From one of my favorite requisite daily hangs.
The commentariat is every bit the equal of the topical authors. Better bring your A-Game if you're gonna participate; they do not suffer fools gladly. ("Yves Smith" is the blog owner.)
Questioning InnovationRead all of it, including the accruing comments.
Posted on December 5, 2019 by Yves Smith
I haven’t quite worked through my reaction to some recent pieces in the Financial Times that seem to merit comment, so forgive me for picking out a just a couple of tidbits that still might serve as grist for discussion.
One thing that has long bothered me is the worship of innovation. Relatively early in my career, I had a consulting gig with a venture capital firm where my job was to look at oddball deals. I learned that quite a few bona fide inventions and technology improvements, even though they might seem cool and engineers would get excited about them, didn’t add up to a business opportunity. The most common failing was they didn’t represent a big enough improvement over the status quo to justify customers making the needed behavior changes to adopt them.
And an even earlier lesson came in college, when I majored in the history and literature of the modern era, which meant the Industrial Revolution to World War II. The first generation, and arguably even two, of the Industrial Revolution led to a decline in worker incomes in England. The revolutions of 1848 were mass pushback against the dislocations of the rise of factory work. So while industrialization eventually increased living standards, the transition costs exacted a great toll on laborers who didn’t live long enough to reap the benefits. And we are now suffering the long-term cost of environmental degradation…
If one wants to get worked up about the US actually being a laggard or being at risk of becoming one, it’s a little late to get worked up now. How about what passes for Silicon Valley talent focusing on….help me…apps? How about our slow and overpriced broadband? How about our generally terrible infrastructure, which is imposing a cost on citizens and businesses on a broad basis? America’s lifespan is falling, and the priority is 5G?
The reason I am increasingly a Luddite is I see too much use of technology to curtail our economic rights and even now our supposed ownership, or otherwise enable better rentierism…Technology is working towards the creation of a new debt cropper society. It may not get anywhere near as far as it did in the Reconstruction Era, but having to pay and pay and pay (then via jacked up financing charges, now via restricted ownership rights leading to unnecessarily high costs, particularly from having to replace consumer durables more often or pay high authorized servicer repair costs), but the trend is underway…
"Rentierism." I am reminded of Quadrant II of Frase's Four.Also, buy and study Yves' excellent book. One of my FIRE Sector favs (in which I did a 5-yr tenure).
The economy is far too important to all of us to leave to experts, particularly when their recommendations often have little in the way of empirical foundations. Both experts and charlatans rely on intimidation, such as the use of arcane (even if useful) terminology and a dismissive attitude to deter reasonable queries. We all need to get in the habit of demanding support, not sound bites or sixth-grade level opinion pieces, but reasoned and complete explanations of why economists believe what they believe. That was the reason for adopting mathematical exposition in the first place, to make the logic and evidence behind their reasoning explicit and transparent. It’s time they adopt that standard for communication with the public. [Ch 9, location 6551]INNOVATION REMINISCENCE: THE ROTARY DIAL PHONE
THE EHR: "INNOVATIVE" OR OBSTRUCTIVE
Patients vs Paperwork
by Danielle Ofri
New York Times
Every doctor I know has been complaining about the growing burden of electronic busywork generated by the EMR, the electronic medical record. And it’s not just in our imaginations.
The hard data have been rolling in now at a steady pace. A recent study in the Annals of Family Medicine used the EMR to examine the work of 142 family medicine physicians over three years. These doctors spent more than half of their time — six hours of their average 11-hour day — on the EMR, of which nearly an hour and a half took place after the clinic closed.
Another study in Health Affairs tracked the activities of 471 primary care doctors over a three-year period, and also found that EMR time edged out face-to-face time with patients.
This study came on the heels of another analysis in the Annals of Internal Medicine in which 57 physicians were observed directly for 430 hours. These researchers found that doctors spent nearly twice as much time doing administrative work as actually seeing patients: 49 percent of their time, versus 27 percent.Yeah. That hardy perennial lament. Can't argue with the beef--except to assert that it's not the technology per se, it's the incumbent business paradigm. "Patients vs Paperwork." Interesting choice of words. I assume Dr. Ofri isn't advocating a return to actual paper recordkeeping.
These study results hovered over my head as I worked through a recent clinic session, most of which felt devoted to serving the EMR rather than my patients. It was the kind of day that spiraled out of control from minute one, and then I could never catch up. The kind of day, nowadays, that is every day.
Part of the issue is that there are simply more patients, most of whom are living longer with many more chronic illnesses, so each patient has much more that needs to be taken care of in a given visit.
But the main reason that I can’t keep up is the EMR. Like some virulent bacteria doubling on the agar plate, the EMR grows more gargantuan with each passing month, requiring ever more (and ever more arduous) documentation to feed the beast…
Although, my friend Margalit might disagree.Relatedly, on the "business paradigm" of health care policy:
The American Health Care Industry is Killing PeopleHmmm... From a prior post.
Yes, transitioning to a more equitable system might eliminate some jobs. But the status quo is morally untenable.
Won’t you spare a thought for America’s medical debt collectors? And while you’re at it, will you say a prayer for the nation’s health care billing managers? Let’s also consider the kindly, economically productive citizens in swing states whose job it is to jail pregnant women and the parents of cancer patients for failing to pay their radiology bills. Put yourself in the entrepreneurial shoes of the friendly hospital administrator who has found a lucrative new revenue stream: filing thousands of lawsuits to garnish sick people’s wages.
