Day 60: Friday
I just got back from an amazing vacation! While I didn’t take many, I wanted to share one picture from my trip – what a dream!!
Day 59: Thursday
Good morning Zak,
Cell phones are dangerous. The other day, I was checking my email on my phone while heading back to my apartment, and I walked right into a parallel universe. That’s the problem. You feel like you can do it. You can multitask. I mean, this morning I was able to sing a song while taking a shower at the same time. Why should this be any different?
Day 57: Wednesday
You may know, but I’m a big fan of efficiency. My first job out of college was nearly half dedicated to automating inefficient processes throughout the department. The other half of my job fed that half too, as I was to design new processes to help us better forecast volume and then match those with pricing strategies. Most of the time these projects were done in a rapid-fire, quick test kind of way, and, if successful, would warrant a more standard, automated approach as applied in the first half.
In arriving at my second job, though not tasked with it, I did much of the same. I’ve since moved on to other things, but for the most part, I have a thorough passion for efficiency. It’s why I made my sandwiches with homemade bread when I realized the savings it would have. It’s why I ate sandwiches in the first place, thinking it a waste to spend money going out to eat for lunch every day. Eliminate waste, wisely use resources. Makes a ton of sense.
Yet efficiency isn’t an end goal (obviously), and it isn’t even always the best one.
It’s also really hard to know what’s efficient.
Let’s look at health insurance. If we look at one end of the spectrum, we’ll call it the “market theory” we have individuals who are each responsible for their own insurance and savings. In this, they often buy insurance to some degree and have dollars out of pocket for what insurance doesn’t cover. Each individual has to save so that they can cover their costs. Two observations:
First, this means individuals should save more than they would if they pooled resources. If something happens to them (and in healthcare, it’s literally a matter of life and death), they will spend all of their resources on that health. Without health, their resources aren’t worth anything to them, because they would be unable to reap their rewards (can’t go on the fancy trip if you’re in a hospital bed…). So they are incentivized to save more in case of catastrophe — either through their savings or through buying much higher coverage in insurance. Notice that if resources were pooled, the total for the whole system is lessened, because the impact of even a rare risk happening and costing dollars is borne by a large, collective group (this is how insurance companies can make money).
Second, in practice, individuals are not good about saving enough to be covered. Because it is a very unknown risk (we don’t have great information on risk scores for e.g. cancer, heart disease at an individualized level), and because people discount the possibility it happens to them and not a neighbor, they often buy crappier insurance and/or don’t save enough to cover the out-of-pocket costs. This is also a bad outcome because you have individuals who need access to care in order to live but do not have a way to pay for said care.
As human beings, there is moral responsibility to help life flourish, and it would seem that one way to do so is setting up systems that encourage flourishing. This is why those who do argue for a “market theory” can’t just be cast aside – having incentives to save money, spend it wisely, make ongoing healthy choices, etc. can be remarkably valuable. If in a system where all resources are pooled, the incentives to overuse, for example, creep in. It’s simply not clear cut.
I’m a little all over the place. I’ll likely try again Friday. I’m trying to get at the idea that efficiency isn’t always the best goal; that there are, at times, externalities with inefficiency that are worthwhile and create a better system.
Day 57: Tuesday
Good morning Zak,
“When man wanted to make a machine that would walk he created the wheel, which does not resemble a leg.”
Descending melody is a universal in world music. Every culture that we know of has some examples of melodies that generally start high in pitch and end low. Ethnomusicologists think this is simply due to the nature of our physiology: whenever someone breathes out to sing a melody, they start with a lot of breath and end with very little. This makes it natural to descend in pitch toward the end of a melodic line.
If I were to indulge myself in speculation about this, I might even take the explanation a step further. It seems like downward motion is a pretty universal part not only of our physiology, but of all of nature in general. I mean, here on earth, things pretty much always move downward if nothing stops them. Water, tree branches, trees themselves… I guess in that way descending melody is a lot like Cage’s 4’33’’; it’s the sound of nature when people don’t interfere that much.
The so-called “lament meter” in ancient Hebrew poetry is probably an example of this. Although we don’t have direct evidence of the original melodies, the lopsidedness of the poetic meter itself seems to evoke a diminishing energy toward the end of the verse. The first part of the verse (the first “colon”) is generally longer then the second.
I feel like there’s something inherently lament-ful about this kind of verse structure. Isn’t it kind of sad how everything on earth eventually falls back to the ground and dies? Everything except for some small amount of helium, which, I understand, escapes the atmosphere because it’s so light.
But the really strange thing is how relatively rare this melodic typology is within Western concert music. Our melodies tend to climax about two-thirds of the way in. In a sense, you could maybe say our musical tradition is about contrasting the entropy the natural world with the creative energy of human life.
“Right, well, I mean… this piece behind me, I call it ‘The Afous II.’ And, I mean, it’s really about how confusing, you know, society is. Because, you know, it’s all a jumble, isn’t it.”
A river or a waterfall might tend to flow downward, but human discourse generally moves the opposite way: I say something, you say something, and eventually we reach some kind of logical consequence… an agreement or a main point or something like that. Contrary to the entropy of the natural universe, human conversations, or “language games,” tend to snowball, accumulating more energy as logical discourse progresses.
Here’s a a very famous lament, which climaxes, no less, toward the end of each strophe.
God, who created all that comes and goes
and shaped this faraway love,
give me strength, since I already have the intention,
so that I see this love far away
in reality and in a fitting place
so that rooms and gardens
shall seem to me to be new palaces.
