Steel, Coffee Beans, and Healthcare

Steel, Coffee Beans, & Healthcare

“GM spends more on health care than steel, just as starbucks spends more on health care than coffee beans.” Dave Chase writes in his book The Opioid Crisis Wake-Up Call. “For most companies, health care is the second largest expense after payroll. This puts you in the health care business.”

 

It is incredible to think that major companies like Starbucks and GM spend more on healthcare than on the products they produce that make them stand out. It feels incredibly troubling and a bit counter to our American pro-business narrative for our companies to spend so much on something that is not a key part of their business and that is not part of their core competency. But as a quote from Warran Buffett that Chase uses to open the 11th chapter of his book says, “GM is a health and benefits company with an auto company attached.” 

 

I am among those who think that one of the greatest failures in America’s healthcare past was to allow businesses to provide health benefits with a tax break for the company. Rather than paying employees more money, which would come with higher tax rates, companies have been allowed to provide health benefits, which instead come with tax breaks. This is how we have fallen into a system where the quality of care, the structure of access to healthcare, and what you pay is largely determined by how well your employer does with navigating the complex healthcare landscape. You might work for someone like Harris Rosen who has figured out how to provide large amounts of preventative services with low costs, or you might work for a cash strapped organization with a random HR person trying to make healthcare plan decisions while also dealing with that employee who won’t take down the inappropriate calendar in their office and is simultaneously trying to review several applications for a new position.

 

The reality of healthcare spending by companies shows us that they cannot reasonably expect to have an inexperienced HR person handle healthcare benefits. The spending is too high for someone who is not completely focused on industry trends and changes, someone who doesn’t understand how insurance companies and PBMs work, and someone who has multiple other responsibilities to manage. If we want to keep private health insurance tied to our jobs, then we need to demand better from our employers and our public policy.

 

When we discuss the costs of healthcare in our nation, and when we consider whether a single entity (the Federal Government) should provide health insurance versus having everyone either buy private insurance through individual markets or receive health insurance through their employer, we need to consider the reality of business spending on healthcare. We need to ask whether GM should be producing cars and accountable to so many employees for their basic health needs. Maybe there is still a space for GM to be involved with the health of their workforce, but should they be the entire determining factor, spending more on healthcare than the steel that goes into the cars they produce? These are the questions I would like to focus on when we think about how we should access and pay for the care we receive.
The First Value of Deep Work

The First Value of Deep Work

“Deep work is not some nostalgic affectation of writers and early-twentieth-century Philosophers,” writes Cal Newport in his book Deep Work. “It’s instead a skill that has great value today.”

 

A tension that I think a lot of us face (I know its true for me) is that we are pulled in two different directions when it comes to media and information. The news cycle moves so fast today that it feels hard to keep on top of whats happening in the world. We all want to feel connected and feel like we are in the know, and we like being the person at the water-cooler who has the latest information about some nationwide or global event. We have a drive to constantly stay on top of what is happening right now.

 

Pulling against this urge is the desire to know interesting things and to consume media that is thoughtful, thorough, and interesting. It is one thing to know what is happening in the world right now, but it is an entirely different thing to truly understand the context and antecedents that gave rise to the current news cycle.

 

The first desire we have is to know new things about the world, the second desire is to truly understand the world. One desire encourages shallow quick headlines, while the other desire encourages deep thoughtful engagement. It is very challenging to do both.

 

Cal Newport’s suggestion is to shoot for the latter. Learning and engaging with complex topics requires real focus and deep work. The value from the second will far outlast the first. The first value of deep work that Newport shares in his book reads, “We have an information economy that’s dependent on complex systems that change rapidly. … To remain valuable in our economy, therefore, you must master the art of quickly learning complicated things.”

 

Staying on top of the news simply requires that we flutter around on Twitter, absentmindedly distracting ourselves and taking in a few headlines and quotes without thinking critically about how it all links together and exactly why people are reaching the conclusions they reach. This is does not develop the skills that are necessary for quick learning, even thought it is a quick way to sort through information.

 

Learning complex things quickly requires that we be able to engage in deep work and focus on the most important items. Failing to build these skills and abilities means that you won’t be able to truly master changing technologies and markets. You will be left behind reading headlines about changes, without actually understanding changes and adapting to them. Deep work is valuable because learning and critical thinking are both becoming more valuable, and both require deep work in order to be done well and timely. The answer then to how we should handle the tension I mentioned above is to more or less abandon the headlines and give up on staying on top of the news. We might look a little uninformed to others about current world events, but we will have a better background and understanding of what is shaping the world today than the others around us, and we will be able to learn the important lessons faster.

