I’m heading out the door. If you’re looking for something to read, I suggest Atul Gawande’s latest New Yorker article on “hot spotting”, which has been posted for non-subscribers.
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Come for the politics, stay for the snark.
Wow, I can’t imagine what it was like to comment in morse code.
Come for the politics, stay for the snark.
Let there be snark.
The GOP couldn’t organize an orgy in a whorehouse with a fist full of 50s.
Technically true, but collectively nonsense
Russian mouthpiece, go fuck yourself.
if you can’t see it, then you are useless in the fight to stop it.
Their freedom requires your slavery.
Accused of treason; bitches about the ratings. I am in awe.
The willow is too close to the house.
And now I have baud making fun of me. this day can’t get worse.
A snarling mass of vitriolic jackals
Our job is not to persuade republicans but to defeat them.
Something needs to be done about our bogus SCOTUS.
Impressively dumb. Congratulations.
Reality always lies in wait for … Democrats.
We’ve had enough carrots to last a lifetime. break out the sticks.
Since when do we limit our critiques to things we could do better ourselves?
If senate republicans had any shame, they’d die of it.
Let us savor the impending downfall of lawless scoundrels who richly deserve the trouble barreling their way.
The party of Reagan has become the party of Putin.
The words do not have to be perfect.
Let’s delete this post and never speak of this again.
It’s always darkest before the other shoe drops.
cathyx
You’d think the insurance companies would be all over this. Too bad they’re not.
stuckinred
The union looks great here.
Dave
I think Gawande is one of the best contributors the New Yorker has right now. His piece on end-of-life care for cancer patients was amazing.
jeffreyw
Too good. Never happen. They prefer us ignorant.
Punchy
So….this story warranted a 20-second blurb at 7:19 am on the Today show. Almost 20 minutes in. Anyone wanna guess how many femtoseconds after the opening it would have gotten run if it had been a Icky Brown Guy(TM) targeting a cracker christian church somewhere?
Woulda knocked the impending Snowpocalypse into the 3rd hour.
Superluminar
Question: The article talks a bit about that whole “broken windows” policing stuff they did in NYC and elsewhere. I have heard conflicting – and largely partisan – arguments about whether or not it actually works. Does anyone have any good sources/studies to share on this? Thnx.
stuckinred
@jeffreyw: Whoa! A political post!!!!!
Belafon (formerly anonevent)
I’m only going to copy the quote that GOS posted because I don’t want to spoil the moment, but Douchehat is making sense:
Nutella
The sad thing about that article is that the true source of the problem is the lack of health care here. We have health insurance and a new health insurance reform act, but we don’t have health care even for the people who have insurance. We have individual incidents that are either insured or not.
The stories of the people who had multiple chronic problems that prevented them from working at all and the woman with chronic migraines who lost so much work are a terrible indictment of our crappy system. Both the continued suffering and loss of productivity ought to be completely unacceptable in a civilized country.
edited to add: Not only do we have sicker and less productive people our costs are the highest in the world.
geg6
This was an amazing read. Thanks for posting it, mistermix.
Very thought provoking and seemingly logical, this approach. I hope they can continue what they are doing, despite all the forces that will try to stop them.
What really struck me, besides the fact that these people are using common sense to approach the problem of medical costs and outcomes, is the doctors trolling the ERs to try to deceive patients into coming back to them so they can continue raking in huge payments and provide inadequate or even contraindicated care. Disgusting. They are no different than the MoUs on Wall Street, IMHO. Subhumans with no thought for anything but what they can put in their pockets.
jeffreyw
@stuckinred: Actually more of a Doc Searles fanboi post. LOL
debit
Amazing article, thank you.
Face
Those rioting Egyptians are in the state of Da Nile.
PeakVT
Very good article.
I wonder if Gawande has looked at a comparable situation – a wealthy country with a large number of very unhealthy people. I can’t think of a country that might have been in the same situation.
Also, too, savings in the realm of health care delivery is not the same as savings from the reform of health insurance. Even if the total cost of health care didn’t go down, shifting resources spent on the inefficiencies caused by private health insurance to health care delivery would be good for the country.
eemom
@jeffreyw:
let me respond with a cooking post. Tried a couple of soup recipes from your blog recently and they came out GREAT! Thanks.
Also, your recipes are much more fun to read than the average Joe Q. Cook’s.
Linda Featheringill
@Face:
So bad!
