Twice the Cost, Significantly Worse Results - The Sad State of Health Care in the USA

Why Is the United States So Sick?

Americans die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on health care. That was the startling conclusion of a major report released earlier this year by the U.S. National Research Council and the Institute of Medicine.

Not so startling if you have paid attention the last few decades. The deadly disease of excessive health care costs (with, as Deming noted, the bad results that come from poor systems that are bloated with cost, waste and poor quality) has been a huge problem for decades.

The newest part of the breakdown is how even the massive spending in the USA has not been successful in even keeping the USA at a mediocre level compared to other rich countries. It was maybe arguable the results in the USA were no worse than average 20 years ago. It is getting impossible to make that claim today. Twice the cost, significantly worse results. Eventually you would think people would get tired of excuses.

The poorer outcomes in the United States are reflected in measures as varied as infant mortality, the rate of teen pregnancy, traffic fatalities, and heart disease. Even those with health insurance, high incomes, college educations, and healthy lifestyles appear to be sicker than their counterparts in other wealthy countries.

Related: USA Spends $7,960 Compared to Around $3,800 for Other Rich Countries on Health Care with No Better Health Results - Can We Expect the Health Care System in the USA to Become Less Damaging to the Economy? - Measuring the Health of Nations (USA ranked 19 of 19 rich countries) - CEOs Want Health-Care Reform (2009) - posts on the health care system on my management blog

Giving and Accepting Advice and Feedback

Reaction to: The Trap of False Hypocrisy

When you are getting feedback or advice the most important factor is if you can use it effectively.

When you giving feedback or advice the most important factor is doing so in a way that is most likely to result in it being used effectively.

When you get feedback or advice that isn't particularly well delivered (lets say much delivered in way that is much worse than the example - even cruelly given). Your reaction (if what you care about is getting better) should be based on what would help you be better, not the form the advice takes. If what you care about is doing what is suggested in a good manner (which may even be lousy advice) then your reaction should be baed on how they give feedback, or advice to you.

People are affected by how advice is given and in fact how much they like the person giving advice and whether they think the advice is good or not. Those are factors to consider in giving advice. In my opinion those are factors to overcome in accepting advice. If I miss good advice because the person delivers it inelegantly or I don't like them or whatever it is I who lose.

If the core issue the person raises with feedback is something you should address, do so. Don't have how you respond determined by how successfully they gave feedback. In the post one of the issues I think Benjamin was trying to address was providing better feedback and in encouraging logical thinking. Both of which are worthy and make sense doing. I would say that is a 2nd issue. Issue 1 is if the feedback has merit. Issue 2 is if the feedback provided could be improved and if the logic behind the explanation of the feedback is good.

As I said in a previous post, I believe you should evaluate advice on merit, not whether the advisor follows the advice.

Related: The difference between respect and disrespect is not avoiding avoiding criticism - Respect for People, Understanding Psychology - I would much rather hear that someone felt a proposal won’t work than have them be quiet because they don’t want to be seen as negative

=== more thoughts, based on James' comments on my comments above ===

James, I agree with your thoughts. One of the things I continually struggle with is completely presenting my thought in writing - normally I think of 4 caveats I should make then what I say is so long I get tons of complaints it is too long. In general I have tried to reduce that. But I often leave things with too much imprecision (that is too much that is/can be wrong). Trying to be clear, complete and conscience is something I still need lots of work on. Your points about really most isn't right... are exactly my thoughts.

I think not wanting to take the "time to process hostile feedback" is something everyone does though often with less self awareness. And it extends beyond "hostile" to any type that is hard to process (different people have different points they struggle with most). If it is too much bother to figure out why this is useful (logically, emotionally...) we don't want to deal with it.

We will seek out people that we work well with. We will pay more attention to feedback from those who have given us feedback in the past that we used to make a change and saw a good result (either because they are perceptive in seeing the problem, skilled at presenting the case to us, skilled at showing us a way forward, skilled at providing feedback we can actually use (you can give me all the feedback in the world about how to be a better pro basketball player I am not going to be able to use it effectively).

And much more we will block, ignore and deflect feedback we don't want - whether it is hostile, confusing, impossible for us to figure out how to act on, unconvincing... That is why, if you care about having your feedback listened to you often need to design it for the person you are talking to - do they want it all dressed up with compliments about their overall wonderfulness, do they want you to provide some possible options for doing things differently, do they want you to explain the impact of the issue...

I think most people are frustrated with feedback that "takes too much energy and time to process." I think this is why there is so much talk about giving effective feedback. I see too little talk on how to take even effectively given feedback and use it to improve, which is a big part of taking too much energy to implement.

My opinion is that many people have trouble processing the feedback they get, but even more so they have trouble figuring out what to do with it even if they could understand what the issue was (I have a feeling that isn't nearly as big a problem for you but I am just making guess). Even if they can really see what could be improved, turning that into actual improved performance is often not easy.

There are lots of details to consider in order to provide effective feedback. If your goal is to get the feedback used (such as when you are coaching an employee) I think it is often wise to spend the most time on helping people with process of improvement. If people get feedback they can easily use to improve and they can see the results they often want more. The same ideas as your "feedback into information I can use."

And when I say "they can see the results" that again is an indication that it might be an effort to improve feedback in an organization will be enhanced by increasing people's ability to see results (which to me is about understanding data, understanding processes, customer focus, systems thinking...).

