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Thursday, April 27, 2017

An American Sickness

Elisabeth Rosenthal, MD, former ER physician and subsequently New York Times reporter of lengthy, considerable note, is now Editor-in-Chief at Kaiser Health News.

Elisabeth Rosenthal, Editor-in-Chief, joined KHN in September 2016 after 22 years as a correspondent at The New York Times, where she covered a variety of beats from health care to environment to reporter in the Beijing bureau. While in China she covered SARS, bird flu and the emergence of HIV/AIDS in rural areas. Libby’s 2013-14 series “Paying Till it Hurts” won many prizes for both health reporting and its creative use of digital tools. Her book, “An American Sickness: How Healthcare Became Big Business And How You Can Take it Back,” is being published by Penguin Random House in April 2017. She is a graduate of Stanford University and Harvard Medical School and briefly practiced medicine in a New York City emergency room before converting to journalism.
I am deep into her new book. A sobering, riveting, and at times infuriating read. I'm already well aware of of lot of what she writes, but it at once raises my BP and validates my own take on this morally untenable aspect of health care. I'm not crazy (or naive) after all.


Hashtag #anamericansickness.

The more I read, the more the word "Pultizer" repeatedly wafts up in my mind.
INTRODUCTION
Complaint: Unaffordable Healthcare

In the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.

Everyone knows the healthcare system is in disarray. We’ve grown numb to huge bills. We regard high prices as an inescapable American burden. We accept the drugmakers’ argument that they have to charge twice as much for prescriptions as in any other country because lawmakers in nations like Germany and France don’t pay them enough to recoup their research costs. But would anyone accept that argument if we replaced the word prescriptions with cars or films?

The current market for healthcare just doesn’t deliver. It is deeply, perhaps fatally, flawed. Even market economists themselves don’t believe in it anymore. “It’s now so dysfunctional that I sometimes think the only solution is to blow the whole thing up. It’s not like any market on Earth,” says Glenn Melnick, a professor of health economics and finance at the University of Southern California.

Nearly every expert I’ve spoken with— Republican or Democrat, old or young, adherent of Milton Friedman or Karl Marx— has a theoretical explanation as to why the United States spends nearly 20 percent of its gross domestic product on healthcare— more than twice the average of developed countries. But each one also has a story of personal exasperation about the last time a family member or a loved one was hospitalized or rushed to an emergency room or received an incomprehensible, outrageous bill.
Stephen Parente, Ph.D., a health economist at the University of Minnesota and an adviser to John McCain in the 2008 presidential election, believes that studies overstate the excessive healthcare spending in the United States. But when he talks about the hospitalization of his elderly mother, his dispassionate academic tone shifts to one I’ve heard thousands of times, brimming with frustration:
There were a dozen doctors all sending separate bills and I couldn’t decipher any of them. They were all large numbers and the insurance paid a tiny fraction. Imagine if a home contractor worked this way? He estimates $ 125,000 for your kitchen and then takes $ 10,000 when it’s done? Would anyone ever renovate?
Imagine if you paid for an airplane ticket and then got separate and inscrutable bills from the airline, the pilot, the copilot, and the flight attendants. That’s how the healthcare market works. In no other industry do prices for a product vary by a factor of ten depending on where it is purchased, as is the case for bills I’ve seen for echocardiograms, MRI scans, and blood tests to gauge thyroid function or vitamin D levels. The price of a Prius at a dealership in Princeton, New Jersey, is not five times higher than what you would pay for a Prius in Hackensack and a Prius in New Jersey is not twice as expensive as one in New Mexico. The price of that car at the very same dealer doesn’t depend on your employer, or if you’re self-employed or unemployed. Why does it matter for healthcare?

We live in an age of medical wonders— transplants, gene therapy, lifesaving drugs, and preventive strategies— but the healthcare system remains fantastically expensive, inefficient, bewildering, and inequitable. Faced with disease, we are all potential victims of medical extortion. The alarming statistics are incontrovertible and well known: the United States spends nearly one-fifth of its gross domestic product on healthcare, more than $ 3 trillion a year, about equivalent to the entire economy of France. For that, the U.S. health system generally delivers worse health outcomes than any other developed country, all of which spend on average about half what we do per person.

Who among us hasn’t opened a medical bill or an explanation of benefits statement and stared in disbelief at terrifying numbers? Who hasn’t puzzled over an insurance policy’s rules of co-payments, deductibles, “in-network” and “out-of-network” payments— only to surrender in frustration and write a check, perhaps under threat of collection? Who hasn’t wondered over, say, a $ 500 bill for a basic blood test, a $ 5,000 bill for three stitches in an emergency room, a $ 50,000 bill for minor outpatient foot surgery, or a $ 500,000 bill for three days in the hospital after a heart attack?

Where is all that money going?


