The Age: Doctor obsession has led to health blowout

  • Peter Brooks says we will have an excess of doctors
  • He suggests there are $20B in “low value” medical procedures

 

From: http://www.theage.com.au/federal-politics/political-news/healthcare-doctor-obsession-to-lead-to-cost-blowout-20140101-30672.html

Healthcare: ‘Doctor obsession’ to lead to cost blowout

Jonathan Swan — January 2, 2014

Decisions made by Tony Abbott when he was health minister will soon cause a blowout in healthcare costs dwarfing the money saved by introducing a $6 fee for GP visits, a health workforce expert says.

As health minister in the Howard government, Mr Abbott oversaw a massive expansion of new medical schools and student intakes, leading to an oversupply of graduating doctors, said Peter Brooks, former director of the Australian Health Workforce Institute and now a professorial fellow at the University of Melbourne.

Australia is expected to have 2811 superfluous doctors by 2025, based on projections in a March 2012 report by the government body Health Workforce Australia. The figure assumes a modest 5 per cent increase in productivity in the healthcare system.

Health lobby groups often said Australia would be short 2700 doctors by 2025, but the figure was misleading because it assumed no productivity gains would be made, Professor Brooks said.

The boom in medical graduates would ”lead to a blowout in costs” with doctors already giving patients too many unnecessary procedures so they could earn a good living in Australia’s fee-for-service system, Professor Brooks said.

At least $20 billion of ”low value” medical procedures were already being done every year in Australia, he said. If Mr Abbott wanted a ”sustainable” healthcare system, he should address these multibillion dollar structural healthcare problems rather than “fiddling around” with fees for GP visits, Professor Brooks said.

The Medicare controversy kicked off at the weekend with reports of a submission to the government’s commission of audit from Mr Abbott’s former health adviser, Terry Barnes. Mr Barnes said the government would save $750 million over four years by forcing patients who are bulk-billed to pay $6 to visit their GP for each of the first 12 visits a year.

A spokeswoman for Mr Abbott said on Wednesday the Coalition ”won’t be commenting on speculation around what the commission of audit may or may not recommend”. ”Labor spent a lot of money on creating huge health bureaucracies,” she said.

”The Coalition government is committed to directing more of that money back to delivering and improving frontline services for patients.”

The debate over the $6 GP fee – which experts say will harm the poorest and sickest Australians – was obscuring a more important debate over healthcare costs, Professor Brooks said.

Australian governments had become ”doctor obsessed”, ignoring evidence that many of the tasks performed by doctors could be given to other health professionals such as pharmacists, nurse practitioners and physician assistants.

Health Workforce Australia reports that in 2003, 1889 students began medical degrees. By 2012 there were 3686 students starting medicine. Even with international students excluded, the medical education peak body, Medical Deans Australia, said medical graduates more than doubled between 1996 and 2012.

Read more: http://www.smh.com.au/federal-politics/political-news/healthcare-doctor-obsession-to-lead-to-cost-blowout-20140101-30672.html#ixzz2paMRNfzU

Miso soup

From: http://www.taste.com.au/recipes/23977/miso+soup

Rating: 5 stars

Ingredients
  • 4 cups (1 litre) dashi stock
  • 20g dried seaweed (see note)
  • 1/4 cup (75g) red miso paste
  • 150g silken tofu, cut into 2cm cubes
  • 3 green onions, trimmed, thinly sliced
Method

  1. Step 1Place the dashi in a large saucepan over medium heat. Bring to the boil. reduce heat to low. Add the seaweed and cook for 1 minute or until seaweed softens. Add the tofu and cook for a further 1 minute or until heated through.
  2. Step 2Place the miso paste in a small bowl. Add a little of the dashi, stirring until miso dissolves. Add the miso mixture to the saucepan and gently stir to combine. Bring to a simmer. remove from heat.
  3. Step 3Ladle miso evenly among serving bowls. Sprinkle with green onions and serve immediately.

