Category: Economics

Medical Paperwork Wastes Resources and Burns Out Physicians

(p. A23) Consider the use of medical scribes, who complete doctors’ electronic paperwork in real time during patient visits. The American College of Medical Scribe Specialists reported that 20,000 scribes were working in 2014, and expects that number to climb to 100,000 in 2020.

I have heard doctors say they need a scribe to keep up with electronic medical records, the mounting demand of which is driving a burnout epidemic among physicians. Scribes allow doctors to talk with and examine patients without having a computer come between them, but at base they are a workaround for the well-known design flaws of electronic medical records.

As a nurse, when I first learned about scribes, I was outraged. On the job, nurses hear repeatedly how health care companies can’t afford to have more nurses or aides to work with patients on hospital floors — and yet, money is available to pay people to manage medical records. Doctors who use scribes tend to see their productivity and work satisfaction increase, but the trade-off is still there: Scribes demonstrate the extent to which paperwork has become more important than patients in American health care.

For the full commentary, see:

Theresa Brown. “Our Jury-Rigged Health Care.” The New York Times (Friday, September 6, 2019): A23.

(Note: the online version of the commentary has the date September 5, 2019, and has the title “The American Medical System Is One Giant Workaround.”)

Median Income Rising More Under Trump Than Under Bush and Obama

Source of graph: online version of the WSJ article quoted and cited below.

(p. A17) President Trump’s critics can’t deny that the economy is doing well, so instead they insist all the benefits have gone to the rich and large corporations. “America’s middle class is under attack,” Sen. Elizabeth Warren asserted in her presidential campaign announcement last December.

The latest data from the Census Bureau monthly surveys tell a different story. Real median household income—the amount earned by those in the very middle—hit $65,084 (in 2019 dollars) for the 12 months ending in July. That’s the highest level ever and a gain of $4,144, or 6.8%, since Mr. Trump took office. By comparison, during 7½ years under President Obama—starting from the end of the recession in June 2009 through January 2017—the median household income rose by only about $1,000.

These statistics were published by two former census income-research specialists with 50 years experience who now run Sentier Research, a nonpartisan research group.

For the full commentary, see:

Stephen Moore. “Trump’s Middle-Class Economic Progress.” The Wall Street Journal (Monday, Sept. 30, 2019): A17.

(Note: the online version of the commentary has the date Sept. 29, 2019, and has the same title as the print version.)

Environmentalist Greta Thunberg’s Sailboat Crew Flew to and from New York by Airplane

(p. B4) A year ago, a 15-year-old in leopard-print tights sat down outside the Swedish Parliament building with a purple backpack and a sign announcing she was on strike over climate change.

This week, Greta Thunberg arrived by solar-powered sailboat in New York, now as the 16-year-old poster child for younger generations’ climate angst. Also making its way to the New World, as evidenced in the coverage of her carbon-neutral trip, was a concept that in just a few years has swept Europe: flight shame, often hashtagged in the original Swedish, #flygskam.

. . .

As Greta . . . hopped ashore in southern Manhattan on Wednesday after 13 days at sea, loud cheers rose from the hundreds in the crowd there to greet her.  . . .

Amanda LaValle, a mother of three from Kingston, N.Y., brought her two eldest daughters to be part of the crowd. “I’m encouraging them to be involved. I have already blown my own climate credentials by having three kids,” she said, half in jest.

She acknowledged how difficult it can be to put her principles into practice. Earlier in August, when she needed to travel to Minneapolis for a three-day training sponsored by Al Gore’s Climate Reality Project, she briefly considered taking the train. But, she said, “It would have taken two days and I couldn’t see taking more time away from my family.”

Greta’s voyage has had its own critics, who have pointed out that some members of the sailing crew will return by plane, while others fly in to sail the boat back to Europe.

Boris Herrmann, captain of the sailboat, Malizia II, said that the criticism was expected but that Greta shouldn’t be held responsible for the flights by crew members. “We are kind of the ferry to bring her over. We’re a professional sailing team and sometimes we need to fly. We used this voyage also to train,” he said, adding that the team offsets its flights by funding sustainability projects, including mangrove planting in Indonesia. “The trip is an example of how difficult it is to have zero carbon impact.”

For the full story, see:

Sofia McFarland. “‘Flight Shame’ Comes to U.S.—Via Sailboat.” The Wall Street Journal (Saturday, Aug. 31, 2019): B4.

(Note: ellipses added.)

