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Sunday, June 13, 2021

Sad WaPo headline


Estimates of how many of these US deaths were preventable range widely. Given an actual Trump administration “A+“ response, I would speculate that perhaps all but 100,000 or so were unnecessary. We remain at 4.3% of the world’s population, but with 20% of the COVID-19 cases and 18% of the deaths.
 
JHU data, June 16th.
 
APRIL 2020
 
Click to enlarge.

NEW BOOK RELEASE
“Painfully good. The book could have been called, ‘Outrageous.’ The story Andy Slavitt tells is not just about Trump’s monumental failures but also about the deeper ones that started long before, with our health system, our politics, and more.” --Atul Gawande, author of Being Mortal

The definitive, behind-the-scenes look at the U.S. Coronavirus crisis from one of the most recognizable and influential voices in healthcare


From former Biden Senior Advisor Andy Slavitt, Preventable is the definitive inside account of the United States' failed response to the Coronavirus pandemic. Slavitt chronicles what he saw and how much could have been prevented -- an unflinching investigation of the cultural, political, and economic drivers that led to unnecessary loss of life.

With unparalleled access to the key players throughout the government on both sides of the aisle, the principal public figures, as well as the people working on the frontline involved in fighting the virus, Slavitt brings you into the room as fateful decisions are made and focuses on the people at the center of the political system, health care system, patients, and caregivers. The story that emerges is one of a country in which -- despite the heroics of many -- bad leadership, political and cultural fractures, and an unwillingness to sustain sacrifice light a fuse that is difficult to extinguish.

Written in the tradition of The Big Short, Preventable continues Andy Slavitt’s important work of addressing the uncomfortable realities that brought America to this place. And, he puts forth the solutions that will prevent us from being here again, ensuring a better, stronger country for everyone.
[Amazon blurb]
June 15th release.

Andy Slavitt has Cred. 
 

AND, FROM THE DEPARTMENT OF OCCAM'S CHAINSAW
“Depopulation” by COVID-19 vaccines?
COVID-19 and antivaccine conspiracy theorists like Joe Mercola, Michael Yeadon, and Peter McCullough are spreading the conspiracy theory that COVID-19 vaccines are intended as a tool for “global depopulation.” This is nothing more than an old antivaccine conspiracy theory repurposed for the pandemic. As ridiculous as it might seem, it is nonetheless very appealing to antivaxxers...
I keyword-search my own blog history for "antivaxxers." See also here.
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Thursday, June 10, 2021

Solving public problems

An interesting find (props to Science Magazine). Digitech, focused analytics, collaborative methodology, all in the synergistic service of empathic, effective problem mitigation? What's not to love? to wit,
 
She had me at Paragraph One.
AUTHOR’S NOTE
On January 6, 2021, a systematic, relentless campaign of grievance and falsehood, led by former President Donald Trump and stoked by members of the Republican Party in Congress and right-wing media, culminated in a violent attack on the Capitol. The incompetently planned but nonetheless deadly coup attempt counted among its leaders White supremacists, neo-Nazis, and devotees of the paranoid conspiracy theory QAnon. Yet support among Americans for the insurrection went way beyond the far-right fringe. According to YouGov about 45 percent of Republicans said they backed the attack on the Capitol, while 74 million Americans voted for Trump in 2020, despite his undisguised contempt for democratic institutions and decision-making both during the campaign and over the four years of his presidency. Watching these events, one could be forgiven for thinking that American democracy was reaching its final hours. I have written this book in the firm belief that this is not so…


Noveck, Beth Simone. Solving Public Problems. Yale University Press. Kindle Edition (location 35).
Yeah. Recall my January post "A Republic, if you can keep it."
 
One thing led to another, and I found myself forthwith at her NYU site TheGovLab.
 
THE GOVLAB’S MISSION IS TO IMPROVE PEOPLE’S LIVES BY CHANGING THE WAY WE GOVERN.

Our goal is to strengthen the ability of institutions – including but not limited to governments – and people to work more openly, collaboratively, effectively and legitimately to make better decisions and solve public problems.

We believe that increased availability and use of data, new ways to leverage the capacity, intelligence, and expertise of people in the problem-solving process, combined with new advances in technology and science can transform governance.

We approach each challenge and opportunity in an interdisciplinary, collaborative way, irrespective of the problem, sector, geography and level of government.
    
WE LEARN BY DOING


We embrace failure: failing fast and often, learning from our mistakes and sharing experiences.

We collaborate with and connect experts and practitioners, across sectors and disciplines, levels of governance and geographies.

We rely on reproducible experiments and metrics to better understand what works (and what doesn’t) and to translate theory and hypotheses into actionable insights.

We put users at the center, to ensure we stay focused on improving people’s lives.
'eh? Pretty cool. 

The other day I logged in to my Science Magazine account to surf the current issue. I'm increasingly frustrated with the random, protracted Bill DeJoy USPS hardcopy delivery delays (which now extends to my Parkinson's Rx refills, grrrr...). I get a lot of my books from Science book reviews (I typically read 2-3 books a week, along with my numerous periodicals and broader daily web reading).
 
