David Howard

We absolutely need to embrace cost-saving technology in health care. Hopefully the nurses strike at Kaiser Permanente over the use of AI for mental health care will not discourage more adoption.

@anup_malani Fragmentation also makes it more difficult for rulers to appropriate the gains from innovation (David Landes).

The implication cuts deep: political fragmentation isn't inefficiency — it's an insurance policy for radical ideas. Culture is infrastructure. Build the wrong one and no amount of gunpowder gets you to an industrial revolution.

China had gunpowder, the compass, movable type, and the blast furnace — centuries before Europe. So why did the Industrial Revolution happen in Britain, not Beijing? Mokyr's answer: Europe's greatest advantage was political disunity.

Great report by @CBSNews CBS News Investigation: Hundreds of LA hospices have multiple indicators of fraud | @CBSNews cbsnews.com/projects/2026/…

@richiebratton @rickdicksonreal ha. Went there last summer. Rented clubs.

@rickdicksonreal St. George, UT! High Desert kinda stuff

Headed on a golf trip with a few buddies and some of their buddies for a few days. They got the intro group text going and only about half the dudes know who I am so I hit em with the "Are you guys renting clubs or bringing your own?" to break the ice. Buddy already got the "Is this guy serious?" text.

First we had one child and I thought I knew what children are like. Our second child was completely different; I’d overgeneralized. There are actually two types of children.

@AssumeNormality And removing a convenient phrase from the language that does not have a close substitute.

I find this entire discussion insufferable. It's creating an issue where there is none, and a thinly-veiled attempt to use language to reinforce a dominant position in the hierarchy.

@Allie_Elisabeth So sorry to hear that.

3 yrs ago I packed up my life in MI for a dream job w the Atlanta Journal-Constitution. Sadly, I’m part of the latest round of cuts. It’s been an honor reporting on this complicated, beautiful region. Pls DM if u have leads/want to work together. I’m sad but (stupidly) hopeful <3

When someone sends an email saying "... I'm a lobsterman...", you probably think it's pretty clear that he's a person who, as his job, catches lobsters. But, when someone sends *me* such an email, it's ~30% chance it's someone who wants to be part human and part lobster - a LobsterMan if you will, and a ~5% chance it's someone who says he already *is* a human/lobster hybrid. The only remaining question then becomes whether he's an alien cyborg lobster from an alternate past or something more exotic.

@cblatts Thanks for this post. I feel the same way re "Why is it all in vague gobbledygook?"

Approximately 1/3 of my X feed is people gushing about Claude code. I’m already an intensive ChatGPT user so I am open minded. And I will try it. I can't help but wonder: 1. Why do most of these posts sound like they were written by their AI? 2. Is this a viral marketing campaign? 3. Is this just the Twitter algorithm running wild? 4. Why don't I understand from these posts what these people are actually doing with Claude? Why is it all in vague gobbledygook? They talk about tasks in weird jargon, and it's like they're speaking a different language. I really don't understand what 5. Can someone explain in plain English what I would as an academic would do concretely with Claude code? We are already testing it out to clean and analyze basic survey data where it does okay. I'm going to be trying to play around with some new theoretical models, adapting IO models to criminal firms where ChatGPT has been doing ok. Will Claude code do better? Anything else I should be thinking about kind of work they're doing.

@nikillinit Conversely, I spoke with an ophthalmologist in an independent practice. He said they have an advantage in recruiting because they can offer more flexible schedules compared with system-owned practices. I thought that was interesting. Maybe call isn't as relevant for optho.

I had an interesting convo with a doc yesterday about what it would take for a group of docs to leave a health system and go independent. A lot of issues I expected came up around costs to start, certificate of need laws, etc. But the two big roadblocks which I thought were interesting - Basically none of the docs wanted more intensive on call schedules. They’re on call once every 2-3 months in the hospital, vs. with a smaller group it would have to be once a month. This is solvable by finding docs that would actively want to do this, but increases the coordination costs significantly since you need to find a bunch of those types of docs simultaneously. - They wouldn’t be able to get hospital admitting privileges anywhere because there are basically no community hospitals around anymore. Any specialty with some amount of complex surgeries is going to need this. He said there’s another option to go cash pay, which he’s seen some other docs do. And basically for any “serious” procedure they essentially kick them to the emergency department. But he doesn’t feel good about the ethics of that so didn’t want to do it. Just thought it was an interesting perspective and one that’s probably going to be really hard for any specialty that has surgeries.

Public health has drawn controversy since it began ~150 years ago, but the disputes have only grown more heated since Covid. Even though we unquestionably live longer and healthier lives than our ancestors, there’s so much discontent that we now have RFKJr.— 1/11

@CharlesCMann's book "1491" was incredible, and I look forward to reading this series.

@nikillinit Sorry, I didn't read the comments. But I think it's just a matter of increasing the deductible.

@nikillinit Isn't it just defined by costs (e.g., spending of $10,000 in a year)? Proposals to distinguish between primary care and non-primary care do run into this problem.

There's a lot of discourse right now about how health insurance should just be for "catastrophic" health events But I'd also be curious who should be the one deciding what counts as "catastrophic" - is heart failure considered a catastrophe? Are debilitating migraines considered catastrophic? In other countries that decide whether to cover treatments for more catastrophic issues, there are committees established by their governments to make those choices. Would the American people be willing to let their government make those choices for them? I think it's pretty complicated!

@timurkuran Imagine the line for the elevators.

Extraordinarily creative and beautiful, but why the expense? If the sky structure were to house restaurants and bars, it would make sense. But the spectators will want to watch the game. Perhaps I’m missing something.

Link: Drug pricing and pharmaceutical innovation: a false promise - The Lancet

and large pharma is only willing to pay a premium acquire smaller companies with new drugs because they can charge high prices.

@TheLancet editors display a lack of logic and economic reasoning in claiming that high prices don't fund drug innovation because large pharma mostly buys the right to drugs. But investors only fund small biotechs because they will get acquired...

@MarcGoldwein @DrOzCMS @BudgetHawks If you don't mind, what are some of the changes he discussed? I'm aware of mandatory alternative payment models, site neutral payments, fraud and abuse detection. Anything else of note?

Great talk from @DrOzCMS on what the Admin is going to secure Medicare. #TrustFundSolutions @BudgetHawks

Open faculty positions at @EmoryUniversity Department of Health Policy and Management. faculty-emory.icims.com/jobs/153884/job faculty-emory.icims.com/jobs/153884/job faculty-emory.icims.com/jobs/153885/job