Nutrition per serve

Energy
408kJ
Fat saturated
1.00g
Fat Total
4.00g
Carbohydrate sugars
5.00g
Carbohydrate Total
7.00g
Dietary Fibre
g
Protein
8.00g
Cholesterol
mg
Sodium
1217.33mg

McKinsey: building blocks of strategy

Source PDF: Mastering_the_building_blocks_of_strategy

Left unchecked, market forces continually conspire to deplete profits. Powerful business strategies can counteract those tendencies, but good strategy is difficult to formulate.1 Indeed, the latest McKinsey research (see “The strategic yardstick you can’t afford to ignore.”) finds that a very small number of companies create most economic profit.2 The research also shows that a significant number of good companies outperform even in so-called bad industries, where the average economic profit is less than the market average.

How do they do it? In other words, where do powerful strategies come from? Sometimes it’s luck, or good timing, or a stroke of inspiration. In our experience, it’s also possible to load the dice in favor of developing good strategies by focusing on the core building blocks that often get overlooked. One is the need to gain agreement—before creating strategy—on the essential decisions and the criteria for making them. Another is to ensure that the company is prepared and willing to act on a strategy once it is adopted. Too much of what passes for strategy development, we find, consists of hurried efforts that skip one or more of the essentials. The resulting strategies are often flawed from the start.

It’s also easy, though, to go too far in the other direction and make the creation of strategy a rigid, box-checking exercise. Appealing as a formula-driven approach might be, it ignores the truth that strategy creation is a journey—and an inherently messy one at that. Proprietary insights are hard to come by. Shaping keen insights into good strategies requires deep interpersonal engagement and debate from senior executives, as well as the ability to deal with ambiguity in charged and often stressful circumstances. When would-be strategists overlook these dynamics, they cover the essentials in name only. Consequently, they miss opportunities and threats, or create great paper strategies that remain unfinished in practice.

In this article, we’ll outline a middle path—an end-to-end way of thinking that views the creation of strategy as a journey, not a project. This method, developed through our work with some 900 global companies over the past five years, can help senior executives approach strategy in a rigorous and complete way. We’ll also describe some principles that strategists should keep in mind as they use the method to ensure that their strategic-planning processes embody the spirit of debate and engagement, which, in turn, yields inspiration. By better understanding both the method and how to get the most out of it, companies can boost the odds that the strategies they create will beat the market.

There’s something about TED

  • excellent talk by a Visual Arts Professor about the light, deceptive folly of TED
  • despite the entirely valid criticisms, I think TED still fills a void in the public discourse
  • placebo technoradicalism
  • middlebrow megachurch infotainment

We need to talk about TED

Science, philosophy and technology run on the model of American Idol – as embodied by TED talks – is a recipe for civilisational disaster
theguardian.com
In our culture, talking about the future is sometimes a polite way of saying things about the present that would otherwise be rude or risky.

But have you ever wondered why so little of the future promised in TED talks actually happens? So much potential and enthusiasm, and so little actual change. Are the ideas wrong? Or is the idea about what ideas can do all by themselves wrong?

I write about entanglements of technology and culture, how technologies enable the making of certain worlds, and at the same time how culture structures how those technologies will evolve, this way or that. It’s where philosophy and design intersect.

So the conceptualization of possibilities is something that I take very seriously. That’s why I, and many people, think it’s way past time to take a step back and ask some serious questions about the intellectual viability of things like TED.

So my TED talk is not about my work or my new book – the usual spiel – but about TED itself, what it is and why it doesn’t work.

The first reason is over-simplification.

To be clear, I think that having smart people who do very smart things explain what they doing in a way that everyone can understand is a good thing. But TED goes way beyond that.

Let me tell you a story. I was at a presentation that a friend, an astrophysicist, gave to a potential donor. I thought the presentation was lucid and compelling (and I’m a professor of visual arts here at UC San Diego so at the end of the day, I know really nothing about astrophysics). After the talk the sponsor said to him, “you know what, I’m gonna pass because I just don’t feel inspired …you should be more like Malcolm Gladwell.”

At this point I kind of lost it. Can you imagine?