Rosenthal, Elisabeth (2017-04-11). An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (pp. 1-3). Penguin Publishing Group. Kindle Edition.
My contextual triangulation will eventually extend to a number of others I've previously cited. e.g.,


to wit,
In spite of the clear and recent data, the United States stumbles when addressing these social determinants of health. Although Americans do not like being mediocre in national health outcomes, they have been even less enthusiastic about facing the complex web of social conditions that produce and reinforce these outcomes. They continue to pay top dollar for hospitals, physicians, medications, and diagnostic testing yet skimp in broad areas that are central to health, such as housing, clean water, safe food, education, and other social services. It may even be that Americans are spending large sums for health care to compensate for what they are not paying in social services— and the trade-off is not good for the country’s health.

ROUGHLY FIVE YEARS AGO WE started thinking that there might be a connection between soaring health costs and meager social service spending, when we were musing about theoretical roots to the so-called health care paradox in the United States. To explore whether our hypothesis would hold up, we examined ten years of spending and health outcome data from thirty OECD countries that collected data using comparable methodologies. The results confirmed our suspicions.

Our comparative study, published in the academic literature in 2010, broadened the scope of inquiry about health and health spending to include spending on social services as a potential determinant of population-level health outcomes. For the purposes of our study, social services expenditures included public and private spending on old-age pension and support services for older adults, survivors benefits, disability and sickness cash benefits, family supports, employment programs (e.g., public employment services and employment training, unemployment benefits, supportive housing and rent subsidies), and other social services that exclude health expenditures. Health expenditures included public and private spending on curative care, rehabilitative care, long-term care, laboratory and diagnostic services, outpatient and preventive care, and public health services.

The study found that if we counted countries’ combined investment in health care and in social services, the United States was no longer spending the largest percentage of GDP— far from it. In 2007, for example, the United States devoted only 25 percent of gross domestic product to health and social services combined, while such countries as Sweden, France, Austria, Switzerland, and Denmark dedicated about 30 to 33 percent of their respective GDP to the combination. In 2007, while the United States ranked highest in health spending, it ranked only thirteenth in spending on health services and social services combined (see Figure 1.4).

Moreover, the study revealed that America was one of only three industrialized countries (the other two were Korea and Mexico) to spend the majority of its total health and social services budget on health care. On average in the OECD countries other than the United States, for every dollar spent on health care, an additional two dollars was spent on social services. Yet in the United States, for every dollar spent on health care, less than sixty cents was spent on social services. Most important, we found that less spending on social services relative to spending on health services was statistically associated with poorer health outcomes in key measures, such as infant mortality and life expectancy, and this result held even when the United States was removed from the analysis...


Bradley, Elizabeth H.; Taylor, Lauren A. (2013-11-05). The American Health Care Paradox: Why Spending More is Getting Us Less (Kindle Locations 420-448). PublicAffairs. Kindle Edition.
And, Steve Brill's compelling take on the evolution of our health care system (and which recounts his own frustrating experience with acute care), culminating in his analysis of the enactment of the ACA ("ObamaCare").
From its historical roots, to the mind-numbing complexity of the furiously lobbied final text of the legislation, to its stumbling implementation, to the bitter fights over it that persist to this day— the story of Obamacare embodies the dilemma of America’s longest running economic sinkhole and political struggle.

It’s about money: Healthcare is America’s largest industry by far, employing a sixth of the country’s workforce. And it is the average American family’s largest single expense, whether paid out of their pockets or through taxes and insurance premiums.

It’s about politics and ideology: In a country that treasures the marketplace, how much of those market forces do we want to tame when trying to cure the sick? And in the cradle of democracy, or swampland, known as Washington, how much taming can we do when the healthcare industry spends four times as much on lobbying as the number two Beltway spender, the much-feared military-industrial complex?

It’s about the people who determine what comes out of Washington— from drug industry lobbyists to union activists; from senators tweaking a few paragraphs to save billions for a home state industry to Tea Party organizers fighting to upend the Washington status quo; from turf-obsessed procurement bureaucrats who fumbled the government’s most ambitious Internet project ever to the selfless high-tech whiz kids who rescued it; and from White House staffers fighting over which faction among them would shape and then implement the law while their president floated above the fray to a governor’s staff in Kentucky determined to launch the signature program of a president reviled in their state.

But late in working on this book, on the night of that dream and in the scary days that followed, I learned that when it comes to healthcare, all of that political intrigue and special interest jockeying plays out on a stage enveloped in something else: emotion, particularly fear.

Fear of illness. Or pain. Or death. And wanting to do something, anything, to avoid that for yourself or a loved one...