(Note: the online version of the story was last updated on Aug. 30, 2019, and has the title “‘Flight Shame’ Comes to the U.S.—Via Greta Thunberg’s Sailboat.” Where the online and print versions differ, the passages quoted above follow the more detailed online version.)

A.I. Needs People to Set the Objectives

(p. A2) Although Deep Mind’s Alpha Zero can beat a grand master at computer chess, it would still bomb at Attie Chess—the version of the game played by my 3-year-old grandson Atticus. In Attie Chess, you throw all of the pieces into the wastebasket, pick each one up, try to put them on the board and then throw them all in the wastebasket again. This apparently simple physical task is remarkably challenging even for the most sophisticated robots.

But . . . there’s a more profound way in which human intelligence is different from artificial intelligence, and there’s another reason why Attie Chess may be important.

. . .

The basic technique is to give the computer millions of examples of games, images or previous judgments and to provide feedback. Which moves led to a high score? Which pictures did people label as dogs?

. . .

But people also can decide to change their objectives. A great judge can argue that slavery should be outlawed or that homosexuality should no longer be illegal. A great curator can make the case for an unprecedented new kind of art, like Cubism or Abstract Expressionism, that is very different from anything in the past. We invent brand new games and play them in new ways.

. . .

Indeed, the point of each new generation is to create new objectives—new games, new categories and new judgments. And yet, somehow, in a way that we don’t understand at all, we don’t merely slide into relativism. We can decide what is worth doing in a way that AI can’t.

. . .

. . . , we are the only creatures who can decide not only what we want but whether we should want it.

For the full commentary, see:

Alison Gopnik. “MIND & MATTER; What A.I. Is Still Far From Figuring Out.” The Wall Street Journal (Saturday, March 23, 2019): A2.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 20, 2019, and has the same title as the print version.)

Alison Gopnik’s comments, that are quoted above, are related to her paper:

Gopnik, Alison. “AIs Versus Four-Year-Olds.” In Possible Minds: Twenty-Five Ways of Looking at AI, edited by John Brockman. New York: Penguin Press, 2019, pp. 219-30.

“Tech Entrepreneurs Are Just as Mission Driven as People in Nonprofits”

(p. 2) The first rule of Silicon Valley venture capital is never insult a start-up. Founders are always killing it, disrupting the world.

If a start-up is fizzling, shuttering or caught scamming? The socially acceptable response is total silence.

Everyone knows that. Except Jason Palmer.

The start-up in question was AltSchool, a Mark Zuckerberg-backed project to turn school into a start-up experience. It had just announced it was pivoting out of existence after raising $174 million.

Mr. Palmer is in this field: He is a venture capitalist in Washington, D.C., focused on education technology. On June 29, he tweeted that AltSchool was always a bad idea, and he was glad that his firm hadn’t invested in it.

That single jab at a failed company sent the investor elite into conniptions.

. . .

So, two months after the tweet, how is Mr. Palmer feeling? The outrage that came both in public and private did not, in the end, oust him from the industry. He continues to invest.

For him, it was “a reminder,” he said, that tech entrepreneurs truly believe they are saving the world. He wanted to be clear now that he truly believes this, too. They were right. His tweet was very bad. He has been chastened.

“Tech entrepreneurs are just as mission driven as people in nonprofits,” Mr. Palmer said. “They believe they are helping the world just as much as nonprofit founders.”

But of course most start-ups fail, he added, a little quieter, and the tech world ought to learn how to talk about failure.

“In fact, most high-risk start-ups are nonprofits,” he said. “Effectively nonprofits.”

For the full story, see:

Nellie Bowles. “In Silicon Valley, Skin Is Thin.” The New York Times, SundayStyles Section (Sunday, Sept. 22, 2019): 2.

(Note: ellipsis added.)

(Note: the online version of the story has the date Sept. 20, 2019, and has the title “Want to Do Business in Silicon Valley? Better Act Nice.” (Where there is a slight difference in wording between the online and print versions, the passages quoted above follow the print version.)

Some Workers Willingly Forego Higher Pay for Greater Flexibility

(p. 11) In a survey of 11,000 workers and 6,500 business leaders by Harvard Business School and Boston Consulting Group, the vast majority said that among the new developments most urgently affecting their businesses were employees’ expectations for flexible, autonomous work; better work-life balance; and remote working. (Just 30 percent, though, said their businesses were prepared.)

Technology is a big reason for the change. The youngest people entering the work force don’t remember a time when people weren’t always reachable, so they don’t see why they would need to sit in an office to work. (They also say they are more practiced than older colleagues at setting boundaries on how much they use their phones, so it doesn’t become overbearing.)