Think about it: an actual scientist who produces actual knowledge should be more like a journalist who recycles fake insights! This is beyond popularisation. This is taking something with value and substance and coring it out so that it can be swallowed without chewing. This is not the solution to our most frightening problems – rather this is one of our most frightening problems.

So I ask the question: does TED epitomize a situation where if a scientist’s work (or an artist’s or philosopher’s or activist’s or whoever) is told that their work is not worthy of support, because the public doesn’t feel good listening to them?

I submit that astrophysics run on the model of American Idol is a recipe for civilizational disaster.

What is TED?

So what is TED exactly?

Perhaps it’s the proposition that if we talk about world-changing ideas enough, then the world will change. But this is not true, and that’s the second problem.

TED of course stands for Technology, Entertainment, Design, and I’ll talk a bit about all three. I Think TED actually stands for: middlebrow megachurch infotainment.

The key rhetorical device for TED talks is a combination of epiphany and personal testimony (an “epiphimony” if you like ) through which the speaker shares a personal journey of insight and realisation, its triumphs and tribulations.

What is it that the TED audience hopes to get from this? A vicarious insight, a fleeting moment of wonder, an inkling that maybe it’s all going to work out after all? A spiritual buzz?

I’m sorry but this fails to meet the challenges that we are supposedly here to confront. These are complicated and difficult and are not given to tidy just-so solutions. They don’t care about anyone’s experience of optimism. Given the stakes, making our best and brightest waste their time – and the audience’s time – dancing like infomercial hosts is too high a price. It is cynical.

Also, it just doesn’t work.

Recently there was a bit of a dust up when TEDGlobal sent out a note toTEDx organisers asking them not to not book speakers whose work spans the paranormal, the conspiratorial, new age “quantum neuroenergy”, etc: what is called woo. Instead of these placebos, TEDx should instead curate talks that are imaginative but grounded in reality.  In fairness, they took some heat, so their gesture should be acknowledged. A lot of people take TED very seriously, and might lend credence to specious ideas if stamped with TED credentials. “No” to placebo science and medicine.

But … the corollaries of placebo science and placebo medicine areplacebo politics and placebo innovation. On this point, TED has a long way to go.

Perhaps the pinnacle of placebo politics and innovation was featured at TEDx San Diego in 2011. You’re familiar I assume with Kony2012, the social media campaign to stop war crimes in central Africa? So what happened here? Evangelical surfer bro goes to help kids in Africa. He makes a campy video explaining genocide to the cast of Glee. The world finds his public epiphany to be shallow to the point of self-delusion. The complex geopolitics of central Africa are left undisturbed. Kony’s still there. The end.

You see, when inspiration becomes manipulation, inspiration becomes obfuscation. If you are not cynical you should be sceptical. You should be as sceptical of placebo politics as you are placebo medicine.

T and Technology

T – E – D. I’ll go through them each quickly.

So first technology …

We hear that not only is change accelerating but that the pace of change is accelerating as well. While this is true of computational carrying-capacity at a planetary level, at the same time – and in fact the two are connected – we are also in a moment of cultural de-acceleration.

We invest our energy in futuristic information technologies, including our cars, but drive them home to kitsch architecture copied from the 18th century. The future on offer is one in which everything changes, so long as everything stays the same. We’ll have Google Glass, but still also business casual.

This timidity is our path to the future? No, this is incredibly conservative, and there is no reason to think that more gigaflops will inoculate us.

Because, if a problem is in fact endemic to a system, then the exponential effects of Moore’s law also serve to amplify what’s broken. It is more computation along the wrong curve, and I doubt this is necessarily a triumph of reason.

Part of my work explores deep technocultural shifts, from post-humanism to the post-anthropocene, but TED’s version has too much faith in technology, and not nearly enough commitment to technology. It isplacebo technoradicalism, toying with risk so as to reaffirm the comfortable.

So our machines get smarter and we get stupider. But it doesn’t have to be like that. Both can be much more intelligent. Another futurism is possible.

