America’s Advisor

From David Roth’s The New Republic piece, “American Psycho,” an absolutely scathing brief profile of Jared Kushner’s role in unquestionable pandemic mismanagement:

So here we have Kushner, a powerful special adviser with no meaningful expertise in public health or epidemiology, using a breathtakingly specious chart produced by an economist who’d flubbed the biggest prediction he’d ever made—all as a justification for the federal government to do less to confront a rampaging pandemic. While the Trump years have offered many such crystalline and bottomless moments of executive abandonment, this one felt uniquely Jared. The collaboration is what makes it—a legacy figure in the field of elite ineptitude, delivering the old egregiousness in a style optimized for the vacuous new avatar of elite incompetence. The gilded tools of one generation of catastrophic conservative governance pass into the soft and clammy hands of the next. If it weren’t for all those people dying, it would be beautiful.

John Oliver’s “Police”

I love John Oliver’s show, and I love that HBO puts the spotlight segment of every episode up on YouTube for free. I think he provides a meaningful, funny, and appropriately disparaging look at both important popular issues as well as important obscure ones.

This is an important issue, and while also extremely depressing, it’s a fantastic episode.

Timeless Advice: The Golden Rule will never fail you

Kevin Kelly, former editor of Wired and the writer who popularized the 1000 true fans idea, decided to give 68 bits of unsolicited advice on his sixty-eighth birthday. It’s an excellent quick collection, but here are a few great ones that apply especially well to medical training:

Being enthusiastic is worth 25 IQ points.

Promptness is a sign of respect.

To make mistakes is human. To own your mistakes is divine. Nothing elevates a person higher than quickly admitting and taking personal responsibility for the mistakes you make and then fixing them fairly. If you mess up, fess up. It’s astounding how powerful this ownership is.

And one particularly timely one:

When crisis and disaster strike, don’t waste them. No problems, no progress.

Living Happily in a World You Don’t Understand

Morgan Housel, discussing the problematic narrowness and personal bias of most people’s mental models:

I don’t know what I don’t know. No one does. But we can’t walk around confused all day. Nassim Taleb says “I want to live happily in a world I don’t understand.” Which is exactly what we do. We take the world we live in and try to make a coherent story out of it based on the mental models we’ve developed during our lifetimes.

The takeaway: we are more likely to be influenced by our past than to truly learn from it. We are prone to overfitting life lessons to overly specific details instead of taking away useful general principles.

When this is over and we’re making decisions about how to best function in a post-COVID world, how much do you want to bet that people will say, “Yeah, but that was different. Those were special circumstances,” as a way to revert back to bad practices.

The Overtautness of American Healthcare

Siddhartha Mukherjee, author of the excellent Pulitzer Prize-winning The Emperor of All Maladies, writing for The New Yorker (emphasis mine):

To what extent did the market-driven, efficiency-obsessed culture of hospital administration contribute to the crisis? Questions about “best practices” in management have become questions about best practices in public health. The numbers in the bean counter’s ledger are now body counts in a morgue.

Deep, deep burn.

We’ve been teaching these finance guys how to squeeze,” Willy Shih, an operations expert at Harvard Business School, told me, emphasizing the word. “Squeeze more efficiency, squeeze cost, squeeze more products out at the same cost, squeeze out storage costs, squeeze out inventory. We really need to educate them about the value of slack.”

Medicine is a business, but it shouldn’t be run as just another business.

Everyone loves analogies with Toyota. There’s even one in this story, though it’s one that doesn’t usually make it into your average managerial or quality training, where people just love their black belts in Six Sigma, Lean, and tossing around those Japanese terms like Kaizen and Kanban. As Mukherjee argues, there’s a wide gulf between actually helping professionals take care of human beings and the complex dance of people and parts that requires and just ordering the fewest and cheapest widgets sourced from a factory in China.

What you really want to measure, model, and establish is the capacity to build something when a crisis arises. And this involves human as well as physical capital. We need to measure talent, versatility, and flexibility. Overtaut strings inevitably break.

Not only have they broken, but they’ve been unraveling for years.