Month: June 2015

It Takes Longer to Explain a Medical Bill than It Takes to Explain Newton’s Second Law

(p. 4) I CONFESS I filed this column several weeks late in large part because I had hoped first to figure out a medical bill whose serial iterations have been arriving monthly like clockwork for half a year.
As medical bills go, it’s not very big: $225, from a laboratory. But I don’t really want to pay it until I understand what it’s for. It’s not that the bill contains no information — there is lots of it. Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others. It tells me I’m being billed $29.90 for each of nine things, but there is an “adjustment” to one of $14.20.
At first, I left messages on the lab’s billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: “I’m sorry, this is what I’m told, and I don’t want to lose my job.”
. . .
One recent study found that up to 90 percent of hospital bills contain errors.
. . .
Before you embark on the journey of decoding your bill, you might also want to have a look at a tutorial — Understanding Your Medical Bill — produced by the Khan Academy, an online educator, and the Brookings Institution in Washington. It’s a bit over 12 minutes. That’s about five minutes longer than the Khan Academy’s tutorial explaining Newton’s second law.

For the full commentary, see:
ELISABETH ROSENTHAL. “The Medical Bill Mystery.” The New York Times, SundayReview Section (Sun., MAY 3, 2015): 4.
(Note: ellipses added.)
(Note: the date of the online version of the commentary is MAY 2, 2015.)

Under Perverse Institutions, It Takes “Canny Outlaws” to Do What Is Right

Practical Wisdom is a hard book to categorize. It is part philosophy, and one of the co-authors is an academic philosopher. But most of the book consists of often fascinating, concrete examples. The examples are usually of perverse institutions and policies that create incentives and constraints that reward those who do bad and punish those who do good. The authors’ main lesson is that we all should become stoical “canny outlaws” by finding crafty ways to do what is right, while trying to avoid or survive the perverse incentives and constraints.
Maybe–for me the main lesson is that we all should get busy reforming the institutions and policies. But whether their lesson or my lesson is the best lesson, their book is still filled with many great examples that are worth pondering.
In the next few weeks, I will be quoting several of the more useful, or thought-provoking passages.

The book discussed, is:
Schwartz, Barry, and Kenneth Sharpe. Practical Wisdom: The Right Way to Do the Right Thing. New York: Riverhead Books, 2010.

Mathematician Says Mathematical Models Failed

The author of the commentary quoted below is a professor of mathematics at the Baltimore County campus of the University of Maryland.

(p. 4) . . . , in a fishery, the maximum proportion of a population earmarked each year for harvest must be set so that the population remains sustainable.

The math behind these formulas may be elegant, but applying them is more complicated. This is especially true for the Chesapeake blue crabs, which have mostly been in the doldrums for the past two decades. Harvest restrictions, even when scientifically calculated, are often vociferously opposed by fishermen. Fecundity and survival rates — so innocuous as algebraic symbols — can be difficult to estimate. For instance, it was long believed that a blue crab’s maximum life expectancy was eight years. This estimate was used, indirectly, to calculate crab mortality from fishing. Derided by watermen, the life expectancy turned out to be much too high; this had resulted in too many crab deaths being attributed to harvesting, thereby supporting charges of overfishing.
In fact, no aspect of the model is sacrosanct — tweaking its parameters is an essential part of the process. Dr. Thomas Miller, director of the Chesapeake Biological Laboratory at the University of Maryland Center for Environmental Science, did just that. He found that the most important factor for raising sustainability was the survival rate of pre-reproductive-age females. This was one reason, in 2008, after years of failed measures to increase the crab population, regulatory agencies switched to imposing restrictions primarily on the harvest of females.    . . .
The results were encouraging: The estimated population rose to 396 million in 2009, from 293 million in 2008. By 2012, the population had jumped to 765 million, and the figure was announced at a popular crab house by Maryland’s former governor, Martin O’Malley, himself.
Unfortunately, the triumph was short-lived — the numbers plunged to 300 million the next year and then hit 297 million in 2014. Some blamed a fish called red drum for eating young crabs; others ascribed the crash to unusual weather patterns, or the loss of eel grass habitat. Although a definitive cause has yet to be identified, one thing is clear: Mathematical models failed to predict it.

For the full commentary, see:
Manil Suri. “Mathematicians and Blue Crabs.” The New York Times, SundayReview Section (Sun., MAY 3, 2015): 4.
(Note: ellipses added.)
(Note: the date of the online version of the commentary is MAY 2, 2015.)

