bittubers.com/playlist/1006/11 For by unlike zone and I'm reading the war on normal people by injury hanging 21 Health Care in a world without jobs as jobs disappear in temporary employment becomes more prevent reforming our Healthcare System will be more and more crucial right now many of us rely upon our employers to pay for and provide Health Insurance in whole or in parts this will be increasingly difficult to sustain has jobs with benefits become hotter and hotter to come by on the consumer side spiraling healthcare costs are already become a crushing burden for Americans healthcare big bills with a number one cause of personal bankruptcy in 2013 in a study that year found that 56,000,000 Americans over 20% of the adult population struggled with Health Care expenses they couldn't afford to pay we will see in heard the horror stories of people coming back from the hospital with a bill for tens of thousands of dollars for many Americans it's a double whammy if you get sick you not only have to deal with the illness or injury but you have to figure out how to pay for treatment I work in the Healthcare Software startup based in New York from 2002 to 2005 I was 27 years old at the time a ceo was a talented forward position names menu, for we were one of the early Electronic Medical records companies that specialize fifth in talking paper info and taking paper info and at digitize and it's our niche was pre surgical info so our clients were large hospitals that hosted a lot of surgeries I was the head of client engagement in this small teams that rolled out our software to clerks doctors' offices secretaries nurse's office managers residence anesthesiologists and you occasionally surgeon that ago while to train the dozens of hundreds of people who could be touching a particular patient file we were modifying behavior from paper to digital I would spend weeks and months in urban hospitals in the Bronx morning side Heights or West Palm Beach distributing user names and passwords training people troubleshooting an answering the OKs all in Brea phone call I hung out outside operating rooms at 7:00 AM because surgeons like to start early and I ate at the ihop across the street from the U.N. Dian Ji hospital in new work so many times that I still can't see foot in one set foot in one today although we pass null passionately believes in the benefits of our product we found that it was difficult to make what seemed like a pretty simple and straightforward process change there were many reasons for this not the least of which was that the hospitals had a limited ability to police doctor's office behavior the surgeons were in charge their procedures were the big money generators each surgeon's office was its own business with different systems and practices some doctors like to invest in technology and people while others were clearly happy spending very little in order to maximize profitability they just wanted to come in 3.5 days a week and get to their golf courses or boats has fought fast as possible was like a fast moving assembly line filled with people scrambling to get through each day and little accountability or incentive to improve used to joke around as the months wore on that the Health Care is where good ideas go to die we never did accomplish our any goals as adoption was painstaking and difficult I left after four years having helped build a client base of about a dozen hospitals learn firsthand how even something that made sense and should help and should make things more efficient will be slow going in the healthcare industry is no real reason for them to change I know my experiences in the early two thousands have played out over and over again for others who would try to improve the Health Care System with technology in general the use of technology has not transformed healthcare the way the optimists would hope healthcare costs if continue to climb to a record 17.8% of the economy in 2016 up from 11.4% in 1989 and less than 6% in 1960 we spend about twice what other industrialized countries do on Health Care per capita with lesser results according to a 2014 commonwealth fund report we are last among major industrialized nations in efficiency equity and health outcome SP attributable two Medical Care is fight spending much more than anyone else another study had the United States last among developed countries in basic measurements such as rate of women dying due to pregnancy or childbirth and rate of survival two age five to the extent that new technology is used in tends to be expensive new design devices and implants the drive costs ever higher the basic practice of medicine as well as the training is the same as it's been for decades are job based Health Insurance System does the very thing we most want to avoid into Sturges businesses from hiring of now run a couple of companies and if I hire a fulltime entry level worker in New York at $42,000 I have to factor that during an additional $6000 for Health Care Insurance costs for employers company subsidize Health Insurance costs are a major impediments to a hiring and growth the cost in a lot higher for senior people with families my last company was spending more than $2500 a month on certain people's insurance plans if these costs words on our books we definitely would have hired more people Health Insurance also pushes a company's to make as many employees as possible into part time key aide workers or contractors your denies Asians Iran were generous my education company made instructors who worked more than 20 hours a week full time employees and provided benefits accordingly this was highly unusual in our industry and very expensive we can do it because we were growing and profitable and there was always important to me to check take care of people for many companies insurance costs are increasingly out of control and they can make or break a business is very difficult to pass increase costs are two employees or take back benefits after if they'd been providing so you're setting yourself up for increase costs in good times and bad on the worker side I know tons of people who hang on to jobs that they do not want to be in just for the Health Insurance economist refer to this as job lock in mix the labor market much less dynamic which is bad in particular for young workers replacing Health