I must now cheer for the Patriots of college basketball

Good morning everyone. Duke University’s Margolis Center for Health Policy has a very important (to me) bio page:

David Anderson

Research Associate, Health Policy Evidence Hub
My primary interests are currently examining Medicare end of life payment reform models and a personal interest in the distributional impacts of different health insurance reform proposals.


Insurance network design, benefit configuration, cost-sharing and policy analysis.

That is meat space me.  Richard Mayhew has been a brash alter ego and pen name that I needed to use while I was employed in the insurance industry.  My last day at UPMC Health Plan in Pittsburgh was right before Christmas.  I’ve started at Duke this week.

It has been a strange trip.  This entire process my wife has been chuckling at me.  It is a bit odd.

I write extremely dry/technical material with and for a bunch of snarky liberals with a blue streak.  I’ve written under a pen name for years in a place where the phrase “hookers and blow” routinely shows up as useful shorthand.  This is not the typical career development path of someone who works at one of the world’s best universities.

It’s been a year long journey that still makes my wife shake her ahead in bemusement while I shake my head in amazement.  She was always curious about the “what’s next ” was with my policy writing.    I had been exploring the the “what’s next” for a while.  December 2015 I was speaking with a group in DC that does some really interesting work but they needed something a little different than what I offered.  But that process started the conversation between my wife and I regarding the stay or go decision parameters. We talked, and then we talked some more before talking some more.   We developed a shared understanding of what we needed if we were to leave Pittsburgh.  When Duke started the conversation, we knew our reservation criteria.

So how did this happen?

I had been getting frustrated at work so I tweeted a throw-away tweet:

Anyone hiring a health insurance and health policy nerd — I’m looking

— Richard Mayhew (@bjdickmayhew) October 3, 2016

I expected nothing from this tweet besides a bit of sympathy.  I was wrong.  By dinner time, I had half a dozen good leads.  By the second cup of coffee the following day, I had a dozen leads and my wife looking at me funny.   A few people I thanked after a short conversation while declining further investigation.  A few leads  led to a good meal and excellent conversation but no more.  And then a few were really interesting.

Duke stood out to me.  I was being chased hard and they made everything too easy.  Duke has big projects tackling big problems.   I would have a chance to work with a great team of people on personally and professionally fulfilling projects in a very supportive environment.

Sign me up… and so they did.

At the Margolis Center, I’ll be working with Don Taylor and his team as we tackle end of life and palliative care payment and process reforms for Medicare.  My new job will be to take my industry experience and apply that perspective to system transformation where I can see both the obvious but impractical as well as the non-obvious and productive routes forward from an industry perspective.  I’ll write some at Free for All and at the Margolis Medium channel.  Both of those communication channels will be at a higher level of editing and refinement than Balloon Juice because the audience and intent of the communication is a bit different.

So what does this mean for “Richard Mayhew” now that Dave Anderson is at Duke?

I’ll be negotiating things as I go .  Balloon Juice will still have health policy (and soccer) posts written under the Richard Mayhew pen name as that is where I have some brand equity.  I’ll talk with John and Alain to create a Bio page with the appropriate disclaimers that everything here is my personal views and not those of any employers (current, past, and future).  This as my scratchpad and home of first thoughts as it has been for the past three years.   This is where I see something and start wrestling with it in public.  Sometimes interesting things will emerge from that grappling.  Other times, I’ll fall face first in the mud.  I’m okay with that as it is the process of grappling with an idea and more importantly writing things down to clarify my thinking that has educated me  and I hope has helped some of the community.

I also need to thank everyone here.

First and foremost, I need to thank John for giving me the keys to this place and letting me wander around with whatever I found interesting.   He has done an amazing job of curating a community of eccentrics, curmudgeons, grumps and generally nice people.    I also need to thank Tim F.  I know Tim in real life. He was the person I approached in the summer of 2013 to write here.  I thought I had maybe twenty or thirty posts and maybe 15,000 words in me.  He bugged John to get me the keys and gave me the ground rules — show sympathy to cat pictures and write whatever I wanted.

I need to thank the community here.  I get energy from everyone here.  I get great ideas.  I get ready access to a bunch of experts who are more than willing to share.  I get purpose and meaning.  I take a lot from you all and I try to give back.  You’ve given me a place to publicly work through half formed thoughts and a place to listen to why an idea is idiotic or sounds nice but is impractical.  You’ve given me a lot and I want to thank everyone for that.

I also really need to thank my wife.  She puts up with this hobby.  And when Duke came and made me say “WOW” she was on board with picking our family up to chase some of my dreams.  So I just have to say thank you to my wife as I do the happy dance every morning that I get to spend my life with you.

Wednesday Morning Open Thread


Generous blogger Batocchio has posted the Jon Swift Roundup 2016, including Cole’s choice for Balloon Juice post of the year, and entries from half a dozen bloggers who also comment here. Highly recommended, especially if you’re looking for fresh voices for the new year.
What’s on the agenda, as we start another day?

There is always an applicable XKCD

I’m still trying to put together thoughts that don’t evolve into seventeen hundred words of profanity.

Open thread

The Republican Party is tearing itself apart. It’s about damn time.

The following is from a Tweetstorm I composed yesterday in the hours before that shitshow of a “debate.” There are probably some spelling and grammar errors, because for the most part, I just copied and pasted from my Twitter account, @soonergrunt.