Genius Physicist Dyson: Global Warming Is a Religion Where Belief Is Strong, Evidence Weak

(p. 8) On to controversial topics: What books would you recommend on climate science? On the relationship between science and religion?
On climate science, I recommend “Cool It: The Skeptical Environmentalist’s Guide to Global Warming,” by Bjorn Lomborg. On science and religion, “The Varieties of Religious Experience,” by William James. Lomborg is an economist, and James was a psychologist. Both books were written by skeptics, with understanding and respect for the beliefs that they were questioning. The reason why climate science is controversial is that it is both a science and a religion. Belief is strong, even when scientific evidence is weak.

For the full interview, see:
“Freeman Dyson: By the Book.” The New York Times Book Review (Sun., April 16, 2015): 8.
(Note: bold in original.)
(Note: the online version of the interview has the date April 19, 2015.)

The Lomborg book recommended by Dyson, is:
Lomborg, Bjørn. Cool It: The Skeptical Environmentalist’s Guide to Global Warming. New York: Alfred A. Knopf, 2007.

Homo Sapiens Arrived in Europe at Least 41,000 Years Ago

(p. D6) . . . , research reported last week in the journal Science adds heft to recent findings that the first modern human migrants arrived earlier than previously thought, perhaps at least 43,000 to 45,000 years ago.
Two teeth found in separate archaeological sites in Italy appeared to tell the tale of the early effect of Homo sapiens in southern Europe. The teeth were those of modern humans who lived 41,000 years ago, scientists concluded. This seemed to settle a longstanding debate over whether the sharp stone blades and ornaments uncovered at the sites belonged to modern humans or Neanderthals.

For the full story, see:
JOHN NOBLE WILFORD. “Teeth Tell of Earlier Trek to Europe by Humans.” The New York Times (Tues., April 28, 2015): D6.
(Note: ellipsis in original.)
(Note: the online version of the story has the date APRIL 27, 2015, and has the title “Teeth Tell of Earlier Trek to Europe by Humans.”)

The academic article summarized above, is:
Benazzi, S., V. Slon, S. Talamo, F. Negrino, M. Peresani, S. E. Bailey, S. Sawyer, D. Panetta, G. Vicino, E. Starnini, M. A. Mannino, P. A. Salvadori, M. Meyer, S. Pääbo, and J. J. Hublin. “The Makers of the Protoaurignacian and Implications for Neandertal Extinction.” Science 348, no. 6236 (May 15, 2015): 793-96.

Jury Out on Whether Bossless Zappos Will Succeed

(p. A1) Brironni Alex was so good at answering telephone calls and emails from customers at Zappos.com Inc. that the company promoted her to customer-service manager.
But when the online retailer adopted a management philosophy called Holacracy, she lost her job title and responsibility for performance reviews. Since the end of April, Zappos has zero managers to oversee employees, who are supposed to decide largely for themselves how to get their work done.
“I am managing the work, but before I was managing the worker,” says Ms. Alex, 26 years old, now part of a team implementing Holacracy throughout Zappos. Ex-managers haven’t been guaranteed another job and could have their pay cut next year, though Zappos says that is unlikely. Ms. Alex says the changes give her more time for a workplace diversity committee and to perform on the Zappos dance team.
The shake-up has been jarring even for a company famous for doing things differently. Earlier this month, Zappos said about 14%, or 210, of its roughly 1,500 employees had decided Holacracy wasn’t for them, and they will leave the retailer.
They were offered at least three months of severance pay by Zappos Chief Executive Tony Hsieh, who wrote in a 4,700-word memo in March that the company hadn’t “made fast enough progress towards self-management.”
. . .
(p. A10) Mr. Hsieh, 41, concedes that Holacracy “takes time and a lot of trial and error.” He still has faith that the system empowers employees “to act more like entrepreneurs” and stokes faster “idea flow,” collaboration and innovation, he says.
. . .
Research shows that the value of flat organizations is mixed, though highly motivated workers who thrive on creativity generally are best suited for going bossless.
The results at Zappos will be watched closely because it has long embraced employee independence even while striving to meet exacting customer-service standards. “Delivering Happiness,” a 2010 book by Mr. Hsieh, was a best seller and spawned a management consulting firm.
. . .
“They are adopting Holacracy as more how to get to the next level, as opposed to how to fix something broken in their system, which is actually one of their unique challenges,” says Brian Robertson, 36, the inventor of Holacracy. The term comes from the word “holarchy,” coined by writer Arthur Koestler for self-organizing units that combine to form a larger organization.