The funny thing is that I haven’t seen this anywhere else.
jeffreyw
@eemom: Thank you! I’m not much of a recipe guy, you may have noticed. More a stream of consciousness chef.
Woodrow "asim" Jarvis Hill
@Belafon (formerly anonevent): WHATISTHISIDONTEVEN
1) al-Zawahiri’s radical history goes much farther back that Mubarak; he was looking to overthrow the Egyptian Government in the ’60, fer Christssakes!
2) In the lists of “Governments bin Laden really, really hates” The Saudi regime is much higher up that any of the Egyptian rulers, as can be proved by, for example, Actually Looking At Who They Target
3) It’s the hateorade of the US as not only a “meddler” in “Islamic” affairs, but also a sponsor of the Saudi, not Egyptian, regime, that was the most direct reason we were, and continue to be, targeted by that organization.
That’s not to say our role in Egypt wasn’t a contributing factor. Certainly we clearly have a tangled skein there of blood and war and abuses, and we’re far from blameless in that regime’s actions. But Doughboy is doing nothing but blowing smoke up people’s chimneys with this kind of horrific revisionary history. Worse, it’s another pass at the “How America matters in this Egyptian Crisis” business that has a role — but not as big a one as many commentators keep implying. It’s like the Egyptian people can’t be allowed to actually be angry without it having to secretly be about what America is doing.
The one thing I might give him is that al-Zawahiri might have played a significant role in 9/11. But honestly, I’ve never seen a detailed account of how deep a role he played. Despite his more-than-a-rumored control of day-to-day ops in “The Base”, it’s never really been clear how much he did to plot or execute that attack, from what I’ve read.
Ben JB
to the front-pager formerly known as DougJ:
Conor at Sully’s place approvingly linked to a Douthat column where the final moral is
“But history makes fools of us all. …
Sooner or later, the theories always fail. The world is too complicated for them, and too tragic.”
(https://www.nytimes.com/2011/01/31/opinion/31douthat.html?_r=1&ref=rossdouthat)
Thought that would be a nice way to wake up–the reminder that all human thought and action isn’t worth waking up for.
I know they won’t fire his broken-record 3rd-grade generalizing self, but I wish they would.
leinie
Fascinating article. It’s an interesting approach, but relationships and trust appear to be the key to making it work, and I think that would combine with the trolling doctors opposition to be major stumbling blocks.
Alan
I’m working on this! I work for a New Jersey nonprofit (that shall remain nameless) in the health field, and we’re working with the state Department of Health and Senior Services to use some of Dr. Brenner’s hospital-use data to target public housing authorities with high rates of certain illnesses for policy and healthcare interventions.
PurpleGirl
@cathyx: No. Programs like these would cost the insurance companies their profits. They aren’t in the business of CARE, they are a conduit for payments and they get their profits as a cut of the pass-through of payments.
CA Doc
Gawande, he’s like the kid in the Emperor’s New Clothes who calls out the BS. He has a way of humanizing the fallout of our non-system in a way that wakes everybody up. The primary care community loves his work. Not sure what those $500,000 plus a year specialists think, though. Those oxen are getting pretty nervous.
jayackroyd
Funny. What I took away from that article was as documentation of a complete system FAIL. A system that routinely used inexpensive, preventative approaches would not have “hotspots” of people who REALLY need preventative care.
You know, like the rest of OECD.
Persia
@Dave: Agreed. He’s fantastic.
General Stuck
In case you were wondering, the lizard brain never sleeps.
They want to keep the Chinese fat and happy and not thinking about calling in our debts, but let granny pay the rent with republican principle. Thanky you PA!
PurpleGirl
@General Stuck: I suggest a counter measure: They stop cutting paychecks and benefit checks for all and active and retired congresscritters and their staffs. Staff members may suffer, and that’s the point. Let them experience what their bosses want to wreck on the population at large.
Chance of happening? Nada, zilch, no way. I can dream, can’t I?
geg6
@Alan:
That is awesome! Keep up the good work. This sounds like a very fulfilling and, dare I say, patriotic line of work.
Joey Maloney
Meanwhile, back in the real world…Glenn Greenwald has dengue fever.
RSA
Amazing. Thanks for the link, mistermix.
lamh32
James Fallows on the “huntsman for president” talk that eating the village.
The Latest Huntsman 2012 News
James Fallows
lamh32
Huntsman Needs to Make a Decision
by BooMan
JGabriel
Al Jazeera English reports that Egypt State TV is now showing video of the protests in Tahrir Square. State TV had been broadcasting empty streets and cooking programs, so there is some sort of public acknowledgement now.