Brill, Steven (2015-01-05). America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System (Kindle Locations 131-146). Random House Publishing Group. Kindle Edition.
There will be many more books to cite pertaining to this topic (the byzantine economics and policy perplex of health care). Stay tuned.
The Bradley/Taylor "Paradox" book is particularly interesting, putting per capita and aggregate "health" spending in a deservedly broader context. Think about the "Upstream."
BTW, see also my 2015 reporting on Steve Brill's excellent series "America's Most Admired Lawbreaker."
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I wrote my first blog post musing about our health care "system" on another of my blogs eight years ago. See "The U.S. health care policy morass."
Some reform advocates have long argued that we can indeed [1] extend health care coverage to all citizens, with [2] significantly increased quality of care, while at the same time [3] significantly reducing the national (and individual) cost. A trifecta "Win-Win-Win." Others find the very notion preposterous on its face. In the summer of 2009, this policy battle is now joined in full fury. I will try to add some constructive argument to the fray.

This likely will be a lengthy post that will accrue over time, given the complexity and importance of the topic, but,


FIRST, A PREFATORY STORY

In the mid-late 1990s, while caring for my terminally ill daughter in Hollywood, I recall reading that there were more MRI machines deployed in the Los Angeles area than in the entire nation of Canada, the inference being that the American economics of hugely expensive sense-extending diagnostic imaging technologies such as MRI units, CAT scanners, cardiac dynamic stress test machines, etc tended toward the economically problematic. Every medical institution feels compelled to have them to be credible, competitive Players in the market, but everyone also needs to keep them all profitably humming, with viable billable payers at the end of the back office line. And, every additional install exacerbates the billable utilization problem. Damned if you do, damned if you don't...


THE U.S. "HEALTH CARE" "SYSTEM"?

I will by no means be the first to note that our medical industry is not really a "system," nor is it predominantly about "health care." It is more aptly described as a patchwork post hoc disease and injury management and remediation enterprise, one that is more or less "systematic" in any true sense only at the clinical level. Beyond that it comprises a confounding perplex of endlessly contending for-profit and not-for-profit entities acting far too often at ruinously expensive cross-purposes...
See also my more recent take on what I call the "shards" of our fragmented, crazed non-"system."


I frequently say "if you're not confused, you've not been paying attention."

One of the most maddening implications of "An American Sickness" is that the leading GOP "health care reform / repeal ObamaCare" proposals are virtually certain to make things materially worse.

Elisabeth concludes,
EPILOGUE 
The Fate of Empires describes an age of decadence into which all great societies— Rome, Greece, Persia, Great Britain— descend before they finally fall for good. The decadence, according to the author, Sir John Glubb, is due to a period of wealth and power, selfishness, love of money, and loss of a sense of duty. Does this sound familiar? Societies, it says, typically take over two hundred years to get to the age of decadence. American healthcare has arrived far faster. 

The fathers of modern medicine— doctors and scientists like Frederick Banting, who pioneered insulin treatment; Jonas Salk, who discovered the polio vaccine; Albert Starr, who invented a lifesaving artificial heart valve; and Thomas Starzl, who fathered modern organ transplant— helped usher in a new era of scientific healing. They are the reason for medicine’s lofty reputation. But the respect they earned through their noble efforts has been squandered in the past quarter century. The treatments we get and the prices we pay are governed as much by commerce as by humanism or science. The mission of this book is to advocate for a return to a system of affordable, evidence-based, patient-centered care. 

No one player created the mess that is the $ 3 trillion American medical system in 2017. People in every sector of medicine are feeding at the trough: insurers, hospitals, doctors, manufacturers, politicians, regulators, charities, and more. People in sectors that have nothing to do with health— banking, real estate, and tech— have also somehow found a way to extort cash from patients. They all need to change their money-chasing ways. 

To make that happen, however, we patients will need to change our ways too. We must become bolder, more active and thoughtful about what we demand of our healthcare and the people who deliver it. We must be more engaged in finding and pressing the political levers to promote the evolution of the medical care we deserve. 

I hope the book you have just finished has made you not just outraged but also better prepared for these tasks. Now you understand that the free coffee and artwork display in a hospital’s marble atrium aren’t free at all. That what’s sold to you as the newest drug or device to treat your illness may not be, in fact, the best. That the anesthesiologist who comes in to say “hi” before a procedure is perhaps not being kind, but making an appearance so that he and/ or his extender can bill for a consult. You’re wise to the heist and emboldened with new tools and ideas about how to take back your health and our medical system. 

Medicine is still a noble profession. There are many great doctors, nurses, pharmacists, and others working their hearts out, even in these troubled and troubling times. Even as the healthcare sector faces a future of great financial uncertainty and humiliating bureaucracy, many of the best and brightest students are flocking to medical school. They’re doing it because they want to take care of patients, to heal using some of the time-honored tools in the doctor’s black bag as well as the miraculous scientific innovations of the last twenty-five years. That is, after all, the only really compelling reason to go into medicine. 

They want to deliver patient-centered, evidence-based care at a reasonable price. We, the patients, need to help, to rise up and make that possible. We have to remind everyone who has entered our healthcare system in the past quarter century for profit rather than patients that “affordable, patient-centered, evidence-based care” is more than a marketing pitch or a campaign slogan. 

