Health care industry eschews new technology

On virtually every visit to a private doctor’s office, I am amazed at the amount of clerical staff that even relatively small offices employ. Having run a law office for many years, I understand that the amount — and productivity — of clerical staff is an important component in the overall profitibility of the office. There is no discernible reason why that principle should be any different in most doctors’ offices.
This NY Times article may explain a part of this phenomenom. Despite pressure from an array of interest groups, only a few dozen medical centers across the country are making full use of the latest computerized patient safety systems. Hospitals and doctors contend that they have good reason to be cautious about the new technology because they believe that the computerized systems will never repay their multimillion-dollar cost, or will be outmoded or cost much less in a few years. Moreover, many doctors complain that using the systems to write prescriptions and order tests diverts them from patient care and running their offices on already stressful workdays.
The coordination of technology with patient care and medical practice business operations is one of the most challenging problems in the complicated field of health care finance at this time. This is an issue that we all need to follow closely.

Yeah, but do they have rubber chicken?

This NY Times article relates some airline industry executives’ frustration with the glowing media reports that low-budget airlines such as Southwest Airlines and JetBlue have been receiving recently. The article is a good summary of where the airline industry stands at this point, and includes the following classic Warren Buffett analysis of the industry generally:

Now anyone who really, truly understands the economics of airlines is probably too smart, or unstable, to be working for either an airline or a newspaper. As Warren E. Buffett has often pointed out, if one tabulates all of the airline industry’s finances since the day the Wright Brothers bounced into the air at Kitty Hawk in 1903, one will discover that, cumulatively, there has not been a single penny of profit. (Mr. Buffett has also suggested that, in hindsight, shooting down the Wright Brothers on that beach would have been a reasonable financial, if not moral, move.)

Friday Night Lights

Some of my non-Texan friends chide me that the phrase “Texas culture” is an oxymoron. However, Texas actually is a place rich in many distinctly interesting cultures, and the following are a few noteworthy books and movies that explore those cultures.
Texas author Larry McMurtry has brilliantly explored the diversity of Texas culture in many of his novels. His Pulitzer Prize-winning novel “Lonesome Dove” and the extraordinary television mini-series based on the book (with Robert Duvall and Tommie Lee Jones in th lead roles) captures many of the frontier aspects of Texas culture. Similarly, Mr. McMurtry’s “Last Picture Show,” — which Peter Bogdanovich made into a fine movie — is an exceptional depiction of West Texas culture, just as his alternately hilarious and heart-wrenching “Terms of Endearment” (also made into a wonderful movie starring Shirley McLaine, Debra Winger and Jack Nicholson) is an insightful view into the upper crust of Houston culture.
One of my favorite movies about Texas is John Sayles‘ movie “Lone Star,” which is a fine murder mystery set in the complicated culture of Texas’ Rio Grande Valley near Texas’ border with Mexico. As the characters in this movie remind us on several occasions, “This isn’t Houston, ya know.”
But one of the most popular books about Texas culture is H.G. Bissinger‘s “Friday Night Lights,” the definitive book on the fascinating culture of Texas high school football. In this fine book, Mr. Bissinger examines the spirit of one of Texas high school football’s most successful programs: the Odessa Permian Panthers. Set in a city in decline in the West Texas desert, Mr. Bissinger explores the town, the school, the coaches, the team, its players, and how — for better and for worse — the team becomes the town’s identity. The picture is not always pretty, but the image is impossible to forget.
“Friday Night Lights” is now about to become a movie. This Chronicle article describes the current Houston-area filming of the new movie, which stars Billy Bob Thorton. Here’s hoping that this movie can live up to the standard of the above-described movies in portraying yet another fascinating aspect of Texas culture.

Well, that went over about as well . . .

as the proverbial turd in a punchbowl. ‘Stros are cruising behind Roy O. and lead the Giants 4-1 through 7. Then, the Giants get a couple of bloop hits and Bonds cranks a homer to tie it up. Then, Dotel comes in for the top of the 9th, promptly hits a batter, the Giants sacrifice him to second, Dotel wild pitches him to third, and a sacrifice fly brings him home. Biggio and Everett — at the top of the Astros’ order and two of the poorer hitters in the starting unit –go out meekly in the bottom of ninth, and Bagwell fans to end it.
The ‘Stros have questionable enough hitting to be having poorer hitters such as Biggio and Everett batting at the top of the order.
Andy Pettitte tries for a better result in Game Two of the series. Stay tuned.