Someone asked me recently why I’m a dick to Conservatives who engage me on Twitter. I’m not to everyone. @RadioFreeTom is a notable example. There are others. But I’ll tell you the answer now. I came to political conscience in the age of Ronald Reagan. I liked him as a person, but I didn’t agree with him on much. But I respected him. He was my President, for one thing, but also my parents taught me that the other side were decent people who wanted what they saw as best for the country. They just happened to usually be wrong. And sometimes they were right. That kind of consideration is something I’ve rarely received in return. Rare enough that I remember a lot of those respectful interactions.  They stick out due to their rarity.

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A Note About Hurricane Katrina

Back in early 2010 I wrote the Concept of Operations (CONOP) for the US Army’s first cultural program, the Human Terrain System, about applying what, at the time, I was referring to as socio-cultural research, analysis, and mapping to emergency response and disaster management. This was done specifically for the founding Program Manager so that he had something to work with if US Southern Command asked for assistance from the program as part of the response to the earthquake in Haiti. I was tapped to write this for several reasons, but not least of which because I had been working (among others) for him on building out the conceptual basis for what we were actually tasked with doing for the Army in Iraq and Afghanistan and thinking ahead to other types of operations where having on site, real time socio-cultural support might be helpful. Another reason I was tasked with working on this was the conceptual/scholarly work I had done prior to going to work for the Human Terrain System, which included work on emergency response and disaster management.

In late 2009 I represented the program as an invited panelist at the St. Thomas University (Miami Lakes, FL) conference on disaster management and emergency response to terrorism, other man made disasters, and natural disasters (and yes, I was on the same panel with Max Mayfield). Some of the work I had done for that presentation made its way into the CONOP, including an analysis of where, what I would now in 2016 call, cultural operations and Engagement, would have been beneficial in the response to Hurricane Katrina. Ultimately this was written up in 2011-2012 into a longer treatment for the Army’s second cultural program – the Army Culture and Foreign Language Directorate – looking at how to apply cultural operations to facilitate humanitarian assistance, emergency management, and disaster response – regardless of the nature of the emergency or disaster  – including several case examples such as the response to Hurricane Katrina and the Haitian earthquake of 2010.

Below you’ll find an excerpt from that 2011-2012 report. In Hillary R’s first post on Hurricane Matthew she referenced Amanda Ripley’s book on surviving disasters. And while Ms. Ripley wrote an excellent book and her observations about who did and did not survive are correct, what was outside of its scope, and the scope of Hillary R’s post, is that ultimately the lack of survivability of Hurricane Katrina was really about total systemic failure at all levels of the emergency management and disaster response process. And I think that’s important to understand and its equally important to remember that the loss of life in Hurricane Katrina was preventable, but failures at the municipal, state, and Federal levels ensured they would occur. I’m adjusting the language a bit – replacing socio-cultural research, analysis, and mapping with Cultural Operations and Engagement.

Disaster Management and Emergency Response: Three Phases

In the case of responding to disasters, whether natural or man-made, disaster management specialists have identified three stages of the response: emergency, rehabilitation, and restoration(9). Conducting Cultural Operations and Engagement across all three dimensions of context, dynamic, and location would be of great use in assisting and facilitating with these disaster management responses. With greater situational awareness available from the beginning of the response and management effort, it would be possible to engage in more focused and effective response leading to better outcomes for the affected populations.

In the emergency response phase the focus is on getting to the affected area, initially assess what needs to be done, and get to the work of the assistance and response as quickly as possible. It also includes a focus on life saving missions and the delivery of emergency supplies, including medical assistance. Phase two, rehabilitation, focuses on building off of the initial response and moving towards stabilization in order to facilitate long term restorations of essential services and a return to normal routine. The focus in this phase is on restoring the host nation country (or in the case of a domestic disaster the local and state authorities) to the levels of functionality that existed prior to the disaster. This is intended to get the required infrastructure back into place and running so that the host nation can begin to provide for the health and welfare needs of the population. The third stage, restoration, is concerned with capitalizing on successes from the first two stages, consolidating them, and then expanding on them by assisting the host nation and its population with building out its infrastructure, services, and facilitating disaster proofing through hardening of vulnerable sites.
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Open thread

Forgot to post this yesterday.

Not a labor-related question, but I noticed that the “why is the campaign so long” columns are already beginning. Got me thinking: what is the single most annoying topic for pundit columns? Getting rid of the penny? Stuff a taxi driver told me? The Stanford marshmallow experiment? Anything by or having to do with Chris Hitchens? Feel free to suggest your own.

I’m not outraged about Colin Kaepernik

I’ve been seeing a lot of stuff on Twitter and Facebook about how Colin Kaepernik insulted Veterans with his refusal to stand for the National Anthem.

I personally am not offended by Kaepernik’s actions. I wish he’d chosen a different method, but only because the substance of his protest, the glaring racial iniquities of policing and the legal system, have been ignored while the outrage machine over his refusal to stand for the anthem has burned up all the oxygen. I honestly had no idea who the guy was before this week. Those glaring racial iniquities of policing and the legal system? That’s the real outrage here, or it should be if you buy into the idea that “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Speaking for myself, I for one am real Goddamned tired of people appointing themselves to be outraged on my my behalf.

I joined the army for a lot of reasons, patriotism being one of them, but patriotism had little if anything to do with my decisions to re-enlist over and over again. Every place I ever fought, I fought FOR my brothers, the guys to my left and right. If politics entered into it at all, it was because we fought against people who would string up the Colin Kaeperniks of the world for being a racial minority, or for not toeing some religious or political line. So there was always some knowledge and understanding that on some level there was a difference between us, or what we still aspire to but haven’t yet become, and them.

But mostly it was for my brothers. And a paycheck.