Greetings from the Last Homely House! I am so excited! I just recorded my first episode for the Being in the World podcast (with Michele Dillon on sociology and religion - talked about it this past weekend) and it went really well. I can’t wait to release it, but I am going to, anyway. Probably now it will be a Sept 1 first release. We had a great conversation about religion and spirituality, and driving change in large organizations like the Catholic Church. I hope you will listen to it when it comes out. Also soon to be on the pod, Marc Hubbard, the UNH Men’s Soccer Coach to talk about the virtues of sport, Professor Scott Smith to talk about Seneca and stoicism, and more!
The lovely wife and I went to Hampton Beach, just down the road from us, on Friday. I saw this bus load of kids from a local YMCA camp with their orange shirts and had to get a shot. What’s better than summer camp at the beach?
I know you want to know, so I will tell you, I am in week 3 of returning to jiu-jitsu training and the giddiness has worn off. I feel like I have been run over by a truck most days after training. Usually when I hurt after a hard work out, I say it is a good kind of pain. I’m not sure about this kind of pain. It’s more like the body saying, you are too old to be wrapped up like a pretzel by a 20-year old. But I am loving it, anyway. It's a great community and I really like the informality of this school that I have found. Hopefully the body will catch up! It’s good to be outside your comfort zone - literally and figuratively.
See you Sunday with another essay. As usual, willing good for all of you!
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Read
What: US Bureau of Labor Statistics, Healthcare Occupations: Characteristics of the Employed
https://www.bls.gov/spotlight/2023/healthcare-occupations-in-2022/home.htm
Why: This is one of those posts you can read for the pictures - lots of interesting charts. Like:
Nursing professions by number of employed represent 5 of the top 6 largest groups in healthcare.
Physicians work the longest hours.
Most healthcare professions are women-dominated, but nursing isn’t the top of the list!
Home health and personal care aids take the top two spots for percent who are foreign born, followed by … physicians!
More cool charts. Look at the pictures!
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What: WSJ, It’s Time to Bring Back Asylums
Why: I can’t count the number of conversations I have had with healthcare leaders in which the topic of inadequate inpatient behavioral health beds has been a topic. Most emergency rooms in New Hampshire have multiple individuals, at any given time, “boarding” because there are an insufficient number of inpatient beds available for people with behavioral health issues. In other words, they are taking up beds in the ED that should be reserved for people with immediate, acute medical needs. And if you have ever spent any time in an ED, it is not a calm place where one might feel safe and be able to overcome a frightening mental health crisis. Never mind spending days or even weeks. It’s not a place I want to spend hours in as a patient.
But this article goes beyond that to argue that maybe we need to reexamine involuntary commitment. Being committed to a hospital is the same level of loss of autonomy - perhaps more so - than being imprisoned. And yet, most homeless (unsheltered) people have severe mental illness, coupled with drug addiction. These people need something better than what the current system provides.
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Watch
What: ReasonTV, Great Moments in Unintended Consequences: Subsidized Trees, Daycare Fees, NY Alcohol Ban (Vol. 11) (4 min)
Why: I’d never heard of a Raines sandwich, and I definitely don’t want to eat one. Learn about it in this irreverent video.
The series presents a bunch of policy decisions that result in, you guessed it, unintended consequences. This is a popular idea with economists. It’s very hard to see how people will respond to changes in policies, governmental or corporate. One thing you can predict is they will look for the loopholes that give them the highest payoffs. This is just four minutes of fun. (I do wish they would just stick to legal policies, rather than just dumb ideas by corporations. Corporations will change policies in response to losing money - governments don’t have those incentives. Think DMV or some other government office you have interacted with.)
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Listen
What: HBR IdeaCast, How One F-35 Fighter Pilot Makes Decisions Under Pressure (27 min)
Why: I am not a great decision maker. I should clarify: I am not a great decision maker under pressure. It’s part of why, when I was working in professional practice as an administrator, I turned away from operations and toward finance. It’s not that finance doesn’t have pressure - it’s that you usually have time to make decisions in finance. People expect a deliberate decision from the finance folks. Operations people basically walk in every day and someone lights their pants on fire, and they have to make snap decisions continuously. I wish I could make decisions with my pants on fire - I mean I will, but they won’t be good decisions. It always impresses me that some people are actually good at thinking while their pants are burning.
The guest on this pod talks about how to make snap decisions, but also how to make better decisions, even when you have the luxury of time.
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What: EconTalk, Lydia Dugdale on the Lost Art of Dying (78 min)
Why: As the saying goes, the only things that are inevitable are death and taxes. None of us are getting out of here alive, so why don’t we prepare better for death? I think this interview with a physician who has thought and written about the experience of death was fascinating. As a healthcare researcher, one of the things we know is that the health spend at end of life is fantastically high - even for the elderly - and ultimately with the same result. Estimates range between 13-25% of Medicare dollars are spent at end of life. It would be one thing if that spend was primarily to make the person comfortable, but in fact many of the things doctors are forced to do by well-intended family members amounts to torture of their loved ones. But it isn’t about the money - it’s about dying well. This is definitely worth a listen. I plan to read the book.
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What: The Reason Interview With Nick Gillespie, Mike Rowe: The Missing 7.2 Million Male Workers (96 min)
Why: In case the name is not familiar, Mike Rowe is the creator of the TV series Dirty Jobs, where he “offers an unflinching look at American men and women who make their living doing the most unthinkable, but vital, jobs.” While Rowe does dramatize some of the dirtiest jobs, he really advocates for the trades. As I have pointed out many times, there are many men who have left the workforce for a variety of reasons. Some of those reasons have to do with not having a preference for cognitive jobs, but instead what journalist David Goodhart categorizes as “hand” jobs - jobs that rely on physical skill like plumbers, electricians, carpenters, and mechanics. (Goodhart classifies jobs as head, hand, and heart, with head being cognitive, white collar jobs; hand being blue collar, skilled labor jobs; and heart being the caring professions, such as nursing at all levels.) The drain from my kitchen sink was blocked and required a professional intervention (not your simply plunger solution), so I had to call in “Jeff the Drain guy” as my plumber referred to him. Jeff brought in a big power snake and had my drain cleared in about 15 minutes. He charged me $150, and at about 10AM, I was his fourth job of the day. This is a guy who is making bank. I of course was chatting with him about his work and he said he would love to have an apprentice, but he can’t find anyone. Jeff the Drain Guy makes a good living. I can’t imagine that it would take too many months (not years) to learn the trade to begin making pretty good money. It’s significantly more money than most of my students make for years after they graduate. So what’s the problem? Stigma. We need to fix our obsession with cognitive jobs. We have too many people trained for head jobs and not enough trained for hand or heart jobs.