Well I went on far to long and it is still not very clear I don't think but, that is the best effort I could make today...

Learn from Experience Only When Theory Drives Learning

We learn when we test our theory and get confirmation or learn it is flawed. When people fail to learn from experience they normally failed to create a theory to base the learning on. In many ways we are lucky that our brain will do a bunch of this for us. We are lucky because if our brain wasn't automatically doing it, many of us wouldn't learn from experience much at all. But it is a problem in that we then don't understand that we need a theory to learn from and so when our brain can't subconsciously do all the theory testing and learning we struggle.

Comment on: Managers, Are You Learning from Experience?

Drucker's CEO Pay Suggestion 15 to 25 Times the Lowest-Paid Employee Pay. Actual CEO Pay Today: 354 times Median Employee

Payday Disclosure (on the Drucker Institute blog):

Today, the CEOs of the largest U.S. companies make 354 times more than the average rank-and-file worker. At some companies— including Abercrombie & Fitch, CBS and Nike—the ratio is in excess of 1,000 to 1.

As far as Drucker was concerned, this sort of pay structure was absurd. “It is surely not professional altogether for people who are employees and not ‘owners’ to pay themselves salaries and bonuses greatly in excess of what their own colleagues, that is, other members of management, receive,” Drucker wrote in The Frontiers of Management. “And it is not professional to pay oneself salaries and bonuses that are so far above the social norm as to create social tension, envy and resentment. Indeed there is no economic justification for very large executive incomes.”

In fact, in The Changing World of the Executive, Drucker recommended that companies have a “published corporate policy that fixes the maximum compensation of all corporate executives, after all taxes but including all fringes, as a multiple of the after-tax income of the lowest paid regular full-time employee (including fringes).” He added, “The exact ratio is less important than that there should be such a ratio.” (His suggestions ranged from 15-to-1 to 25-to-1, depending on the size of the company.)

Thanks for posting this. I have been posting about the damage done by excessive executive pay for years. In doing so I have pointed to Drucker as someone who saw this practice as extremely damaging.

I agree the burdens of regulation need to be considered. The abuses by those on boards and in the senior executive positions of the control they have over the corporate treasury to take what they don't deserve completely overwhelms the regulatory burden. We sadly have many boards and senior executives that are enriching themselves at the expense of companies and doing great damage to those companies, the stock holders, the employees and other stakeholders.

Related: Narcissistic Cadre of Senior Executives - Tilting at Ludicrous CEO Pay 2008 - Pay Practices Say More About Respect for People Than Words Say - CEOs Plundering Corporate Coffers - Obscene CEO Pay (2006)

Grades, Test Scores and Complex Brain Teasers Are Not Good Ways to Pick Employees

Google HR Boss Explains Why GPA And Most Interviews Are Useless

Google doesn't even ask for GPA or test scores from candidates anymore, unless someone's a year or two out of school, because they don't correlate at all with success at the company. Even for new grads, the correlation is slight, the company has found. Bock has an excellent explanation about why those metrics don't mean much. "Academic environments are artificial environments. People who succeed there are sort of finely trained, they’re conditioned to succeed in that environment,".

Exactly right. Graduating (and the difficulty of course - lots of math or science course for example tell you something about the students capability) tell you something about a person's ability to put up with a constraining system (which many jobs also have) but grades are not very valuable. And graduating just gives you a bit of data, people can have that same capability without graduating.

Google also used to be famous for posing impossibly difficult and punishing brain teasers during interviews. Things like "If the probability of observing a car in 30 minutes on a highway is 0.95, what is the probability of observing a car in 10 minutes (assuming constant default probability)?" Turns out those questions are"a complete waste of time," according to Bock. "They don’t predict anything. They serve primarily to make the interviewer feel smart."

Dee Hock has some very good ideas on hiring: "Hire and promote first on the basis of integrity; second, motivation; third, capacity; fourth, understanding; fifth, knowledge; and last and least, experience." Related: Hiring the Right People for Your Company - Signs You Have a Great Job, or Not - Google’s Answer to Filling Jobs Is an Algorithm - Hiring: Silicon Valley Style - Interviewing and Hiring Programmers

Setting Goals Can Easily Backfire

Response to: Goal-Setting is as Easy as 1+3

Aligning actions with strategic goals is key. And frankly this rarely happens. It is great when it does but it takes a much more systemic approach than just goal setting. Without a systemic focus on evidence based management goals often end up having people just focus on numerical targets whatever that results in for the rest of the business:

  The Trouble with Incentives: They Work
  Deming on the problems with targets or goals
  “I achieved my goal by not my aim. That happens a lot, we honestly translate aims to goals. And then we do stupid things in the name of the goal get it the way of the aim. We forget the aim sometimes and put the goal in its place.” - nice story (webcast) from Mike Tveite

It doesn't have to do so. It just does, quite frequently in many organizations. A culture that understands variation, thinks systemically and uses evidence based systemic measures of progress helps make sure the dangers are avoided. But that understanding is missing in most places that use goals.

Without that you should spend at least as much time worrying about the dangers the goals you are setting will pose and put in counter-measures to try and deal with them as you do on the rest of the effort around goals.

How to improve results: good process improvement practices.