Half a century ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses—13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies—remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.
It should be no wonder that you have not mastered the understanding of them all. No one ever will. That’s why we as doctors and scientists have become ever more finely specialized. If I can’t handle 13,600 diagnoses, well, maybe there are fifty that I can handle—or just one that I might focus on in my research. The result, however, is that we find ourselves to be specialists, worried almost exclusively about our particular niche, and not the larger question of whether we as a group are making the whole system of care better for people. I think we were fooled by penicillin. When penicillin was discovered, in 1929, it suggested that treatment of disease could be simple—an injection that could miraculously cure a breathtaking range of infectious diseases. Maybe there’d be an injection for cancer and another one for heart disease. It made us believe that discovery was the only hard part. Execution would be easy.
Category: Leadership
How to Get Our Democracy Back: If You Want Change, You Have to Change Congress
We should remember what it felt like one year ago, as the ability to recall it emotionally will pass and it is an emotional memory as much as anything else. It was a moment rare in a democracy’s history. The feeling was palpable–to supporters and opponents alike–that something important had happened. America had elected, the young candidate promised, a transformational president. And wrapped in a campaign that had produced the biggest influx of new voters and small-dollar contributions in a generation, the claim seemed credible, almost intoxicating, and just in time.
Yet a year into the presidency of Barack Obama, it is already clear that this administration is an opportunity missed. Not because it is too conservative. Not because it is too liberal. But because it is too conventional. Obama has given up the rhetoric of his early campaign–a campaign that promised to “challenge the broken system in Washington” and to “fundamentally change the way Washington works.” Indeed, “fundamental change” is no longer even a hint.
Instead, we are now seeing the consequences of a decision made at the most vulnerable point of Obama’s campaign–just when it seemed that he might really have beaten the party’s presumed nominee. For at that moment, Obama handed the architecture of his new administration over to a team that thought what America needed most was another Bill Clinton. A team chosen by the brother of one of DC’s most powerful lobbyists, and a White House headed by the quintessential DC politician. A team that could envision nothing more than the ordinary politics of Washington–the kind of politics Obama had called “small.” A team whose imagination–politically–is tiny.
These tiny minds–brilliant though they may be in the conventional game of DC–have given up what distinguished Obama’s extraordinary campaign. Not the promise of healthcare reform or global warming legislation–Hillary Clinton had embraced both of those ideas, and every other substantive proposal that Obama advanced. Instead, the passion that Obama inspired grew from the recognition that something fundamental had gone wrong in the way our government functions, and his commitment to reform it.
For Obama once spoke for the anger that has now boiled over in even the blue state Massachusetts–that our government is corrupt; that fundamental change is needed. As he told us, both parties had allowed “lobbyists and campaign contributions to rig the system.” And “unless we’re willing to challenge [that] broken system…nothing else is going to change.” “The reason” Obama said he was “running for president [was] to challenge that system.” For “if we’re not willing to take up that fight, then real change–change that will make a lasting difference in the lives of ordinary Americans–will keep getting blocked by the defenders of the status quo.”
In the Next Industrial Revolution, Atoms Are the New Bits
The door of a dry-cleaner-size storefront in an industrial park in Wareham, Massachusetts, an hour south of Boston, might not look like a portal to the future of American manufacturing, but it is. This is the headquarters of Local Motors, the first open source car company to reach production. Step inside and the office reveals itself as a mind-blowing example of the power of micro-factories.
In June, Local Motors will officially release the Rally Fighter, a $50,000 off-road (but street-legal) racer. The design was crowdsourced, as was the selection of mostly off-the-shelf components, and the final assembly will be done by the customers themselves in local assembly centers as part of a “build experience.” Several more designs are in the pipeline, and the company says it can take a new vehicle from sketch to market in 18 months, about the time it takes Detroit to change the specs on some door trim. Each design is released under a share-friendly Creative Commons license, and customers are encouraged to enhance the designs and produce their own components that they can sell to their peers.
The Rally Fighter was prototyped in the workshop at the back of the Wareham office, but manufacturing muscle also came from Factory Five Racing, a kit-car company and Local Motors investor located just down the road. Of course, the kit-car business has been around for decades, standing as a proof of concept for how small manufacturing can work in the car industry. Kit cars combine hand-welded steel tube chassis and fiberglass bodies with stock engines and accessories. Amateurs assemble the cars at their homes, which exempts the vehicles from many regulatory restrictions (similar to home-built experimental aircraft). Factory Five has sold about 8,000 kits to date.
Bill Gross Puts US On Notice over Debt Binge
If the bond vigilantes are ready to ride again, there should be little doubt who will be leading the charge.
Bond guru Bill Gross at Pimco in Newport Beach this week has ramped up his warnings to the Obama administration and the Federal Reserve about the perils of unfettered government borrowing.
In an interview in Time magazine on Tuesday, Gross suggested that Pimco, which manages nearly $1 trillion in mostly fixed-income assets, now feels more comfortable owning German government debt than U.S. Treasury debt:
“There are a number of reasons to have doubts about Treasuries, not just because of America’s sovereign risk but also from the standpoint of an over-owned currency [the dollar]. . . . At Pimco we would probably try and substitute for our Treasuries with sovereign bonds of potentially higher quality. Germany looks interesting to us. Germany has problems, but it’s in a much better budget situation than the U.S. because of a constitutional amendment three months ago that forces a balanced budget in four years.”
Double Bubble & Built on Sand
Neda Soltan: Person of the Year
Every few years a man, or a woman, whose name is often familiar to few beyond the circle of their family and friends, is ambling through a more or less anonymous life when they find themselves ambushed by history. For many of these people, their life changes forever. Frequently, tragically, it ends; leaving behind an image that haunts the world long after they themselves have gone.