VDH on Fallujah

Arguably the most insightful commentator on the war against the radical Islamic fascists — Victor Davis Hanson — posts this excellent article with his insights into last week’s debacle at Fallujah:

I am sorry, but these toxic fumes of the Dark-Ages permeate everywhere. It won?t do any more simply to repeat quite logical exegeses. Without consensual government, the poor Arab Middle East is caught in the throes of rampant unemployment, illiteracy, statism, and corruption. Thus in frustration it vents through its state-run media invective against Jews and Americans to assuage the shame and pain. Whatever.
But at some point the world is asking: ?Is Mr. Assad or Hussein, the Saudi Royal Family, or a Khadafy really an aberration?all rogues who hijacked Arab countries?or are they the logical expression of a tribal patriarchal society whose frequent tolerance of barbarism is in fact reflected in its leadership? Are the citizens of Fallujah the victims of Saddam, or did folk like this find their natural identity expressed in Saddam? Postcolonial theory and victimology argue that European colonialism, Zionism, and petrodollars wrecked the Middle East. But to believe that one must see India in shambles, Latin America under blanket autocracy, and an array of suicide bombers pouring out of Mexico or Nigeria. South Korea was a moonscape of war when oil began gushing out of Iraq and Saudi Arabia; why is it now exporting cars while the latter are exporting death? Apartheid was far worse than the Shah?s modernization program; yet why did South Africa renounce nuclear weapons while the Mullahs cheated on every UN protocol they could?

Then, Mr. Hanson lays it on the line:

The enemy of the Middle East is not the West so much as modernism itself and the humiliation that accrues when millions themselves are nursed by fantasies, hypocrisies, and conspiracies to explain their own failures. Quite simply, any society in which citizens owe their allegiance to the tribe rather than the nation, do not believe in democracy enough to institute it, shun female intellectual contributions, allow polygamy, insist on patriarchy, institutionalize religious persecution, ignore family planning, expect endemic corruption, tolerate honor killings, see no need to vote, and define knowledge as mastery of the Koran is deeply pathological.

And sums it up as follows:

I support the bold efforts of the United States to make a start in cleaning up this mess, in hopes that a Fallujah might one day exorcize its demons. But in the meantime, we should have no illusions about the enormity of our task, where every positive effort will be met with violence, fury, hypocrisy, and ingratitude.
If we are to try to bring some good to the Middle East, then we must first have the intellectual courage to confess that for the most part the pathologies embedded there are not merely the work of corrupt leaders but often the very people who put them in place and allowed them to continue their ruin.
So the question remains: did Saddam create Fallujah or Fallujah Saddam?

Read the entire piece. VDH is the essense of clear thinking.

Batter up! Stros 2004 Review: Season Preview

The Astros (or “the Stros” as they’re known locally) open the 2004 Major League Baseball season this evening at 6 p.m. in Minute Maid Park against the San Francisco Giants. Ace Roy Oswalt will pitch for the ‘Stros and Kirk Rueter will hurl for the Giants. A NY Times article on the ‘Stros is here.
The mainstream media’s coverage is typical Astros’ propaganda, echoing the club’s theme that the off-season acquisition of Roger Clemens and Andy Pettitte make “this the Astros’ season,” whatever that means.
In reality, while the Astros’ pitching staff is strong, the rest of the team has some big question marks. My sense is that the ‘Stros will struggle to score enough runs this season to be a championship caliber team. They have huge holes in the hitting lineup at catcher (Brad Ausmus, one of the worst hitters in baseball), shortstop (Adam Everett good field, no hit) and centerfield (Craig Biggio, probable Hall of Famer, but over the hill). Of their better hitters, one has a bad wrist (Jeff Kent), one has had one good season out of the last three (Richard Hidalgo) and one is beginning his sixth straight season of declining production (Jeff Bagwell). With the exception of promising OF Jason Lane (who should be starting in front of Biggio in CF), the bench players are uninspiring. That leaves solid young hitters Lance Berkman and Morgan Ensberg, who probably will have to have spectacular seasons to pull up the others on the club who will likely be declining.
To make matters worse, Astros’ manager Jimy Williams’ batting card has the light hitting Biggio and Everett batting one and two, while the far better hitting Berkman and Ensberg are listed at sixth and seventh. Go figure.
The bottom line: the ‘Stros have solid pitching with questionable hitting, below average depth, and a bull-headed manager. Not exactly a prescription for a championship season, but I’ll be following developments with interest, anyway.

