Quiet Declarations

David Goldhill’s “How American Healthcare Killed my Father” from this month’s Atlantic is the most comprehensive survey I’ve read of the current state of American healthcare, the factors that make it so complicated, and how we should be thinking about effective solutions.

The analysis develops from Goldhill’s quest to figure out how his father–and 100,000 other patients annually–could have died from infections acquired in the hospital.  At 17 pages it’s about as concise as one could be while really discussing the issues thoroughly.  I almost shied away from an excerpt because I really think it’s worth reading the whole thing, but here’s a frame-up:

Keeping Dad company in the hospital for five weeks had left me befuddled. How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations?

I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.

This is precisely the way we ought to be thinking about healthcare.  If we aren’t thinking critically about why the same radical innovations we see from market forces aren’t occuring in this industry, we aren’t thinking clearly about the issue.

At least, you should consider it if you’re desperate to get married and you don’t want to “settle.”  Here’s why.

These young’uns simply don’t have what it takes to be a college tour guide these days.

Also, training tour guides to give anecdotes, not facts?  Geez, it’s like preparing them to go into politics instead of the real world!

Check them out here.  I’ve seen eight of the ten, and most of them are among my favorites — although I must confess, I vastly prefer movies with clever endings over movies with happy ones.

T.X. Hammes has converted me to PowerPoint hater with this essay, taking senior leadership to the woodshed for using it as a crutch to both centralize and dumb down their decision-making processes.  In brief:

Make no mistake, PowerPoint is not a neutral tool — it is actively hostile to thoughtful decision-making. It has fundamentally changed our culture by altering the expectations of who makes decisions, what decisions they make and how they make them.

The piece is worth reading in its entirety.  Hammes contends that PowerPoint does have some effective uses, most notably for educators.  Indeed, that’s why I’ve historically been a pretty big fan of PowerPoint, and basically figured that problems like this were easily correctable deficiencies in presentation skills.  But his assessment of how managers use PowerPoint to overinvolve themselves in decision-making and to make big decisions with far too little information strikes me as generally accurate and entirely damning.

Tyler offers up an intelligible (and more importantly, charitable) definition of progressivism, and Matt responds with his case for libertarianism.

I tried to keep the title of this post from being misleading.  I really did.

I get busy for a couple of weeks and Slate publishes three new feeds!  Read them here.

I don’t meet these criteria, but I’m pretty sure this is correct nonetheless.

Aside: I love that for their photo they chose the one restaurant in Clarendon that I never visit.

“Such a pleasant honeymoon — yet all we got was this lousy stimulus bill.”

A column worth reading by Michael Gerson.

Two people written up in the Times this weekend:

Andrew J. Hall, due a $100 million bonus from Citigroup for netting them $5 billion in investment revenue:

 Two years ago, Mr. Hall waged a legal fight with the Historic District Commission of Fairfield over an 82-foot concrete sculpture that he had placed on the front lawn of his 7,300-square-foot Greek Revival mansion, where he lives with his wife, Christine. He thought he did not need permission to display the work, but because of his neighborhood’s preservation restrictions, the state Supreme Court ultimately ruled that he did.

“The strange part is that I think he would been approved if he’d asked for permission,” says Richard Hatch, who headed the commission at the time.

Mr. Hall lent this work to the Massachusetts Museum of Contemporary Art, though not because he lacks display space. A few years ago, he bought a medieval castle in Germany from the neo-expressionist painter Georg Baselitz, and he and his wife have turned the property, said to contain roughly 150 rooms, into a private museum for their collection.

And Michael O’Leary, CEO of Ryanair:

“Our customer service is unlike every other airline, which has this image of, ‘We want to fall down at your feet and you can walk all over us and the customer is always right,’ and all that nonsense.”

By contrast, Mr. O’Leary continued, Ryanair promises four things: low fares, a good on-time record, few cancellations and few lost bags.

“But if you want anything more — go away! Will we put you in a hotel room if your flight was canceled?” Mr. O’Leary asked rhetorically. “No! Go away.”

He was sitting in a cafe at the chamber of commerce here in London, drinking coffee. Soon, he would hold a news conference where, among other things, he would call Prime Minister Gordon Brown a “twit” and a “Scottish miser.”

During the interview, he began riffing on the theme of when Ryanair grants refunds, which is never.

“Will we give you a refund on a nonrefundable ticket because your granny died unexpectedly?” he asked. “No! Go away. We’re not interested in your sob stories! What part of ‘no refund’ do you not understand?”

Awesomeness.