Richard Hirth

Heard from @AHRQNews that the entire grants staff has been let go. They are unable to issue funds for grants already funded, let alone fund new grants. This will make Americans poorer and sicker. Why? A brief thread about just some recent AHRQ-funded research:

The Agency for Healthcare Research and Quality has just officially canceled nearly all of its grant mechanisms, and awarded only ONE new grant last year. Congress, you appropriated $202M in FY26 for #AHRQ research grants - tell HHS to act as you directed! grants.nih.gov/grants/guide/n…

The White House posted a video on social media that shows Team USA hockey player Brady Tkachuk saying: “They booed our national anthem, so I had to come out and teach those maple-syrup-eating-f**ks a lesson.” The only thing—the video wasn’t real, it was AI generated. Count on people who have never been in the arena to display pathetic behavior that completely misunderstands excellence and competition. Tkachuk immediately distanced himself from the video: “It’s clearly fake. It’s not a thought that would ever happen in my head. I would never say that. It’s not who I am,” he explained. I can’t make assumptions about why the White House did this. I can only say it’s typical trolling behavior of insecure punks who are on the sidelines and long for greatness but have never come close. Actual competition fosters great respect for your rivals. Sure, when the clock is ticking you want to destroy them. But you also appreciate how hard they’ve worked and how much they’ve poured into the pursuit. You can’t not. This is why it’s always immature people who have never even been close to the arena who get it totally wrong. Pseudo, punk-ass competition is about disrespecting your opponents. The real thing is the opposite. It’s not just sport either. Anyone who has tried to be great at anything knows this. Only unserious people who are clueless about true excellence would post an AI-generated video of an American star badmouthing his opponent in such a distasteful way. To those who tell me “stay in your lane”—at least now I’m squarely in it; I literally wrote the book on excellence. To those who say “this post will cost you book sales”—two of my core values are truth and integrity. A part of how I define excellence is values. Here I am. To those of you who say “why are you being so political?”—I’d write the same exact post if the other party did this unbelievably stupid shit too.

Hemodialysis Facilities, Vascular Access Surgeons, and Central Venous Catheter Use: A Retrospective Cohort Study bit.ly/3ZK5TWp #OpenAccess @MKOerline @RichardHirth @dorkstweet

How states implement new Medicaid cost-sharing rules created by the OBBBA will have significant impact on program efficiency and enrollee health. | Forefront @betsyqcliff and @RichardHirth | @UChicagoPHS, @MichiganHMP healthaffairs.org/content/forefr…

@Codie_Sanchez “Homes” or “houses”? Big difference. 5-12 homes (maybe rented part time but bought for personal use) is way more decadent and implausible than 5-12 houses (smallish RE investor, not bought for personal use)

Curious... who is aware of anyone whose parents own 5-12 homes? One generation hoards assets, another can't pay rent... and the global elite are completely out of touch.

The University of Michigan was ranked as the top U.S. public university and ninth overall among the world’s top 500 higher education institutions in @TIME’s new world rankings! myumi.ch/R3bVD #LookToMichigan #GoBlue

Medicare Advantage insurers made 53 million prior authorization determinations in 2024. That's an average of 1.7 determinations per enrollee. It's no wonder patients, physicians, and hospitals find the system burdensome and complex.

Insurance companies are not the primary driver of health care costs. It's hospitals. But, it’s also not clear that we’re getting a lot of value from insurers in driving down health care costs.

Changes in Employment Status After Initiation of Peritoneal and In-center Hemodialysis bit.ly/4pKLXgA @RichardHirth @MKOerline @dorkstweet

Video message from Federal Reserve Chair Jerome H. Powell: federalreserve.gov/newsevents/spe…

