Weekend Update

Congress remains at work on Capitol Hill this week. The Senate is expected to confirm Seema Verma to be Administrator of the Centers for Medicare and Medicaid Services.  The Senate Health Education Labor and Pensions Committee will hold a confirmation hearing for the President’s latest nominee for Secretary of Labor, R. Alexander Acosta, on Wednesday afternoon. These are both significant positions in terms of ACA administration.

Modern Healthcare features an interesting article on the state of the burgeoning telehealth market. The large vendors are turning their attention to serving hospitals and health systems. It’s always seemed like a no brainer to the FEHBlog that telehealth services could help avoid unnecessary readmissions. But it appears that hospitals are using telehealth services to replace staff for inpatient services. Time marches on. We get closer to the Jetsons.

The FEHBlog et ux (look it up) have been listening to an audiobook of Malcolm Gladwell New Yorker articles. Today we heard Mr. Gladwell who narrates his own work describe the difference between puzzles and mysteries.

The national-security expert Gregory Treverton has famously made a distinction between puzzles and mysteries. Osama bin Laden’s whereabouts are a puzzle. We can’t find him because we don’t have enough information. The key to the puzzle will probably come from someone close to bin Laden, and until we can find that source bin Laden will remain at large.
The problem of what would happen in Iraq after the toppling of Saddam Hussein was, by contrast, a mystery. It wasn’t a question that had a simple, factual answer. Mysteries require judgments and the assessment of uncertainty, and the hard part is not that we have too little information but that we have too much. The C.I.A. had a position on what a post-invasion Iraq would look like, and so did the Pentagon and the State Department and Colin Powell and Dick Cheney and any number of political scientists and journalists and think-tank fellows. For that matter, so did every cabdriver in Baghdad.
The distinction is not trivial. If you consider the motivation and methods behind the attacks of September 11th to be mainly a puzzle, for instance, then the logical response is to increase the collection of intelligence, recruit more spies, add to the volume of information we have about Al Qaeda. If you consider September 11th a mystery, though, you’d have to wonder whether adding to the volume of information will only make things worse. You’d want to improve the analysis within the intelligence community; you’d want more thoughtful and skeptical people with the skills to look more closely at what we already know about Al Qaeda. You’d want to send the counterterrorism team from the C.I.A. on a golfing trip twice a month with the counterterrorism teams from the F.B.I. and the N.S.A. and the Defense Department, so they could get to know one another and compare notes.
If things go wrong with a puzzle, identifying the culprit is easy: it’s the person who withheld information. Mysteries, though, are a lot murkier: sometimes the information we’ve been given is inadequate, and sometimes we aren’t very smart about making sense of what we’ve been given, and sometimes the question itself cannot be answered. Puzzles come to satisfying conclusions. Mysteries often don’t.

Drug pricing falls into the mystery category. Indeed all health care pricing falls into the mystery category. But drug pricing is a peculiar mystery.  That’s why the FEHBlog appreciate the Drug Channels blog which lately dicusses a Johnson & Johnson subsidiary pricing transparency report. He gives it two thumbs up.  Check it out.

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