For the full story, see:
RACHEL EMMA SILVERMAN. “Going Bossless Backfires at Zappos.” The Wall Street Journal (Thurs., May 21, 2015): A1 & A10.
(Note: ellipses added.)
(Note: the date of the online version of the story is MAY 20, 2015, and has the title “At Zappos, Banishing the Bosses Brings Confusion.”)

Ed Telling’s Band of Irregulars Had the Freedom to Perform

(p. 482) . . . Bill Sanders, Charlie Bacon’s replacement as the head of corporate personnel, . . . had once served Telling in the East despite having hair that flowed far below his ears. Sanders had grown his hair out in order to irritate an old-school store manager who exercised his sovereign rights by refusing to hire any man not sporting a crew cut. The fact that Telling never told Sanders to cut his hair was an early indication to others in the East that Ed Telling was much more interested in people who could do the job and who exhibited a healthy contempt for the status quo than he was in appearances.
. . .
(p. 492) It was more than dumb luck that his band of loyalists happened to include several supersensitive and insecure men, some deeply religious men, some obsessively ambitious men, several quite short men, and others, from secretaries to former window-dressers, who never fit into the status quo until Ed Telling discovered them and helped them flourish among his private band of irregulars. Along the way, the Eastern Territory troupe was joined by others. Whether they were bright-button kids from Utah itching to accomplish an act that truly counted on a large scale, or frustrated wordsmiths so enamored of the metaphors of power that the practice of management appeared to them in Biblical panoramas, they all had a part. All irregulars were welcome, and in his quiet way Ed Telling played them all. Telling could sense through instinct which people were willing to submit and which ones were willing to fight. Far from being unaware of his motivational skills, Telling would on occasion call Pat Jamieson into his office after one of his managers left, then convey to Pat the elliptical words he’d uttered to the manager, and predict the number of days it would take the officer to come back with the problem ironed out. He was rarely off by more than twenty-four hours. He said his management style involved giving subordinates a great deal of freedom, “the freedom,” he called it, “to perform.”

Source:
Katz, Donald R. The Big Store: Inside the Crisis and Revolution at Sears. New York: Viking Adult, 1987.
(Note: ellipses added.)

Constitutional Superheroes Created the American Nation

(p. 12) When and how did the United States ­become a nation? This question is the core of “The Quartet.” In his customary graceful prose, Joseph J. Ellis, the author of such works of popular history as the prizewinning “Founding Brothers,” argues that the United States did not become a nation with the Declaration of Independence in 1776. Rather, he says, American nationhood resulted from the creation, adoption and effectuation of the United States ­Constitution.
Ellis declares, “Four men made the ­transition from confederation to nation ­happen. . . . George Washington, Alexander Hamilton, John Jay and James Madison” (along with three supporting players: Robert Morris, Gouverneur Morris and Thomas Jefferson). He writes that “this political quartet diagnosed the systemic dysfunctions under the Articles, manipulated the political process to force a calling of the Constitutional Convention, collaborated to set the agenda in Philadelphia, attempted somewhat successfully to orchestrate the debates in the state ratifying conventions, then drafted the Bill of Rights as an insurance policy to ensure state compliance with the constitutional settlement. If I am right, this was arguably the most creative and consequential act of political leadership in American history.”
. . .
Ellis’s “quartet” are constitutional superheroes, the Fantastic Four of American nationalism.

For the full review, see:
R. B. BERNSTEIN. “Gang of Four.” The New York Times Book Review (Sun., MAY 10, 2015): 12.
(Note: ellipsis internal to paragraph, in original; ellipsis between paragraphs, added.)
(Note: the online version of the review has the date MAY 5, 2015, and has the title “”The Quartet,’ by Joseph J. Ellis.”)

The book under review, is:
Ellis, Joseph J. The Quartet: Orchestrating the Second American Revolution, 1783-1789. New York: Alfred A. Knopf, 2015.