Not clear what it signifies yet, though one imagines there would be no desire to broadcast it if they were planning a crackdown on the demonstrators, so it may be a good sign.
.
pk
I went to a party over the weekend and was told by one of the guests (female) that Sarah Palin is a strong articulate woman. This woman’s insurance is going up from $13000/yr to $17000 and she was complaining about how little the teachers in our district pay for their health coverage (which is true, but besides the point). There was no point in arguing with her. All I wanted to do was pick up the birthday cake and hurl it at her face.
gene108
@PeakVT:
There isn’t a wealthy country anywhere as large as the U.S. Canada competes with us on total square miles but we have 9 times Canada’s population.
Great Britain, Germany,and France are much smaller than us and none of them has more than a third of our population, if that.
It’s hard to make an apples to apples comparison between how the U.S. manages things and other wealthy countries. Between our large population and continued (relatively) open immigration policies, we have degree of ethnic diversity and income distribution not seen anywhere else.
In terms of unhealthy people and income distribution, I think Great Britain may be a good comparison, but again, they are much smaller than us and probably don’t have issues like someone in rural Wyoming having to travel hours to get to a doctor or hospital, since they aren’t that big and are heavily populated enough that issues facing rural medicine in the U.S. just don’t exist there or anywhere else in other industrialized nations.
JGabriel
Superluminar:
I don’t. I can tell you this much: As a New Yorker, I never bought it. The lower crime statistics that accompanied Giuliani’s implementation mirrored national trends, and continued into Bloomberg’s term despite not continuing the policy.
So my conclusion is that it’s probably ineffective.
.
New Yorker
http://andrewsullivan.theatlantic.com/the_daily_dish/2011/01/big-lunacy.html
More proof above that the right in this country is now beyond parody. Extra points to the loon who somehow managed to mix Bill Ayers into the Egyptian protests.
gene108
@ Woodrow “asim” Jarvis Hill:
Just to add, the Muslim Brotherhood, if I understand has been around since the 1920’s, when pan-Arab nationalism started taking root after the collapse of the Ottoman Empire.
The organization really went nuts against Egypt, after Sadat made peace with Egypt and assassinated him.
There issues are much deeper and older than our support of Mubarak.
jwb
@General Stuck: Gotta love the optics on this one. Usually, even the lizard brain isn’t this stupid.
Belafon (formerly anonevent)
Woodrow @18:
Like I said, I didn’t even want to dig into the article. I just liked the particular paragraph. And yes, I know the world is way more complex than “If Egypt weren’t a dictatorship 9/11 wouldn’t have happened” but Chunky Bobo was at least admitting that having a dictator backed by the US wasn’t helping matters. I think the term is progress.
Persia
@JGabriel: On Friday, Al-Jazeera was showing Egyptian state TV vs. what was happening in the streets. And a few of the Al-Jazeera journalists were arrested today, and their equipment taken away. Maybe control is slipping? Or this is an attempt at a show of openness?
Punchy
My ole lady has vociferously insisted that I not engage in political talks at parties, for fear that I will either spew rude invectives or incite the other person to act similar. My tolerance for such wanton ignorance is at an all-time low, and anyone who would have the stones to announce to me that Palin is “articulate” would be left with an earful they wouldn’t enjoy.
So instead, I just drink more and pet the dog/cat and pretend a naked Katie Perry is in the other room.
ThatLeftTurnInABQ
@lamh32:
and thus we have:
The Hunting of the Huntsman.
..sounds about right. Meta is all the Village knows how to do anyway.
Superluminar
@JGabriel
Ah thankyou. This is not actually the
Argument i had seen, but it was the trend i had noticed both amongst American cities and in the wider world hence my scepticism – here in the UK the trend has been the same from the mid nineties to the present day, even though we haven’t implemented similar policies ( also true of much of the EU). Thanks again.
JGabriel
@Persia:
I think it’s definitely a show of openness. The question is whether it’s just a show, or a preparation for some further state action, or an actual commitment to gradually increasing openness.
.
Superluminar
@punchy
What, Lady GaGa’s pen1s put you off?
jwb
@Persia: About all I would infer from this is the state has determined that, if the it wants to control coverage, it has to acknowledge the obvious. I also find the arrest of the English-language Al-Jazeera reporters an interesting twist: it sounds like the state is more concerned with controlling the information flowing to the broad international audience—it has been reported that Obama has been monitering Al-Jazeera closely—than with the street.
meander
Dr. Gawande was on Fresh Air from WHYY a few weeks ago talking about his new article, for those who are audio-inclined or like to listen to Fresh Air-type programs while driving, cooking, exercising, etc.
