How “Single-Payer” Socialized Medicine Works for American Indians

(p. A1) EAGLE BUTTE, S.D.—Kate Miner walked into the Indian Health Service hospital, seeking help for a cough that wouldn’t quit.

An X-ray taken of Ms. Miner’s lungs that day, Oct. 19, 2016, found signs of cancer.

What exactly the IHS doctor said to Ms. Miner about her exam remains in dispute. Notations in her medical file indicate the doctor told her to come back for a lung scan the next day. Her family says they never were given such instructions and weren’t told of the two masses the X-ray revealed.

What is clear is that no further tests were done. And no IHS provider followed up when Ms. Miner returned twice more to the hospital, the only one on the Cheyenne River Reservation, over the next six months, medical records show.

Finally, on May 7, 2017, as the 67-year-old Ms. Miner lay crumpled on a hospital cot, the right side of her body shaking, a physician assistant ordered a CT scan, after her family insisted, according to the records and family members.

“You have two very large masses in your right lung. It’s probably a malignancy,” Ms. Miner’s daughter Kali Tree Top recalled the physician assistant saying.

Ms. Miner reached for her daughter’s hand and started to cry.

Ms. Miner’s encounters with the IHS, and her family’s repeated efforts to get her help there, illustrate how the federal agency can fail the patients who need it most.

For the full story, see:

Dan Frosch. “A Tragic Journey Through the Indian Health Service.” The Wall Street Journal (Tuesday, December 24, 2019): A1 & A8.

(Note: the online version of the story was updated December 23, 2019, and has the title “Kate Miner’s Tragic Journey Through the U.S. Indian Health Service.”)

Opposed by China and WHO, Trump Administration Declared Covid-19 Public Health Emergency on January 31, 2020

(p. A1) The U.S. imposed entry restrictions on foreign nationals and quarantines on Americans returning from the Chinese province at the center of the coronavirus outbreak, as markets tumbled over fears about the impact on global growth.

Health and Human Services Secretary Alex Azar declared a public health emergency Friday [Jan. 31, 2020]. He said foreign citizens who have traveled anywhere in China within the past 14 days would be denied U.S. entry, while Americans who visited Hubei province would be quarantined for up to two weeks.

. . .

(p. A8) “Many countries have offered China support in various means. In sharp contrast, certain U.S. officials’ words and actions are neither factual nor appropriate,” Chinese Foreign Ministry spokeswoman Hua Chunying said. “Just as the WHO recommended against travel restrictions, the U.S. rushed to go in the opposite way.”

For the full story, see:

Alex Leary and Brianna Abbott. “U.S. Curbs Entry to Combat Virus.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A8.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story has the date January 31, 2020, and has the title “U.S. Imposes Entry Restrictions Over Coronavirus.”)

Apple Will Make Its Own Mac Processor Chips

In similar stories told in books by Grove and by Christensen and Raynor, technology firms work better when large, if components require careful design to work well together. When components become standardized and interchangeable, technology firms work better when smaller, buying components from specialized component suppliers. Deciding what is best at any moment requires uncertain judgement, and can change over time. In the passages quoted below, it appears that Apple thinks better performance can be achieved by integrating a key component back within the firm.

(p. B4) Apple Inc. built its gadget empire by outsourcing production to a vast ecosystem of chip makers and other component specialists. Under Chief Executive Tim Cook, it is taking a lot of that business back.

The company, which released its first iPhone processor in 2010, said Monday [June 22, 2020] it plans to ship Macs later this year with custom chips, a move that ends a 15-year technology partnership with Intel Corp. Apple said the custom-designed chips are more efficient and offer higher-performance graphics.

. . .

The strategy springs from Apple’s philosophy—fostered by its late co-founder Steve Jobs—that owning core technologies provides a competitive edge. Customized chips and sensors can help its iPhone, iPads and Macs leapfrog rivals in battery performance and features. It also can protect Apple from Chinese rivals that buy universally available parts.

. . .

The initiative—called insourcing by some suppliers and analysts—can give Apple a two-year jump on competitors in device performance because Apple can plan how multiple chips work together to limit power consumption and free up space inside iPhones and iPads for other components, analysts said.

It also reduces potential leaks of its product plans.

For the full story, see:

Tripp Mickle. “By Making Its Chips, Apple Gains Control.” The Wall Street Journal (Wednesday, June 24, 2020): B4.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story was updated June 24, 2020, and has the title “Apple Is the Newest Chip Giant in Town.”)

