1000 Left Shoes by Aaron Levine MD


I am a fan of the Big Bang Theory. One episode a few years back had Leonard being pursued by a bully from high school. The Bully had an idea for an invention. When the gang asked how it worked, he answered that he only came up with the idea, and the geniuses needed to solved the problems in developing it. History has often shown idea men stimulating the process of invention and technology. The moon landing is an example. Most fail, such as the war on poverty, war on drugs, no child left behind. The common issue was setting goals and not having practical solutions. This came to light with commentary on Bernie Sanders’ new health program. The New York Times reporter, Margot Sander Katz, investigated the program and reached the conclusion it was more a tax program than having content for health program. She wrote:

“Gerald Friedman, a professor of economics at the University of Massachusetts at Amherst, provided the campaign with estimates of the program costs. Friedman sent detailed tables explaining his calculations. He assumes that spending in some categories of health care would go up…Others, he said, would drop because the single-payer system would give the federal (sic) government improved bargaining power and lower administrative costs…He estimates that the single-payer system would cost the country less over time….Friedman calculates, for example, that the cost of physician services in a single-payer system could be lowered by 10.7 percent-his estimate of how much doctors currently spend on billing and administration staff that they would no longer need. I asked him how the payer would get to that number…He couldn’t say with certainty, “The pleasure of being an academic is I can just spell things out and leave the details to others,” he said. “The details may very quickly get very messy.””

In other words, I’ll come up with the ideas. You make it work.

I worked with a physician from the Soviet Union about 35 years ago. He reported that they were measured for productivity and outcome based on determined standards. I don’t recall how the parameters were made. I do recall that he told me of a shoe manufacturing company that had a quota of 1000 shoes to make a week. The problem was they had a list for one size left shoe and none for any right shoe. They met their quota of 1000 shoes. They were useless for most people as they were only one size left shoe. But they met the quota and the manager got a medal. I see this with the quotas set by current quality measures.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – do[email protected] 

  3 comments for “1000 Left Shoes by Aaron Levine MD

  1. Seneca
    January 23, 2016 at 8:59 am

    Bernie Sanders’ state, Vermont, just dumped single payer healthcare after a little more than a year because it a) wasn’t working, and b) was sucking up more money than that state’s entire budget. His solution: Let’s expand it to the federal level!

  2. Steve O'
    January 23, 2016 at 8:27 am

    -I had heard a similar story about a light-bulb factory which, of course, was measured in the light bulb wattage produced per month. This measure, watts/month, was the standard across the USSR for measuring light-bulb factories. So, unsurprisingly, they made phenomenally huge light bulbs for the general public’s use – 500 watt bulbs, 1000 watt bulbs, far too bright for most household use, but hey – it meets quota! So these 1000 watt bulbs became the standard bulb wattage in homes. People would light their apartments bathed in terrific floods of light. They would wear sunglasses indoors, in the dead of winter. The light bulbs also helped to heat the apartments toasty warm. Incandescent bulbs are notoriously inefficient, and produce lots of heat. Imagine touching a 1000 watt bulb when it’s going for a while.
    -And why so much light at home? Apartments would pay their electric bill every month as a fraction of the total number of apartments in that complex. $30,000 a month for 3000 apartments? Everyone pays $10 a month, no matter how much they use. If you are a thrifty, resource-saving comrade, ten bucks a month. If you are a wasteful comrade, heat your house to 80 degrees F, leave the lights on all day and night – ten bucks from you, as well!
    -So of course, human nature being what it is, people would leave the lights on all day and night – they’d be damned if they were paying so much for electricity that THEY weren’t getting a piece of! Heat up the apartment to 80 F and walk around naked, just to get your fair share!
    -So of course, there is the great absurdity of regulations in the Workers’ and Peasants’ Paradise, in the middle of the winter when the sun is up for maybe three hours – but the people walk around bathed in light, wearing sunglasses and little else, all the time! It’s a tropical paradise, right there in Leningrad! Except they had to build these plants like Chernobyl, and you know how that went….

    • Steve O'
      January 23, 2016 at 8:47 am

      PS: These stories were going around during Gorbachev’s attempts with glasnost and perestroika in the old USSR. I’d heard them in the US at that time. They were openly discussed in Russia – these were the bad old ways, the senseless old ways of doing things, and this is the sort of stuff we need to stop!
      We’ve fallen into the same tiger trap thirty years later. Russians aren’t bad or lazy people – but they had a system that selects for badness and laziness. So do we.
      How many shoe factory inspectors, light bulb factory inspectors, clenched their teeth at the pointlessness and waste of the regulations that produced junk out of raw materials? But, hey, I just have to follow regulations, nobody’s asking me to make the place run efficiently. In fact, you make too much noise about such wasteful things, it’s your neck! Nobody cares, nobody will support you, go ahead and catch a bullet if your life is that meaningless, comrade!
      To the eternal horror of governments everywhere, the Russians put two and two together, figured out that the WHOLE COUNTRY was running on bad principles, so they just turned off the switch that powers the whole system, and walked off the job. The horror! That wasn’t just a story – THAT ACTUALLY HAPPENED! What a nightmare for bureaucrats everywhere!

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