Three Cures for Wasteful Healthcare
David Cutler served at Harvard University as an Assistant Professor of Economics from 1991 to 1995, was named John L. Loeb Associate Professor of Social Sciences in 1995, and received tenure in 1997. He is currently the Otto Eckstein Professor of Applied Economics in the department of economics and Kennedy School of Government and recently completed a five-year term as associate dean of the Faculty of Arts and Sciences for Social Sciences.
Professor Cutler served on the Council of Economic Advisers and the National Economic Council during the Clinton Administration and was senior health care advisor to Barack Obama's Presidential campaign. Professor Cutler also advised the Presidential campaign of Bill Bradley. Among other affiliations, Professor Cutler has held positions with the National Institutes of Health and the National Academy of Sciences. Currently, Professor Cutler is a Research Associate at the National Bureau of Economic Research and a member of the Institute of Medicine.
Professor Cutler is the author of Your Money Or Your Life: Strong Medicine for America's Health Care System, published by Oxford University Press. This book, and Professor Cutler's ideas, were the subject of a feature article in the New York Times Magazine, "The Quality Cure", by Roger Lowenstein. Cutler was recently named one of the 30 people who could have a powerful impact on healthcare by Modern Healthcare magazine and one of the 50 most influential men aged 45 and younger by Details magazine.
Question: Why is their so much waste in our healthcare system?
David Cutler: Let me give you three examples of why we have waste, and how you could get rid of them. The first example is, look at what actual providers are doing on a moment-to-moment basis. So if you...people have done studies where you follow nurses in a hospital with stop watches, or you have them carry a Palm Pilot where they record everything that they do. The most common thing that a nurse in a hospital does, is document things. She takes the printouts from electrical equipment, gets it on paper, reenters it into the computer. That’s a third of the time that doesn’t need to happen—no other industry does that. That’s probably thirty billion dollars a year spent on that. So that’s one example.
There all sorts of other examples, ranging from infections that are not prevented and so driving up spending, to doctors who spend Seventy-Thousand dollars a year on the telephone with the insurance companies and pharmacies, and their staff doing that. So the first item is just money spent to doing things than no other industry do we tolerate—which is why productivity is very low in health care.
You could get rid of that with information technology, both what we have, and what we can expect, in the reasonably near future. You could get rid of that with the payment changes, you could get rid of that through organizational changes.
The second area is insurance companies that drive up spending a lot by separating out who’s helping and who’s sick. So they spend a lot of money figuring out who the healthy people are and who the sick people are, and how to ensure only the healthy people. That is a big, big loss for society. Of course someone has to pay for the sick people, they’re not going to pay for hundred of thousands of dollars on their own; so me and you are going to pay for it through tax dollars or through other programs. The money spent shuffling them around is just a complete waste, and many of the insurance company recognize this and are willing to do something about it. So that’s the second example.
The third example is people who have more very acute episodes than they need to. And when they have those episodes they cost more than they should. An example: diabetic patients were not treated well and an outpatient basis wind up going into the hospital with kidney failure, immediate amputations of extremities, going blind with heart attacks. Why? Because we couldn’t get it together to treat them better when they had diabetes without those complications. And then when they have the complications, of course, we don’t manage it very well. They go into the hospital, they come out of the hospital—they don’t get a doctor’s appointment, they don’t see the nurse right away, they wind up coming back into the hospital three weeks later with further complications. All of that is expense that doesn’t need to happen.
And if we do a better job coordinating care for people; better job managing them when in their less acute states; better job of dealing with them throughout the course of their illness rather than just that the very end—we can save an enormous amount of that expense as well.
Recorded on: July 06, 2009
The Harvard economist, David Cutler, outlines healthcare’s biggest inefficiencies, and explains how to solve them.
It's just the current cycle that involves opiates, but methamphetamine, cocaine, and others have caused the trajectory of overdoses to head the same direction
- It appears that overdoses are increasing exponentially, no matter the drug itself
- If the study bears out, it means that even reducing opiates will not slow the trajectory.
- The causes of these trends remain obscure, but near the end of the write-up about the study, a hint might be apparent
Through computationally intensive computer simulations, researchers have discovered that "nuclear pasta," found in the crusts of neutron stars, is the strongest material in the universe.
- The strongest material in the universe may be the whimsically named "nuclear pasta."
- You can find this substance in the crust of neutron stars.
- This amazing material is super-dense, and is 10 billion times harder to break than steel.
Superman is known as the "Man of Steel" for his strength and indestructibility. But the discovery of a new material that's 10 billion times harder to break than steel begs the question—is it time for a new superhero known as "Nuclear Pasta"? That's the name of the substance that a team of researchers thinks is the strongest known material in the universe.
Unlike humans, when stars reach a certain age, they do not just wither and die, but they explode, collapsing into a mass of neurons. The resulting space entity, known as a neutron star, is incredibly dense. So much so that previous research showed that the surface of a such a star would feature amazingly strong material. The new research, which involved the largest-ever computer simulations of a neutron star's crust, proposes that "nuclear pasta," the material just under the surface, is actually stronger.