Having Your Intellectual Property Stolen, Modifies Your Views on Piracy

(p. C18) Dear Dan,
My nephew has been downloading music and movies illegally from the Internet. Without sounding self-righteous, how can I get him to respect intellectual-property rights?
–Patricia
My own view on illegal downloads was deeply modified the day that my book on dishonesty was published–when I learned that it had been illegally downloaded more than 20,000 times from one overseas website. (The irony did not escape me.) My advice? Get your nephew to create something and then, without his knowing, put it online and download it many, many times. I suspect that will make it much harder for him to keep up his blithe attitude toward piracy.

For the full advice column by Dan Ariely, professor of behavioral economics at Duke , see:
DAN ARIELY. “ASK ARIELY; It’s Risky to Rely on Retirement Questionnaires.” The Wall Street Journal (Sat., May 23, 2015): C18.
(Note: italics in original.)
(Note: the online version of the advice column has the date May 22, 2015.)

Hominins Used Stone Tools at Least 3.3 Million Years Ago

(p. A4) One morning in July 2011, while exploring arid badlands near the western shore of Lake Turkana in Kenya, a team of archaeologists took a wrong turn and made a big discovery about early human technology: Our hominin ancestors were making stone tools 3.3 million years ago, some 700,000 years earlier than previously thought.
The findings promise to extend knowledge of the first toolmakers even deeper in time, probably before the emergence of the genus Homo, once considered the first to gain an evolutionary edge through stone technology.
. . .
The stones showed that at least some ancient hominins — the group that includes humans and their extinct ancestors — had started intentionally knapping stones, breaking off pieces with quick, hard strikes from another stone to make sharp tools sooner than other findings suggested.
After further field research and laboratory analysis, the findings at the site known as Lomekwi 3 were described Wednesday in the journal Nature.
. . .
In a commentary in the journal, Erella Hovers, an archaeologist at the Hebrew University of Jerusalem, wrote that some form of toolmaking may have extended back to the last common ancestor of chimpanzees and hominins, as much as seven million years ago.
Dr. Hovers and other scientists not involved in the new research said that the dating of the material appeared solid and that the objects were deliberately produced tools, not scraps of rock broken by accident or natural causes.
“Because the sediments in these layers are fine-grained, and a flake found by the authors could be fitted back onto the core from which it had been detached,” Dr. Hovers said, “it is unlikely that the tools accumulated through stream activity or that substantial disturbance of the sediments occurred after the tools had been discarded.”

For the full story, see:
JOHN NOBLE WILFORD. “Stone Tools From Kenya Are Oldest Yet Discovered.” The New York Times (Thurs., May 21, 2015): A4.
(Note: ellipses added.)
(Note: the date of the online version of the story is MAY 20, 2015.)

The academic article summarized above, is:
Harmand, Sonia, Jason E. Lewis, Craig S. Feibel, Christopher J. Lepre, Sandrine Prat, Arnaud Lenoble, Xavier Boës, Rhonda L. Quinn, Michel Brenet, Adrian Arroyo, Nicholas Taylor, Sophie Clément, Guillaume Daver, Jean-Philip Brugal, Louise Leakey, Richard A. Mortlock, James D. Wright, Sammy Lokorodi, Christopher Kirwa, and Dennis V. Kent. “3.3-Million-Year-Old Stone Tools from Lomekwi 3, West Turkana, Kenya.” Nature 521, no. 7552 (May 21, 2015): 310-15.

Sears Democratized the Washing Machine

(p. 301) The pieces of a new dream had finally been drawn in–big, diverse businesses that could combine as a sum greater than the proverbial parts. Now Sears could continue to “democratize” products that were previously too expensive or sophisticated for everyday people.
The automatic washing machine was an artifact owned only by the rich until Sears democratized the machine in 1942: $37.95–three bucks down and four more a month on time. The process was at the core of the entire industrial revolution-the humbling of products: buckles, buttons, and beer–and the efficient distribution of previously unattainable things to the huge pools of human desire called markets. Now the possibility stood before them of starting the cycle all over again.
Sears could spin a grand, gilded net for the people that included housing, mortgages, all manner of insurance, variations on banking sources, investment services, and, of course, consumer goods. People could get a house from Sears again. When the system was up and running, they could even get the money to buy the house; get the stuff that goes in the house; and the services that ensure the sustenance of the house if something unforeseen happens.

Source:
Katz, Donald R. The Big Store: Inside the Crisis and Revolution at Sears. New York: Viking Adult, 1987.