And who can forget the lawyers? And the lobbyists! Oh, aren’t they all having a ball in America’s health care thunderdome. Like the two lobbyists who were just caught drafting newspaper editorials for Democratic state representatives in Montana and Ohio, decrying their party’s push toward a “government-controlled” health care industry. It’s clear why these lobbyists might prefer the converse status quo: a government controlled by the health care industry. If we moved to a single-payer system, how would lobbyists put food on the table, and who would write lawmakers’ op-ed essays?
Welcome to the bizarre new argument against “Medicare for all”: It’s going to cost us jobs. Lots of jobs. Good, middle-class, white-collar jobs in America’s heartland, where Democrats need to win big to defeat Donald Trump…
I am reminded of a passage from a David Graeber book:
wherein he asks,
Does this mean that members of the political class might actually collude in the maintenance of useless employment? If that seems a daring claim, even conspiracy talk, consider the following quote, from an interview with then US president Barack Obama about some of the reasons why he bucked the preferences of the electorate and insisted on maintaining a private, for-profit health insurance system in America:'eh?
“I don’t think in ideological terms. I never have,” Obama said, continuing on the health care theme. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork.’ That represents one million, two million, three million jobs [filled by] people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we doing with them? Where are we employing them?”I would encourage the reader to reflect on this passage because it might be considered a smoking gun. What is the president saying here? He acknowledges that millions of jobs in medical insurance companies like Kaiser or Blue Cross are unnecessary. He even acknowledges that a socialized health system would be more efficient than the current market-based system, since it would reduce unnecessary paperwork and reduplication of effort by dozens of competing private firms. But he’s also saying it would be undesirable for that very reason. One motive, he insists, for maintaining the existing market-based system is precisely its inefficiency, since it is better to maintain those millions of basically useless office jobs than to cast about trying to find something else for the paper pushers to do.
So here is the most powerful man in the world at the time publicly reflecting on his signature legislative achievement—and he is insisting that a major factor in the form that legislature took is the preservation of bullshit jobs…
Graeber, David. Bullshit Jobs: A Theory (p. 157). Simon & Schuster. Kindle Edition.
WEEKEND UPDATE, MORE NAKED CAPITALISM
Financialization of the U.S. Pharmaceutical Industry
Posted on December 7, 2019 by Yves Smith
Yves here. This article is a bit geeky but very much worth your attention. It shows how pharmaceutical companies are flat out lying when they say they need higher drug prices to support R&D. Their profits go almost entirely to buybacks and dividends. And this analysis does not incorporate another unflattering fact: that Big Pharma spends more on marketing than research. It also describes how government funding of drug research has increased more than three times in real terms since the 1980….as executives have lined their pockets.NC rocks. Again, be sure to always read the comments.
The authors make a short set of recommendations at the end, starting with regulating drug prices...
From the post:
Perhaps no business activity is more important to our well-being than the discovery, development, and distribution of medicines. Unfortunately, many of the largest U.S. pharmaceutical companies have become global leaders in financialization at the expense of innovation. Drug prices are at least twice as high in the United States as elsewhere in the world.Rx "Innovation." Yeah, right.
Over the decades, pharmaceutical companies have lobbied vigorously against proposed market regulations designed to control drug prices in the United States. The main argument that the industry’s lobby group, the Pharmaceutical Research and Manufacturers of America (PhRMA), habitually makes against drug-price regulation is that the high level of profits that high drug prices make possible in the U.S. drug market enables pharmaceutical companies to be more effective in drug innovation…
OFF-TOPIC PERSONAL ERRATUM
Hope draws nigh, scheduled to arrive this Christmas Eve. Hope Eleanor Nyquist, my first Great Niece, daughter of my awesome Niece April, wife of Neurotrainer.com CEO and Chief Scientist Dr. Jeff Nyquist.
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| I shot this--and a couple hundred more--at their wedding. |
I am remiss in not citing the Hopewell Cancer Support center here in the Baltimore area.
Gave 'em a permanent upper right-hand links column link (click the image). Looked up their most recently available IRS 990. Looks totally legit. They're only maybe 5 miles from our house. Will have to pay them a visit, looks for ways to help.
Tangentially, saw this discussed recently on TV and bought the book.
Our grief can’t just be buried alongside the ones we love. Even years after our losses, we still have moments of gut-wrenching sadness. We’re still annoyed by a wide variety of major and minor Hallmark holidays. We still get pissed thinking about the hand we’ve been dealt. But guess what?Haven't read much of it yet, but I will shortly and review it. Been rather sick of thinking about cancer and loss this year. My grief, while manageable, is permanent. I'm absolutely sure I'm not alone.
These days, we’re tagging family members on Instagram. They’re just not the ones we thought we’d be tagging—and ones that in our darkest moments we never thought would be in our lives.
Eventually, we’re all going to lose people we love. Eventually, we’re all going to die. This is true whether or not we admit it to each other. So there’s value in building a community where there’s no stigma to talking about death and the countless ways it impacts our lives. And with this book, and the candor of those who contributed to it, we hope to open up the conversation so that, ideally, in the future, nobody has to hear crickets in the face of a loss.
Soffer, Rebecca. Modern Loss (pp. xxiii-xxiv). Harper Wave. Kindle Edition.
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More to come...
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