Tag Archives: Weekend Long Reads

Weekend Long Reads: How to Save a Quarter-Trillion Dollars in Our Healthcare System

by Kevin Schofield

Each year nearly $4 trillion is spent on health care in the United States; of that, about one-quarter, or $950 million, is spent on administrative expenses. This week’s “long read” is a report by the business consultant McKinsey & Company on how money could be saved through administrative simplification and other business process improvements.

American health care is a multi-payer (over 900 of them), largely for-profit system. The benefit of such a system is that it can drive innovation in technology and treatments, as we have seen during the COVID-19 pandemic with vaccines to reduce infections and new drugs to treat the disease. But as we all know only too well, it is a broken system in many aspects: It’s expensive, often inefficient, and far less than comprehensive. Many of the policy decisions that brought us to this point are beyond the scope of McKinsey’s study, but it doesn’t take much work to identify the inefficiency and expense derived from the overhead of having multiple payers, providers, and patients. The health care industry is also heavily regulated, which protects patients but creates additional overhead for compliance.

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Weekend Long Reads: What’s the Cheapest Form of Energy?

by Kevin Schofield

This week’s “long read” is light on words and heavy on charts and graphs. It’s a comparison of the cost to generate electricity from a number of different sources, both clean and dirty.

The business and finance consultant company Lazard has compiled an analysis of the “levelized cost of energy” every year since 2007. By “levelized,” they mean that they factor in all of the costs: capital costs to build out electricity generation facilities, including the materials, manufacturing, construction, installation, permitting, and property; ongoing operational and maintenance costs; fuel costs for the types of generation that require fuel; and regulatory costs. They calculate the expected operational lifetime of a power generation facility and then divide the sum of the costs by the total expected power generation over a facility’s lifetime to arrive at a cost per megawatt-hour.

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Weekend Long Reads: The Vaccine Efficacy Studies

by Kevin Schofield

Over the past 18 months, I’ve read well over a hundred research papers on COVID-19, treatments, and vaccines. This week’s “long read” is hands down the most informative of all of them.

One of the essential tenets of science is that it must be repeatable: Every time an event happens, we should expect the same result. In practice we often don’t see precisely the same result, even in laboratory conditions, because of experimental error, contamination, sampling error, unknown confounding factors, and bias (intentional or otherwise). That’s why in the world of science a single research study alone isn’t enough to establish new knowledge; the scientific community waits until other researchers have replicated the study and independently confirmed the results.

In our mad rush to save lives by developing treatments and vaccines for COVID-19, we have often substituted a single carefully crafted and skeptically reviewed clinical trial for the greater assurance that we would get with multiple complete studies — at least for the purposes of “emergency use authorization” by the U.S. Food and Drug Administration (FDA). But with the passage of time, and the need to recertify the vaccines in multiple countries, there is now a substantial number of vaccine studies that have been published. Together they give us much higher confidence in our estimates of the effectiveness of the vaccines.

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Weekend Long Reads: Deconstructing Productivity

by Kevin Schofield

This weekend’s “long read” is an article published by Noah Smith, looking at the productivity of construction workers and how it’s measured.

The conventional wisdom is that for decades construction productivity has been in a slow decline, in sharp contrast to other intensive industries such as agriculture and manufacturing. This graph from the Economist sums up the picture well:

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Weekend Long Reads: Puget Sound’s Tech Workers

by Kevin Schofield

This week’s long read is a survey — but mercifully one that doesn’t ask a single question about candidates on the November ballot. The local organization sea.citi, which bills itself as “a tech industry nonprofit strengthening our region by promoting civic engagement and building relationships between community, government, and innovation workers,” recently polled Puget Sound-area tech workers to test their views on a range of civic issues, their employers’ actions, and where they want to live and work post-pandemic.

The report buries the demographic data in the back, but it’s worth addressing it first to provide some context because tech workers are not representative of the general population in the Seattle area. Not surprisingly, the survey group skewed male, white, and middle-aged. They also are predominantly transplants to the area: 72% of them moved here as an adult.

