RWL #230
fun survey edition! and other cool stuff
Greetings from the University of New Hampshire! Whew! Week two of my 5-week summer course is behind me and I’m deep into week 3. I’m enjoying the material, but I don’t mind saying the pace is intense! Hard to believe this week is the half-way point already.
I thought this week I might do something a little different. I thought I’d ask you to share something with me. I’ve created a one question survey - the question is, “What advice would you give your 20-somthing self and why?” Click on the link to share your answer. The survey is anonymous unless you write your name in the answer box, I won’t know whose answer is whose. I’m thinking I’ll leave that out there for a couple of weeks, and then share back some of the themes, and maybe some of the interesting answers. Please don’t make stuff up - this isn’t a fiction writing contest. I think it will be fun! So click the link below and tell me your answer:
https://unh.az1.qualtrics.com/jfe/form/SV_54rogofirpruqhw
Now back to the newsletter… This week I’ve got a bunch of cool stuff for you to check out - several items that I found to support the course I’m teaching - others that just floated by and I plucked for you. I hope you enjoy them.
Speaking of floating, I was able to get some time on the water this week, which was nice. We’re having quite a hot-spell up here - for New Hampshire! It’s been one of the warmest springs I can remember.
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Read
What: John Heniger, Emberism
https://emberism.com/2021/04/30/discipline-2/
Why: John is a former student from my Army-Baylor days - Army officer and healthcare leader by day - and thoughtful illustrator after hours. John has been working on a daily illustration - finding and illustrating a management quote each day. You can subscribe to his blog or follow him on LinkedIn.
I loved this one - talent without discipline is nothing - it is dead in the water - just like he shows. You should check out his collection and follow him.
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What: PetersonKFF Health System Tracker, How costly are common health services in the United States?
Why: This is mostly a collection of graphics that show how expensive (and how variable) healthcare costs are in the US. There’s some serious sticker shock in there. Worth scrolling through and looking at the pictures.
I’ll include here a bonus link, a podcast with Dr. Keith Smith, founder of the Surgery Center of Oklahoma, who runs a cash-only practice and has not raised prices since 1996. I’ve shared this podcast before, but it’s been a few years (!). I shared it with my health systems students and they found it enlightening.
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What: Paul Graham, How People Get Rich Now
http://paulgraham.com/richnow.html
Why: Graham is a co-founder of Y-Combinator, the famous startup incubator where AirBnB, DropBox, and other giants were started. He writes a fairly lengthy post about the changing source of wealth among the Forbes 100 since 1982. This is relevant because many people (i.e., politicians) are obsessed with other people’s wealth and want to impose punitive taxes on wealth. The argument is usually something akin to “You didn’t make that - you inherited it - so you don’t deserve it anymore than anyone else.” They also point to an economic measure called the Gini coefficient that shows how wide the differences in wealth are in a country. A wide Gini coefficient means that there are big inequities between the wealthy and the poor. That’s a bad thing in a stagnant economy where wealth is inherited. It’s a good thing in a dynamic economy where people can create wealth, because it means people are creating wealth.
From the introduction to the article:
Every year since 1982, Forbes magazine has published a list of the richest Americans. If we compare the 100 richest people in 1982 to the 100 richest in 2020, we notice some big differences.
In 1982 the most common source of wealth was inheritance. Of the 100 richest people, 60 inherited from an ancestor. There were 10 du Pont heirs alone. By 2020 the number of heirs had been cut in half, accounting for only 27 of the biggest 100 fortunes.
Why would the percentage of heirs decrease? Not because inheritance taxes increased. In fact, they decreased significantly during this period. The reason the percentage of heirs has decreased is not that fewer people are inheriting great fortunes, but that more people are making them.
How are people making these new fortunes? Roughly 3/4 by starting companies and 1/4 by investing. Of the 73 new fortunes in 2020, 56 derive from founders' or early employees' equity (52 founders, 2 early employees, and 2 wives of founders), and 17 from managing investment funds.
There’s quite a bit of interesting discussion about the sources of wealth today. Indeed, historically wealth was passed down, primarily in the form of land. (We’re still watching The Crown, by the way.) There are other kinds of inheritances, but it doesn’t seem that the most wealthy people keep showing up at the top.
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Watch
What: TED, Katherine Eban, A Dose of Reality about Generic Drugs (16 min)
https://www.ted.com/talks/katherine_eban_a_dose_of_reality_about_generic_drugs
Why: Katherine Eban has a fantastic book I’ve previously recommended, Bottle of Lies. I came across this talk when I was looking for something on technology advances in the pharmaceutical space for the Health Systems class I am currently teaching and was pleased to find this talk. Eban writes about the generic pharmaceutical industry, and in particular the risks of a global supply chain. What she found was shocking levels of corruption - both organizational and corruption in the medications themselves. When I think of generics, I typically think of over the counter medications, but she was talking about all levels of drugs - including medications for managing HIV and chemotherapy. This video is a good summary of her work - if you find it interesting, I strongly recommend her book.
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Listen
What: No Turning Back, Dr. Atul Gawande (55 min)
https://www.mcchrystalgroup.com/insights/no-turning-back-dr-atul-gawande/
Why: I was turned on to the No Turning Back podcast by an Army buddy last week and I’ve become a fan. They have interviewed some great leaders. I’ll probably be sharing more (after a break), but when I saw they had talked to Atul Gawande, I knew I had to give that one a listen. What was really great about this interview was to have two military guys talk to a surgeon about process control. The irony is that the two fields have more in common than you would initially think. This is a great interview.
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What: SpyTalk, Cyber Counterpunch (13 min)
https://shows.acast.com/spy-talk/episodes/cyber-counterpunch
Why: We’ve seen a sudden surge in cyber attacks on infrastructure in the past couple of weeks. This podcast discussed how business leaders and political leaders should be responding. I’ve been thinking about how military strategy through the ages vacillates between defensive dominance and offensive dominance and technology, political structures, and history evolve. Thinking about the stagnation of WWI and how defensive strategy was shattered by the Nazi’s use of the tank in WWII - it seems we are facing a new evolution of technology where we are being shown that our defenses are sorely lacking against new offensive technologies of state and non-state actors alike. Healthcare facilities are particularly tender targets. SpyTalk is a clever new podcast I recently found - interesting discussion of national security. Try this episode out and let me know if you like it!
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
If you’re looking for a searchable archive, you can see my draft folder here: https://drive.google.com/drive/folders/1jwGLdjsb1WKtgH_2C-_3VvrYCtqLplFO?usp=sharing
Finally, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://markbonica.substack.com/welcome
See you next Friday!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
'It is the small things, everyday deeds of ordinary folk, that keep the darkness at bay. Simple acts of kindness and love.' - Gandalf (The Hobbit: An Unexpected Journey)