After over two years in Goizueta Business School, I took Access to Healthcare at Rollins School of Public Health. I will be an administrative fellow at Texas Children's Hospital starting in July and I figured I mine as well see what is brewing in the discipline as I enter a highly sophisticated institution. What I learned was most interesting. There are 3 areas that most people blame for USA's cost of healthcare (standing at 17% of GDP at the moment).
1. Administrative costs
2. CEO pay
3. Insurance companies
As a good business school student, it caught my attention that all of these actually were blaming the business function of the sector as the scapegoat for the problem. It seemed that all major medical publications also backed this theory. I decided to see what my friends in the "business world" thought of what drives cost. I found a great document from the gurus at Mckinsey (http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp) that argued a different reality. Three of the main drivers in the report are:
1. Administrative costs (due to the complicated multi-payer system)
2. Physician Pay (8 of 10 highest paid US occupations are physicians - CEO is number 8) See: http://www.bls.gov/bls/blswage.htm
3. Consumer use of new drugs (Americans tend to buy and use the latest and greatest drug - paying premium price over generic)
This got me to thinking about the healthcare game and in particular how did physicians end up getting paid more than 6 times their counterparts in developed countries...one thing I was curious about was one of the major issues in the Public Health schools was how to get Doctors to treat people in rural/poor/crime-heavy/ugly places...I thought this interesting because in the business world to get managers to move to Kansas City or bodunk Oklahoma is not an issue because there are 15 MBAs waiting in line to take a position with a good company eventhough it is not in NYC...
A major part of the game is played between the Ameican Medical Association and the US government. American Medical Association has been pretty smart to limit the access to medical education and, of course, they will site that is because "people are saving lives" and the "quality must be perfect" and this is true but interesting if compared to business education where the if you are innovative and driven we will take you, train you, and teach you to perform...
The business world then creates a equilibrium where supply of MBAs slightly exceeds demand in turn driving competition for jobs and price checks on the price of an MBA...let's just say that the average MBA with the same amount of experience as a physician will not be making $250K a year when they are 50...unless of course they work for HP and bonuses kick-in...this is not to say that managers are not overpaid as well but supply demand actually works...
Now, let's turn to the medical profession...limited supply+extreme demand = supplier power!!! Do I hear monopoly? Doctors are no dummies...they actually are not over-paid in the current equation but what would happen if they doubled their supply...the equation would lessen and they might just have to compete on efficiency and productivity...
Last week on Grey's Anatomy, a fictitious example happened where 3 doctors were competing in to see who could be the "most productive" physician which meant treating the most cases...running tests gave physician points...in one day one patient a physician spent $125000 on tests...in the business world this would not happen...
The problem I see is that unfortunately it looks as if noone is home in this game on the American people or government side of things...or that physicians are the players on both sides of the table...colluding and quickly agreeing that the problem does not reside on the spending habits of physicians but in turn on those that manage the spending of medical practitioners...maybe one side needs to wake up or overthrow the party...
Pre-SDA Response
Pre-SDA Response
Oops..
Someone did not assess the problem correctly...
Post SDA Response Part 1
Post SDA Response Part 1
Post SDA Response Part 2
Post SDA Response Part 2
SDA #7 - Real Life Psychology
I have a few interesting examples of some ways that minds play tricks on us:
Example A: "I knew I was going to marry him/her from the moment I laid eyes on him/her."
Hindsight Bias:
As a skeptic of the institution of marriage, (the sad reality of a child of a messy divorce), I always found it interesting when I was around newly engaged people and this comment was made. I always thought "oh really, you mean all those times you were annoyed by them when they did something ridiculous in public did not make you question just a little bit." Of course, when I would say this people would give me the look of "you must not really be with 'the one' because you did not 'know it all along." Now, thank goodness, I have a term for it.
Example B:
Selective Perception:
About 2 years ago, I was awoken at 5:30am in the morning to banging on the front doors of my home. I figured my roomate had locked herself out while running so stumbled to the front door only to see a very large man, shaking the doors, pointing at me "let me in, let me in." Stop. What do you think this man looks like?
Now, I screamed and my roomate's boyfriend came out and yelled at the man "get out of here." Following, this interaction the man sits down on the front porch and the two men have a staring contest for 30 minutes through the glass until the police come. The police arrive and take the man to the car and a few moments later the policeman returns and informs us that "this man is not your average prowler. He actually is wearing prada shoes and a rolex watch. I asked him who he is and he responded with I am the CEO of XX company. Are you all sure you want to press charges?" Of course, we responded "yes, we don't care if he is Warren Buffett, he was trying to break into our house."