Origuy
@gene108: One area of the UK that might be comparable to rural USA is western Scotland, which is lightly populated and travel can be difficult, particularly in the islands.
Mapping hotspots is nothing new. In 1854, a physician named John Snow plotted incidents of cholera in London and discovered they were all connected to a public well that was contaminated by sewage.
JGabriel
@jwb:
Al Jazeera is the major alternative (non-state) news network in Egypt. I doubt Mubarak, et. al.,are more concerned about international opinion than what’s happening outside their door — though I’m sure it’s a factor.
Anyway, the Al Jazeera reporters have been released. Of course, the equipment hasn’t been.
Good point. That may be all we’re seeing here, at the moment.
.
Tom Hilton
The lessons progressives should take from this (and other articles looking seriously at the question of cost control) is that 1) controlling healthcare costs is a complicated endeavor that requires a lot of different simultaneous approaches to different aspects of the problem, and there isn’t any magic bullet that solves the problem by itself (*cough*PublicOption*cough*); and 2) funding a variety of pilot programs and scaling up the successes, as the ACA does, is exactly the right approach.
liberal
@JGabriel:
That’s one thing that drives me nuts about coverage of the effectiveness of this or that anti-crime measure: they never seem to “regress out” the national trend.
Mnemosyne
One of the things that really struck me in that article is how counterproductive it is to try and insert morality into healthcare. Take the 560-pound guy with congestive heart failure who was also an alcoholic and cocaine addict whose recovery wasn’t going very well.
The right wing wants you to say, “Oh, well, he caused all of his own problems, so now he has to deal with the consequences.” But by getting him into this program and not judging him as a bad person, he’s been off cocaine for three years, off alcohol for two years, lost over 200 pounds and lives in much better circumstances once he was able to get on disability.
But Republicans think that improving his life is a bad thing, because he didn’t deserve it.
Steeplejack
@Punchy:
Similar situation here. I was at a very casual social gathering last night, TV on in the background, and someone happened to see Assange on the 60 Minutes piece (sound muted) and sneered, “Who decided this guy should be the judge of what is secret and what isn’t?”
That ticked me off, and, without really intending to, I launched into a Balloon-Juice-quality mini-rant about how no government is going to spontaneously decide, “Hey, we’ve been keeping too much stuff secret, so here it all is,” sunlight is the best disinfectant, 80 percent of the problems we have now are related to dumb-ass stuff that our government (and other institutions, e.g., Wall Street) did in secret, etc., etc. The guy just looked at me and sort of dismissed it all with: “Sorry I hit a nerve.” Nothing on the issue itself. I dialed it back and asked him what he thought is the appropriate level of government secrecy and how you would police it to prevent abuse, but he just mumbled something and initiated the universal “I will pretend I need to get another drink because you are crazy” maneuver.
Later I apologized to the host if I had come on too strong, and he said, “Forget it. Most of these people aren’t politically aware and don’t want to be, and when anything penetrates the bubble it makes them uncomfortable.” I thought that was interesting coming from him, since I think of him as a closet Republican–you know, one of those rare “liberal” Republicans that used to roam the land. I’m pretty sure he voted for Obama, though.
Whatever. End of anecdata. My point is that, like you, I have to watch myself these days when I hear teatard-level stupidity in the real world. It triggers my inner rageaholic. Not saying the guy I talked to was necessarily stupid to be criticizing Assange. It was more the stupidity of the knee-jerk reaction and no interest in actually delving into the issue.
chopper
@Steeplejack:
doesn’t even need to be teatarded shit. i once went on a crazy epic jag on a friend of mine at dinner during the primaries when he said something completely retarded about clinton vs obama. i apparently sounded like i was reading from glengarry glen ross, at least according to the wife.
every so often i hear something so retarded, and am in such a bad mood (or am so surprised and disappointed to hear it from someone who i expected better out of) that i flip the fuck out. i think it’s because i’m getting old and don’t like it.
Steeplejack
That’s part of it, I realize. The guy who made the dismissive comment about Assange is about 40 and works for a high-tech company (in a technical job). You would think–or at least I did, apparently–that someone in that demographic would be at least a little plugged in to what is going on and would have some opinion–right or left–beyond just “Assange bad.”