WSJ on the case of Colonel Dowdy

This Wall Street Journal ($) article relates the interesting story of Marine Colonel Joe D. Dowdy, who was relieved of his command during the U.S. invasion of Iraq last year. Not only is this a fascinating story about the pressures involved in commanding a Marine regiment in battle, but it also provides insight into the battlefield tactics that the U.S. military has executed brilliantly and effectively in the last three major military operations — Desert Strorm, Afghanistan, and the latest Iraq operation:

A potential 150-mile bypass around Nasiriyah didn’t seem feasible. Col. Dowdy wasn’t sure he had enough fuel and didn’t know what resistance he might face. The First Regiment was stuck.
The halt was anathema to Gen. Mattis, a devotee of a modern military doctrine known as “maneuver warfare.” Though Marines have practiced the technique for years, the Iraqi war was its first large-scale test. Instead of following rigid battle plans and attacking on well-defined fronts, this tactic calls for smaller forces to move quickly over combat zones, exploiting opportunities and sowing confusion among the enemy. The technique is summed up in Gen. Mattis’ radio call name: “Chaos.”

* * *

The issue of speed in Iraq remains in debate. Last fall, the Army War College, a Pentagon-financed school where officers analyze tactics, released a study saying there was little evidence that speed affected the outcome of the war. The stiff resistance outside Baghdad suggests U.S. forces may have done better by moving at a more measured pace, entering more cities, rooting out fighters and leaving more troops in the provinces to enforce order, the report said.
However, in another study yet to be finalized, the military’s Joint Center for Lessons Learned says speed was integral to U.S. military success in Iraq. In a speech in February, Adm. E.P. Giambastiani, commander of the Joint Forces, said speed “reduces decision and execution cycles, creates opportunities, denies an enemy options and speeds his collapse.”

As noted in this earlier post, the creative and effective military tactics used in the current Iraq operation and the two earlier operations were not embraced easily within the military establishment. Author Robert Coram’s book, “Boyd: The Fighter Pilot Who Changed the Art of War,” presents a compelling story of how dedicated military experts outside of the Pentagon establishment fought over a 20 year period to change traditional Pentagon thinking on military tactics. As noted in the earlier post, appearances are deceiving with regard to the Pentagon, the special interests that attempt to control it, and the elected officials who attempt to lead it.
This is not a story that the mainstream media covers well, so Mr. Coram’s book and a few others are essential to an understanding of the way in which the U.S. Armed Forces confront issues of military tactics in modern warfare. It is particularly noteworthy that, during their service in the Reagan, first Bush, and current Bush Administrations, Messrs. Rumsfeld, Cheney and Powell have been leaders at the forefront of facilitating these new ideas on military tactics. Their support for those new ideas has often put them at odds with the Pentagon establishment, which is a “behind the scenes” conflict that the mainstream media has largely ignored. That is an important point to remember during this political season when these public servants will likely be accused of being lapdogs for the military establishment.

One Tyco juror’s account

This is the account of one of the Tyco jurors, who is a writer for Sports Illustrated. Hat tip to TigerHawk for the link.

Nuclear winter

In this absolutely fascinating piece of photographic story telling, a Russian woman named Elana rides into the Chernobyl region of Russia and reports on what she finds. Don’t miss this. Hat tip to Online Jounalismus via BuzzMachine for the link to this thought-provoking story.

Professor Balkin on environmental policy

In this post, Professor Balkin points to this NY Times article regarding the Bush Administration’s use of administrative power to restructure over thirty years of federal environmental policy. Professor Balkin’s post insightfully points out how the Republicans’ control of the executive and legislative branches of the federal government have allowed it to reshape a generation of federal environmental policy, and it is not at all clear that such restructuring was either necessary or in the public interest.
In one of the more important parts of Ron Suskind’s “The Price of Loyalty,” former Bush Administration Treasury Secretary Paul O’Neill describes how the Bush Administration undermined the common sense environmental policies that former EPA administrator, Christine Todd Whitman was advocating that the administration follow in 2001. Mr. O’Neill used this incident as an example of his primary criticism of the Administration, which is its lack of policy analysis before establishing governmental policy.
As noted several times in this blog, I am generally supportive of the Bush Administration’s handling of the war against radical Islamic fascists. However, I continue to maintain that the Administration’s Achille’s heel is its lackluster performance on a variety of domestic issues, such as health care finance, tax policy, and environmental policy. If President Bush loses this November, my bet is that its performance on these issues will be the primary reason for the defeat.