like the policy wonks are catching on to the fact that there are a few more levels to the fractal after all. Not only is the doctor the problem, now it's the region's doctors and how they cooperate with each other. Now its the patients.
... I wonder what they would find if they lumped clusters of regions together as well? Would these differ? You know my own view. ;-)
-"We have met the enemy and he is us."
All I can repeat is "all medicine is local" and we docs have know this for a very long time. Changing one person's behavior (like your own when you want to loose a few pounds) is hard enough. Changing entire communities' behavior is something entirely different. Having personally been down this very road many times (and I am only talking about 5 hospitals 250 miles apart where I know all the providers by first name), I can verify that it is really really really hard changing groups of people.
Here is an example: if people would stop shooting each other, this would save a boat load of money. So why not change this behavior?
Yet somehow they wonks think they can change the health provider behavior of entire regions of the country?
Will they use money to change behavior?
Oooohhhh, money! In our evil "money driven medicine" culture? (Sorry, I had to get that dig in, Maggie can be... I'll let it go) Now we will use the root of all evil to solve "their" problem?
PhD policy wonks are so good at seeing the interchangeable nature of people within their own models. I only wish they would cooperate with a few MBAs so they could see that people are not always as interchangeable as they often would like them to be.
Perhaps the military term that comes to mind to best predict what will happen is "fragging".
... And by saying this I most certainly do not want to imply in any way that I will personally "frag" policy wonks in their attempts to change collective behavior. Indeed far from it, I actually really do support their general goals and will try my darnedest to help them out.
But do I think it will work?
Do I think they will change enough people on a regional basis to change regional differences?
I might again ask if we are still shooting each other? Do we still use plenty of drugs as a society?
Are there regional differences in these behaviors? ;-)
I will be very interested to see if the people of New York or Miami will truly be willing to change their own collective attitudes towards uncertainty. Will they become as comfortable as someone from Minnesota with statement from their doctors like: "yes, you might have heart disease but what are we really going to do about it anyway so don't go looking for something that isn't a problem. If you do, you'll save someone else money."
... Indeed in a kind of twisted version of this logic, why not get rid of screening all together? ;-)
All I can say is that Gallipoli comes to mind. (start at 5:35)
I do not think policy wonks see how providers will frag them on this issue which is a shame. Providers are not their enemies.
Think about your own family, what you would be willing to hear a physician tell you and then tell me what you think?
... Or maybe if the physician tells you a different way. After all, physicians do not really serve you, physicians serve the collective. We all know this. ;-)
Thursday, May 20, 2010
Terrific Disorder?
This billboard started showing up in Akron recently. I am deeply confused by it. What exactly are we supposed to think about this disorder? I cannot imagine seeing a billboard selling an upside to necrotizing fasciitis. Who is paying for these and what are they trying to accomplish and how are we to understand it given the billboard on the left which I have also seen in the area?
No one wants to admit it but we really need more of this...
From Tyler Cowen's: "much cheaper, almost as good".
If something does 80% of what is needed for only 20% of the price, there would be a great many situations where this absolutely makes sense.
Of course this kind of thinking is currently illegal in this country as it runs contrary to the concept of "standard of care" (unless we modify this concept) and if it were pursued by a physician, (s)he would loose their license.
When will we grow up?
If something does 80% of what is needed for only 20% of the price, there would be a great many situations where this absolutely makes sense.
Of course this kind of thinking is currently illegal in this country as it runs contrary to the concept of "standard of care" (unless we modify this concept) and if it were pursued by a physician, (s)he would loose their license.
When will we grow up?
Well, we finally did it...
Unleash the philosophical dogs of war, the day has finally come.
PS- I'm in the "and this is a good thing" camp but I see there is going to be a firestorm.
It is what it is
PPS- JP, any thoughts on patent issues you care to share?
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