The competition between forces from protons and neutrons inside a neutron star create super-dense shapes that look like long cylinders or flat planes, referred to as "spaghetti" and "lasagna," respectively. That's also where we get the overall name of nuclear pasta.
Caplan & Horowitz/arXiv
Diagrams illustrating the different types of so-called nuclear pasta.
The researchers' computer simulations needed 2 million hours of processor time before completion, which would be, according to a press release from McGill University, "the equivalent of 250 years on a laptop with a single good GPU." Fortunately, the researchers had access to a supercomputer, although it still took a couple of years. The scientists' simulations consisted of stretching and deforming the nuclear pasta to see how it behaved and what it would take to break it.
While they were able to discover just how strong nuclear pasta seems to be, no one is holding their breath that we'll be sending out missions to mine this substance any time soon. Instead, the discovery has other significant applications.
One of the study's co-authors, Matthew Caplan, a postdoctoral research fellow at McGill University, said the neutron stars would be "a hundred trillion times denser than anything on earth." Understanding what's inside them would be valuable for astronomers because now only the outer layer of such starts can be observed.
"A lot of interesting physics is going on here under extreme conditions and so understanding the physical properties of a neutron star is a way for scientists to test their theories and models," Caplan added. "With this result, many problems need to be revisited. How large a mountain can you build on a neutron star before the crust breaks and it collapses? What will it look like? And most importantly, how can astronomers observe it?"
Another possibility worth studying is that, due to its instability, nuclear pasta might generate gravitational waves. It may be possible to observe them at some point here on Earth by utilizing very sensitive equipment.
The team of scientists also included A. S. Schneider from California Institute of Technology and C. J. Horowitz from Indiana University.
Check out the study "The elasticity of nuclear pasta," published in Physical Review Letters.
Scientists think constructing a miles-long wall along an ice shelf in Antarctica could help protect the world's largest glacier from melting.
- Rising ocean levels are a serious threat to coastal regions around the globe.
- Scientists have proposed large-scale geoengineering projects that would prevent ice shelves from melting.
- The most successful solution proposed would be a miles-long, incredibly tall underwater wall at the edge of the ice shelves.
The world's oceans will rise significantly over the next century if the massive ice shelves connected to Antarctica begin to fail as a result of global warming.
To prevent or hold off such a catastrophe, a team of scientists recently proposed a radical plan: build underwater walls that would either support the ice or protect it from warm waters.
In a paper published in The Cryosphere, Michael Wolovick and John Moore from Princeton and the Beijing Normal University, respectively, outlined several "targeted geoengineering" solutions that could help prevent the melting of western Antarctica's Florida-sized Thwaites Glacier, whose melting waters are projected to be the largest source of sea-level rise in the foreseeable future.
An "unthinkable" engineering project
"If [glacial geoengineering] works there then we would expect it to work on less challenging glaciers as well," the authors wrote in the study.
One approach involves using sand or gravel to build artificial mounds on the seafloor that would help support the glacier and hopefully allow it to regrow. In another strategy, an underwater wall would be built to prevent warm waters from eating away at the glacier's base.
The most effective design, according to the team's computer simulations, would be a miles-long and very tall wall, or "artificial sill," that serves as a "continuous barrier" across the length of the glacier, providing it both physical support and protection from warm waters. Although the study authors suggested this option is currently beyond any engineering feat humans have attempted, it was shown to be the most effective solution in preventing the glacier from collapsing.
Source: Wolovick et al.
An example of the proposed geoengineering project. By blocking off the warm water that would otherwise eat away at the glacier's base, further sea level rise might be preventable.
But other, more feasible options could also be effective. For example, building a smaller wall that blocks about 50% of warm water from reaching the glacier would have about a 70% chance of preventing a runaway collapse, while constructing a series of isolated, 1,000-foot-tall columns on the seafloor as supports had about a 30% chance of success.
Still, the authors note that the frigid waters of the Antarctica present unprecedently challenging conditions for such an ambitious geoengineering project. They were also sure to caution that their encouraging results shouldn't be seen as reasons to neglect other measures that would cut global emissions or otherwise combat climate change.
"There are dishonest elements of society that will try to use our research to argue against the necessity of emissions' reductions. Our research does not in any way support that interpretation," they wrote.
"The more carbon we emit, the less likely it becomes that the ice sheets will survive in the long term at anything close to their present volume."
A 2015 report from the National Academies of Sciences, Engineering, and Medicine illustrates the potentially devastating effects of ice-shelf melting in western Antarctica.
"As the oceans and atmosphere warm, melting of ice shelves in key areas around the edges of the Antarctic ice sheet could trigger a runaway collapse process known as Marine Ice Sheet Instability. If this were to occur, the collapse of the West Antarctic Ice Sheet (WAIS) could potentially contribute 2 to 4 meters (6.5 to 13 feet) of global sea level rise within just a few centuries."
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