It is our health, the future of our children and our nation. High-priced healthcare is America’s sickness and we are all paying, being robbed. When the medical industry presents us with the false choice of your money or your life, it’s time for us all to take a stand for the latter. [An American Sickness... pp. 328-329]
Between the Introduction and the Epilogue lies a ton of spot-on (albeit frequently aneurism-inducing) detail. It's also the kind of book you can roam around in effectively (which I am still doing; eventually I'll report on her Chapter 18 take on digital health IT).

Chapter by chapter, she recurrently relates her details back to her take on fundamental health care market "rules."


All excellent stuff. Do yourself a favor it you're still on the fence, go to Amazon, read the extensive "Look Inside" preview excepts.

ERRATUM

A comment I recently posted under an article at THCB.
ALL stakeholders in health care, with the exception of patients, argue that they are all “losing money” and need higher prices, or they will pull out of their service domains. Yet somehow “competitive market forces” will make them all happy earning even LESS as we “bring down the cost of health care” for the benefit of patients (who have ZERO individual market leverage, and are ACTUALLY losing money).
CODA 

From my Facebook page,


Noteworthy in this regard, Elisabeth's American Sickness book dedication:
Dedicated to all the patients, doctors, and other healthcare professionals who so generously shared their stories and experiences to bring this book to life. Waiving privacy concerns, they agreed to have their real names appear in print. In the hope of contributing to change in our healthcare system, they spent hours digging up copies of their bills, insurance statements, correspondence, and other documents to provide verification. I’m deeply grateful for their help, commitment, and courage.

They—and all Americans—deserve better, more affordable healthcare.
I will have more to relate shortly on my daughter's worsening circumstance, in the hope that it (like other personal disclosures I have posted over time) will help others.

Speaking of "affordable healthcare," I just did a quick 'n dirty graphic in Illustrator.




What am I missing?
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Much more to come. Meanwhile, buy Elisabeth's book...

Sunday, April 23, 2017

#MarchForScience San Francisco

OK, so, I grabbed one of my many Health 2.0 Conference press lanyards, made up a fake generic 2-sided highly visible 4x6 "press pass" to put in the plastic sleeve, and put it on after I got off BART, hoping it might serve to get cops/security peeps to not hassle me were I trying to get photos from certain locations that might be "out of bounds."


A young volunteer saw it and pointed me to a tent behind the stage inside the metal barriers and rope lines. "Have you signed in yet? They have the the press packets and food and drinks back there." She escorted me to the area, where another young volunteer with a clipboard took my card and signed me in, and gave me a 2nd pass, the one with the event logo.

Sweet. I'd not even noticed on the website that you could apply to pre-register as "media," given the tumultuous events in our lives the past few weeks in the wake of my daughter's diagnosis. Didn't even think about it.

Great turnout. Huge crowd. A few of my pics:

Baratunde Thurston. That cat is funny!
Indeed.
I even made it into a CBS affiliate news segment, LOL (lower left corner, camera raised over my head).





I have a lot more shots (took more than 100), but, you get the idea. The pro photographers were all over it. A zillion shots are up on Twitter and all major media.

I have yet to see any crowd size estimates, other than vague "tens of thousands" (which is what it looked like to me).

MEDSCAPE CHIMES IN
Physicians Make Themselves Heard at the March for Science

WASHINGTON — Physicians added their voices, their presence, and their passion to the thousands of people who spent a rainy Saturday here in support of the principles and practice of science.

The March for Science, held in conjunction with Earth Day in Washington, DC, and an estimated 600 satellite marches worldwide, is "the first step of a global movement to defend the vital role science plays in our health, safety, economies, and governments," according to the site's website.


In a rally held prior to the DC march from the Washington Monument to Congress, more than 50 speakers representing all realms of science — from climate to space to science education to nature conservancy to biological and chemical science — exhorted the crowd to continue to press for science funding and against the anti-science attitudes and "alternative facts" some have said are coming from the Trump administration.

Ignore Science at "Own Peril"

Georges Benjamin, MD, executive director of the American Public Health Association, was among a handful of physician speakers. "Public health science is the heart of so many successes that have prolonged our lives and improved our well-being," he said in his remarks, listing seat belts, vaccines, and a reduction in the threat of second-hand tobacco smoke as examples.
"A nation that ignores science, that denies science, that underfunds science, does so at its own peril. We cannot allow this to happen. We need to ensure that data and evidence drive policy-making, not uniformed ideology," he said in his speech...
TRUMP CHIMES IN
Trump on Earth Day: 'Rigorous science is critical to my administration'
He stressed "jobs matter" over environment

By EUGENE SCOTT , CNN

(CNN) - President Donald Trump declared his support for the environment and scientific research on his first Earth Day in the White House amid harsh criticisms over his actions to roll back environmental regulations and proposed cuts to non-military spending, including at the Environmental Protection Agency.