Neda Soltan was such a person, a young beautiful woman who had studied philosophy, was now an aspiring singer, who found herself abruptly catapulted from the crowds of Tehran to become the face of protest against Iran’s repressive rulers; a symbol of rebellion against the fraudulent election that had just returned Mahmoud Ahmedinejad to power.
Like the nameless student who taunted that tank in Tiananmen Square, like Jan Palach, the Czech student who died after setting himself alight in Wenceslas Square in January 1969 to protest against the Soviet-led invasion of Czechoslovakia, Neda Soltan became the icon for the mutiny against Iran’s brutish regime as images of her face, and amateur footage of her murder by a sniper from the pro-government Basij militia, sprinted around the world. Like the photograph taken in South Vietnam of a bewildered young girl, the victim of a napalm attack, running naked down a road; and like the images of those skin-and-bones internees, standing semi-naked in the prison camp run by Bosnian Serb forces in Omarska in 1992, their ribs as prominent as xylophone keys, the image of Neda Soltan lying bleeding on a Tehran street has become the shorthand for the horrors of a conflict. With their beseeching eyes such images become, as the war photographer Don McCullin has pointed out, our modern versions of religious icons.
Certainly a superior choice to the Political Class bank’s CEO: Goldman’s Lloyd Blankein.
Congress Travels, The Public Pays
The expenses racked up by U.S. lawmakers traveling here for a conference last month included one for the “control room.”
Besides rooms for sleeping, the 12 members of the House of Representatives rented their hotel’s fireplace-equipped presidential suite and two adjacent rooms. The hotel cleared out the beds and in their place set up a bar, a snack room and office space. The three extra rooms — stocked with liquor, Coors beer, chips and salsa, sandwiches, Mrs. Fields cookies and York Peppermint Patties — cost a total of about $1,500 a night. They were rented for five nights.
While in Scotland, the House members toured historic buildings. Some shopped for Scotch whisky and visited the hotel spa. They capped the trip with a dinner at one of the region’s finest restaurants, paid for by the legislators, who got $118 daily stipends for meals and incidentals.
Eleven of the 12 legislators then left the five-day conference two days early.
The tour provides a glimpse of the mixture of business and pleasure involved in legislators’ overseas trips, which are growing in number and mostly financed by the taxpayer. Lawmakers travel with military liaisons who carry luggage, help them through customs, escort them on sightseeing trips and stock their hotel rooms with food and liquor. Typically, spouses come along, flying free on jets operated by the Air Force. Legislative aides come too. On the ground, all travel in chauffeured vehicles.
Overture
Madison is truly blessed to have such a fine facility, courtesy of Jerry Frautschi’s landmark $200M+ gift. However and unfortunately, the financial spaghetti behind its birth is complicated and controversial, particularly at this moment when Overture’s parent lacks liquidity to fund the project’s remaining debt.
Yet, the facility is simply stunning. Have a look at these panoramic views.
Overture Hall Lobby:
MMOCA:
In an effort to preserve the pre-Overture scene, we shot panoramic images in 1999 and again, after construction in 2006.
I do have one financing suggestion. Give Goldman Sachs Lloyd Blankfein a call. After all, Goldman Sachs’ record bonuses are a direct result of massive taxpayer intervention to prop up certain banks and other “too big to fail” entities such as AIG. GS is well connected at the very top of our Government.
Playing with fireForget China, the US Federal Reserve is the world’s biggest currency manipulator
As US President Barack Obama glided through China, a chorus erupted in New York and Washington: the problem with the global economy is China’s exchange-rate policy, and Obama’s No 1 job is to slay it. It’s sad that these people actually believe what they are saying: the same “logic” got the world into the current mess. In the feverish hallucination of salvation, they think that moving China’s currency policy would right all wrongs.
The US Federal Reserve is the biggest currency manipulator in the world. Not only does it keep the short-term interest rate at zero through its vast purchase programme for mortgage-backed securities, it also keeps credit spreads and bond yields artificially low. Its manipulation stops money, bond and credit markets from pricing either the Fed’s policy or the US economic plight. All the firepower is packed into the currency market, giving speculators a sure bet on a weaker dollar and everything else rising. Here comes the biggest carry trade ever: the Fed is promising no downside for shorting the dollar.
The US Treasury writes an annual report, judging if other countries are manipulating their exchange rates. It should look in the mirror. Even though the Fed is not directly intervening in the currency market per se, its manipulation is equivalent to pushing down the dollar by non-market means.
Playing with fireForget China, the US Federal Reserve is the world’s biggest currency manipulator
As US President Barack Obama glided through China, a chorus erupted in New York and Washington: the problem with the global economy is China’s exchange-rate policy, and Obama’s No 1 job is to slay it. It’s sad that these people actually believe what they are saying: the same “logic” got the world into the current mess. In the feverish hallucination of salvation, they think that moving China’s currency policy would right all wrongs.
The US Federal Reserve is the biggest currency manipulator in the world. Not only does it keep the short-term interest rate at zero through its vast purchase programme for mortgage-backed securities, it also keeps credit spreads and bond yields artificially low. Its manipulation stops money, bond and credit markets from pricing either the Fed’s policy or the US economic plight. All the firepower is packed into the currency market, giving speculators a sure bet on a weaker dollar and everything else rising. Here comes the biggest carry trade ever: the Fed is promising no downside for shorting the dollar.
The US Treasury writes an annual report, judging if other countries are manipulating their exchange rates. It should look in the mirror. Even though the Fed is not directly intervening in the currency market per se, its manipulation is equivalent to pushing down the dollar by non-market means.