E and economics

A better ‘E’ in TED would stand for economics, and the need for, yes imagining and designing, different systems of valuation, exchange, accounting of transaction externalities, financing of coordinated planning, etc. Because states plus markets, states versus markets, these are insufficient models, and our conversation is stuck in Cold War gear.

Worse is when economics is debated like metaphysics, as if the reality of a system is merely a bad example of the ideal.

Communism in theory is an egalitarian utopia.

Actually existing communism meant ecological devastation, government spying, crappy cars and gulags.

Capitalism in theory is rocket ships, nanomedicine, and Bono saving Africa.

Actually existing capitalism means Walmart jobs, McMansions, people living in the sewers under Las Vegas, Ryan Seacrest … plus – ecological devastation, government spying, crappy public transportation and for-profit prisons.

Our options for change range from basically what we have plus a little more Hayek, to what we have plus a little more Keynes. Why?

The most recent centuries have seen extraordinary accomplishments in improving quality of life. The paradox is that the system we have now –whatever you want to call it – is in the short term what makes the amazing new technologies possible, but in the long run it is also what suppresses their full flowering. Another economic architecture is prerequisite.

D and design

Instead of our designers prototyping the same “change agent for good” projects over and over again, and then wondering why they don’t get implemented at scale, perhaps we should resolve that design is not some magic answer. Design matters a lot, but for very different reasons. It’s easy to get enthusiastic about design because, like talking about the future, it is more polite than referring to white elephants in the room.

Such as…

Phones, drones and genomes, that’s what we do here in San Diego and La Jolla. In addition to the other insanely great things these technologies do, they are the basis of NSA spying, flying robots killing people, and the wholesale privatisation of biological life itself. That’s also what we do.

The potential for these technologies are both wonderful and horrifying at the same time, and to make them serve good futures, design as “innovation” just isn’t a strong enough idea by itself. We need to talk more about design as “immunisation,” actively preventing certain potential “innovations” that we do not want from happening.

And so…

As for one simple take away … I don’t have one simple take away, one magic idea. That’s kind of the point. I will say that if and when the key problems facing our species were to be solved, then perhaps many of us in this room would be out of work (and perhaps in jail).

But it’s not as though there is a shortage of topics for serious discussion. We need a deeper conversation about the difference between digital cosmopolitanism and cloud feudalism (and toward that, a queer history of computer science and Alan Turing’s birthday as holiday!)

I would like new maps of the world, ones not based on settler colonialism, legacy genomes and bronze age myths, but instead on something more … scalable.

TED today is not that.

Problems are not “puzzles” to be solved. That metaphor assumes that all the necessary pieces are already on the table, they just need to be rearranged and reprogrammed. It’s not true.

“Innovation” defined as moving the pieces around and adding more processing power is not some Big Idea that will disrupt a broken status quo: that precisely is the broken status quo.

One TED speaker said recently, “If you remove this boundary … the only boundary left is our imagination”. Wrong.

If we really want transformation, we have to slog through the hard stuff (history, economics, philosophy, art, ambiguities, contradictions). Bracketing it off to the side to focus just on technology, or just on innovation, actually prevents transformation.

Instead of dumbing-down the future, we need to raise the level of general understanding to the level of complexity of the systems in which we are embedded and which are embedded in us. This is not about “personal stories of inspiration”, it’s about the difficult and uncertain work of demystification and reconceptualisation: the hard stuff that really changes how we think. More Copernicus, less Tony Robbins.

At a societal level, the bottom line is if we invest in things that make us feel good but which don’t work, and don’t invest in things that don’t make us feel good but which may solve problems, then our fate is that it will just get harder to feel good about not solving problems.

In this case the placebo is worse than ineffective, it’s harmful. It’s divertsyour interest, enthusiasm and outrage until it’s absorbed into this black hole of affectation.

Keep calm and carry on “innovating” … is that the real message of TED? To me that’s not inspirational, it’s cynical.

In the US the rightwing has certain media channels that allow it to bracket reality … other constituencies have TED.

• This article first appeared on Benjamin Bratton’s website and is republished with permission. It is the text of a talk given at TEDx San Diego