. . .

. . . more young people, recruiters say, are asking for flexibility upfront, and some prioritize it over pay or seniority. Recruiters who visit college campuses say new graduates no longer see it as something to negotiate for, said Marcee Harris Schwartz, the national director of diversity and inclusion at BDO, the accounting firm: “It’s just assumed it’s part of the deal.”

“Years ago, the interview was, for lack of a better word, a test,” said Kamaj Bailey, who works in recruiting at Con Edison, the power company. “Now it’s a conversation. Yes, I want to show that I’m a good candidate, but I’m also seeing if I’m going to get what I expect.”

John Paul Graff, 34, is a pathologist, as was his father, who worked in private practice at least 12 hours a day. Dr. Graff decided to work in academic medicine, and the No. 1 reason was for work-life balance. He estimated that he gave up about $100,000 a year but said it’s worth it to work 40 hours a week.

For the full story, see:

Claire Cain Miller and Sanam Yar. “Can I Work When I Want?” The New York Times, SundayStyles Section (Sunday, Sept. 22, 2019): 1 & 10-11.

(Note: ellipses added.)

(Note: the online version of the story has the date Sept. 20, 2019, and has the title “Young People Are Going to Save Us All From Office Life.”)

Broad Knowledge “Prepares Us for the Wickedly Unanticipated”

(p. A13) In his latest book, “Range: Why Generalists Triumph in a Specialized World,” Mr. Epstein makes a well-supported and smoothly written case on behalf of breadth and late starts.

. . .

The book blends anecdotal stories with summaries of academic studies. Many of these studies upend standard-issue advice about finding one’s way in life. We are introduced to the “Dark Horse Project,” based at the Harvard Graduate School of Education, which has collected the oral histories of highly accomplished individuals who took circuitous paths to achievement. The researchers were surprised by how many such individuals, in disparate fields, they were able to find. “What was even more incredible,” said one principal member of the project, “is that they all thought they were the anomaly.”

. . .

Not all of the chapters speak directly to range. In “Learning to Drop Your Familiar Tools,” we learn that many cardiologists are unwilling to forsake their use of stents, despite clear evidence that stents are not only ineffective in preventing cardiac events but also introduce fresh risks of complications. It’s sobering to learn that a 2015 study showed that patients suffering cardiac arrest were less likely to die if they were admitted to a hospital when such cardiologists were unavailable to install the devices.

. . .

The chapter titled “Deliberate Amateurs” is a delight, permitting us to spend time with some exemplars in science and medicine who have stepped outside of their cozy professional nests. One such exemplar is Arturo Casadevall, the chair of the molecular microbiology and immunology program at the Johns Hopkins Bloomberg School of Public Health. A much-cited scientist, Dr. Casadevall has led an overhaul of the curriculum at his school to help broaden the education of specialists. Philosophy, history, logic and ethics are incorporated into interdisciplinary classes. “How Do We Know What Is True?” is one of the course offerings. On the wall in Dr. Casadevall’s office, along with the certificate commemorating his election to the National Academy of Medicine, hangs a community-college degree in pest control, the “practical” expertise his father pressed Dr. Casadevall to acquire.

The advice that Dr. Casadevall dispenses to junior colleagues is “read outside your field, everyday something.” If the world were a kinder learning environment, this would not be needed. But as David Epstein shows us, cultivating range prepares us for the wickedly unanticipated.

For the full review, see:

Randall Stross. “BOOKSHELF; Late Bloomers Bloom Best.” The Wall Street Journal (Wednesday, May 29, 2019): A13.

(Note: ellipses added.)

(Note: the online version of the review has the date May 28, 2019, and has the title “BOOKSHELF; ‘Range’ Review: Late Bloomers Bloom Best; Late specialization demonstrably helped Roger Federer, Vincent van Gogh and Charles Darwin. It can serve the rest of us well, too.”)

The book under review is:

Epstein, David. Range: Why Generalists Triumph in a Specialized World. New York: Riverhead Books, 2019.

World Child Mortality Cut in Half

(p. A1) Two decades ago, nearly 10 million children did not live to see a 5th birthday.

By 2017, that number — about 1 in every 16 children — was nearly cut in half, even as the world’s population increased by more than a billion people.

. . .

From 2000 to 2017, all but one of the 97 low-to-middle-income countries that account for the vast majority of deaths of young children lowered their child mortality rates, according to a report released Tuesday [Sept. 17, 2019] by the Bill and Melinda Gates Foundation, along with a research team at the Institute for Health Metrics and Evaluation at the University of Washington, led by Stephen Lim, the institute’s senior director of science and engineering.

