E The Road To A Post-Corona Boom (Healthcare) - Part 2

<< Read More: The Road To A Post-Corona Boom - Part 1

A major impediment to US growth is our complex and the expensive healthcare system. It adds tremendously to the process of hiring, it holds people in undesirable jobs and it creates enormous fear among those with pre-existing conditions. If we try to simply overwrite economic realities (like restrictions on pre-existing conditions) we end up with the government paying insurers massive correction costs without actually driving down the cost of providing care.

I could write up a dry article about my approach, but sometimes it is best to tell things through a story. This one is about the ballooning cost of healthcare and how I think we ought to be dealing with it.

people in white shirt holding clear drinking glasses



I open the door to my new office and step in. A cardboard box is in my hand. It has everything I need. I look at the room, with its two walls of tinted glass, its clean carpet and its massive desk. It smells of industrial carpet cleaner, generously applied. It seems to perfectly match the scent of my dry-cleaned suit.

I close the door behind me, so nobody can see me. And then I smile the broadest smile of my life.

I am finally where I belong.

I step forward and gingerly place the cardboard box on the clear table. I remove the lid and stare down at the contents. Leaning against one side is my laptop and power cord. I remove it and place it on the desk in front of my office chair. I line it up perfectly with the desk and run the wire through to the power port. I take a moment to examine my handiwork and then I return to the box.

I look again. Then I pull out a single sheet of laminated paper. I place it, face up, exactly two inches from the corner of the desk. It will be on the near right corner for those who enter my office. It too is lined up with the desk. Then, on the paper, I place an empty pill bottle, a candy bar with a sale sticker on it and a napkin with a diagram jotted down. All are lined up with one another, perpendicular to my laptop so I can see them easily when I work.

Finally, at the bottom of the box is a collection of over 1000 letters. They come in all shapes and sizes and colors. I pick them out, one by one, and slowly and methodically tape them to my new office walls. I line them up in a pattern I laid out on my computer before coming here.

It has taken me all day, but I am finally done. I lift the box from the table and place it near the door. Then I turn around and look again at the space.

My laptop is in position, but more importantly so are the other objects: the paper, candy car, pill bottle, napkin and letters.

I smile again. This is where I belong.

Finally, I am being recognized.

It has been a long road getting here.

When I was in grade school, I wanted to fit in. But I never managed to do so. When troupes of girls would start obsessing over fashion or a band or even one another, I would try to get involved. I would read up on the subject and maybe watch a video or two. I would prepare a few comments so I could seem to be interested. Then, when I got a chance, I’d join in a conversation. I’d say my piece. But moments later, invariably, everybody would either laugh at me or drift away.

I’d go home and cry. And then I’d try again. I’d adjust my approach, of course. I’d analyze the probabilities of different elements combining to realize the desired outcome: popularity, or at least acceptability.

Time after time, I’d keep trying. Time after time, I’d keep failing.

It seemed I didn’t know how to communicate with my peers.

It took me a while to realize that the real problem was that they didn’t know how to communicate with me. I didn’t realize that they were really interested in the band or the fashion or how they did their hair. I thought they were just pretending. I thought it was all some sort of social dance necessary to achieve popularity. I thought it was a means to an end. I didn’t realize the dance itself was the point.

I thought, I truly believed, that they were like me. I thought they saw the world like numbers and patterns and geometric relationships. I thought they watched others walk and pulled out patterns in their movements. I thought they also saw equations in their movements through the playground; in the ways, they clumped and shifted. I thought they thought like I did.

But they didn’t.

It turned out I even dreamed differently than they did. Where they dreamed in images, I dreamed in formulas and integers and geometric relationships.

I had nothing in common with them. I was different from them. And so, over time, I pulled away from them. What I was interested in, they could not understand. And it seemed like the inverse was also true.

As I grew older, the differences only grew starker. As a child I consumed numbers. I read mathematics textbooks. I saw patterns around me. But, bit by bit, I began to create in numbers. Just as an artist would bring an image to life on a canvas, or a writer in words, I began to create in numbers. Patterns would speak to me, telling stories – capturing beauty only I seemed able to see and revealing truths others wanted to hide. I went through college this way. I got a degree in mathematics but the coursework was simple. Far more of my time was spent conjuring numerical realities that nobody but I seemed capable of appreciating.

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Joseph Cox 8 months ago Author's comment

I wrote a piece that brought together all the various policies under a single concept - empowering America... talkmarkets.com/.../empowering-america?post=265437

Joseph Cox 8 months ago Author's comment

One more wrinkle: providers would be able to report monetary malingerers (those who seek out treatment to get the 5%) and would get a portion of their fraud as a reward. Likewise, patients would be able to report providers who stack on services to raise their cash input. Each of these would make it more difficult for fraud to be organized between patients and providers.