"Rigorous science is critical to my administration's efforts to achieve the twin goals of economic growth and environmental protection," Trump said in a statement Saturday as thousands of marchers filled the streets of downtown Washington to support science and evidence-based research -- a protest partly fueled by opposition to Trump's threats of budget cuts to agencies funding scientists' work.

"My administration is committed to advancing scientific research that leads to a better understanding of our environment and of environmental risks," Trump said. "As we do so, we should remember that rigorous science depends not on ideology, but on a spirit of honest inquiry and robust debate.

"This April 22nd, as we observe Earth Day, I hope that our nation can come together to give thanks for the land we all love and call home," Trump added...
"Robust debate" is the Trumpian denialism dog-whistle code phrase for endless continuing obstructive "debate" over matters of science where the accrued weight of credible overwhelming empirical scientific consensus must yield to small minorities of irrational skeptical voices and the disingenuous voices of well-heeled incumbent commercial interests.

"Fair and balanced," my ass.

Among the many works I've cited and reviewed on this blog (see also my post "I am not a scientist"), I refer you again to Shawn Otto's must-read.


See also


Just to cite three for now.

OK, #MARCHFORSCIENCE, NOW WHAT?

It behooves us to not underestimate the difficulties we face in overcoming ignorance (a good bit of it willful), irrational doubt, and Trumpian venality.


Yeah, I know, that's kind of obtuse, perhaps. Great song, though.

Second verse:
Outcast is all he's ever been.
Holy fathers doomed and branded him with sin.
They taxed his soul and made it hard to survive.
Only one path for Galileo so he lied.
He found the truth on his own,
And what he finally discovered...He had to rub the stone.
Lots more to say about this stuff.

UPDATE

From The Atlantic:
"Book publishers are rarely held accountable for publishing invalid health information. Rather, there seems to be an incentive to publish the most outlandish claims that purport to upend everything the reader has ever heard ... Cycles of fad dieting and insidious misinformation undermine both public health and understanding of how science works, giving way to a sense of chaos. It seems that every doctor has their own opinion about how to protect your body from calamity, and all are equally valid, because nothing is ever truly known."
'eh? From "The Next Gluten."

FROM THE NEW YORKER
"On April 29th, Donald Trump will have occupied the Oval Office for a hundred days. For most people, the luxury of living in a relatively stable democracy is the luxury of not following politics with a nerve-racked constancy. Trump does not afford this. His Presidency has become the demoralizing daily obsession of anyone concerned with global security, the vitality of the natural world, the national health, constitutionalism, civil rights, criminal justice, a free press, science, public education, and the distinction between fact and its opposite..."
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More to come...

Friday, April 21, 2017

The March for Science



See my prior posts on The March for Science.

Article at The Atlantic:

How the March for Science Misunderstands Politics

If protesters want to change policies, they need to target the values, interests, and power structures that shape how research is applied.
This Saturday, in Washington, D.C., and around the world, scientists and their supporters will hit the streets. From Ketchikan to Buenos Aires to Bhutan, marchers will demand that politicians support scientific research, publish its results widely, and base their policies on those results.

I will be marching with them. But I worry about the movement’s arguments. A few skeptics have charged that the march will politicize science, reinforcing an already widespread perception of scientists as liberal activists rather than dispassionate researchers. As march advocates note, however, science is already enmeshed in politics. It could hardly be otherwise, write Jonathan Foley and Christine Arena, in an article reposted on the official March for Science website: “After all, politics is how we are supposed to solve problems in a democratic society, and science is crucial to nearly everything we do — our economy, our health, our security, our future.”

My concern is the opposite of the usual objection. The March for Science, I believe, is not political enough. I do not mean that the marchers should campaign for Democratic or Republican candidates or take stands on contentious issues such as immigration reform. Rather, I hope that they will come to grasp much more clearly how political power works, how it intersects with social conflicts, and how policies emerge from this nexus.

The movement’s rhetoric suggests that if governments simply fund and heed scientific research, the world will march steadily toward peace and prosperity. Applying science to politics will create “an unbroken chain of inquiry, knowledge, and public benefit for all.” This is, dare I say, an unscientific conception of human action...
"Who knew that science could be so complicated?"

No, I don't like the guy.


From The Atlantic article:
"The march organizers imagine a future world in which science promotes equality and justice, rather than simply wealth and health for the few. Evidence-based policy is important, and science should certainly play a role in politics. Yet more and better data is hardly enough to ensure equality and justice. Societies employ science in accordance with their leading values, interests, and power structures. If March for Science participants want science to advance the causes of equality and justice, they will need to help create a society in which those values predominate."
We seem to be moving in the other direction of late. Consider the ruminations set forth in "Four Futures."