I came upon this:
Solving Public Problems
Reviewed by Ming Ivory

Governance professor Beth Simone Noveck, who formerly served as the first White House deputy chief technology officer, believes that “public entrepreneurship” can counter the failures that have dominated public policy design in the United States since the 1960s. Her new book, Solving Public Problems, revisits the four stages of policy design—identifying problems, identifying solutions, designing for implementation, and evaluation and evolution—while identifying 20 crucial decisions that prioritize “human-centered public policies.”

Experts often expend much effort on program design, but once these programs are created, there is usually little fine-tuning of the implementation and hardly any emphasis on measuring whether the desired outcomes are achieved. The US federal civil service, for example, first celebrated as a defense of the “public interest” for its structural insulation from shortsighted patronage and political corruption, has recently come to be viewed by some as a nonelected “deep state” that frustrates legitimate partisan power and private-sector freedom. Noveck fearlessly defends the existence of “public interests,” arguing that their complexity and ethical significance are distinct from academic theory, electoral politics, and private-sector capitalism…
So far, so good. Stay tuned. Coheres with a lot of my recent reads.

TANGENTIALLY apropos OF THE TOPIC

Nations, like individuals, tell stories in order to understand what they are, where they come from, and what they want to be. National narratives, like personal ones, are prone to sentimentality, grievance, pride, shame, self-blindness. There is never just one—they compete and constantly change. The most durable narratives are not the ones that stand up best to fact-checking. They’re the ones that address our deepest needs and desires. Americans know by now that democracy depends on a baseline of shared reality—when facts become fungible, we’re lost. But just as no one can live a happy and productive life in nonstop self-criticism, nations require more than facts—they need stories that convey a moral identity. The long gaze in the mirror has to end in self-respect or it will swallow us up.

Tracing the evolution of these narratives can tell you something about a nation’s possibilities for change. Through much of the 20th century, the two political parties had clear identities and told distinct stories. The Republicans spoke for those who wanted to get ahead, and the Democrats spoke for those who wanted a fair shake. Republicans emphasized individual enterprise, and Democrats emphasized social solidarity, eventually including Black people and abandoning the party’s commitment to Jim Crow. But, unlike today, the two parties were arguing over the same recognizable country. This arrangement held until the late ’60s—still within living memory.

The two parties reflected a society that was less free than today, less tolerant, and far less diverse, with fewer choices, but with more economic equality, more shared prosperity, and more political cooperation. Liberal Republicans and conservative Democrats played important roles in their respective parties. Americans then were more uniform than we are in what they ate (tuna noodle casserole) and what they watched (Bullitt). Even their bodies looked more alike. They were more restrained than we are, more repressed—though restraint and repression were coming undone by 1968.

Since then, the two parties have just about traded places. By the turn of the millennium, the Democrats were becoming the home of affluent professionals, while the Republicans were starting to sound like populist insurgents. We have to understand this exchange in order to grasp how we got to where we are.

The 1970s ended postwar, bipartisan, middle-class America, and with it the two relatively stable narratives of getting ahead and the fair shake. In their place, four rival narratives have emerged, four accounts of America’s moral identity. They have roots in history, but they are shaped by new ways of thinking and living. They reflect schisms on both sides of the divide that has made us two countries, extending and deepening the lines of fracture. Over the past four decades, the four narratives have taken turns exercising influence. They overlap, morph into one another, attract and repel one another. None can be understood apart from the others, because all four emerge from the same whole…
"Free America (romantic Libertarianism)," "Smart America (technocratic, increasingly neoliberal elites)," "Real America (Sarah Palin demographic)," "Just America (activist long-marginalized minorities)." 
 
A long-read. See what you think.
 
Also, what of public"deliberation?"
(I will eventually have to quibble just a tad with Beth's drive-by characterization of the term.)
UPDATE

Recall discussing "High Conflict?" Dealing with our growing overpopulation of "conflict entrepreneurs?"
 
BRIEF OFF-TOPIC ERRATUM

Three days a week we run the Paddington Road Graycare Center for our fabulous grandson Calvin. He goes to commercial daycare two days a week for the peer socialization. The other day he was mowin' some Cheerios for snacks when I shot this.
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Monday, June 7, 2021

"Are we there yet?"

 
We might ask PGA golfer Jon Rahm.
 
He finished Round 3 of the PGA "Memorial" Tournament in Ohio on Saturday, June 5th with a 6-stroke lead, whereupon he was informed that he'd tested positive for Covid-19 and would have to withdraw and head straight to 10 days of quarantine.