The Grove book mentioned above is:

Grove, Andrew S. Only the Paranoid Survive: How to Exploit the Crisis Points That Challenge Every Company. New York: Bantam Books, 1999.

The Christensen and Raynor book mentioned above is:

Christensen, Clayton M., and Michael E. Raynor. The Innovator’s Solution: Creating and Sustaining Successful Growth. Boston, MA: Harvard Business School Press, 2003.

“Run With the Herd or Be Crushed by It”

The author of the passages quoted below writes poetry and novels in Havana.

(p. 7) Throughout my life, I’ve seen how powerless parents are in matters regarding their own children. Parents have no say over how their children should be raised, whether they will be conscripted or sent away to school in rural areas, and what dangers could befall them being so far from home and such a young age. They have no say over their children’s manners, religious teachings and political ideologies. There are only two choices: Run with the herd or be crushed by it.

As a teenager in the 1980s, I was taught in a “scientific communism” class that family was the heart of society. But from what I could see, that was no longer the case; organizations with mass followings like the Young Communist League had taken its place.

. . .

I was born and raised in a system that exerts control under the guise of paternalism — a system that caresses you as it beats you, that teaches you but also inhibits you, enlightens you and censures you. We are hostages to a government that behaves like an abusive, old-fashioned and sexist father, from whom we must seek consent and forgiveness.

For the full commentary, see:

Wendy Guerra. “Cuban Women Need a Revolution.” The New York Times, SundayReview Section (Sunday, October 13, 2019): 7.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Oct. 12, 2019, and has the title “‘Cuban Women Await Their #MeToo Moment.” The first paragraph quoted above is from the online version and differs in several respects from the equivalent paragraph in the print version.)

Resilient Eaten Beetle Persists to the End

(p. D2) It’s a familiar story: Predator hunts prey. Predator catches prey. Predator gulps down prey.

Usually, that’s it. But the water scavenger beetle Regimbartia attenuata says, “Not today.” After getting swallowed by a frog, this plucky little insect can scuttle down the amphibian’s gut and force it to poop — emerging slightly soiled, but very much alive.

For the full story, see:

Katherine J. Wu. “A Beetle Swallowed By a Frog Decides To Do an End Run.” The New York Times (Tuesday, August 11, 2020): D2.

(Note: the online version of the story has the date August 3, 2020, and has the title “There Are Two Ways Out of a Frog. This Beetle Chose the Back Door.”)

The scavenger beetle’s escape is documented in:

Sugiura, Shinji. “Active Escape of Prey from Predator Vent Via the Digestive Tract.” Current Biology 30, no. 15 (2020): 867-68.

Wasteful Administrative Health Care Costs

The study quoted from below suggests that the main cure for wasteful administrative costs is a “single payer” system, which is a politically correct euphemism for socialized medicine. I suggest that a better cure would be to eliminate the government middle-man, and make the patient be the payer. The patient as payer would seek and buy low-cost cures or therapies, which would shift efforts at healthcare innovation toward lower cost innovations. As has been suggested for education, vouchers could provide poor patients with the means to pay for basic care.

(p. B4) Even a divided America can agree on this goal: a health system that is cheaper but doesn’t sacrifice quality. In other words, just get rid of the waste.
A new study, published Monday [October 7, 2020] in JAMA, finds that roughly 20 percent to 25 percent of American health care spending is wasteful. It’s a startling number but not a new finding. What is surprising is how little we know about how to prevent it.

. . .

Teresa Rogstad of Humana and Natasha Parekh, a physician with the University of Pittsburgh, were co-authors of the study, which combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy.

. . .

The estimated waste is at least $760 billion per year. That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.

. . .

The largest source of waste, according to the study, is administrative costs, totaling $266 billion a year. This includes time and resources devoted to billing and reporting to insurers and public programs. Despite this high cost, the authors found no studies that evaluate approaches to reducing it.

For the full commentary, see:

Austin Frakt. “THE NEW HEALTH CARE; Up to 25% of Health Costs Called Wasteful.” The New York Times (Tuesday, October 8, 2019): B4.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the commentary has the date Oct. 7, 2019, and has the title “THE NEW HEALTH CARE; The Huge Waste in the U.S. Health System.”)