Placing Blame Rather Than Working Toward a Solution

I like to think deeply about public policy. I think there are very interesting structures and ideas that we could put in place which would help us to achieve better outcomes in our societies. The challenge, however, is that the outcomes we want to see are based on value judgement. As in, I think the world should be more this way or that way. When we use the word should we are expressing a judgement that represents some type of value that we hold, which other people might not hold. That means that our political structure is ultimately based on opinion and preference rather than rational cold hard facts.

 

But we don’t really see our world of politics in this way. We see the world of politics differently, believing instead that there is a clearly preferential best answer that can be empirically determined, and arguing as if we know what that perfect answer is. The result from this in the United States, where we have a two party system, seems to be polarization and contempt for the people on the other team. Across the globe, this tends to result in blaming others for bad things that we see around us, and voting for politicians who make us feel warm and fuzzy and rationalizing our support for them even if their ideas might not actually make sense when fully implemented.

 

In his book The Complacent Class, Tyler Cowen writes about this phenomenon, “Elections these days often seem more about who is to blame than who is to govern.” We don’t think deeply during an election about the governable skills that someone has. We discuss policy, but the reality is that almost none of us understand policy in a deep way, and if we do, we only understand one narrow policy space. We are not all economic experts across the board, we are not all education experts, and we are not all medical experts. But we have vague senses about what would be in our interest and what types of views we should hold to fit in with other people like us. As a result we fall into a blame game where we criticize the other side for bad things and put blinders on to ignore the governance shortcomings of our own team.

 

Cowen continues, “Voters are less inclined to see their selection as a long-term contract with a candidate or party and more likely to see it as resembling a transaction with a used car salesman.” This is not surprising if you consider that no one is actually a policy expert. We want to see people like us do well in society, so we align with whoever seems to be best positioned to do that. We don’t really know what will lead to good outcomes, but as long as the politician or party says that people like us are good, then we know to align with and vote for.

Signaling Loyalty

Politics is an interesting world. We all have strong opinions about how the world should operate, but in general, most of us don’t have much deep knowledge about any particular issue. We might understand the arguments about charter schools, about abortions, or about taxes, but very few of us have really studied any of these areas in considerable depth. Anyone with a career in a specific industry understands that there is a public perception of the industry and the deeper and more complex inner workings of the actual industry. But when we think about political decisions regarding any given industry and topic, we suddenly adopt easy surface level answers that barely skim the surface of these deep and complex inner dynamics.

 

If we all have strong opinions about politics without having strong knowledge about any of it, then we must ask ourselves if politics is really about policy at all? Kevin Simler and Robin Hanson suggest that politics is generally about something other than policy. In The Elephant in the Brain they write, “Our hypothesis is that the political behavior of ordinary, individual citizens is often better explained as an attempt to signal loyalty to our side (whatever side that happens to be in a particular situation), rather than as a good-faith attempt to improve outcomes.” 

 

If the main driver of politics was doing good in the world and reaching good outcomes for society, then we would likely be a much more hands-off, technocratic society. Instead, we have elected a president who doesn’t seem to have a deep understanding of any major issues, but who does know how to stoke outrage and draw lines in the sand to differentiate each side. We generally look around and figure out which team we belong to based on our identity and self-interest, and separate into our camps with our distinct talking points. We don’t understand issues beyond these talking points, but we understand how they make our side look more virtuous.

 

I believe that people who are deeply religious are drawn toward the Republican Party which currently denies climate change partly because a society that has less emphasis on science is likely to be more favorable toward religious beliefs. The veracity of climate change and the complex science behind it is less important than simply being on a side that praises people for religious beliefs. Similarly, I believe that people with higher education degrees are more likely to align with the Democrat Party because, at the moment, it is a party that encourages scientific and technical thought. It is a party that socially rewards the appearance of critical thinking and praises people who have gone to school. Without needing to actually know anything specific, people with degrees who appear to think in a scientific method framework are elevated in the party where people with religious beliefs are disregarded. Both parties are operating in ways that signal who is valuable and who belongs on a particular side. Issues map onto these signals, but the issues and policies are not the main factors in choosing a side.

