Don’t do stupid shit is a good guiding principle for almost anything going forward.
Kevin Drum makes a predictable but real point about how no longer doing stupid shit leads to good results.:
We were poisoning our children with a well-known neurotoxin, and this toxin lowered their IQs, made them into fidgety kids, wrecked their educations, and then turned them into juvenile delinquents, teen mothers, and violent criminals. When we got rid of the toxin, all of these problems magically started to decline….
In the end, we’ve learned a valuable lesson: don’t poison your kids. [my emphasis]
As some level, not dumping massive amounts of powerful neurotoxins into the air is blindingly obvious and simple. At other points, it is profound at how much a simple change in what we allow dumped into the commons has and will have in our society. Getting most of the lead out of the air and decreasing the amount on surfaces radically alters the political profile in this country and allows for greater liberalism as crime is less salient now than it was thirty years ago. Going to unleaded gas was fixing a stupid, self-inflicted problem vector.
Cleaning up other people’s stupid shit is a full time career for policy wonks and promoters. I was lucky enough to have a good two hour walking coffee tour of Boston with Tom Levenson last weekend, and as we were talking, he asked me what I would do if I was the health care dictator for a day in the United States. That was one hell of a good question that took a good block for me to formulate my thoughts as there were so many opportunities. The reason why there are so many opportunities is that there are numerous areas of stupid shit that are inherent to the current American health care system. We batted around some ideas:
- Changing graduate medical education
- Changing medical education finance
- Changing scope of practice regulations for CRNPs and Physician Assistants (PAs)
- Standardizing electronic medical records
- Changing the ideal model of doctor as an Olympian diagnostician towards a model where the doctor uses far more decision supports and the expertise is in the edge cases
- Changing how we fund public infrastructure to encourage more walking/biking and less car trips
- Allowing big buyers of medical services to act like big buyers of anything else in this country by being able to negoatiate hard
At some level, that is depressing as all of these changes would have massive impact on at least one factor of well-being or health costs, and none involve fundamental paradigm busting. They merely require significant changes to current practices and habits to produce better results. There are minimal new technological demands in most of these areas of discussion, there are no hopes for pie in the sky molecular development, the changes are mostly organizational and thought process based changes. I settled on saying that if I could change one thing, it would be to allow Medicare to truly leverage its size and budget in order to actively drive prices down instead of being effectively a price taker. That would involve breaking a cartel (the AMA) which sets its own rates for the government to pay, and it would probably lead to a few doctors leaving the Medicare network, but it would address the biggest problem in American healthcare — we pay too much, compared to the rest of the world, per unit of care delivered.
At the same time, the fact that there are so many stupid practices embedded within the American health care financing and delivery systems means there are numerous opportunities for systemic improvmeent without causing too much pain or taking too much non-political risk. Stupidity can be liberating as there are numerous opportunities for change and improvement. So much like the simple lesson that we should not poison our kids with powerful, persistant neurotoxins, once we remove stupidity, the long term effects can be massive and pervasive.