Joseph Cox 9 months ago Author's comment

Third part added... foreign policy...


Mike Faragut 9 months ago Member's comment

Your way of telling a story within an article is unusual for me, but interesting. Undecided if I like it as I'm more used to just reading facts. I didn't realize what was happening at first.

I will say that our health system, though expensive, is the also the best in the world as a result. But when it comes to COVID-19, tests and treatments should be free. Otherwise some who suspect they are infected, will do nothing, simply because they can't afford to.

Joseph Cox 9 months ago Author's comment

We have an incentive system that rewards better health outcomes. We just need to adjust the structure so it also rewards better cost outcomes. It is like setting up a system of subsidized cars that only allows the very nicest cars on the road - paid for by third-party car providers with actual drivers having no incentive to shop around individually. They'll be nice cars, but they will cost a lot more than they should.

Terry Caruso 9 months ago Member's comment

For those following Mr. Cox's Covid analysis and reports, there's some new news in. It looks like herd immunity isn't very likely:


Joseph Cox 9 months ago Author's comment

That is fascinating.

First, Sweden said it would *like* herd immunity but that wasn't the point. For them the point was balancing the cost (including in lives) of an economic shutdown against the life savings gained. This is an important consideration - the hidden deaths are substantial and have always been my concern. I don't think I've even claimed the virus wasn't dangerous - just that the total extended shutdowns would be more dangerous and not effective in the long-term.

Second, despite only voluntary and limited social distancing Stockholm has less than half the infection rate of New York. It *hasn't* spread like wildfire. We are still learning what works, but it seems like our social distancing can afford to be more targeted and still cut the infection rate.

Second, Stockholm has 3,900 deaths out of a population of just under a million. 7.3% infection implies 70,000 infected. This is a *very* high death rate comparatively (close to 5%).

6% of Miami-Dade had positive antibodies. There have been about 2,000 deaths and they have 2.7 million people - including many elderly. Back of the napkin deaths and they should have have twice cases with half the deaths of Sweden for 1/4 the death rate (1.2%).

Why does Florida have a lower death rate?

The fact is, we still don't know. New York has a 20% infection rate - despite a strong lockdown. Their death rates vs. antibody surveys are around 1.4% - a touch higher than Florida's.

London has a strict lockdown. 17% are infected. The death rate is 2.2%.

What I'm getting at is that the benefits of full shutdown vs. partial shutdown in places that can't really totally shut down (the border with Mexico is porous and 40 million Americans can't be without work indefinitely) are probably not that great - and the costs are huge.

Even in lives.

For countries that *can* shut their borders (Australia, New Zealand, Israel) a shutdown can actually suppress the virus. Otherwise you're looking at 'bending the curve.' Sweden hasn't had a hospital shortage, so bending the curve wouldn't help. They seem to have other problems in delivering care.

Who's right? The jury is still out. If there is actually a vaccine in the fall, Sweden will look pretty stupid. If not, as the costs continue to mount, Sweden might actually be well ahead of the game. Their 'limited social distancing' does seem to have limited the spread of the virus.

Of course, they have to get better at protecting their vulnerable (like Florida) and treating the sick. In these regards they are clearly well behind others. The high death rates implies a lot of infected old people relatively.

I am personally surprised their infection rate isn't higher. I was hoping it would be, as I'm sure many Swedes were. It would be great if they were nearing the end of their curve. If they had 1/4 the death rate they do Stockholm's infection rate would have been close to 30%.

Nonetheless this data continues to feed our understanding of what really works in countries that have already seen widespread community infections within their countries.

Sweden's infection control is working reasonably well - despite being limited. Their protection of the elderly/treatment of the sick, however, is quite poor.

Ayelet Wolf 9 months ago Member's comment

There's still so much we don't know and so much conflicting info. I wonder how long it will be until we can look back with confidence and know the truth about all this.

Joseph Cox 9 months ago Author's comment

It will be never. We still argue about 1918.

My current totally uninformed theory is that pre-existing bat coronaviruses have been giving humans in certain areas a level of immunity. This would be why Scandanavia is so different from the bulk of Europe.

I don't have any data to support this although I bounded it off an epidemiologist friend of mine (formally with the the US Army, CDC and WHO) and he is researching it.

Ayelet Wolf 9 months ago Member's comment

Any updates from your epidemiologist friend?

Joseph Cox 9 months ago Author's comment

I asked. Nothing yet.

Andrew Armstrong 9 months ago Member's comment

Enjoyed, thanks.