Two Messages

In The Elephant in the Brain Kevin Simler and Robin Hanson write about the ways in which we act to signal something important about ourselves that we cannot outright express. We deceive ourselves to believe that we are not sending these signals, but we recognize them, pick up on their subtle nature, and know how to respond to these cues even if we remain consciously ignorant to them. In the book, the authors focus on how we use these cues in language and communication.

 

The authors write, “Every remark made by a speaker contains two messages for the listener: text and subtext. The text says, ‘Here’s a new piece of information,’ while the subtext says, ‘By the way, I’m the kind of person who knows such things.’ Sometimes the text is more important than the subtext … but frequently, it’s the other way around.”

 

It is important to acknowledge that sometimes the text truly is the important part of our message. Because we occasionally have really important things that people need to know, and because that information outweighs the fact that we are the one who knows it and shared it, we can use that as a screen for us in this game of two messages. We can believe that all our communication is about important important information because there are times where the things we communicate are crucial to know. Hanson and Simler’s idea above only works if sometimes it is true that the text is the important piece and if almost always we can plausibly say that we are just trying to convey useful information as opposed to showing off what we know or what we have learned.

 

No matter what, at the same time our communication says something about us and about what knowledge and information we may have. It can also say something about what we don’t know, which may be part of why we go to great lengths to make it seem like we were not ignorant of something – our language/knowledge might tell people we are not the kind of person who knows something that everyone else knows.

 

Our language also tells people that we are the kind of person who cares about something, or has great attention to detail, is strict and disciplined, or is from a certain part of the country/world. Some of these signals are fairly hidden, while others are more clear and obvious. When we look more closely at the way we signal in our conversation, we can see how often our words are only part of what we are communicating.

Remember Your Bubble

A huge challenge for our world today is the way we get stuck in our own echo-chambers and fact bubbles. The world is a large and incredibly complex place. We never truly know that much about any one thing. We might be an expert in our field of study, we might be an expert in the area we work in, and we might have a hobby that has made us an unofficial expert in a random thing, but we can never truly know everything there is about a subject or topic. As a result, we rely on a body of knowledge that is incomplete to make assumptions to form a belief about the world.

 

Colin Wright writes about these fact bubbles in his book Becoming Who We Need To Be, “We also find ourselves stuck inside fact bubbles which reinforce our existing ideologies, and which fail to provide us with full context, with complete, accurate information, and which leave us, as a result, holding worldviews that are not based on accurate representations of what’s happening.” This is not a new problem in human history, but it feels like it is a more acute problem today than it has been in the past. We have more access to information today than any humans before us, but the overwhelming tidal wave of information that we can focus on puts us in a position where we have to make choices about the information we take in. We can build a world for ourselves in which our worldview is always reinforced, and never seriously challenged. We can create a world in which all of our problems are blamed on some “other” who we must vilify in order to improve things. We advocate for specific ways that we think the world should organize itself because it is what we see, what we know, and what is familiar for us.

 

These bubbles however, are incredibly limited and our singular perspective does not accurately represent the complete range of experiences and possibilities for the human condition. As a response to these bubbles, many people advocate for stepping outside our groups and tribes to understand the worldviews and ideas of others. I do not think this is realistic advice.

 

The world is busy and we only have a limited amount of time and attention to direct toward any given thing. Trying to take in information that we can understand and identify is in many ways a by product of long work hours, long commutes, too much information to know where to focus, and a world that seems to place unlimited demands on our thoughts and actions. Rather than trying to jam in more time reading things that challenge us or listening to news that might spike our blood pressure, I instead advocate for more self-awareness. Recognize how frequently we act and are inspired by a story that makes us look like the hero. Acknowledge the times when you select something to read because it looks like it will already fit in with what you want to believe. Be aware that your perspective on the world is incomplete and that the information you absorb is limited and filtered to present the world a certain way. We likely won’t be eliminating bubbles from our lives any time soon, but we can at least acknowledge their existence and recognize that we don’t have the certainty we would like about the information that helps us know what is really happening in the world.

Turn Off the Ego and Learn

There is always something we can learn and something we can better understand. No matter how smart we think we are or how smart we feel, we can always adopt new perspectives, work to see things from new points of view, and begin to see the world in a more clear way. Challenging ourselves to see the world beyond the perspective we are accustomed to or beyond the perspective that is comfortable can open up new possibilities and help us understand the people in our lives who we would otherwise find puzzling. We never fully understand everything there is about something, and even if we feel we are a true master in a field, we likely don’t have a full grasp of how exactly our field connects with adjacent fields. Adopting this attitude however, cannot be done if we don’t clear our ego.