The article is fine. Buy the book, it's better. See also Paul Mason's excellent "Postcapitalism: a guide to our future." I cited him last year here.



Quadrant IV, folks.

In that vein,
...At the end of the day, the collapse of Western civilization — and perhaps all of civilization — is less likely to be a consequence of cultural factors than economic and ecological ones. Indeed, just a few days before the Brooks column was published, the BBC posted a noteworthy article titled “How Western civilization could collapse.” According to the computer models of system scientist Safa Motesharrei, the leading factors will likely be “ecological strain and economic stratification.”

Under this scenario, the BBC’s Rachel Nuwer wrote, “elites push society toward instability and eventual collapse by hoarding huge quantities of wealth and resources, and leaving little or none for commoners who vastly outnumber them yet support them with labour. Eventually, the working population crashes because the portion of wealth allocated to them is not enough, followed by collapse of the elites due to the absence of labour.”

This sounds more like Karl Marx than Oswald Spengler, and it indicates that it will be people like Donald Trump — rather than Syrian refugees or irritating Social Justice Warriors on Tumblr — who will bring about the end of Western civilization. It also demonstrates how badly we need more thinkers like Adorno and Horkheimer today, and fewer YouTube conspiracy theorists and clueless Beltway columnists. 
- from Salon.com
Quadrant IV.

UPDATE

apropos of our topic here, broadly, from another Salon.com article:
"...[W]hat philosopher Henry Giroux has described as the “culture of cruelty.” It is the intersection of creeping authoritarianism, militarism, surveillance, violence by the state against its citizens, gangster capitalism and extreme wealth inequality, the assault on the very idea of community and government, widespread loneliness, and social dominance behavior against the Other.

How did the culture of cruelty help to create the political and social circumstances for the election of Donald Trump? Is the United States now a fascist and authoritarian state? What are the issues that could potentially unite the American people to create a more humane society and to resist the cultural and political forces that helped to elect Trump? Are Trump’s voters victims? Is American democracy in a state of crisis and permanent decline? What should resistance look like in this moment?
'eh? Again, to me, we look to be on a course toward a iron-fisted dystopian Quadrant IV.

I may have to buy and study his book.



Above, from the NYC March.
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Another news item, from Vox:

The March for Science on Earth Day, explained

The Trump administration is cutting science budgets and denying research. Scientists are pushing back.

Brace yourself, DC: The nerds are marching in. On Earth Day, April 22, thousands of people will descend on the National Mall in Washington, DC, and take to the streets in cities across the globe — in the name of science. 
Inspired by the success of the January 21 Women’s March on Washington, the March for Science will celebrate the scientific method and advocate for using evidence in decision-makng in all levels of government. Though the event’s website doesn’t explicitly mention Trump, it’s a protest of his administration’s policies, including his proposal to cut billions in funding for scientific research...
More...

Why march for science? Because the value of social trust — under attack by Trump — is worth fighting for 

Defending science is not just about resisting climate denialism. It's about bedrock values of social progress

With science under attack under President Donald Trump as never before in recent memory, this weekend’s March for Science has engendered broad, enthusiastic support, with more than 500 satellite marches listed. The role of science in illuminating the threat of global warming, and how to respond, is a key catalyst behind both the attacks and the response — and for good reason. It’s hard to imagine anything more high-stakes than the gamble we’re taking on our planet’s future. 
Yet the attack on science is broader than global warming, or the environment in general, and there’s still debate and reflection about the idea of the march itself. Some in the field still express reluctance to become politically engaged in fighting back — science shouldn’t be political, they feel. There are also concerns around science’s elite status...
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PERSONAL UPDATE

My daughter was vetted for clinical trials eligibility this week at UCSF amid a "second opinion" eval (She's a Kaiser member). We should know something shortly, after some labs come back. We are still in shock over her recent dx. One of her friends started a crowdfunding page for her. We are amazed and gratified by the results to date. She's gonna need every penny. She's up to several grand in co-pays already. Probably going to have to vacate her job, break her apartment lease, and move back in with us.

We lost Danielle's elder sister to cancer 19 years ago. That still seems like last week. Gonna have to re-title (and add to) that book effort. Struggling to keep it together of late.

Backstory on my girls here.
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More to come...

Wednesday, April 19, 2017

Wow. HIMSS has acquired Health 2.0

Just wow!
CHICAGO (April 19, 2017) - Expanding its global educational offerings to familiar and new audiences, HIMSS has acquired the conference component of Health 2.0, effective immediately. HIMSS will establish a new Health 2.0 business unit within the enterprise that includes HIMSS North America, HIMSS Analytics, HIMSS Media, HIMSS Europe, HIMSS AsiaPacific and the Personal Connected Health Alliance.