It’s time to take back excellence from the grifters, gurus, hackers, optimizers, and everyone else who reduces the human spirit to monetizable clickbait, marketing gimmicks, hacks, secrets, and quick fixes, none of which actually work. Here's 24 ideas to help: 1. Caring is cool. There is nothing to celebrate about an attitude of nonchalance. It’s a cop-out. A protective mechanism. A way to avoid stepping into the arena and risking failure. There are things worth caring deeply about, and you should care deeply about them. 2. Never sacrifice your values. Your values are your North stars, the qualities toward which you aspire. Regardless of what you are pursuing, do it in a way that aligns with your values. ​ 3. The things you work on also work on you. You aren’t just shaping the table, manuscript, marathon, scientific discovery, canvas, or song. Those pursuits are also shaping you. 4. Select big goals but climb where you are. Once you know what peak you’re aiming for, you’ve got to shift your attention to the day-to-day ascent; you’ve got to climb where your feet are. The bigger the goal, the smaller the steps. 5. Embrace a process mindset. Outcomes matter, but they are always the byproduct of a sound and attentive process. Focus on the process. Let the outcomes take care of themselves. Learn and adjust. Rinse, repeat. 6. Nothing great happens without focus. You’ve got to set aside time and space without distraction so the important projects in your life can receive your full attention. 7. Prioritize consistency over intensity. Anyone can crush themselves and have a heroic day, a heroic week, or maybe even a heroic month. But excellence is about generating a heroic body of work. Some days will be great. Some days will be terrible. Most will be somewhere in between. Become known for your consistency. Keep showing up. ​ 8. Abide by the law of compounding. Little by little it becomes a lot. 9. Use technology, but don’t let it use you. A good question to ask yourself regularly: Am I in charge of this technology, or is this technology in charge of me? 10. ​“Balance” is an illusion. You can’t do it all. Trying to is a surefire way to be miserable. You’ve got to make tradeoffs and adjust over time. You can emphasize different pursuits in different seasons of life. 11. Keep the main things the main things. Hacks, fads, and quick fixes have been cycling in and out since the beginning of time. In the fifth century BC, Herodotus searched for the Fountain of Youth as a way to live forever. Thousands of years later, we’re still searching. 12. The secret is there is no secret. The driving force of excellence is hard work done the right way with the right people at the right time. 13. Practice true discipline. Not the chest-thumping machismo performative variety, but the real thing: show up and do what you need to do, with care and integrity. Doing the hard thing today often makes tomorrow just a little easier. ​ 14. Make time for renewal. Stress plus rest equals growth. If you never step away and allow your mind-body system to recover, then you’re guaranteed to stall out long before you reach your potential. It takes discipline to keep going. But it also takes discipline to rest. ​ 15. Confidence comes from evidence. If you want to believe in yourself, you’ve got to give yourself evidence for that belief. Put in the reps. 16. Own your seat. Do the training. Then have the courage to trust it. 17. Stay patient. There is no such thing as an overnight breakthrough. Most good things take time. You can’t rush the process. 18. Stick-to-itiveness is key. The rare quality of staying power in a world that is obsessed with instant gratification is a secret weapon. 19. Motivation follows action. You don’t always need to feel good to get going; sometimes you need to get going to give yourself a chance at feeling good. 20. Create rituals and routines. It does not mean a series of 27 elaborate steps to start the day. It means having a few anchors to keep you grounded in an increasingly chaotic world. Your routine should work for you, not the other way around. 21. Curiosity is a powerful antidote to fear. Whether you play basketball or cello, repair cars or build tables, write books or coach teams, your craft can be a vessel for self-discovery. When you are driven by a genuine curiosity to see what’s possible, nothing can stop you. 22. Don’t go at it alone. Every modern science and every ancient wisdom tradition tells us that the people with whom we surround ourselves shape us. Going at it alone will make you angry and resentful, irrespective of what the internet bros say. Find your people and work together. This is the way. ​ 23. Intensity and joy can coexist. One of the greatest joys is working toward your aspirations with great intensity. ​ 24. Excellence is an infinite game. The goal is the path, and the path is the goal. So much of success simply comes down to staying on it.

@atrupar Wait. If we concede that he won 2020 wouldn’t the 2024 election be his 3rd term, making him ineligible for the presidency today??? Just sayin’

New in PN: Trumpers are *still* scheming to overturn the 2020 election "Trump’s conspiracy theories and threats aren’t simply about proving non-existent fraud. They’re part of an *actual* sprawling plan to sow doubt in future elections Republicans lose." publicnotice.co/p/trump-georgi…

For NEPA's defenders, it's a problem that there are lots of states with their own NEPAs and lots of states without. Does anyone really think that, say, environmental outcomes in Indiana (which has its own state NEPA) are systematically better than in Michigan (which doesn't)?

The @NCAR_Science is quite literally our global mothership. Nearly everyone who researches climate and weather - not only in the US, but around the world - has passed through its doors and benefited from its incredible resources. The National Center for Atmospheric Research (NCAR) supports the scientists who fly into hurricanes, the meteorologists who develop new radar technology, the physicists who envision and code new weather models, and yes - the largest community climate model in the world. That too. Dismantling NCAR is like taking a sledgehammer to the keystone holding up our scientific understanding of the planet. usatoday.com/story/news/pol…

Reducing medical spend w/o reducing value should include efforts to reduce use of low value care. Coverage policy (w/reasonable enforcement) can get us part way there, but given nuances of defining low value, incentives to practice care efficiently should play an important role.

Weedy but important detail: HSA sums would only be available to enrollees opting into the skimpiest — catastrophic or bronze-tier — ACA plans Most Marketplace enrollees have incomes < 250% FPL and receive extra help with cost-sharing, but only if they enrolled in a silver plan

👋 I'm Danielle, and I'm on the #econjobmarket this year! Let's start a description of a segregated school: "The school felt temporary. Built like a warehouse with aluminum siding . . . I had a slipshod education" The twist? The student is white, and her school is private. 🧵:

Very disappointing that cigarette smoking hardly gets mentioned when it is still a/the leading risk factor of preventable death in the US.  Zeroing out the CDC Office on Smoking and Health, gutting the FDA's Center for Tobacco Products, & stalling on the proposal to lower the upper limit of nicotine in combustible cigarettes will not make America healthy.