Insurance is a major source of discouragement for people striking off on their own in starting a new business especially if they have families in a world where we're trying to get more people to both create jobs and start companies are employer based Health Insurance System serves as a shackle holding us in place in a reason not to hire his jobs disappear having one's Health Care late to employment will become increasingly untenable the need for a different approach his growing Health Care is not truly subject to market dynamics for a host of reasons in a normal marketplace companies compete for your business by presenting different value propositions and you make an informed choice with healthcare dutifully have only a few options we have no idea what the real differences are between different providers and doctors cost are high and extremely unpredictable making it hard to budget for them the complexity leaves many Americans overwhelmed and highly suggest noble two ex words or institutions when you actually two get sick or injured you become cost insensitive just trying to get well house rules often employ opaque pricing resulting in patient uncertainty over what their insurance will actually cover more over when you're ill in its possible your faculties can be impaired because of illness emotional distress or even unconsciousness as Steven Burrill wrote in his seminal time magazine article on Health Care costs less to a protected by Medicare the healthcare market is not a market at all is a crapshoot a lack of real market discipline or cost control incentives has driven costs ever higher technology they should decrease costs has been kept at the door because for most actors in a system the goal is to increase revenue and profitability the more services tests appointments procedures and expensive gadgets you use the better the system rewards activity and output over health improvements and outcomes one changing these incentives his key the most direct way to do so would be to move towards a single payer Healthcare System in which the government both guarantees Health Care for all in and negotiates fixed prices Medicare the government provided Health Care program for Americans 65 and over essentially surface role for senior citizens and has successfully driven down costs in providing quality care for tens of millions most everyone loves Medicare is politically bulletproof same Altman and the head of why, nature suggests rolling out of Medicare across the population by gradually lowering the L's of eligibility age overtime a gradual phase it would give the industry time to plan and adjust this is an excellent way forward and a miracle cure for all movement is currently gathering steam there would inevitably remain a handful of private options for the super affluence but most everyone would use the generalized care one harsh reality is that any rationalization of healthcare costs will hit tons of resistance because it's going to reduce a lot of people's incomes dean Baker coal director of the center for economic and policy research has written about the high cost of Health Care including Dr. Salaries we do raise money on insurance we also pay basically twice as much for everything he writes the page was as much to doctors were single parent get our doctors to reset half as much in wages have each won a single payer system Baker says would mean fights with all these powerful interest groups fifth alley some doctors have been voicing their discontent with the current arrangement that puts money and efficiency over time spent with patients doctors say in deep Joe harm a cardiologist and author was that doctors today see themselves not as pillars of any community but as technicians on an assembly line or pawns in a moneymaking game for hospital administrators Dillard notes that only 6% of doctors was described their morale as positive in a 2000 its survey and most are pessimistic about the future of the medical profession a 2016 survey of American doctors by the Physicians foundation from a 63% have negative feelings about the future of the medical profession and 49% said they often or always experience feelings of burnout and 49% would not recommend a career in medicine to their children is same survey found that excessive paperwork in regulation was a consistent burden with only 40% of doctors believing they had enough time to provide patients the highest quality of care that was half were planning on retiring taking a non clerical position going part time or reducing their patient hours due to various frustrations low amount of time spent per patient makes doctors on half the cuts patients short and dries up costs to our notes that many doctors were get paper speed and Colin specialist just to cover their as in case they missed something resulting in ever more tests and costs when I went to brown in the mid 1990s about half of the people around me were premed I remember how hard the all studied for organic chemistry which was the weed out class that separated the people who are going to go on to med school successfully from those who were going to have to rethink their ambitions many people who wanted very badly to be doctors didn't make it one friend in particular I remember being crushed by the realization that she wasn't going to fulfill her childhood and mission none of my friends were doctors today actually use organic chemistry for anything that was just intended to make things really difficult C becoming a Dr. Is a climb through a very competitive and hierarchal system you study to get a high GPA in your premed coursework taking BMC 18 spent a number of spend a summer caddying for a Dr. or researcher compete in med school to graduate with honors applied to match with a desirable residency that pursue the right internship and fellowship in every level the people become smarter and smarter some specializations take as many as six years after medical school or 10 full years after college different specialist taken on different personalities the anesthesiologist are mellow your foot peak surgeons are jocks the pediatricians love children and so on the amount of money you make largely corresponds to how many years you spend in specialized training family medicine doctors make about $200,000 a year on average while orthopedic surgeons make more than $500,000 