 

When we allow our ego to take over and tell us that we are smart and have it all figured out, we cease to learn. The ego wants us to believe that our perspective is the best, that our way of thinking is the only truly valuable way of thinking, that the contradictions in our thoughts are not contradictions at all, but rational decisions that others just don’t see clearly. The ego doesn’t want to be challenged, it doesn’t want the boat to be rocked, and it wants us to be morally and intellectually superior to others.

 

When we abandon this ego drive, we can be more open to the world around us and better learn as we move through an ever changing world. By being more humble about just how much we know and understand about the world, we can become more genuine people who better appreciate those around us. Ryan Holiday writes about this in his book Ego is the Enemy. He writes, “at ever step and every juncture in life, there is the opportunity to learn – and even if the lesson is purely remedial, we must not let ego block us from hearing it again.”

 

Everyone has both received and given the advice to be a sponge when you start a new career, hobby, athletic routine, or cooking class. We tell young people to learn as much as they can from those who are successful and from those who have been in their shoes. For some reason though, we seem to reach a point where being a sponge for knowledge fades away. Holiday would argue that our ego has a big part to do with why we stop focusing on learning from others and from experiences. We get to a point where we feel that we have become the wise elder, the successful person, the one with all the knowledge, and our job becomes teaching others and not learning. But continual learning is crucial if we want to continually adjust to the world around us, maintain the success we build, or even if we just want to stay engaged in the world and have meaningful relationships with those around us. If we can accept that we always have more to learn or that we always need refreshers on basic lessons from our past, we can better connect with the world and approach people and situations with a better perspective focused on gaining more understanding rather than showing how much we already think we know.

The “Learning vs Ego” Clash

Its is not obvious, but our ego prevents us from learning. Our ego is that piece of our brain that thinks we are amazing. It is what drove Kanye West to hang a giant picture of himself in his house so that it is the first thing you see when you walk in. It is the piece of me that put a 1st place plaque in my office at work. And it is the part of our brain that posts “proud mom” photos on Facebook or sticks student of the month stickers on our bumper. Our ego tells us we are amazing, good at everything, and already know it all.

 

This is where the ego clashes with real learning. When we look back at our high school and early college years we all seem to recognize the same thing, that we thought we knew everything when we were younger. As we age and go through new life experiences, we constantly see that we have a lot to learn. Some of my favorite thinkers have often remarked in books or in podcasts that as they have  gotten older, as they have studied a subject more thoroughly, and as they have paid more attention to the world around them, they realize how little they actually do know. When we push aside our ego and look at ourselves truthfully we can see that we really don’t know that much.

 

Ryan Holiday writes about this in his book Ego is the Enemy. Starting with a quote from Epictetus he writes, “It is impossible to learn that which one thinks one already knows,” highlighting the importance of being honest about ones knowledge or lack of knowledge. Holiday continues, “You can’t learn if you think you already know. You will not find the answers if you’re too conceited and self-assured to ask the questions. You cannot get better if you’re convinced you are the best.”

 

Holiday shows that our ego directly interferes with learning and growing. When we are at least slightly humble and can admit that we don’t know everything, we open ourselves up to learning something new about the world. When we admit that we are not the best in the world (or the best we possibly could be) at something, we can begin to see areas where we can improve. Our ego, the piece of us that wants to brag to the world, does not want to admit that there is something we don’t know, that we don’t understand, or that we don’t have everything perfected and we still have areas where we need to get better. The ego makes excuses about all of these things and contorts reality to fit the image that we want to project to the world and see all about us.

 

If we can push past this ego urge and think about the world in a more well-rounded way, we can actually start taking steps to improve ourselves. If we approach the world without a need to validate our ego, we can adopt more perspectives and possibilities that allow us to learn from others and practice things that will allow us to grow in important areas.

The Absurdity of Thinking We Know What is Happening in Another’s Mind

We make claims all the time about what other people are thinking and feeling and about the motivations, beliefs, and desires of others. We can maybe be right about some large things and the study of psychology has given us insight into a lot of patterns of the brain, but to think that we could ever really understand what is happening in the mind of another person is beyond nonsense.

