In the healthcare article of the year, Dr. Atul Gawande has done some outstanding reporting: he has described the core problems of the United States’ healthcare system. He has also pointed out beacons for reform to pursue — the foremost being the Mayo Clinic right here in Rochester, Minnesota:

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

That bolded statement (emphasis mine) gets to the core of the article: costs stem from doctors making decisions day in and day out. In the right circumstances, those doctors can pursue financial gain and justify it (falsely) in terms of patient care. Keep honest people honest, and your care costs drop precipitously.

Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.

If you want to be a responsible, informed healthcare consumer, Dr. Gawande’s article is VERY MUCH worth your time.

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Merlin Mann has some great ideas about taking back control of your life. He emphasizes not seizing control, but constructively yielding to the unknown and managing the interplay between urgent and important tasks. Now I’ve gone and made it sound boring. AU CONTRAIRE! Merlin is endlessly entertaining! In this hilarious video, he talks about some of the ideas in the book he is writing, “Inbox Zero”:

You discover instead that you were scared of something that’s really easy to be scared of and not really that threatening. Once you get good at that [applying Inbox Zero], you discover there are much bigger things to be scared of — which is the extent to which you used to really rely on things like email to distract you from what you really should be doing.

I believe that — if you don’t believe that, I can’t help you. But if you think that might be true, if you think there might be times that you get much more involved in the thing that has got its hooks into you, rather than the thing that you really need to be doing… I really really believe that.

I also really believe in the lizard brain. I really believe — I don’t know if it’s the amygdala, I don’t know if it’s some part of the limbic system (I’ve not done research on this yet), but I do know that there’s an omnipresent voice in most of our heads that gives us terrible advice about how to avoid pain in the short term. And it’s almost always exactly the opposite of the advice we really need to get better at what we do. And so we obsess about “systems,” we obsess about this kind of tactical level of control stuff.

It’s one reason, to be honest, that Getting Things Done has started to drive me crazy, is the extent to which you have to know and control everything. Inbox Zero, I think, isn’t just about email — at the heart of it, Inbox Zero is about the amount of unknown, ambiguous, and incomplete items that you can tolerate in every part of your life. It’s not a system for smashing all of that down — it could be, I guess — but ultimately, I think Inbox Zero is about understanding what you can tolerate.

So what does that have to do with email?

If your sense of the unknown — if you can’t stand not knowing what’s in your inbox for more than 5 minutes, then that hook is into you — and you’re going to respond not to what you need to do with that stuff, but you’re going to be responding almost solely to that need to know the unknown. But then, once you know the unknown, you also generate the ambiguous, because you haven’t decided what to do with it. And if you’re really good and you figure out how to clarify the ambiguous, you still have to complete the incomplete.

And if all that stuff, the unknown, and the ambiguous, and the incomplete, all live in this same inbox — how is that not a recipe for insanity?

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But I really believe it’s about learning to iterate between the effective use of your time and the effective application of your attention.

Apropos of none of the above concepts: if I could make my hair like his, I don’t think I would ever wear it any other way.

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The 3 key parts of news stories you usually don’t get at Newsless.org makes so much sense to me. I always thought that I didn’t understand a lot of current events reporting because I wasn’t rabidly following every minor detail — that the onus was on me to put the article in context. In the aforelinked article, Matt Thompson argues that news becomes more engaging, more useful, better, when put into context. Thompson uses a recent, spectacular Atul Gawande article in the New Yorker as an example of journalism done right:

What Gawande did was to structure his search for truth as a quest narrative. Instead of hiding the details about how he comes by his information, he makes that the very focus. Along the way, he makes us apprentices in his quest for truth. We finish the article with a highly refined sense of how Gawande has acquired and verified the information he presents, as well as a framework for further inquiry of our own.

We get a lot more out of this type of reporting, in other words, than the vast majority of news stories, which leave these details out.

Readers want to be taken along on fact-gathering missions, not given a desiccated outline of the current facts. This change in journalistic style necessitates a certain liquidity of article length — the internet is the perfect medium in which to indulge journalist’s desire for a higher word count. Disseminate the present facts in the daily paper, then put those facts in context using the newspaper’s website.

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How did we manage this one? “The United States is alone among developed nations with the absence of a universal health care system.”

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90 percent of U.S. bills carry traces of cocaine:

Research presented this weekend reinforced previous findings that 90 percent of paper money circulating in U.S. cities contains traces of cocaine.

“When I was a young kid, my mom told me the dirtiest thing in the world is money,” said the researcher, Yuegang Zuo, professor of chemistry and biochemistry at the University of Massachusetts Dartmouth. “Mom is always right.”

The cocaine spreads from the money processing equipment at banks and binds to the green ink in our bills.

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I think I need to take this quote from a post here in May and print it out:

“What have you learned from the Grant Study men?” Vaillant’s response: “That the only thing that really matters in life are your relationships to other people.”

This may be, both scientifically and emotionally, the best advice I have ever read.

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This is a picture of Mykala and myself on Front Street in Old Lahaina Town, Maui. (If you want to get technical, we were standing right in the middle of this map). It was our last night in Hawaii; the last night of our honeymoon. We watched the sun set together, and this was one of the last pictures my camera took before the battery died. The honeymoon was perfect.

I love this picture. I love you, Mykala.

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Right now, roughly 1 in 5 Americans don’t have full time jobs:

A truer picture of the employment crisis emerges when you combine the number of people who are officially counted as jobless with those who are working part time because they can’t find full-time work and those in the so-called labor market reserve — people who are not actively looking for work (because they have become discouraged, for example) but would take a job if one became available.

The tally from those three categories is a mind-boggling 30 million Americans — 19 percent of the overall work force.

This new way of looking at unemployment seems to reveal a rather serious problem in our country — quite literally, there aren’t enough jobs. As Herbert describes, even more insidious is the problem of community cohesion: as jobless rates rise, communities fall apart. As a result, entire neighborhoods, towns, counties, rot from the inside out.

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Dr. Oz, on learning to treat patients once you become a doctor:

When I went into medicine, I assumed, by the time I was done with medical school, I would understand it all. We think that if we study hard enough, we’ll understand how the whole body works. Then you go into practice and someone sits across from you, very sophisticated, smart person, and they haven’t read the book you have read. They have symptoms, and problems, and complaints that just don’t fit what you’ve actually learned seems to be how the body works. So you have two ways of dealing with that — you can assume they’re crazy and ignore them, or you can say “you know what, I think there’s something else going on out there.” So, now, there are a lot of physicians who seem to believe there is something to it [acupressure].

I’m not looking forward to not having all the answers, but I am looking forward to figuring out how to be a more effective helper of humans.

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Well, crap:

There is every reason to believe that the big, grab-bag metro daily that mixes its news in with comics, advice columns, obituaries and recipes, and undertakes an expensive manufacturing and delivery operation each day to put the product on the street, will pass into history. Among the problems faced by Tierney and other publishers is that many of the big thinkers on the periphery of their industry — academics, Web entrepreneurs, former journalists with the wisdom of hindsight — have already moved on. They’re done with paper, ink, trucks, fuel, the whole era.

There’s more, much more: What’s a Big City Without a Newspaper? - NYTimes.com.

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