The police cars pull away and we go out to the porch and find the man's neimann marcus coat on our porch with his business card in the pocket - gotta love google. Turns out this man is a MBA/JD from UNC-Chapel Hill, worth over $30M and has pulitzer prize winning articles written about him and his accomplishments.
Stop! What image do you have in your mind now?
This is exactly how I have told the story over the past two years. Last week, I was at a dinner party with my mom and my old roomate and my old roomate was telling the story. She told the same story except in the first sentence said "this very large African-American man." My Mom turns to me and said, I have heard that story 100 times and until now I never realized he was an African-American man.
What is interesting here to me is that I stopped using adjectives to describe people a few years ago like this white/black/gay/asian/indian/rich/etc. man/woman was doing XXX. While studying sociology and realizing the importance of narrative story telling and its implications for shaping cultural bias , I made a concious effort to stop using terms. I actually noticed that people (even people traditionally viewed as non-discrimanatory) would use a descriptor for negative stories and a not use one for positive stories and not use descriptors of their own race/gender/sexuality when telling a negative story. For example, if the man in this story had been white, generally the person who was white might have said man instead of white man but most likely would have always used black man to describe the person.
Scenario 3: Heuristic ?
Recently, I attended an intensive class in DC focused on the sweet spot of business and politics. The class was basically 4 speakers a day from all walks of Washington discussing their role in the world of government. At lunch on the third day, a few students (Republicans) said I want to complain because almost all of the speakers have been democrats. The interesting thing was that there had actually been 5 Republican speakers and 6 deomcratic speakers. Talk about the impace of hearing things you do not agree with...
Example A: "I knew I was going to marry him/her from the moment I laid eyes on him/her."
Hindsight Bias:
As a skeptic of the institution of marriage, (the sad reality of a child of a messy divorce), I always found it interesting when I was around newly engaged people and this comment was made. I always thought "oh really, you mean all those times you were annoyed by them when they did something ridiculous in public did not make you question just a little bit." Of course, when I would say this people would give me the look of "you must not really be with 'the one' because you did not 'know it all along." Now, thank goodness, I have a term for it.
Example B:
Selective Perception:
About 2 years ago, I was awoken at 5:30am in the morning to banging on the front doors of my home. I figured my roomate had locked herself out while running so stumbled to the front door only to see a very large man, shaking the doors, pointing at me "let me in, let me in." Stop. What do you think this man looks like?
Now, I screamed and my roomate's boyfriend came out and yelled at the man "get out of here." Following, this interaction the man sits down on the front porch and the two men have a staring contest for 30 minutes through the glass until the police come. The police arrive and take the man to the car and a few moments later the policeman returns and informs us that "this man is not your average prowler. He actually is wearing prada shoes and a rolex watch. I asked him who he is and he responded with I am the CEO of XX company. Are you all sure you want to press charges?" Of course, we responded "yes, we don't care if he is Warren Buffett, he was trying to break into our house."
The police cars pull away and we go out to the porch and find the man's neimann marcus coat on our porch with his business card in the pocket - gotta love google. Turns out this man is a MBA/JD from UNC-Chapel Hill, worth over $30M and has pulitzer prize winning articles written about him and his accomplishments.
Stop! What image do you have in your mind now?
This is exactly how I have told the story over the past two years. Last week, I was at a dinner party with my mom and my old roomate and my old roomate was telling the story. She told the same story except in the first sentence said "this very large African-American man." My Mom turns to me and said, I have heard that story 100 times and until now I never realized he was an African-American man.
What is interesting here to me is that I stopped using adjectives to describe people a few years ago like this white/black/gay/asian/indian/rich/etc. man/woman was doing XXX. While studying sociology and realizing the importance of narrative story telling and its implications for shaping cultural bias , I made a concious effort to stop using terms. I actually noticed that people (even people traditionally viewed as non-discrimanatory) would use a descriptor for negative stories and a not use one for positive stories and not use descriptors of their own race/gender/sexuality when telling a negative story. For example, if the man in this story had been white, generally the person who was white might have said man instead of white man but most likely would have always used black man to describe the person.
Scenario 3: Heuristic ?
Recently, I attended an intensive class in DC focused on the sweet spot of business and politics. The class was basically 4 speakers a day from all walks of Washington discussing their role in the world of government. At lunch on the third day, a few students (Republicans) said I want to complain because almost all of the speakers have been democrats. The interesting thing was that there had actually been 5 Republican speakers and 6 deomcratic speakers. Talk about the impace of hearing things you do not agree with...
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