“Bringing Health 2.0 into the HIMSS enterprise is a major expansion of our available resources to achieve better health through technology,” said H. Stephen Lieber, CAE, HIMSS president/CEO. “This approach will align the knowledge and expertise from the Health 2.0 global network of entrepreneurs, developers and end users engaged in the most leading-edge technologies with that of clinicians, IT professionals, executives, policy leaders and other health IT stakeholders to empower and enable people to live healthier lives.”

Lieber noted that HIMSS has no plans of changing the type or scope of the conferences presented in the past by Health 2.0. Instead, this expansion provides an opportunity for HIMSS to expand its own educational offerings with a stronger focus on start-up technologies in digital health.

Staffing: Indu Subaiya, MD, MBA, CEO and co-chairman, Health 2.0, will join HIMSS as executive vice president for the newly established Health 2.0 business unit and continue to co-host Health 2.0's Annual Fall and Wintertech conferences. Matthew Holt, co-chairman of Health 2.0, will continue to co-host Health 2.0's Annual Fall and Wintertech conferences and host Health 2.0's international conferences.

Health 2.0 Conferences: Health 2.0 held its first conference in 2007 and now holds three regular conferences in the US, with others in Europe and Asia. Over the past decade, Health 2.0 has welcomed more than 25,000 conference attendees worldwide, hosted over 4,000 demos, and introduced hundreds of new companies to the health technology industry.

Matthew Holt, co-chairman of Health 2.0, said, “Since the mid-2000s, Health 2.0 has gone from a fringe movement representing bleeding-edge technologists, patients and clinicians to being an ecosystem of thousands of companies working with all stakeholders to improve the healthcare experience for everyone. We’re thrilled to be working with the largest and most influential organization in health IT—HIMSS—to take the movement mainstream.”

Indu Subaiya, CEO and co-chairman of Health 2.0, said, "The creation of a Health 2.0 business unit within HIMSS represents a natural evolution, as digital health technologies are increasingly adopted and integrated by established healthcare organizations. We believe that the union of our businesses and ecosystems will offer unparalleled access and provide new mechanisms for early-stage innovation to permeate and transform the entire healthcare industry in the US and globally...”
Not yet sure how I feel about this. Hope it will be a good thing for the Health 2.0 movement. HIMSS is certainly a huge "non-profit" business. From my Guidestar account.


HIMSS certainly brings major juice to the table.

I tweeted. Matthew responded.

I was fortunate to see Matthew last week at the AARP Innovation 50+ Live Pitch event in Mountain View. I told him that he and Indu were my two favorite people in all of Health IT.

I meant it. Their work is an ongoing inspiration. Their friendliness likewise. I have always been extremely grateful for the invites to all of the Health 2.0 events. I hope the HIMSS alliance will serve to expand the @health2con reach.

From THCB:
Health 2.0 has something important to tell you
Apr 19, 2017. By INDU SUBAIYA and MATTHEW HOLT


Important news about my day job at Health 2.0 from my partner Indu Subaiya and me! You can also see the press release here and watch a video discussion with HIMSS CEO Steve Lieber—Matthew Holt


Indu and Matthew are excited to announce that after 10 years of convening the Health 2.0 community through our events and programs around the world, our conference company has found a new home and a partner who will help us exponentially expand our reach and impact. Effective immediately, we are joining forces with HIMSS and will be established as a new Health 2.0 business unit within the enterprise that includes HIMSS North America, HIMSS Analytics, HIMSS Media, HIMSS Europe, HIMSS AsiaPacific and the Personal Connected Health Alliance...

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More to come...

Thursday, April 13, 2017

#Innovate50 2017

Good Morning AARP Innovation 50+ 2017!


I'm running behind in my blogging. I almost bailed and didn't come this time. We just got some extremely bad dx news. Yet another immediate family member has been diagnosed with advanced cancer. I guess 15 years of next-of-kin caregiver duty wasn't enough. Have to suck it up and strap back in.

But, I have to say, hearing Richard Lui's bracing caregiver story during his interview with Alexandra Drane was leavening. Have to tamp down my Pity Party just a bit.

Richard poignantly recounted his ongoing caregiver routine with his Alzheimers-afflicted Dad. I could relate. My late Dad didn't have Alzheimer's, but he languished in LTC for seven years with increasingly severe dementia. I "interviewed" him once in the nursing home.


And, after that, hearing Missy Krasner recount her decades of caregiver duty with her Mom was another whack upside the head.


We're mostly all in this together at some point. Really glad I came, tired as I am.
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Thursday morning: So, today is "FinTech" day, 'eh?

Couldn't resist.

"Financial Tech," huh. I'll be all ears. For one thing, recall my prior post "Rationing by 'Price'."

BTW, be sure to grab a copy of Jo Ann Jenkins' book:


I will certainly study it in detail and report on it.


UPDATE

Friday morning. I'm home. I live 65 miles from the conference site, in Antioch out by Brentwood. Took me 3 hours to get home. We wrapped at 3:46, I thought "hey, I can be on the road by 4, maybe beat much of the crush."

