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.

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