This is an amusing essay about taking Monty Python seriously and as being worthy of study.
Why do dieters put locks on their refrigerators? After all, if we don't want to eat the cake, then it should follow that we do not eat the cake. The rub, of course, is that we really do want that cake—badly.
In Why Everyone (Else) Is a Hypocrite: Evolution and the Modular Mind (Princeton University Press), Robert Kurzban says he has solved the mystery. The author, an associate professor of psychology at the University of Pennsylvania, explains: "The human mind consists of many, many processes—think of them as little subroutines, or maybe individual iPhone applications—each operating by its own logic, designed by the inexorable process of natural selection." Our behavior is governed by whichever processes, or what Kurzban calls modules of the brain, happen to be in charge at that moment. It's no wonder that we try to thwart our cake-loving modules with padlocks and pictures of ourselves in bathing suits.
Turns out that Walt Whitman was perhaps more right than he knew when he said, "I contain multitudes."
Conditions changed rapidly as the 1970s ended, even as the U.S. economy struggled. The rates of inflation, mortgages, and unemployment reached double digits. Like most states, North Carolina faced staggering budgetary problems and international competition. Japan flooded U.S. markets with cars and electronics, and Japanese managers ridiculed American workers.
Instead of retrenching, however, North Carolina doubled down on its future. The then-governor and General Assembly recognized that filling potholes in streets could be deferred, but limiting educational opportunities and decimating research capabilities would have irretrievably bad consequences.
Yes, "investment = spending", but some spending has longer-reaching effects than other.
So he took what he learned from police reform and tried a Compstat approach to the city’s health-care performance—a Healthstat, so to speak. He made block-by-block maps of the city, color-coded by the hospital costs of its residents, and looked for the hot spots. The two most expensive city blocks were in north Camden, one that had a large nursing home called Abigail House and one that had a low-income housing tower called Northgate II. He found that between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million.
Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.
If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. And, if the stats approach to crime was right, targeting those with the highest health-care costs would help lower the entire city’s health-care costs. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients.
Thanks to
apel for the link -- this is a really fascinating history of one doctor's attempt to cut medical costs in a single city. It's still anecdotal, and the author recognizes that the net savings may not be as great as they first appear, but I think it bears reading and further testing.