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Weekend Long Reads: mRNA Vaccines

by Kevin Schofield

This week’s “long read” is an article in the journal Nature, looking at the long and complicated path leading to the mRNA vaccine technology and techniques used to create the Moderna and Pfizer vaccines against COVID-19.

“Messenger RNA,” or mRNA, is essentially a recipe for building proteins. Living cells use it as a way of passing notes around: Parts of our DNA are transcribed into mRNA, which is then read by the tiny factories in our cells that produce proteins. 

Technically, a virus isn’t alive: It’s just a string of genetic material surrounded by a coating of fat (what biologists call “lipids”) with some proteins on the surface that help it to gain access into our cells (such as the COVID-19 “spike protein”). Once a virus invades our cells, its DNA is also transcribed into mRNA that contains the blueprint for the virus, and then our own cells do all the hard work to churn out thousands of virus copies.

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Weekend Long Reads: Asset Income

by Kevin Schofield

This week’s “long read” is a research report from the Economic Innovation Group looking at Americans’ different sources of income and in particular focusing on the one most closely tied to wealth: income from assets.

The report categorizes income into three types: “transfers” such as Social Security, Medicare, unemployment insurance, and food stamps; wages and earnings; and income from assets. An asset can be a financial investment such as stocks and bonds, but it can also be the housing that a landlord rents out, an apple orchard generating produce, or a manufacturing plant used to create goods.

Over the past fifty years, there has been a steady shift in the sources of personal income from Americans. In 1969, 77% of income was from wages and earnings; as of 2019, it was only 63%. Income from assets, however, has grown from 15% to 20%. 

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Weekend Long Reads: The Evolution of Our Health Care System

by Kevin Schofield

This weekend’s “long read” focuses on two medical research papers exploring how the U.S. health care system has changed over the past two decades: the money going into the system and the outcomes for individuals. And it’s not a pretty picture.

Let’s start with a paper from a group of researchers at the Institute for Health Metrics and Evaluation here in Seattle, looking at health care spending from 2002 through 2016 and broken out by race and ethnicity. Total spending has grown dramatically, from about $1.5 trillion annually in 2002 to over $2.4 trillion in 2016. The amount spent per person increases as they age, from a low of about $3,000 per year for children in 2016 to more than $15,000 per year for those over the age of 65. There are some significant differences in spending across racial and ethnic lines, with Asians, Native Hawaiians, Pacific Islanders, and Hispanics seeing some of the lowest levels of spending across all age groups and white and multiracial individuals seeing the highest spending.

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Weekend Long Reads: The Kids Are Eating a Lot More Pizza

by Kevin Schofield

This weekend’s “long read” is a report from a 20-year study on the food consumption habits of American youth. The National Health and Nutrition Examination Survey (NAHANES) has been collecting data since 1999, in two-year intervals, on what foods kids are eating, broken out across four categories: unprocessed and minimally processed; processed culinary ingredients such as oils; processed foods like cheeses; and “ultraprocessed” foods such as fast food, sweetened beverages, and store-bought ready-to-heat dishes.

In their most recent cohort, 2017–2018, they found that over two-thirds of the calories consumed by youth are from ultraprocessed food, up from 61.4% in 1999. The ready-to-heat/eat category jumped from 2.2% all the way up to 11.1%; that includes store-bought pizza, hamburgers, and sandwiches, and pizza alone is now over 5% of kids’ total calorie consumption.

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Weekend Long Reads: The Climate Change Report

by Kevin Schofield

This week the Intergovernmental Panel on Climate Change (IPCC) issued its new Sixth Assessment Report on the current scientific consensus on where things stand with regard to our changing global climate. It’s an update on its last report (the Fifth Assessment) from 2013, with hundreds of scientists from all over the world collaborating to provide both assessments of the current climate and also updated models of what is most likely to happen from here.

The new report is 3,949 pages. That is a “long read” even outside of my tolerance, so I’m not going to suggest that you read it.  Instead, I’m going to point you to three much shorter documents to read:

  • IPCC’s Summary for Policymakers;
  • IPCC’s Regional Fact Sheet for Central and North America, which focuses on the present and future impacts of climate change here in our own backyard; and
  • An excellent summary by the news site Quartz on the key findings from the full report.
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