per year the average educational debt load for a medical school graduates in his $180,000 with 12% of doctors only a whopping $300,000 for their training in part as a result of the system there's a national shortage of both primary care doctors and doctors who practice in rural areas about 65,000,000 Americans live in what one expert called basically a primary care desserts the association of American Medical colleges estimated that the number of additional doctors necessary to provide appropriate care two undeserved areas was 96,200 in 2014 with a gap of about 25,000 in primary care alone many states are offering grants and incentives to address Dr. Shortages as 12 states have fewer than half the number of primary care doctors necessary to provide adequate coverage after all of the competition and schooling and at many doctors don't want to sign up for the spay and prestige to work in on underserved areas that crosses is also not selecting people for and the thing most medical schools apply a mechanical screen to determine who you interview based solely on Collins' GPA course of study and Mc 18 score was some schools say they are trying to identify applicants who display various personal traits were still talking about 21,030 people per year who studied science and did well on the Mc 18 attending read school which is a very restricted group of people Martin Ford the author of rise of the robots suggest that we create a new class of Health Care provider armed with a I College graduates or master students unburdened by additional years of costly specialization who would nonetheless be equipped to head out to rural areas they could help people monitor chronic conditions like obesity and diabetes and refer particularly Gary problems to more experienced doctors call them primary care specialists in I will soon be at a point where technology in conjunction with a non Dr. Could offer the same quality of care as a Dr. In the vast majority of cases one study in one study IBM's Watson made the same recommendation as human doctors did in 99% of the 1000 medical cases inmate suggestion its human doctors missed in 30% of them a item reference more cases than the most experience position while keeping up to date with the latest journals and studies predictably daughters of lobbied against nurse practitioners and unsupervised residence seeing patients and they would doubtless feel even more negatively about this new class of primary care specialist by this change would make Health Care much more widely available open up a new employment category for smart and empathetic college graduates or jail genuinely want to spend time with patients and eventually lighten the time burden on individual Physicians is brings us back to how to implement a new single payer system we need to do more than rationalize crude costs we need to transform the way that doctors get paid adopting Medicare for all or a single payer system will sell the biggest problems of rampant overbilling an ever increasing costs women appear still generally reimburses based on individual point minced procedures and tests which maintain the incentives for doctors to do more to get paid more there is a movement towards a value based or quality based reimbursement was tries to measure patient outcomes read me admission rates and a like a reward providers accordingly one startup based in merry land's Ellen day did is having success by giving primary care doctors incentives two reduced costs would these pay for performance plans are tough to measure influence a very low proportion of the funds currently being received by providers and have had mixed results the best approach is what they do it the cleaving Cleveland clinic doctors simply get paid flat salaries when doctors aren't worried about billing they can focus on patients Dr. Gallo schools through the ceo of the Cleveland clinic said I think you have to recognize that people do what you pay them to do if you pay doctors do more of something and that's what they'll do if you put the emphasis on looking after patience and they'll do that's the Cleveland clinic is consistently ranked among the top hospitals in the country and Physician turnover is only 3.5% per year much lower than normal the Cleveland clinic as achieve financial success in part by universal icing a sense of cost control they put price tags on things to everyone knows how much it costs to say open up a new set of sutures they don't allow redundant tests they include doctors in purchasing decisions everyone is interested in the company's financial sustainability because they feel a sense of ownership and mission loss at the hospital does well you're more likely to get all raise which required is an honest conversation in which we say to people were interested in becoming doctors if you become a Dr. You'll be respected and admired and heal people each day you'll live a comfortable life but medicine will not be a path to riches on the bright side were not going to burn you out by forcing you to see a million patients a day and fill out paperwork all the time we're going to supplement you with an army of empathetic people acquit with a I will handle most routine cases only call you when the case genuinely requires the state human judgment or empathy we want you to become the best and most human version of yourself not Dr. Speed demon who conveyed out on 9 minutes a point needs this leave that two Watson ensure that many doctors were enjoyed the shift in bowl and embrace becoming better more empathetic clinic the nation's changing their incentives would change everything a shift in incentives would also allow doctors to treat patients holistic Le the Southcentral foundation by Health Care provider for a list and natives trees health problems and behavioral problems as related issues when you get a health checkup you also get the psychological a point mint in turns out that problems like obesity and oppression are linked and the local citizens top concerns child sexual abuse child neglect domestic violence and addictions all involve psychology and behavior as much as menacing and drugs integration of physical and psychological services at south central lower hospital admissions and visits to the emergency room by more than a third between 2020 15 and 97% of patients said they were satisfied with the care