The print version of the academic article in JAMA mentioned above is:

Shrank, William H., Teresa L. Rogstad, and Natasha Parekh. “Waste in the Us Health Care System: Estimated Costs and Potential for Savings.” JAMA 322, no. 15 (Oct. 15, 2019): 1501-09.

Jim Collins Book “Had a Huge Influence” on Reed Hastings’s Creation of Netflix

(p. 6) The Netflix founder and co-chief executive, whose new book is ‘No Rules Rules,’ reads with his mind more than his heart: ‘I generally turn more to television and film for emotional nourishment.’

. . .

What’s your favorite book no one else has heard of?

Probably “Beyond Entrepreneurship,” by Jim Collins and William C. Lazier. It’s not nearly as well known as Collins’s “Good to Great” or “Built to Last” in the pantheon of influential business books. But it came out in the early 1990s, right around the time I was starting my first company, Pure Software. It had a huge influence on how I thought about that business and, later, what I aspired to create at Netflix. Collins and other business authors whose books I benefited from are a big reason I decided to write a book of my own, to try to pay it forward to other entrepreneurs in the same way those other authors have. Years from now, it would be great if someone who found “No Rules Rules” useful today writes their own book improving on it..

. . .

What do you plan to read next?

“Shoe Dog,” the memoir by Phil Knight, who created Nike — and yes, we’re also adapting it for Netflix.

For the full interview, see:

“By the Book; Reed Hastings.” The New York Times Book Review (Sunday, September 27, 2020): 6.

(Note: the online version of the interview has the date Sept. 24, 2020, and has the title “By the Book; Reed Hastings, the Founder of Netflix, Keeps His Library in His Pocket.” The first sentence quoted above, and the questions, are by the New York Times interviewer, who is not identified in either the print or the online versions. The rest is by Reed Hastings. The first sentence quoted above is in the print, but not the online, version.)

Reed Hastings’s book mentioned above is:

Hastings, Reed, and Erin Meyer. No Rules Rules: Netflix and the Culture of Reinvention. New York: Penguin Press, 2020.

Jim Collins’s co-authored book mentioned above is:

Collins, James C., and William C. Lazier. Beyond Entrepreneurship: Turning Your Business into an Enduring Great Company. Paramus, NJ: Prentice Hall, 1992.

Phil Knight’s memoir mentioned above is:

Knight, Phil. Shoe Dog: A Memoir by the Creator of Nike. New York: Scribner, 2016.

Bikini Atoll Is “Best Example of the Earth’s Resilience”

(p. A13) . . . “The Age of Nature” is not just a beautifully made series, it’s also a surprisingly joyful one. It’s about rehabilitation—how humans are correcting environmental outrages from Panama to Mozambique to Central China to Yellowstone Park—and how forgiving Mother Nature can be if we just pay her some affectionate attention.  . . .

The best example of the Earth’s resilience might be the first location visited, Bikini Atoll—or, rather, the crater left by the 23 nuclear detonations the U.S. set off there from 1946-58. More than 60 years later, humans still can’t live in the immediate area, but under the South Pacific’s surface, anemones, polyps, sharks and wrasses flourish in and around the coral reefs that have somehow clung or sprung back to life.  . . .

Elsewhere around the globe, similar acts of restoration and reparation are taking place, or already have: In the ’90s, China’s Loess Plateau, a vast expanse of arable but powdery soil, had been all but ruined by deforestation and grazing, until a massive effort was undertaken to terrace the land and reforest it. Similarly, the Gorongosa National Park in Mozambique, which once suffered the multiple threats of warfare, poaching, and poaching to finance warfare, had to be restocked with certain animals—200 buffalo, for instance, and 180 wildebeest—but other species, such as lions, have re-emerged on their own.

For the full review, see:

John Anderson. “TELEVISION REVIEW; ‘The Age of Nature’: Back From the Brink.” The Wall Street Journal (Thursday, October 15, 2020): A13.

(Note: ellipses added.)

(Note: the online version of the review has the date October 14, 2020, and has the title “TELEVISION REVIEW; ‘The Age of Nature’ Review: Back From the Brink.”)

Even Chimps Seek Cool Comfort

Some humans reject air conditioning. Chimps are unable to create air conditioning. But when they discover a cool cave in a hot summer, they spend time in the cave.

(p. D2) Everyone needs to cool off on a scorching summer day, even chimpanzees. Where do the primates go on sizzling days when woodlands and forests don’t provide respite from the heat?

Caves.

. . .