I was wrong. Got home a bit after 7 pm. Got my fix of NPR (KQED specifically), that's for sure.


Gotta dump and triage all of my photos, and review my notes. Lots to reflect upon. For now, let me note another book. Day 2 Keynoter Jean Chatzky's new collaborative release.


My reading is piling up.


Great presentation.

I have to give major Props to AARP for continuously stepping up their game. This conference presentation was on par with those of Health 2.0. The two (somewhat overlapping) topics of "caregiver" and "financial tech" innovations could not be more timely.

Congratulations to the pitch competition winners.



The full list of pitch competition finalists and alternates is here.
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Well, this is one way to put things...
Old Farts Represent a Huge $ Market for Alternative Financial Services

[CARDTRAK STAFF, APRIL 13, 2017] The economic buying power of the 50-plus population who are increasingly turning to alternative financial services due to feeling that traditional bank offerings are not meeting all of their financial needs is enormous. Fintech companies are hoping to tap into this market by offering digital tools to address the unprecedented financial stress and complexity faced by this demographic.

People aged 50-plus will generate $83 billion in revenue for the fast-emerging alternative financial services sector over the next five years, according to AARP’s Financial Innovation Frontiers report. The research also found that only one in four 50-plus consumers is highly confident they can meet their financial needs in the next five years.

The research found that the 50-plus segment will spend $15.3 billion in the alternative financial services sector by the end of 2017, and that number is expected to grow by a healthy 4.25% annually through 2021. In addition, this industry is expected to syphon off $1.6 billion from banking revenue on checking and savings, consumer credit card and lending products in the next four years in addition to $1.2 billion in organic growth.


Other key findings of the Financial Innovation Frontiers report... (read the entire article)
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UPDATE

Wow. Cool. They've posted the entire videos from both days! 15 hours of footage. (Day One program begins at 18 minutes in).


Day Two:

 

If you didn't attend, I recommend you watch all of these.
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SOME RANDOM PHOTOS OF MINE

AARP had two professional photographers documenting the event, so I didn't work the room like I might normally otherwise do. Just took shots from my front-row seat amid scribbling in my notebook. A few random pics below.


That's enough for now. I have more. Shot a couple hundred across the two days (including a number via my iPhone).

I also have to give a shout-out to a delightful young man I sat with during the Day 2 morning session and then had lunch with. George Song, of MoreHealth.com.


BTW: You can follow AARP Innovation 50+ on Twitter here.

@Innovationat50
Also, avail yourselves of this report (pdf)

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My one critical conference observation goes to presentation recommendations. I found most of the pitches anxious and stiff, a parade of forced Toastmaster Moments to one degree or another. I don't underestimate the difficulty of the high-stakes time-constrained venue, and the fact that these startup Principals are tech and business management people, not performers (like I used to be), but I repeat the recommendations I proffered at the end of last year's Lean Healthcare Transformation Summit I covered. See my take on "The Presentation Secrets of Steve Jobs."

Not the stuff about stage lighting and info-diarrhea slides (scroll past that material), the lessons going to pitch delivery. Among other things,
  1. You really need to have your presentation down cold. Rehearse, rehearse, rehearse, to the point you could do it in your sleep. No nervous, furtive quick glances down at the teleprompter/monitor, commit your presentation deeply to memory (inclusive of its time consumption), and;
  2. Move around (and use confident "body language"). Most of the presenters "hit their (blue masking tape) mark" and stayed stuck there. The video cameras are all on swivel head tripods. Put some physical anima in your presentations.
The trial lawyer's maxim is "he/she with the best story wins!" And, while the "story" in these cases is of course the effectiveness/utility/value propositions of the pitched apps/services, you are part of those stories while pitching them from a stage. Otherwise we could just watch a narrated video or slide deck or read the brochure.

One other thing that caught my ear. I again heard it proffered that peoples' "digital footprints" (a.k.a. "digital exhaust") might serve as "big data" grist for derivation of individualized drill-down metrics such as a "proxy FICO score." Don't get me started on that BS. I used to work in subprime risk modeling and management.
During one of the Health 2.0 WinterTech events I watched one presenter demo an AI-assisted app purporting to dynamically calculate and update your personal "health score" using, among other online factors, your social media activity. What could possibly go wrong there?
I have more thoughts, which I hope to get to ASAP, but I'm unexpectedly overwhelmed these days...

CODA

My younger daughter Danielle recently got a devastating diagnosis of Stage IV metastatic pancreatic cancer (she's gone "public" with the news on FB, and gave me permission to write about it). Danielle is particularly special to me.

We lost her older sister "Sissy" to liver cancer 19 years ago. I am just speechless.

One of her friends started a crowdfunding page, regarding which we could not be more grateful.

PS

The March for Science draws nigh. I've been intending to participate on the San Francisco event. Just in via my email inbox:

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More to come...