For the full story, see:

Alicia Parlapiano, Josh Katz, and Margot Sanger-Katz. “Fewer of the World’s Children Are Dying, but Many Remain at Risk.” The New York Times (Wednesday, Sept. 18, 2019): A1 & A12.

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

(Note: the online version of the story has the date Sept. 17, 2019, and has the title “Almost Everywhere,Fewer Children Are Dying.” In the last paragraph quoted above, the wording follows the online version, and not the print version. The order of the authors’ names in the online version is: Josh Katz, Alicia Parlapiano and Margot Sanger-Katz.)

Cocoa Beach Thrives During Private Space Race

(p. B6) Jeff Bezos and Elon Musk are racing to send people into outer space and eventually to the moon and Mars. They are already improving the fortunes of a coastal Florida city that is home to their budding space ambitions.

Cocoa Beach, which sits south of Cape Canaveral on the Atlantic coast, was hit hard by the 2009 recession and the subsequent end to the National Aeronautics and Space Administration’s space shuttle program. The economic downturn and space program’s demise led to large-scale layoffs and a reduction in tourism.

Now the city of 11,000 is in the middle of a resurgence as the private space industry’s rocket launches bring jobs and visitors back. Blue Origin LLC has built a rocket factory north of Cocoa Beach. The company—founded by Mr. Bezos, the chief executive of Amazon.com Inc. —plans to launch its New Glenn rocket from Cape Canaveral in 2021. Blue Origin hopes one day to bring people to the moon.

Space Exploration Technologies Corp., known as SpaceX, is holding test launches on the cape and is expected to shoot a rocket with 60 satellites into space this week—and, at some point, send people on a mission to Mars. SpaceX was founded by Mr. Musk, who is also a founder of Tesla Inc.

For the full story, see:

Konrad Putzier. “Florida City Buoyed by Space Race.” The Wall Street Journal (Wednesday, May 22, 2019): B6.

(Note: the online version of the story has the date May 21, 2019, and has the title “Space Rockets Spark Property Boom on Florida Coast.”)

“Bureaucratic Madness Is Choking Growth”

(p. A21) Jean Tirole, who won the Nobel Prize in economics in 2014, says that the study of economics is “simultaneously demanding and accessible.”

. . .

“Economics for the Common Good” offers an ambitious yet accessible summary of his ideas on the proper role of economists and the value of their ideas in informing government, business and social life.

. . .

One of the best chapters in the book deals with the issue of employment law in France. Successive governments have tried to micromanage the agreements between companies and employees to ensure fair treatment and low unemployment. But France’s unemployment rate has remained high, entrepreneurship has been stifled, and companies have become loath to hire people because of the prohibitive costs of firing them. Even if an employee proves useless, it’s nearly impossible to sack him.

On the employee’s side, even if you want to resign, it is more lucrative to wait to be fired, since you get both severance pay and unemployment insurance. To resolve the stand-off between workers who want to quit and companies that want to cut staff, employers and employees now collude through a legal formula called “termination by mutual consent.” The employee resigns and receives unemployment benefits as if he has been dismissed, and the company is spared the legal ramifications and costs of dismissal. In Mr. Tirole’s view, such bureaucratic madness is choking growth.

. . .

Mr. Tirole has a patient, explanatory style. But when riled, he lashes out. The French education system, he writes, purports to be non-selective but favors the affluent and well-educated. It “is a vast insider-trading crime.”

For the full review, see:

Philip Delves Broughton. “BOOKSHELF; What Good Is An Economist?” The Wall Street Journal (Tuesday, December 19, 2017): A21.

(Note: ellipses added.)

(Note: the online version of the review has the date Dec. 18, 2017, and has the title “BOOKSHELF; Review: What Good Is an Economist?; A French Nobel laureate and public intellectual discusses the proper role of the dismal science in government, business and the life of the mind.”)

The book under review is:

Epstein, David. Range: Why Generalists Triumph in a Specialized World. New York: Riverhead Books, 2019.

Low-Skilled Workers Benefit from Economic Growth

(p. A2) For years, falling wages and high unemployment seemed proof that low-wage workers needed an entirely new set of skills to succeed in an economy shaped by technological change and globalization.

It turns out what they needed most was time. As the economic expansion reaches a record age and unemployment remains near generation lows, the fortunes of low-skilled workers have turned up markedly. What looked like a permanent setback may be mostly cyclical. Continue reading “Low-Skilled Workers Benefit from Economic Growth”