In southeastern Senegal, temperatures spike to 110 degrees Fahrenheit and fires burn large parts of the landscape over a seven-month dry season. Several natural cave formations pock the terrain, and they can be up to 55 degrees cooler than the surrounding grasslands.

For the full story, see:

Priyanka Runwal. “Why Chimp Moms Flock to Caves on the Savanna.” The New York Times (Tuesday, August 11, 2020): D2.

(Note: ellipsis added.)

(Note: the online version of the story was updated on August 6, 2020, and has the same title as the print version.)

See also:

Diamond, Arthur M., Jr. “Keeping Our Cool: In Defense of Air Conditioning.” Economics & Business Journal: Inquiries & Perspectives 8, no. 1 (Oct. 2017): 1-36.

WHO “Expert” Committee Took Four Months to Endorse Widespread Mask-Wearing

(p. A1) GENEVA—Sylvie Briand landed in China looking for answers. Nearly a month had passed since word of a mysterious pneumonia had emerged. It was now late January and the World Health Organization was struggling to learn more about it.

Frustrated with mounting cases and limited information from China, the WHO’s top brass, including Dr. Briand, flew to Beijing to resolve a burning question: How easily did this new disease spread?

They met with President Xi Jinping. They had a phone call with local WHO staff just back from the Wuhan epicenter, quarantined after one developed a cough. Dr. Briand, the agency’s director of global infectious hazard preparedness, drew up a list of questions for Chinese health officials.

By the time the WHO received answers, the Covid-19 pandemic was stumbling into emergency rooms on three continents. Its spread around the world had already begun on Jan. 30 [2020] when the WHO declared a global public-health emergency, its one and only level of alert.

. . .

(p. A10) “Now is the moment for all countries to be preparing themselves,” Director-General Tedros Adhanom Ghebreyesus declared on Feb. 4, when the WHO reported more than 20,600 cases in 25 countries.

But that same day, the WHO also asked nations not to close borders—following its standard protocol, as such restrictions might discourage governments from reporting outbreaks. Within weeks, the virus landed on the agency’s doorstep, turning Geneva into a hot spot.

. . .

To write its recommendations, the WHO solicits outside experts, which can be a slow process. It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.

. . .

A review of the WHO’s initial response to the pandemic, based on interviews with current and former WHO staff, public-health experts advising it and officials who work with it, suggests that the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.

. . .

On Jan. 3 [2020], representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew. That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.

China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations, said Lawrence Gostin, professor of global health law at Georgetown University who has advised the WHO on international health regulation matters. “Once a government knows that there is a novel virus that fits within the criteria, which China did, it’s obliged to report rapidly,” he said.

China also flouted the IHR by not disclosing all key information it had to the WHO, said David Fidler, an expert on global health and international law at the Council on Foreign Relations. The regulations call for member states to provide the WHO with “timely, accurate and sufficiently detailed public health information available to it on the notified event.”

For the full story, see:

Betsy McKay and Drew Hinshaw. “Doctors Split on Best Way To Treat Coronavirus Cases.” The Wall Street Journal (Saturday, August 29, 2020): A1 & A10.

(Note: ellipses, and bracketed years, added.)

(Note: the online version of the story has the date August 28, 2020, and has the title “How Coronavirus Overpowered the World Health Organization.”)

Young Doctor “Taken Aback” by Deaths Under Nationalized Medicine

(p. 26) Westaby’s book will be a balm to the hearts of curmudgeons everywhere. Sidestepping the contemporary hand-wringing about the lack of empathy in medicine, Westaby, a British surgeon, positions empathy as a threat to the surgical career: “Heart surgery,” he writes, “needs to be an impersonal, technical exercise.”

. . .

The deaths that truly madden him are those that could have been prevented by available technologies not then funded by the British National Health Service (N.H.S.), his employer.

. . .

As a young doctor who imagines nationalized medicine as a way toward comprehensive care for all my patients, I was taken aback.

For the full review, see:

Rachel Pearson. “SHORTLIST; Medical Memoirs.” The New York Times Book Review (Sunday, July 2, 2017): 26.

(Note: the online version of the review has the date June 27, 2017, and has the title “SHORTLIST; Four Timely Memoirs from the Halls of Medicine.”)

The book under review is:

Westaby, Stephen. Open Heart: A Cardiac Surgeon’s Stories of Life and Death on the Operating Table. New York: Basic Books, 2017.