integrating medical and behavioral healthcare could save tens of billions of dollars each year from the nation's Health Care costs south central Ceo Catherine got been on an Alaskan native received a Macarthur genius grant for her work in time freedom from being paid a fee for service would give Physicians and organizations the opportunity to sell problems in new ways that first ago would be to measure patient outcomes and decrease Riyadh mission and errors eventually one can imagine hospitals being measured against statistics on the health of the surrounding population it's it's from your care specialist could distribute biometric devices monitor a patient's interactions with other doctors incurs preventive measures a I coaches could be employed to remind people to stick to their treatment or resume and or to assess with psychological disorders patients can volunteer to share their Health Data to usher in revolutionary new approaches the goal would be to make each hospital hub of health and vitality that sells or reduces problems beyond its walls technology that streamlines costs and improve station peer would become eight clinicians best friends we are so many brilliant doctors they should be innovators detectives guides in sources of comfort comfort not glorified assembly line workers and freeing Health Care from being locked to a job would be a massive boon to economic growth and dynamism and some of the winners in the current system would make less money in the new world even as patient care improves the message should be that you for taking care of us know the country needs you to attack can evolve you possibly knew that this time would come sooner or later we hope you'll be even more excited to help people get will now that you have the time to really focus on its 22 am building people education in the age of automation RE imagining college and the age of automation bags the fundamental question whether people sent to college to learn originally the idea of an education was to develop a sense of morality as Mary Woolley the president of mount Holyoke he stated in 1901 character is the main object of education the Harvard psychologist and philosopher William James wrote and around the same time that character and moral significance or bill through a adopting a self imposed heroic ideal that is presumed to courage endurance integrity and struggle is the development of these ideals that was once the purpose of a university education of course for many decades now the point of colleges been to set people up are jobs or what happens when the jobs disappear similar to healthcare young nation wade should lead us to invest more people in education and human capital development in should also drive us to dramatically increase or emphasis on technical and vocational training in apprenticeships at the high school level to take advantage of the jobs that will continue to exist the difficulty is that schools will need to reinvest in adept even as the monetary returns on education diminish in jobs become order to call my to fifth some people saw some believe that we can and expressively educate large number of people using the latest technology a couple years ago I spoke at an awards dinner with Salk on the founder of the, academy if you don't know, academy you should they make education videos that argues by millions around the world on everything from basic arithmetic to raise miniature to quantum physics sale was a hedge fund and lead analyst turned explainer of all things bill gates kids used to watch the videos to supplement their schooling leading bill to become one of the many $1,000,000 donors to, academy their mission is to educate the world say look even inspiring talk that night the high point when something like this back in the middle ages if U.S. belligerent monks and scholars how many of the farmers and peasants walking around would be capable of learning to read that stuff and say read and most of the peasants we never learn to do something like that's you might guess that 2 to 3% of the peasants would be capable of becoming literate today we know that the real number is closer to 99% virtually everyone is capable of learning to read that if I ask you to date how many people are smart enough to study quantum fed and physics you might say only two or 3% this is a shortsighted as the most were in the middle ages religious prejudice Rivers of how smart people can become if we give them the proper tools to learn in the years ahead will find that people are capable of much more than we can imagine sales was speech received a rousing ovation it was an exhilarating vision technology and universally accessible low cost education materials would accelerate a new age of smarter human beings presumably these new smart are human beings would innovate in create new jobs and businesses that we walked away I found myself asking is he writes at least here in the United States is very hard to say that he is the Internet became widely available an adopted in 2002 a majority of American households have had broadband Internet at home for more than 10 years now and 85% a day have either up one binge home connection or a smart phone we have years of information about how unlimited access to materials like, academy has influenced learners around the country unfortunately sat scores have declined significantly in the last 10 years by school graduation rates have edged up words college readiness is generally down we don't seem to be getting any more enlightened despite ubiquitous online lessons is impossible not to love, academy I fully intend to strap my kids in as soon as they're ready for its life fantasize about coming home and having them say things like I learned thermodynamics today but if one gives a 12 year old access to high speed Internet they are infinitely more likely to chat with their friends play video games or what's the latest on as trailers video the delve into a deep thought provoking discussion of war and peace among the biggest gainers from, academy are people of Russia and learners like Bill Gates kids while really had some things going for them the clears impact of technology on teen developments to date has been starkly negative according to psychologist Jeanne twenties 2017 book on age and smart phone use has caused a spike in depression and anxiety