-Jaufre Rudel, source
Day 56: Monday
Yesterday was the biggest day of the year for American sports. The Super Bowl has come and gone.
I tried to pitch having a party where there was only soup to eat, and you had to pick between that soup or getting a bowl. It would have built teamwork between party guests, not too dissimilar to how the big game builds teamwork between players. Your sister wasn’t having it.
Over the weekend we celebrated a friend’s birthday at The Cheesecake Factory. It was a nice to spend time catching up with friends. When most meals come with a side, the waitress asks “…and would you like a soup or salad with that?” I take way too much joy in saying “Oh! Yes, a super salad does sound really good, thank you!”
In case you missed the game, it was quite exciting. The Patriots overcame a scoring deficit greater than twice what any team had overcome previously (in the super bowl…). Those are the silly kinds of statistics we got to hear on the TV. “No team has ever played in the Super Bowl in 2017 before these two; these two are both setting records right now because of that”.
But nevertheless, it was exciting. The grit to keep on chugging is commendable. As a wise woman once said:
What a game! Kinda gives you a lesson to never give up even if things look bad and you’re down 28 to 3.
It only really applies when you’re down 28 to 3, though…
Day 55: Friday
Good morning Zak,
Under the present circumstances I am reminded of something the wise old Socrates once said: “there is nothing more annoying than someone who quotes the wisdom of Socrates on almost every occasion.”
Maybe you don’t remember that one. There’s a long tradition of falsely attributing things to Socrates, so it’s hard to know what the dude actually said. For all we know he might have said that. He might also have said, “come on guys, stop pretending to quote me all the time.”
Can you imagine being Socrates? This is one of the things I spend a lot of time thinking about. I mean, how frustrating would that be. Like, one of my students represents me and my views however he wants in his books, and then those books get read for millennia after my death. And I’m just supposed to be cool with that?
Zak, you raise a serious moral question.
“Thinking about healthcare as a business feels kind of grimy at times — you are making money off of those who desperately need help, many times in order to live.”
This is the sort of thing that could keep a person in your shoes up at night. But to me, it’s just a mildly entertaining intellectual exercise. I’m not in your shoes. Your shoes are like, ten sizes too big for me. But in the face of an issue like this it would be nice to have access to some real wisdom…
The other day I walked past a mom with two boys practicing their multiplication facts:
“Tre per quattro.”
One of the boys was literally jumping up and down with energy, anxious to beat the other to the answer.
We train little people to be very fast at these kinds of things. I remember those days of training myself. They might as well have thrown us circus peanuts when we got the answers right.
Some people know other things in the same kind of way. Things besides math facts. Many of us haven’t outgrown the habit. For grownups in higher education, the fastest and loudest person… to identify the source of a Shakespeare quotation… wins the smartness contest. That’s why we have standardized testing.
But, Zak, something’s just occurred to me: when thinking about a moral issue like healthcare monetization, the ability to quickly recall a large number of Shakespeare quotations is actually not that helpful. I mean, I’m trying to remember… did Othello ever say anything smart about medicine? Maybe if we recite the lines loudly enough the answer will come… “O THAT THIS TOO TOO SULLIED FLESH WOULD MELT!”
“The sages there were marked with dignity
And grave authority their faces showed.
They spoke infrequently with gentle voices.”
One day, Zak, we’re going to make ourselves a nice little locus amoenus, a “pleasant place.” You’re going to build us a library like you always say, and we’ll find one or two friends who will sit, read, and think… especially think. That’s really all one could ever ask for. Nothing beats rich conversation (well, nothing except for the fast, loud person who beats it). For as Socrates himself once said, “the answers to the modern public health crisis lie in proper legislation and systemic reform.”
Day 54: Thursday
Tim as you well know I work in healthcare. Thinking about healthcare as a business feels kind of grimy at times — you are making money off of those who desperately need help, many times in order to live. That said, having worked with a lot of Catholic hospital systems, the usual saying goes “No margin no mission”. In order to operate, in order to help all of those people, they need to have the financial backing to do so. They certainly have a lot of write-offs each year, essentially donating care back to communities; but it’s no news that in the U.S., healthcare is expensive, and many people are paying all they can afford in medical bills.
I’m not sure how I’m supposed to think about making money off of others’ misfortune. In one hand, I’m helping them extend life; in the other, the cost of that extension is often a poor quality of life, constantly fretting about bills and work.
I recently came across some articles about financially backing legal cases. I asked a friend of mine with a law degree to explain in a bit more detail, but the gist is that there are many wrongs done to people – e.g. abuse, discrimination, etc. – done by a corporation that has quite a bit of money. If the individual were to sue, there are legal ways for the corporation to spend those dollars quickly prolonging and “drowning” the individual, making it effectively impossible to sue in many cases. There are some lawyers who will work on a contingency basis, not getting paid until the individual does — but they typically have caps far smaller than would be necessary to take on a corporation.
The linked article discusses financially backing some of these cases. Now I certainly don’t have enough money to bankroll anyone’s legal case, but the idea still intrigues me. If real harm was done, shouldn’t there be some recompense paid? The same problem we saw above begins to arise, though – in order to operate like this, the financial backer would need some form of compensation, thus taking a portion of what would go to the individual. There’s this feeling of doing good while simultaneously lessening the good done.
I’m not sure there’s any way around it within healthcare. Hopefully make it cheaper to deliver care, I suppose. It’s just unfortunate that there’s a cost to doing good.