It's not over yet. As we rush to open all manner of sports and entertainment venues absent prophylactic NPI measures (mainly masks, "social distancing), we may be unhappy with the eventual public health upshot.
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Thursday, June 3, 2021

Nothing personal, just bidness. Pillaging Hahnemann


Fine piece of writing by Chris Pomorski in The New Yorker.
Hospitals in the U.S. are estimated to be closing at a rate of about thirty a year. Most closures happen for financial reasons, in places where there are relatively few privately insured patients. Increasingly, hospitals are regarded as businesses like any other: at least a fifth of hospitals are now run for profit, and, globally, private-equity investment in health care has tripled since 2015; last year, some sixty-six billion dollars was spent on acquisitions. The industry’s movement into health care has been linked to price hikes, an increase in unnecessary procedures, and the destabilization of health-care networks.
    
The bad actors of private equity are sometimes accused of destroying American health care. But they are more symptoms than disease…


Philadelphia is one of the poorest big cities in the United States, with about a quarter of its 1.6 million residents living below the poverty line. Since 1977, when Philadelphia General closed, it has also been the largest American city without a public hospital. Hahnemann, with nearly five hundred beds, occupied a city block on the edge of North Philadelphia, an area that includes several impoverished neighborhoods. A majority of the more than fifty thousand patients that the hospital treated each year had publicly funded medical insurance or none at all; two-thirds were Black or Hispanic.

Because Hahnemann treated so many poor patients, it had significant financial difficulties. But patient outcomes rivalled those of practically any hospital in the country, and the people who worked there were driven by a sense of mission. “The doctors at Hahnemann were there because they wanted to be there,” Logio said. “Hahnemann took care of the people that no one else wanted to take care of...”
This is a great read, about 40 minutes worth. It should piss you off. It did me.
 
I first came to the healthcare space 28 years ago in 1993, initially as a Nevada hospitalizations outcomes analyst for the then- CMMS nonprofit Peer Review (pdf) contractor for the state. While the focus of my eventual 3 tenures with them was on the technical side (acute care outcomes, cultural disparities mitigation, workflow, and electronic medical records systems), I have also given much ongoing attention to the ECON / Business side of things. I did my first grad school paper on an argument analysis of the 1994 JAMA-published "Single Payer" proposal (pdf).

I recall briefly encountering news of Hahnemann last year during the cacophony of pandemic news coverage last year (Philly running short of Covid19 bed space).

Chris has completed the larger picture for me in BP-raising detail. This place was looted for profit.
In Philadelphia, as elsewhere across the country, people of color have borne the brunt of the coronavirus pandemic. In March, 2020, city officials entered negotiations with Freedman to reopen Hahnemann to house covid patients during an anticipated surge. But Freedman asked for more than four hundred thousand dollars a month to lease the facility—a rate that he said was “very reasonable.” The talks quickly broke down. Responsibility for the care of coronavirus patients fell heavily on the remaining hospitals in the area, including Temple, which converted a seven-story pavilion to a coronavirus clinic, and erected a tent outside the E.R. There have been some hundred and fifty thousand confirmed infections in the city, and more than thirty-six hundred deaths...
Read it. Listen to the companion Audm audio transcript. Excellent. Read Chris's other stuff as well. Very nice.

(Dang, my Parkinson's is giving me hell today...)

UPDATE

From an Intercept story last year:
A PRIVATE EQUITY BARON SITTING ON AN EMPTY PHILADELPHIA HOSPITAL IS IN LINE FOR HUGE TAX GIFT IN THE COVID-19 STIMULUS
Joel Freedman, who shuttered Philadelphia’s Hahnemann University Hospital in September, could benefit from a provision that favors real estate investors.


...HAHNEMANN, WHICH HAD served the city’s poorest and most critically ill residents since 1848, was acquired in 2018 by a subsidiary of American Academic Health System LLC, of which Freedman is the founder and chief executive officer. That subsidiary, Philadelphia Academic Health Systems, filed for bankruptcy in June. Freedman said Hahnemann had been losing millions of dollars a month, but the hospital’s real estate was not included in the bankruptcy filing. Rather, it was redistributed to another of Freedman’s companies, Broad Street Health Care Properties.

Under the federal stimulus, which passed unanimously in the Senate and by a voice vote in the House, corporations and businesses will still see the bulk of dollars allocated, while workers get modest increases in unemployment benefits and a one-time check of up to $1,200 per individual. At least one provision benefitting real estate investors, which increases the amount of nonbusiness income and capital gains they can protect from taxation, could result in tax breaks up to $170 billion over 10 years.

“That group comprises the top 1 percent of taxpayers, according to Internal Revenue Service data,” the New York Times reported. “The result is that people can enjoy big tax breaks stemming from only-on-paper losses, even if they enjoy big cash profits in the real world…”
Is this a great country, or what?
 
ANOTHER NEW BOOK ON DECK
 
Neurobiology meets AI.
“We are all well-trained neural networks, but our brains come with a history track, as do ANNs. New information is not stored independent of other safely stored information content. Instead, any new bit of information is processed in the context of the entire history of the network. The same experience means something different for every individual. And the better the information is aligned with previous experiences, the easier it is for the network to “believe” the new arrival. This simple thought has some interesting consequences for the concept of cognitive bias: in a network built on algorithmic growth, bias is a feature, not a bug of the system, whether we like it or not.”
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