amongst people born from 1995 on and diminution in sociability and independence and exit cover book in the Atlantic was aptly titled have smart phones destroyed a generation you're not using their smart phones to learn calculus with the are trying to keep their snap streaks going in 2011 everyone began talking about massive open online courses and Coho CDs and many believed they were going to revolutionize education in 2013 when the city ruled out the core course of Stanford and MIT in topics like artificial intelligence tens of thousands of students around the world and rolled pundits in experts predicted the destruction of college as an institution that stands as the spam 00 sees kind of flopped only about 4% of students completed the average course with many quitting after only one or two sessions in one case in online math course was found to be less affected their own medial college class in person and scale back though these online courses continue to improve college applications remain higher than ever for people still learn from other people too often people mistake content for education and vice versa we act as if we can take a textbook or less in online and make it interactive and then that will hesitate someone that no one would consider putting a child in an empty classroom with a textbook education we would call that reading or maybe punishments next until of the founder and ceo of altschul has said that the worst use the software in education is in replacement of humans this craziness is about the relationship that kids have with their peers with adults is what creates the motivation that creates the learning all school is a company founded in 2014 to personalize education for all children across the country altschul has raised over 175,000,000 from marks of the bird Emerson collective and others is opened six schools that collectively serve hundreds of elementary school students in San Francisco and New York in employs more than 50 engineers were developing tools each day that teachers request would uses video cameras to monitor tiny students interactions for playback we believe that the madness majority of the learning should happen in non digitally Max explains he is the former head of personalize Asian at Mobil and parent to three young children and he wants to build schools they prepare children for the future in any all school classroom most of what a kid is doing is not on a screen but for every kid we have additional representation of the important things that relate to that child's learning not just their academic learning but also their non academic learning they learn that their character skills matter that their greats their perseverance that their experience with being successful after failing a bunch of times is as much a part of that education as learning history facts and knowing how to multiply two numbers altschul represents a sophisticated blinds of using software to do the things that acknowledging his excellent cast recording and synthesizing large amounts of data over a fifth of over a growing number of people and making recommendations while retaining the essence of how people learn from other people a dinner with Max and his wife Jennie in San Francisco last year I can see how altschul raised $175,000,000 Max is an exceptional guide and completely sincere in his mission of furthering how our children learn is it for the long-term they probably helps that his mother and sister our teachers perhaps the best thing about altschul is that it focuses on character scales in an age with less and less employment the abilities to sell manage and socialized will become the new keys to success in life we should recognize that the majority of high school students will not go to college and that their ability to function to be independent of further education rich persistence adaptability financial literacy interview skills human relationships conversation communication managing technology navigating conflicts preparing healthy food physical fitness resilience self regulation time management basic psychology and mental health practices arts and music all of these would help students and make and also make school seem much more relevant our fixation on college readiness needs are high school curricula for purely academic subjects and away from a life skills the purpose of education should be to enabled a citizen to live a good positive social a productive life independence of work education starts at home are enormous favor one enormous favor we can do for teachers would be to try to keep parents together children raised into parent households have better all comes by most emissions technology could potentially helped here one can imagine in a I live coats with the voice of Morgan freeman tried to help people manage their differences the government should provide or subsidize marriage counseling to essentially anyone who wants its if you have kids and you want to stay together we should help you do it's even successful married couple shudder if you bring up the earliest years when their children were first born any marriage or relationship that remains whole is a win for the next generation we should also make sure that parents have ample time to spend with their children are lack of family leave for new patient is barbaric entire family sexist regressive economically a rational and just plain stupid studies have shown that robust family leave policies improve children's health and height and women's employment rates because they don't feel they need to leave work entirely in order to be successful United States is one of only four out of 196 countries in the world and the only industrialized country that does not have federally mandated time off from work for new mothers the other three are this so flow swaziland's and Papua New Guinea not exactly a list of world beaters were in the bottom 2% of recognizing that new parents might need to spend time with their new baby is the most obvious example of our prioritizing capital in a misguided way over skew manatee in contrast Denmark gives 52 weeks of paid leave they can split between them with a minimum of 18 weeks of full paid for the mother and will stop there and I'm reading the war on normal people by Andrew Yang and I'm like zone thanks for listening fourth of the fifth of fifth of