JCT
@Mnemosyne: As someone who has spent a good part of her career at a big NYC public hospital — THIS. It’s actually an important part of medical school training (IMO) to keep the students sensitized to the real person, not just the seemingly “hopeless” patient. It can be an uphill battle, but some of my students have this sort of empathy and focus — I go out of my way to make sure they ask me for residency letters — more fun to write for them as opposed to the guy with “all the answers” who avoids patients like this.
The article was dead-on, BTW, regarding the patient populations and approaches. We call them “frequent-flyers” and keeping them out of the hospital is a full-time endeavor. Mind you , of course, keeping them out of the hospital is a laudable goal for more than just QoL and cost, but *bad* things happen in hospitals, the less time in, the better off you are.
One of the heart failure clinics I’m affiliated with (the ultimate frequent flyers, BTW) uses this full-court press approach and it works.
But yes, just throwing $$ at the system is not the way to go….lots of thoughtful effort involved, but it really works.
Exurban Mom
@Steeplejack: Oh honey, I feel your pain. I’m resorting to the “drink more” and “move my seat elsewhere” plan or I too become a rageaholic ass.
The stupidity, the severe blind stupidity that passes for Republican thought…I try to avoid it in real life whenever possible, but it is in such large amounts that it staggers the imagination.
2wrongs
I’m somewhat conflicted about this trend in medicine.
Let me explain. All the things that Dr. Gawande has talked about have been around in other fields for over 100 years. This “hot spotting” technique is covered in first year Operations Research courses. At various points in my life I’ve been a sailor, pilot and engineer. I can’t remember a time in my life where I didn’t use a checklist for even the most mudane task.
While I’m very glad that the medical profession is starting to use basic reasoning in attacking public health problems, It seems to me, and it is a little disconcerting, that they seem to be re-inventing the wheel and then telling the tire industry about this great thing that they invented that will revolutionize the transportation industry.
Let me be clear, this is a great thing that they are doing but let us also be clear that considering that doctors are supposed to be bright people, they are somewhat to blame in that they haven’t used basic systems science to solve some of their most basic problems with tools that have been around since the turn of the last century.
Better late than never I suppose.
Bill H.
I read about the first half of it and could not figure out what the hell it was about. What did the initial event, with the guy shot in his car, actually illuistrate? Was the article about health care? I rather though it was about management of police forces, but was unclear what it was trying to say about that management. I gave up reading once I decided that the author didn’t actually know what his subject was any more than I did.
evinfuilt
@PurpleGirl:
Yeah, I got the feeling that most of the problems he ran into were related to people trying to get as much profit out of health care services as possible.
The driving cost in healthcare seems to be profit motivation from many parties.
Nutella
@pk:
Was Palin described as a woman “who is articulate and bright and clean and a nice-looking” like Biden said about Obama?
Tom Hilton
@2wrongs:
Gawande agrees with you. This is precisely the point he makes over and over again, both in his reporting and in his practical efforts to reform the practice of medicine.
2wrongs
@tom hilton
While I haven’t read everything that Gawande has written, the stuff that I have read, didn’t highlight the fact that they were re-inventing the wheel. I mean, the “hot spotting” article mentions that the police use this technique but didn’t mention that this was basic science that is used everywhere to glean information from data.
A small difference but I think it is important as when you start looking at the roots of the tools then you see that there are numerous tools to solve similar problems. At no point did I see that he mention Operations Research or Systems Analysis. Maybe he mentions it in other articles or I didn’t read it closely enough, in which case I apologize.
Tom Hilton
@2wrongs: Read (or read about) The Checklist Manifesto, and you’ll see him making the point that there are things that could vastly improve the practice of medicine that other professions have been doing routinely for years.
Cheryl from Maryland
I have the greatest respect for Dr. Gutwande. His main concern is that stupid shit shouldn’t happen (the checklists). His current issue is a cry for a deep seated commitment from doctors to help patients with multiple issues who cannot improve under the current system. And it is so true. With both my mother and my spouse, quick treatment of symptoms took precedence over trying to answer why the symptoms appeared. My mother died from it. My spouse is improving because we found doctors who can put the pieces together. The ultimate result — already my husband is off several medications and is getting better. So his health is improving and the system is saving money. But what if we hadn’t noticed? — hence the hot spots article. Someone should care and work on the puzzle. Leaving this complexity and motivation up to the patient is a crap shoot.