 

This fallacy starts with our misunderstandings of our own brain and our own consciousness. We like to think that there is a single actor in our brain, observing the universe, directing our actions, and making sense of the world in an objective and rational manner. What everything seems to indicate, however, is that this experience of our consciousness does not align with reality. People often fail to act in a way that is in their rational best interest. We are driven by the stories that we tell ourselves, giving rise to prejudices and allowing us to be swayed by our self-interests. When meditating we see just how hard it is to focus on a single thought, even if we try our best to make our conscious mind think about our breath and not the candy jar on our co-workers desk. In all of these situations, our thoughts seem to be a bit beyond our control, a bit random, and heavily influenced by factors that we perceive or imagine even if they don’t exist.

 

When we look inward at our own mind we begin to see just how jumbled our own thoughts and consciousness can be. When we truly work to improve our mind, we can build our self-awareness, look at the world more objectively, and start to recognize patterns of our own thoughts and behaviors, but this is hard work and reveals a confusing set of contradictions within ourselves. Indeed, as Thich Nhat Hanh wrote in his book The Miracle of Mindfulness, “If you want to know your own mind, there is only one way: to observe and recognize everything about it. This must be done at all times, during your day-to-day life no less than during the hour of meditation.”

 

To know our mind is to recognize the times when our mind is not what we think or imagine it to be. And if we cannot even know our own mind without constant study and evaluation of what we are thinking and believing, then how can we ever claim to understand another person’s mind, even for a second? We can hide things from ourselves, fail to recognize the reality of the world around us and of ourselves, and we can develop false beliefs in our thinking. This is true for each one of us, and for everyone else around us. When we think of other people, of their desires, habits, actions, fears, and their general mindset in any given situation, we must remember that they are as complicated as we are, and that we cannot possibly understand what is happening in their mind.

 

When I think of this, when I read Hanh’s quote about self-awareness and how difficult it is to know ourselves, I remember to judge people less harshly, to slow my thinking down, and to first interrogate my own mind before assuming something about the mental state of another person. This is not easy to do, and it undoubtedly leads to a place where I think to myself, “well the world is hard and this person is influenced by many things and feels many fears and pressures, so their actions and behaviors can to some extent be deemed understandable.” This works well when I am confronted by a grumpy person in line at the bank or a jerk driving next to me on the freeway, but it is less that satisfying when thinking about people who commit serious crime (an area I don’t have solid thoughts on right now), or people who seem to antagonistically oppose beliefs that I find important and noble. What I can say is that remembering how challenging it is to know myself helps me be more empathetic with others and view what they say or do in a less attacking and critical light. In personal relationships and in the office this is a great skill to cultivate, because it stops me from assuming I know what is happening in another person’s mind, and reminds me that they may not even have their own thoughts fully understood.

Advice Doesn’t Help Us Generate Knowledge

As you would expect, Michael Bungay Stanier’s book The Coaching Habit is all about how to be a more effective coach. Part of becoming a more effective coach involves understanding how the brain works so that you can understand how the people you coach are going to learn and react in certain situations. To help demonstrate the importance of knowing how the brain works, Bungay Stanier references Josh Davis and his colleagues from the NeuroLeeadership Institute and their model known as “AGES”. Specifically, Bungay Stanier focuses on the “G” from AGES.

 

G stands for Generation, and commenting on knowledge generation, Bungay Stanier writes, “Advice is overrated. I can tell you something, and it’s got a limited chance of making its way into your brain’s hippocampus, the region  that encodes memory. If I can ask you a question and you generate the answer yourself, the odds increase substantially.” What is important here is understanding that we create memories and generate our knowledge in an active process. Learning and creating knowledge are not passive processes. We don’t sit in a sea of information and passively absorb new lessons and knowledge as tides of information wash into our brains. Instead, we hunt down the specific information we need or want (or sometimes we inadvertently pursue it) and emotion and engagement pull the knowledge into our minds.

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Quoting the NeuroLeadership Institute, Bungay Stanier writes, “When we take time and effort to generate knowledge and find an answer rather than just reading it, our memory retention is increased.” The chance of us remembering something a professor says, or something we hear on TV, or the advice our parents give us is not great when it is just verbally directed toward us. If we truly seek out the information, if the information is presented to us in a way that forces us to be more engaged to get the answer we need, and if we have to truly use the faculties of our mind to find meaning, reason, and truth, then we will have a more powerful connection to the knowledge. We will generate new information in our brain and become more knowledgeable than we would if the information was simply presented to (or at) us.